Consultant for Pediatricians Vol 5 No 11

A 14-year-old girl came to the office with severe hip pain, which occurred after she attempted a cheerleading maneuver on a trampoline. She reported that she was bouncing as high as she could and landed on the trampoline with her left knee flexed and her right hip extended. On impact, she felt a "pop" that was immediately followed by right hip pain. She could barely move after the landing but managed to get off of the trampoline; she has been walking with pain since her injury.

If you’ve been a reader of Consultant For Pediatricians for more than afew months, you’ve probably noticed that the journal is growing. Over thepast year, the number of editorial pages has increased considerably-thanks to your readership support.

The American Academy of Pediatricians (AAP) holds that pediatricians are responsible for oral health supervision of children younger than 3 years. How can I do a credible job of this in a busy office practice?

Ten-day-old boy born vaginally at 37 weeks breech without complications. Has history of poor feeding with vomiting and has lost weight since birth. One episode of vomiting described as projectile. Ultrasonography ruled out pyloric stenosis but revealed bilateral hydronephrosis. Patient referred to the emergency department for further evaluation.

A 13-year-old Hispanic boy presented to emergency department with a 1-day history of red eyes. The eye changes were not associated with vision changes, increased tearing, discharge, pain, fever, or trauma.

A 4-year-old boy was bitten on the right index finger by a goat at a petting zoo. The bite created 2 superficial 2-mm open wounds. One of the lesions developed into an indurated 8-mm nodule during the following week. A second nodule developed about 5 days later. The boy was seen by his physician 2 weeks after the bite wounds occurred. At that time, an 8-mm umbilicated nodule and a satellite papule were present.

What are the indications for use of an insulin pump in veryyoung children (infants and preschoolers)?

A 14-year-old girl was referred for evaluation of a several-year history of growth failure, chronic abdominal pain, and intermittent emesis. The parents described the child as a "picky eater," and various foods (eg, meat products and beans) frequently caused abdominal distention.

Your last appointment of the day is with a 16-year-old boy who needs medical clearance to participate on the school basketball team. You have read about young athletes who die suddenly on the field. Is there anything you should do in addition to a history and physical examination to assure yourself that it is safe for your patient to play sports?

A 9-year-old Hispanic boy, previously in good health, was admitted for evaluation of chronic right cervical adenopathy. The node had been present for about 6 weeks. The patient was initially taken to his primary medical doctor and given dicloxacillin, but there was no improvement. The patient reported no fever, sore throat, travel history, or animal exposure. He and his parents denied contact with any persons with tuberculosis. During the past year, the patient had undergone extensive dental work for excessive caries.

A 4-year-old girl presents with a highly pruritic rash. The day before, she had been playing outdoors at her grandmother's house. No pets were present, and the patient does not recall being stung or bitten by insects. There are bushes on the grandmother's property.

A 6-month-old infant was brought to the emergency department with a 2-day history of increasing redness and swelling of the cheek. Her primary care physician had been concerned about a possible facial abscess.

This 7-year-old boy was recently brought to my office having received a diagnosisof pemphigus foliaceus. His parents were seeking a second opinion.

A 14-year-old Hispanic boy presented with bilateral nodular lesions on the dorsal aspect of his tongue. He guessed that the lesions had been present for more than a year. They were not painful and had not changed in size or color.

I'm a pediatrician who started out with some interest, and eventually developed some expertise, in what is euphemistically called child protection. I'm glad that child protection occupies only about 20% of my clinical time--it's more than I could bear full-time. After 25 years in this field, I have heard many stories. Here is one I can't forget.

The parents of this 4-month-old infant were concerned about an atrophic, 0.6-cm area on their son's parietal scalp that was surrounded by dark hair. The rest of the scalp was normal, and the child was otherwise healthy. Benjamin Barankin, MD, of Edmonton, Alberta, made the clinical diagnosis of the hair collar sign--growth of long, dark, coarse hair around a scalp lesion that may be a marker for underlying defects. The sign is sometimes found in association with aplasia cutis congenita, in which a portion of skin is absent--most commonly this manifests as a solitary round lesion on the scalp. These lesions may have healed at birth with a scar or they may remain eroded or ulcerated.

A 17-year-old Haitian girl who was visiting Florida presented to the emergency department after she experienced pain and a change in vision in her left eye. Her right eye was asymptomatic. For the past 3 to 4 days, she had been wearing a pair of colored contact lenses she bought for fun at a discount store.

Head shape abnormalities in infants may be the result of pressure on the malleable bones in the newborn skull during a vaginal delivery (molding), of constant gravitational forces on the occiput when an infant is kept in the same supine position for prolonged periods (positional deformational plagiocephaly), or of premature fusing of one or more of the cranial sutures (craniosynostosis).

A 3-year-old boy with high fever, malaise, anorexia, and drooling of 3 days' duration was brought to the emergency department (ED). A bacterial throat infection was diagnosed, and oral antibiotic therapy was started.