Consultant for Pediatricians Vol 5 No 9

Botulinum toxin type A has a role in managing spasticity and dystonia in pediatric patients. It can improve gait and upper extremity function when used appropriately.

An 8-year-old Hispanic child with no significant medical history presented to our pediatric clinic after 2 episodes of vomiting, diarrhea, and abdominal pain. Symptoms had begun earlier the same morning; the child and his parents described the vomitus as "yellowish" and diarrhea "watery." There was no associated fever.

A 9-year-old girl presented with a 3-hour history of unremitting severe cramping in her hands and legs. A similar episode occurred a month earlier, but it resolved with massage.

Photo Essay: A Collage of Infectious Diseases in Children Perichondritis Periorbital Cellulitis Bacterial Conjunctivitis Roseola Infantum (Exanthem Subitum) Tinea Corporis ("Ringworm")

The July 2006 issue, which featured an update on STDs, included a case on primary syphilis in a teenager (page 427). Therapy with intramuscular penicillin G (weekly for 3 weeks) or ceftriaxone (daily for 2 weeks) was recommended. However, the CDC's newly published guidelines on STD treatment recommend therapy with a single intramuscular dose of 2.4 million units of penicillin G.1 If the patient is allergic to penicillin, the alternative is therapy with doxycycline (100 mg orally bid for 14 days) or tetracycline (500 mg qid for 14 days). Ceftriaxone is not a recommended treatment for syphilis.

Steven, a 13-year-old boy, experienced his first headache at age 7 years. The frequency, intensity, and duration of his headaches have been increasing over the past 6 months. Steven now experiences 7 to 10 headaches each month that last up to 8 hours. The headaches are associated with mild nausea, light and sound sensitivity, dizziness, fatigue, occasional abdominal discomfort, and difficulty in concentrating. Last year, he had a vomiting episode because of a headache. The pain is usually more prominent in the forehead and does not favor either side of the head. The headaches usually begin in the morning before he leaves for school. As a result, Steven has missed nearly 25% of his school days this semester; his parents are considering home tutoring for "sick children who are unable to attend school."

A 16-year-old boy complains of right lower leg pain that began 2 weeks earlier, after his first week at a summer basketball conditioning camp. Before he left for the camp, he was jogging off and on, averaging a few miles a week. At camp he began running 7 miles a day and doing sprints 3 times a week.

On waking up from a nap, a 5-month-old infant was noted to have a watery right eye. The mother thought an eyelash was the problem and flushed the eye with water. Soon afterward, the eye watered again and began to close. There was no history of injury, foreign body, upper respiratory tract symptoms, or fever.

A 17-year-old Asian male with no significant medical history presented to the emergency department (ED) with acute shortness of breath and associated left-sided chest pain. Symptoms began while the patient was at rest: the pain was sharp and worsened with inspiration. He denied a history of fever, trauma, cough, or any other constitutional complaints.

Musculoskeletal infections in children include osteomyelitis, septic arthritis, and pyomyositis. Most of these infections are bacterial. Staphylococcus aureus is the most common organism in children in all age cat-egories. Others include group A Streptococcus, Neisseria meningitidis in purpura fulminans, Streptococcus pneumoniae, Neisseria gonorrhoeae, Mycobacterium tuberculosis, and Borrelia burgdorferi.

I enjoyed reading the article "Diaper Dermatitis" in your June issue. To the many treatments discussed, I would offer 2 additional management points. First, persistent and/or recurrent diaper rash is more common when children older than 12 months continue to drink from the bottle. Excess fluid intake leads to soppy diapers and often, sloppy stools. When the cup replaces the bottle, diapers and firmer stools ensue--and accompanying rashes disappear.

For several weeks, an 18-year-old man has been bothered by itchy ears. He has seasonal allergies that are well controlled with oral antihistamines. He has not been exposed to contactants and has not used any nutritional supplements or new shampoos or conditioners. He works out at a gym 5 days a week.

The parents of a 4-year-old girl are concerned because she has experienced hair loss for several weeks. The child is otherwise healthy and active, has no known disorders, and takes no medications.

Two children--one with a history of infection, the other with a history of an allergic reaction--were noted to have postinflammatory hyperpigmentation.

A 45-day-old boy was referred for evaluation of persistent hyponatremia and hyperkalemia. On the 9th day of the boy's life, his serum potassium level was elevated (8 mEq/L) and on the 12th day, his serum sodium level was low (131 mEq/L). Supplementation with sodium chloride was initiated.

This 9-month-old infant was brought for evaluation of anteroposterior elongation of the cranium. The infant was born at term via uncomplicated vaginal delivery. His mother had noticed that his head was more elongated and narrower than his sibling's. He had achieved appropriate motor and social milestones for his age. Neither parent had a family history of abnormal head shape. The rest of the examination findings were unremarkable.

Seven-month-old boy with hyperpigmented lesions on his legs. Lesions first noted at 4 months of age. His 32-year-old father and 58-year-old grandfather had similar lesions on their legs.