Consultant for Pediatricians Vol 6 No 10

As the father of a child with classic autism and an academic pediatrician who cares for many affected families, I thought my perspective might be helpful to other physicians who deal with the conundrum of complementary or alternative therapies that parents of children with autism may choose.

One week after vaccination with diphtheria, tetanus, and acellular pertussis/inactivated poliovirus/hepatitis B, Haemophilus influenzae type b, pneumococcal conjugate, and rotavirus, this 2Z\x-month-old infant presented with a vesicular rash. No other children in the home had a rash. The infant's primary caregiver was the grandmother, who had shingles 2 weeks earlier.

As the father of a child with severe classic autism--and as a pediatrician--I understand how much parents want to try different treatment approaches to help their child. Many parents ask me about complementary (or alternative or holistic) therapies, such as restrictive diets, secretin, chelation, and omega-3 supplements. Some inquire after hearing claims that a particular diet or supplement or herb can work wonders. Others ask about these therapies after reading studies on the Internet, in magazines, or in newspapers.

After experiencing frequent headaches, this 10-year-old girl awoke with a "funny smile" involving left-sided facial paresis. She was evaluated in an emergency department and a complete blood cell count, Lyme IgM and IgG screen, and CT scans of the head and sinuses were ordered.

A 2-week-old infant was assessed for an abnormal penis with a dorsal hood and a meatus that extended to the corona. Both testes were palpable in the scrotum. No chordee was apparent. Hypospadias occurs in 1 in 250 male newborns.1 In neonates with this congenital anomaly, the urethral meatus is ectopically positioned to open proximal to the normal site and on the ventral aspect of the penis or, in severe cases, on the scrotum or perineum. The prepuce is incompletely developed over the glans and presents as a hood. Some cases are associated with a chordee, which causes a ventral curvature of the penis with erection.

There are frequently stories in the news and talk among the public of the over-diagnosis and treatment of attention deficit hyperactivity disorder (ADHD) in today's hypervigilant society. However, a study recently published in Archives of Pediatrics and Adolescent Medicine may serve to debunk this common belief.1

ABSTRACT: Chronic recurrent multifocal osteomyelitis (CRMO) is an inflammatory bone disease that occurs primarily in childhood. The clinical picture often is confused with bacterial osteomyelitis. Awareness of CRMO as a clinical entity helps avoid diagnosis and treatment delays. Our patient, an 8-year-old girl, presented with acute left hip pain. One month after presentation, a lytic lesion was seen on plain radiographs; biopsy revealed nonspecific inflammation. It was not until more than 2 years later, when multifocal bone lesions and psoriasis developed, that the diagnosis became clear. Our patient's case demonstrates several key points: not all children with CRMO present with multifocal disease, patients frequently have comorbid inflammatory conditions, and there are no diagnostic laboratory studies. The optimal treatments remain unknown.

A 23-month-old girl presented with an erythematous papular rash on her torso that extended in a linear pattern around to the back. The mother first noticed the rash while bathing the child 3 days earlier. The child had no associated itching, irritability, or fever, but she had mild rhinorrhea preceding the rash that resolved without treatment. The patient and her older sibling were cared for at home by their mother.

This skin condition is present at birth and usually has significant systemic manifestations. Would you be able to identify it in the nursery?

The sharply demarcated, smooth red plaques on this 3-year-old's tongue had been present for several months. The child initially refused to stick out his tongue. He cooperated after he was offered a lollipop (with the stipulation that "the wider he opened his mouth, the bigger the lollipop he would receive").

The parents of a 7-month-old girl brought their daughter for immediate medical attention after she passed bright green-colored stool. For the past 24 hours, the child had mild fussiness and a low-grade fever (temperature, 38.1°C [100.6°F]); she also had vomiting and mild diarrhea, with yellow-colored stools. The mother was advised to begin small, frequent feedings of oral rehydration solution with gradual return to the baby's normal diet, as tolerated. Over the next 12 hours, the vomiting and fussiness decreased and the fever resolved, but the mild diarrhea persisted and stools turned bright green. The parents denied giving the child green-colored drinks or food.