A 9-month-old white boy was brought to the emergency department (ED) after he had been crying inconsolably for 2 hours. The parents thought the crying was related to the child's left leg, which they felt "did not look right." Two weeks earlier, the boy had a similar episode of inconsolable crying, and a fracture of the right distal radius was diagnosed. The fracture was presumptively caused by entrapment of his arm in the crib railings.
A 4-year-old boy presented with a pustular rash on the radial aspect of the right wrist. The rash appeared about 4 days earlier as a group of vesicles on an erythematous base. The lesions caused mild discomfort.
I agree with Dr Kirk Barber's comments about treating molluscum contagiosum: that removal of the lesion's core is curative and that autoinoculation at the time of treatment is only a small concern. I have found, however, that it is not necessary to go through the trouble of removing the core.
We frequently see children who have just returned from India with fever, diarrhea, and constitutional symptoms. It is our job to determine whether they have a benign viral illness or something more serious. Some of the children have received malaria prophylaxis (usually mefloquine [Lariam] and occasionally atovaquone and proguanil [Malarone]). The number of children who have been vaccinated against hepatitis A infection is certainly on the rise, but few have been vaccinated against typhoid fever.
It was my first day back at the office after a 2-month medical leave, which included 14 days of hospitalization for severe depression. I'd had plenty of time to ponder whether this was an endogenous or exogenous depression. There were many things that could have caused me to be depressed: the death of my wife a few years ago, a pediatric career devoted-in large part-to abused children, conflicts between the medical school and the hospital, administrative decisions forcing my division to "do more with less" that made life difficult, and a general pervasive attitude that making a profit mattered above anything else.
This 6-month-old infant, born at 29 weeks' gestation, was transferred to Childrens Hospital Los Angeles for evaluation of intermittent stridor and a history of poor feeding.
This infant was brought to the emergency department after a week-long exacerbation of her atopic eczema. She had not received any therapy for her eczema or for these erosions.
These 2 swellings on the scalp of a 13-year-old boy had appeared about 8 months earlier and had slowly enlarged. The mother had massaged the lesions when they were small in an attempt to heal them. There was no history of local trauma (eg, from hair-cutting tools) and no pain or discharge from the lesions.
In his recent case involving a child with a black tongue, John Harrington, MD, noted that certain types of yeast and bacteria produce porphyrins that can give the tongue a black appearance.
An otherwise healthy 3-year-old girl was brought for evaluation of fever, sore throat, and shaking chills of 12 hours' duration. She had beefy-red, posterior oropharyngeal erythema and a scarlatiniform rash on her shoulder that had been present for a few hours. The rash faded out over her chest but reappeared in the perineum and lower abdomen. She also had vulvovaginal inflammation with surrounding erythema. The mother was surprised to see the inflammation, but in retrospect added that the child had complained of vaginal discomfort as well. A rapid antigen test for group A b-hemolytic streptococci (GABHS) from a swab of the oropharynx was positive.
A 6-year-old girl is brought for evaluation of an asymptomatic indurated erythematous lesion that erupted on the metacarpophalangeal joint of one hand 2 weeks ago. The patient has no history of trauma or exposure and is otherwise healthy.
ABSTRACT: Dramatic progress has been made in our understanding of pediatric rheumatic disease. Various classification systems help identify juvenile idiopathic arthritis (JIA), which involves unique considerations that distinguish it from rheumatoid arthritis in adults. Vaccination issues are important for children with JIA. Renal involvement with systemic lupus erythematosus (SLE) is more common and more severe in children than in adults, but treatment of children who have SLE is similar to that of adults. Neonatal lupus erythematosus may occur in infants whose mothers have SLE. Juvenile dermatomyositis is associated with significant morbidity and mortality. Kawasaki disease is a common vasculitis of childhood, especially in infants and toddlers. Each of at least 8 major familial periodic fever clinical syndromes has specific distinguishing characteristics.
A 3-year-oldgirl is brought to the office because of a 1-week history of hematuria and dysuria. Her mother had noticed bright red blood in the child's urine and diaper. The child did not have dysuria initially but later complained of a burning sensation. A week earlier, the patient had been seen at an urgent care center. Oral trimethoprim/sulfamethoxazole was prescribed after urinalysis showed numerous red blood cells and few white blood cells. However, the hematuria persisted.
During a routine physical examination, a 3-year-old boy was noted to have speech delay and hyperactive behavior. The child was born at term to a 25-year-old mother with epilepsy, which was managed with phenytoin. His birth weight was 3.5 kg (7.8 lb); he had no neonatal problems or features of fetal Dilantin syndrome. However, he had undergone bilateral hydrocele and inguinal hernia repair and tube placement for recurrent ear infections. His half sister (from his mother's previous marriage) needs help in reading and math. His father is healthy.
