The diagnostic test is a Wood light examination. An example of another child with these lesions as they appear under Wood light is shown in Figure B. The Wood light is ultraviolet; it exploits the fact that melanin will preferentially absorb the light and appear darker. Those areas that contain less melanin thus will be highlighted.
Twenty-four hours after receiving a standard 5-unit purified protein derivative of tuberculin (PPD) skin test, a young African American presented with a slightly pink, raised, firm plaque at the site of the injection (A). His previous PPD test results were negative. He denied any constitutional symptoms and rashes. He was otherwise healthy, was not taking any medication, and was HIV-negative.
These lesions on the tongue of a 7-year-old white girl had been present since she was 2. Her physician at that time had diagnosed "geographic tongue." Over the years, the lesions have increased in number, although not in size.
A 4-year-old girl presented with a sore throat, dysphagia, fever (temperature up to 40°C [104°F]), and a pruritic vesicular rash. On the first day of the illness, 4 days earlier, she was evaluated by her pediatrician who prescribed azithromycin for a presumed upper respiratory tract infection. About 2 days later, a papular rash developed on the abdomen and perioral skin; the fever had persisted, and the child's oral intake had decreased. The next day, the rash continued to spread, and the patient refused to take anything orally, including fluids. The mother thought that the rash was a hypersensitivity reaction to the antibiotic.
By the pre-middle school visit, the child should have already received 3 or 4 doses of IPV (only 3 are required if the last dose was given after the age of 4 years); 3 doses of hepatitis B vaccine; 2 doses of MMR vaccine; 2 doses of varicella vaccine; and 2 doses of hepatitis A vaccine.
A 5-year-old girl was brought to her pediatrician after a "fall" 30 minutes before her arrival. The injury occurred in her home; she fell while straddling the back of a chair as she reached for something on a table. Her grandmother, who was serving as the child's foster parent, and an unrelated witness provided the initial history. The child independently confirmed the story provided by the adults.
ABSTRACT: The pre-middle school well child visit is now an important landmark on the vaccine schedule. The pre-kindergarten visit no longer has the distinction of being the last of the visits for "school shots." Pediatricians should emphasize this point at the 4- to 6-year-old well child visit so that parents are aware of the need for another series of vaccines in about 5 years.
Widespread vaccination has led many parents to underappreciate the severity of vaccine-preventable diseases. Many new parents have never seen anyone with such infections as diphtheria, mumps, or measles--or their potential clinical consequences. Some parents wonder why their child needs to be vaccinated against seemingly nonexistent diseases and worry about vaccine safety. The images on the following pages and on page S18 serve as a small dose of reality for those who may have been lulled into a false sense of security.
ABSTRACT: Patient compliance is a significant problem in exercise therapy and bracing for adolescent scoliosis, and exercise has been considered to have no therapeutic benefit. According to recent studies, however, muscle function asymmetry is a consistent finding in patients with this condition and is correctable with progressive resistance exercises. Patients' baseline and progress can be quantified accurately with exercise by performing precise measurements of torso rotation and lumbar strengthening. Strengthening is associated with control of scoliotic curves, if they are below the operative level. Because even some decrease in the amount of curve may be expected, this form of therapy may be as beneficial as bracing. The treatment also may be used for controlling pain in older patients with scoliosis.
ABSTRACT: College is a time of new exposures, risk-taking, and adventure. Thus, protection with proper immunization is paramount. Pediatricians should offer the recommended vaccines whether required for college entry or not. When the young adult comes to the office to have the college health form completed and signed, seize the opportunity to tout the benefits of pre-college vaccination.
A 5-year-old boy with seizure disorder and developmental delay presented to our allergy and immunology clinic for a severe reaction that developed after he had received multiple vaccines. One month before our evaluation, the patient had been vaccinated against varicella, hepatitis A, and influenza at his pediatrician's office. Latex gloves were not used for vaccine administration.
This story was told to me by Dr W, a pediatric resident whom I run into every now and then. He swears that it's true. He had an afternoon to kill one Sunday in late August, before taking call that night, so he went to the Hamtramck Street Festival. Hamtramck is a small city completely surrounded by the city of Detroit. Until 20 or 25 years ago, it was populated nearly almost entirely by families of Polish origin--immigrants and their descendants. Then, as in other Rust Belt cities, time and unemployment produced some drastic changes. The city became poorer; physical decay became more evident. Immigration from Albania, Yugoslavia, the Middle East, Pakistan, and Bangladesh reduced the Polish majority. Still, it's the only city in North America that has a park with a statue of Pope John Paul II. "A touch of Europe in America" say the bumper stickers.
This 21-month-old toddler was brought for a well child visit. His head had been large since birth; at this visit, head circumference was 51 cm (significantly above the 95th percentile). Neurological findings were normal; except for some early developmental gross motor delays, he was on a par with his peers. All other physical findings were normal. His mother's head circumference is 59 cm and his father's is 64 cm.
For years we have been prescribing prophylactic antibiotic therapy for children with a first-time urinary tract infection (UTI) before obtaining imaging studies-as is recommended in the 1999 American Academy of Pediatrics' practice parameter1-and for those with vesiculoureteral reflux (VUR). Although many pediatricians have raised questions about the efficacy and safety of this practice, the risks and benefits of antibiotic prophylaxis have not been well studied.
ABSTRACT: Vaccination must be promoted before and on entry into elementary school. Not only does vaccination provide substantial health benefits to society, it is the law. The recommended childhood vaccination schedule changes on a yearly basis. Similarly, state vaccination requirements for school entry also may change yearly to accommodate these recommendations. Pediatricians need to remain abreast of the most recent vaccine information and to offer all vaccines at the appropriate well child visits. The goal is to limit the number or eliminate altogether the need for catch-up vaccines when the time comes for entry into elementary school.
Perhaps some aspects of this scenario sound familiar? Many pediatricians feel ill-equipped to meet the often complex needs of adolescents. Some physicians have a challenging time convincing teenagers to talk to them about anything. Others worry about opening a Pandora's box of issues that cannot fully be addressed. Given the time and reimbursement constraints facing primary care providers, the wish to avoid time-intensive patients is understandable.
As a clinical immunologist with a special interest in vaccines, it is a pleasure to present this special issue of Consultant For Pediatricians. Vaccines are among the major achievements of modern medicine. Once common serious childhood illnesses, including tetanus, diphtheria, polio, mumps, and measles, are now rarely seen in this country. It is ironic, therefore, that with the precipitous decline in the incidence of many infectious diseases brought about by widespread vaccination--and the very recent availability of several new vaccines--many parents have been lulled into a false sense of security about the risk posed by the diseases these vaccines have been designed to prevent.
Does repeated antibiotic use in an individual patient increase his or her personal risk of infection with a resistant organism? Does such use also increase the risk for the community at large?
Linear bands of hypopigmentation on a child's hand.
