On morning rounds in the well-baby nursery, a nurse brings your attention to a 1-day-old girl who is having trouble latching onto the breast. You examine the child and note the subtle anomalies shown in Figure 1 along with a pronounced head lag and a systolic heart murmur.
As a practicing pediatrician in East Hampton, NY, where Lyme disease is endemic, I read with interest the recently published case by Riva Kamat, MD, involving a girl with Lyme meningitis who underwent a lumbar puncture.1
I always find it difficult to speak with pediatricians about diaper rashes. Pediatricians look after many more children with rashes in the diaper area than I do--and all have their own secret ways to treat these children.
Parents often come to the pediatrician with concerns about their preschooler's temper tantrums. Should we reassure them that tantrums are normal, or should we refer the child for further evaluation? What clues suggest that tantrums might be a sign of future problems?
The patient had been born at term following an uncomplicated pregnancy and labor. Her growth and development were appropriate. Her immunizations were up-to-date. At about 1 year of age, she began to have "wheezing" episodes. Moderate persis- tent asthma was diagnosed, and treatment with fluticasone and inhaled albuterol was initiated.
For 3 weeks, a 3-year-old African American boy had a mildly pruritic rash on his buttocks, lower extremities, upper thighs, and soles. The patient was initially seen at an urgent care center, where he was given amoxicillin for suspected scarlet fever. A week later, he presented to the emergency department and was treated with griseofulvin for tinea corporis. A skin culture did not grow fungus.
A 3 1/2-year-old girl, who is nonverbal because of an underlying neurological disorder, presented to day care with a pelvic bruise. The day-care attendant feared abuse and reported the findings to Child Protective Services (CPS). The parents told CPS that the child had been alone with her father and fell getting out of the bathtub.
This rash on a teenage boy's palms began on his hands and spread to his torso and upper and lower extremities over several days. He had no pain or pruritus. Two weeks before the lesions appeared, he had experienced fatigue, fever, and myalgia of 1 week's duration.
This lacy, purplish skin discoloration was noted on the trunk and lower extremities of a 6-week-old boy during a well-baby visit. The mother had noticed the discoloration periodically since birth. It was most apparent when the baby was cold.