Consultant for Pediatricians Vol 8 No 5

Asthma is one of the most prevalent chronic diseases in the United States, and most medical practitioners encounter patients with asthma on a daily basis. The goal of this 2-part article is to discuss the diagnosis and management of asthma in children younger than 12 years. In part 1, we will briefly outline the epidemiology, pathophysiology, and risk factors; then we will review, in more detail, the diagnosis of asthma and the initial evaluation of asthma severity.

For 2 days, a 17-year-old boy had a widespread pruritic eruption that involved the trunk and extremities but spared most of the face. Many of the lesions were annular, and they would appear and resolve within 1 day. The patient denied shortness of breath, difficulty in swallowing, and periorbital swelling.

The angry mother of a 15-year-old girl has called the office multiple times asking for the laboratoryresults from her daughter’s office visit last week and demanding to know whether the teen was “put on the pill.” Along with other lab work, tests for sexually transmitted infections (STIs) and pregnancy were performed, and the patient was given a prescription for a hormonal contraceptive.

The father of a 10-year-old boy was concerned about the asymptomatic rash on his son’s anterior thighs that had persisted for 9 months. The macular, reticular, erythematous rash hadevident hyperpigmentation bilaterally. The child had been otherwise healthy.

Caudal regression syndrome (caudal dysplasia sequence) is characterized by complete or partial agenesis of the sacral and lumbar vertebrae, along with pelvic deformity. Multiple other anomalies-including femoral hypoplasia; clubbed feet; flexion contractures of the lowerextremities; GI, genitourinary, and heart abnormalities; and neural tube defects-may also be associated with the syndrome.1

A 7-year-old boy with annular, asymptomatic, flesh-colored lesion onthe wrist that had developed slowly over the past month. The parents hadremoved the child from school because they were told that the lesion wasringworm. The lesion had failed to resolve after application of an antifungalcream for 10 days.

A 4-year-old boy presented for further evaluation of persistent right hip painof 2 months’ duration. Before the onset of the pain, he had been limping,favoring his right side. For several days before he was brought in forevaluation, he had had fevers and sweating in addition to the right hippain.

I enjoyed Dr Kirk Barber’s interesting Dermclinic quiz featuring a 5-year-old boy with a dramatic resentation of tinea corporis (CONSULTANT FOR PEDIATRICIANS, February 2009, page 43). I am curious to know why Dr Barber prescribed oral terbinafine for this patient.

A persistent, eczematous dermatitis had developed in the perioral area during the winter months in this 10-year-old boy. Topical corticosteroid creams had been tried, and these seemed to help some, but the ondition never really cleared. Because of the failure of the corticosteroid creams, a topical antifungal cream had also been tried; however, this, too, was of limited effectiveness.

An 18-month-old white boy is brought to his well-care visit by his parents, who are concerned that for the past month he has been less social and active. He has appeared weak and has refused to walk or play with his siblings. He has also had a decreased appetite and has lost about 2 kg. He has vomited several times but with no bile or blood.

The chief residents at the Children’s Hospital of The King’s Daughters in Norfolk, Va, handle about 1 or 2 cases per week. About once a month, they have a great teaching case in their morning report. These standout cases challenge the residents’ diagnostic acumen and underscore key points that are both applicable to daily practice and likely to appear as questions on future board certification examinations.