News

Complete duplication of the left thumb in a baby boy was noted at birth; a radiograph of the thumb showed 2 proximal and distal phalanges with 1 first metacarpal bone. He also had fusion and incomplete bony duplication of the right thumb; a radiograph of this digit showed normal proximal and distal phalanges plus a small tiny bony remnant of the proximal and distal phalanges of an accessory thumb.

Imagine that you are working in an outpatient pediatric practice one morning when a mother arrives with her 3-month-old infant who is in respiratory florid distress.

This baby boy was born with bilateral medial colobomas of the upper eyelids without tarsal plates and bilateral accessory tragi. Radiographs showed no vertebral anomalies, and no other physical abnormalities were evident.

When Lice Won't Leave

A MOTHER ASKS: “In the past month, I’ve used a pharmacist- recommended anti-lice shampoo 4 times and my daughter still has lice. Can you call in a prescription to get rid of them?”

A 7-year-old girl presented with pain and discomfort in the left leg that was exacerbated by physical activity. She had been born with a port-wine stain on the left knee. As her mobility increased, she occasionally complained of discomfort in the left leg. Klippel-Trenaunay syndrome (KTS) was diagnosed at age 3 years after an evaluation for swelling, discoloration, and pain of the left leg. Magnetic resonance angiography and venography had revealed abnormally dilated, tortuous veins in the subcutaneous tissues from the distal thigh to the posterolateral calf with involvement of the proximal anterior tibial muscle. The parents had elected for conservative management with observation.

Although at present there is no cure for type 1 diabetes mellitus, good treatments are available that can enable affected children to lead healthy, active lives. Insulin regimens should be designed to optimize metabolic control while minimizing the risk of adverse events, such as hypoglycemic episodes, which can be more serious in children. Regimens of 3 in- jections per day work well for children who cannot receive an injection at lunchtime, while multiple daily injection (MDI) regimens provide more flexibility. Continuous subcutaneous insulin infusion (CSII) can provide better quality of life than MDI regimens, but CSII requires a high level of motivation and carries its own risks. In all children, insulin regimens must be adjusted to accommodate the physiological changes of growth and development. Long-term follow-up is important to monitor for complications of diabetes.

A 6-year-old boy presents with tall stature (97th percentile for age), motor delays (walking at 16 months), speech delays (expressive vocabulary of 30 to 40 words with recent use of 2-word phrases), and behavioral differences (poor eye contact, lack of pointing, hyperactive behavior with hand-flapping).