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Your patient is a 14-year-old boy who complains of bilateral foot pain of several weeks' duration. Sometimes, he tells you, the pain is so bad that he cannot bear weight and has to crawl from place to place. As you talk with him, you note that all 10 fingernails are abnormally thick and raised.

Your patient is a 10-year-old Latino girl brought to the clinic by her very concerned mother. The complaint is leg and joint pain-severe enough to make walking difficult. The visit comes after your colleague at the clinic saw the girl about a month ago for an unusual rash described in the record as a brownish, linear, papular eruption, possibly urticaria pigmentosa.

The inability to calculate therapeutic dosages for children accounts for the majority of pediatric drug errors, according to Ronda G. Hughes, PhD, MHS, RN, and Elizabeth A. Edgerton, MD, MPH, of the Agency for Healthcare Research and Quality. But there are practical ways for nurses-who often have primary responsibility for ensuring patient safety in the hospital and are usually the providers who administer the medications-to reduce the likelihood of a mistake.

The FDA announced in August that it has expanded the indication for Merck's approved hepatitis A vaccine (Vaqta) to include patients 12 months and older. Previously, Vaqta was approved for children 2 years and older. The change is the result of an open-label study of children with no evidence of hepatitis A infection.

In a recent survey by the American Counseling Association (ACA), eight in 10 adolescent girls said that acne makes them feel embarrassed, unhappy, or less attractive. The survey, underwritten by Dermik Laboratories, polled 738 girls between 13 and 17 years old. Its goal was to raise public awareness of the impact of acne during important moments in a teenager's life.

"Kids Need Flu Vaccine, Too!," a toolkit developed by the National Foundation for Infectious Diseases, now includes new material—available online—to help educate parents about influenza and the importance of annual flu vaccinations for infants and children.

A Food and Drug Administration advisory committee recommended in July that Serevent (salmeterol), Advair (fluticasone propionate/salmeterol), and Foradil (formoterol) be kept on the market, despite safety concerns. The committee, which had convened in response to an FDA request to consider withdrawal of those drugs, did, however, call for the addition of a black box warning to Foradil.

Dr. Schuman will discuss the "EMR" and larger issues of technology in the pediatric office with conference attendees when he visits the Contemporary Pediatrics Exhibit Hall booth (#822) on Sunday, October 9, 2005, from noon until 4 p.m. He'll also bring his novel "Pretty Good Pediatrician" (PGP) program to the booth to recognize the hard work of pediatric clinicians.

As a world-class city, Washington, DC, is home to a wonderful selection of dining establishments featuring a wide array of international and regional American cuisines. Meals run the gamut from the sumptuous and sublime to down-to-earth and down-home. And you can generally choose an ambiance that suits either your lifestyle or current mood. Bon appetit!

I have been a pediatrician for nearly 30 years. I have practiced in affluent suburbs and in poor inner cities and have cared for patients from many religious, ethnic, and cultural backgrounds. Experience has taught me that there are certain ways to approach a child's parents that are nearly universally appreciated.

The mother of this 5-month-old infant was concerned about the lesions that appeared on her son's inner ankles after he had spent the day with his babysitter. The lesions had not been present when the child was dropped off earlier that morning. His grandmother feared they might be cigarette burns.

It is 9:00 on Sunday morning when the first patient of the day registers during your weekend extended office hours. The triage nurse informs you that the patient is a 13-year-old boy with "chest pain."

A 4-day-old boy was transferred to our institution for evaluation of multiple anomalies. He was born to a gravida 2 para 1 mother at 38 weeks of gestation. He weighed 3288 g at birth. Antenatal ultrasonograms at 5, 6, and 7 months had revealed short bones in the legs. The mother was subsequently lost to follow-up--until now.

A new bill to combat child abuse at residential treatment programs in the United States and abroad was recently introduced by Congressman George Miller (D-California). HR1739, labeled "The End of Institutionalized Abuse Against Children Act," comes in response to reports of the death of young people so-called therapeutic boot camps, wilderness camps, and boarding schools.

The Centers for Disease Control and Prevention (CDC) announced that approximately 81% of the nation's toddlers are receiving all the vaccinations in the recommended series."These results are terrific news," said Dr. Julie Gerberding, director of the CDC. "They illustrate the tremendous progress we've made in preventing what were once common childhood diseases. Most importantly, these results show that parents have high levels of confidence in our vaccination recommendations. It's encouraging to see that parents recognize the importance of protecting their children against diseases that while relatively uncommon, can cause serious harm."

Contrary to earlier findings, inhaled nitric oxide (NO) therapy for lung immaturity in premature infants does not reduce an infant's risk of death or further lung problems, according to a study by the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health that appeared in the July 7 issue of the New England Journal of Medicine. "Premature infants weighing less than 1,500 g should not receive inhaled NO therapy unless they are part of a research study," said NICHD Director Duane Alexander, MD.

The Food and Drug Administration (FDA) last week approved a topical acne gel developed and manufactured by the Canadian drug company QLT Inc. for use for patients between 12 and 17 years old.

Children and adolescents who have had a malignancy are at risk of medical, psychological, and social late effects of their disease and its treatment. If you're aware of potential problems and how to screen for them, you can help ensure the good health and proper development of these vulnerable youngsters.

It goes by the acronym D-TECKT, and it's an easy-to-use guide to getting a handle on what's behind a child's or adolescent's behavior problems and lighting the way to an effective solution.

In the four decades since nurse practitioners appeared on the health-care scene, they have become an integral part of pediatric care. Here are some things you may not know about this important practice role.

Gastrointestinal complaints are common, and so is the use of herbs and supplements to treat them, especially when symptoms are recurrent. Some remedies work well but others are best avoided.