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You've been approached by a surgeon at your local hospital to consult on a perplexing patient: an 8-year-old African-American boy who yesterday was brought to the emergency department with a 20-hour history of abdominal pain. The child could neither localize the pain nor describe its quality. He did not have testicular pain. He had eaten dinner without difficulty the night before presentation but had two episodes of nonbloody, nonbilious emesis on his way to the ED. His mother thought that he felt warm; in the ED, the temperature was 38.4? C.

When a patient comes to me for repair of a scalp laceration, the main issue usually is "am I going to get stitches?" (Sometimes the first words out of the child's mouth are "I am not getting stitches!") I have these situations under control because I know I can repair scalp wounds without using staples, stitches, sterile strips, or surgical glue. Instead, I use the patient's hair and a nylon suture to close small scalp wounds. I learned the technique at a meeting given by the staff of Oakland (Calif.) Children's Hospital more than 10 years ago, and it has served me and my patients well ever since. Before you begin, you may wish to apply LET (lidocaine, epinephrine, and tetracaine) gel or a topical anesthetic cream to the wound at least 45 minutes before starting the procedure to ensure that the patient feels no pain.

"Go-to" asthma advice in paperback

The RICE (rest, ice, compression, elevation) prescription for strains and sprains works very well if the patient applies enough cold compresses. A common problem with home compliance is that the patient often runs out of ice (or frozen vegetables and other frozen foods often used as alternatives). I advise young athletes to keep a supply of cold packs on hand by folding several clean washcloths or hand towels lengthwise, soaking them in water (and squeezing out the excess to eliminate dripping), then wrapping them in clear plastic wrap and putting them in the freezer. Because the washcloths or towels are folded lengthwise, they aren't bulky and can be molded easily around joints or other curved surfaces such as a knee or thigh. If a cold pack comes out of the freezer too stiff to be practical, the patient can soften it by running tap water over the wrapped surface. The packs remain cold for approximately one hour. Best of all, they can be readily replaced by another pack waiting in the freezer.

As your specialty seeks to adapt to changing times, the issue is not whether pediatrics will rise to the occasion, but how. The author considers ways in which ingenuity and manpower can combine to meet the challenges ahead. Last of three parts.

In the years since Contemporary Pediatrics first hit physicians' desks, pediatric practice has undergone a phenomenal change. A longtime contributor and a former editor pause to consider just how far the specialty has come.

A 14-year-old high school soccer player, referred by her pediatrician, has been brought to the sports medicine clinic reporting a one-year history of "shin splints." She describes shin pain in both legs that seems to increase with running and brisk walking, mostly over the "front" of her shins. She characterizes her pain as a "tightness" that "pinches" her legs and becomes noticeable five to seven minutes after she begins activity. The pain has become more intense the past two months--to the point where she is unable to run for more than 10 minutes at a time.

Time, cost, and adolescent patients

October 1-3 Current Issues in Child Maltreatment, Toronto, Ont. For information, e-mail ce.med@utoronto.ca

Labor Day weekend is, in ordinary times, the end of summer vacation for members of Congress. Tanned and well-rested, senators and members of the House are ready to get back to work, to tackle at least some of the domestic policy issues they have been unable to resolve until now.But this is no ordinary summer: Some members of Congress responded to the publication of the report of the 9/11 Commission by returning to work in August, and-even with time off for convention-going and politicking in an election year-a special session to deal with homeland security may even be in the cards.

What made the time with my disease infinitely easier was this ability of my parents to brainstorm and find alternative ways for me to enjoy myself.

Preventing Little League shoulder and elbow

Q As a pediatric pulmonologist, I treat quite a few children and adolescents who have exercise-induced asthma and other causes of exercise limitation. The younger children often are reluctant to talk about their experiences with sports, but their parents enthusiastically carry the conversation. In many instances, I have noticed that, when sports are involved, a parent's enthusiasm can go well beyond the usual parental pride. Such parents actually seem far more interested and invested in the sport than the child is. The child may even appear weary and disinterested when the subject comes up.

Far more people have heard of Tourette syndrome than know what it actually looks and sounds like - or how it feels to the person who has it. That's a major reason the diagnosis of this condition - the most severe tic disorder - is often missed. This is part one of a two-part series. See Tourette syndrome--Much more than tics, part 2: Management

What do physicians need to meet the challenge of providing high-quality patient care in this century? A set of well-defined competencies and a system for maintaining them throughout the course of professional practice. Part two of a three-part series.

Obtain free CME credit online

The management of Tourette syndrome is highly individualized and, when it comes to medical therapy, largely trial and error.

Far more people have heard of Tourette syndrome than know what it actually looks and sounds like - or how it feels to the person who has it. That's a major reason the diagnosis of this condition - the most severe tic disorder - is often missed. This is part one of a two-part series. See Tourette syndrome--Much more than tics, part 2: Management

EMRs are here.

EMRs are the wave of the future.

A 4-year-old girl is admitted to the ER with high fever and acute torticollis.

More approaches to toilet training/Did this infant receive proper care?