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What Types of Community Services Are Available?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Health care providers often view the patient through the medical lens and may not see the full view of all aspects of patients and families lives. Even many who work in community centered locations may not be aware of the breadth of services wanted and needed by families. Medical and community services are diverse in every location and often change as funding becomes available or dries up. One of the most difficult tasks for a health care provider (and patients and families) is to move to a new location and need to locate and access various services. Health care providers who take care of patients and families ...
Source: PediatricEducation.org - November 16, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

How Do You Define Professionalism?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion The American Academy of Pediatrics states “[p]rofessionalism has been a central and defining feature in medicine….Pediatricians have a special status in society as priviledged and trusted advocates for the well-being of children. Pediatricians have a responsibility to use their knowledge, skills, and influence to advocate for children and their interests in all domains of society, not just in health care.” The American Board of Pediatrics has endorsed eight components of professionalism for teaching and evaluation of resident physicians. These are: honesty and integrity, reliability and respons...
Source: PediatricEducation.org - November 9, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

What Evaluation is Appropriate for Complex Febrile Seizures?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Febrile seizures are the most common type of seizures in children. They affect about 2-5% of all children. Febrile seizures are characterized into two groups: simple febrile seizures and complex febrile seizures. Basically, if the child does not meet the criteria for a simple febrile seizure it is called a complex febrile seizure. The main characteristics are outlined below: Simple Febrile Seizure Complex Febrile Seizure Age 6-60 months < 6 months or > 60 months Duration < 15 minutes > 15 minutes Type Generalized Focal seizures tonic-clonic Tonic and/or clonic Partial se...
Source: PediatricEducation.org - November 2, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

What Problems Do I Need to Screen This New International Adoptee or Domestic Foster Care Child For?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion There is much overlap between immigrant children and children in foster care - particularly around adoption. Immigrant children are defined as those who are legal and undocumented immigrants, refugees and international adoptees. Children in domestic foster care if not reunified with their parents may be adopted by relatives (kinship permanency) or with non-relatives (national adoptees). Additionally, international adoptees and children initially or recently placed into foster care need similar medical evaluations. Children that are adopted, including those who had been in foster care, have higher rates of asthm...
Source: PediatricEducation.org - October 26, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

What Are Those Blood Group Antigens and Isn’t There Some Treatment I Can Give?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Hemolytic disease of the newborn is usually considered if there is a severe or rapidly developing hyperbilirubinemia, a maternal positive antenatal antibody screening or severely anemic or hydropic fetus, a positive direct Coombs test, hemolysis seen on blood smear, or prolonged hyperbilirubinemia. A differential diagnosis of the multiple causes of unconjungated hyperbilirubemia can be found in a previous case, and a review of the epidemiology of Rh negative HDN can also be found in another previous case. Learning Point Causes of severe unconjungated hyperbilirubinemia due to red blood cells causes includes: M...
Source: PediatricEducation.org - October 19, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

Is There Arsenic in My Environment?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Arsenic (As) is a semimetal found in Group 15 of the Periodic Table of Elements which is shared by Nitrogen, Phosphorus, Antimony and Bismuth. It is not considered by chemists as a heavy metal, but is often lumped in with Mercury and Lead because all have similar toxic affects. Elemental arsenic is not toxic itself, but inorganic and organic compounds are toxic. Trivalent inorganic compounds are particularly toxic because they are highly lipid soluble. Arsenic is bound by plasma proteins, hemoglobin and leukocytes and then is concentrated in the gastrointestinal tract, liver, kidneys, spleen, and lungs. Acute to...
Source: PediatricEducation.org - October 12, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

What is the Appropriate Treatment for a Pedal Puncture Wound?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Ciprofloxacin and other fluoroquinolones have demonstrated cartilage and joint toxicity when administered to immature laboratory animals. Therefore health care providers have been reluctant to use fluoroquinolones in young children and voluntarily have avoided them. However in 2002, more than 182,000 courses of fluoroquinolones were administered to children. Research data is limited but the pediatric safety profile appears to be similar to the adult safety profile. Current indications for fluoroquinolones include complicated urinary tract infections, treatment of opportunistic infections in immunocompromised pat...
Source: PediatricEducation.org - October 5, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

When Does the Rash of Roseola Occur?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Rashes, particularly ones caused by viruses, are common presenting problems. In his first edition of Pediatrics, Dr. Rotch spent 72 pages describing infectious exanthemata. The cause of the exanthemata was unknown at the time, and thankfully many of those that he wrote of have been eradicated (smallpox), have effective vaccines to prevent (measles, rubella, varicella) or effective antibiotics for treatment (streptococcus). Dr. Rotch ends his extensive treatise with a table describing “the chief points of differential diagnosis in the exanthemata.” This is what was state-of-the-art in 1896 with his s...
Source: PediatricEducation.org - September 28, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

What Are the Pros and Cons to Different Wound Closure Devices?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion About 7 million traumatic wound lacerations are repaired each year in emergency departments. Many more are repaired in practitioner’s offices. The ideal wound closure device and technique would be easy to perform consistently, quick to perform, be able to be performed in all clinical circumstances, painless, without the need to remove the device, have excellent cosmetic results and be cost effective. All of the current options for wound closure (i.e. sutures, staples, surgical tapes and tissue adhesives) do not meet all these criteria and therefore choosing among the options is necessary. Sutures have been...
Source: PediatricEducation.org - September 21, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

What Are Some Common Presentations for Inborn Errors of Metabolism?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Each inborn errors of metabolism (IEM) by itself is often rare but taken as a whole, IEM are common. IEM often present in the newborn or infancy periods but can present at any time including adulthood. The genetic defect often causes a problem in the catabolism or synthesis of carbohydrates, fats, or proteins. The defect causes a blockage in the metabolic pathway with intermediate molecules accumulating (often toxic accumulations) before the blockage and metabolites after the blockage being scarce (inadequate energy production/utilization). Diet and stresses including surgery, trauma, and illness often can trigg...
Source: PediatricEducation.org - September 14, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

What Are The Options for Treating Excessive Salivation?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Drooling, excessive salivation, hypersalivation, or sialorrhea can be a big problem for children. It can cause wet clothing necessitating bibs or multiple changes of clothing. It can cause dermatitis of the face, neck and chest, with possible skin breakdown and/or possible secondary infection. Sialorrhea can also potentiate the spread of common infections to others though direct or indirect contact with the saliva. It can also cause impaired social interaction as noted above. Therefore it is a problem that should be taken seriously and treated as necessary. Sialorrhea is generally considered abnormal if it occu...
Source: PediatricEducation.org - September 7, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

How Do I Calculate Mid-Parental Height and Other Growth Parameters?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Parents and pediatric healthcare providers are very concerned with children’s growth as it is such an important marker of their health status. Healthcare providers know, but parents often need to be educated, that it is not the exact measurements but the change in height, weight or head circumference that is the most important determinant. Therefore knowing some basic growth parameters and their changes over time are extremely important for analyzing children’s growth patterns. Children that appear to not be following these general patterns may do so for many reasons such as prematurity, chronic illn...
Source: PediatricEducation.org - August 31, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

If I Had To, How Would I Use Anti-Venom?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion In the United States there were 3264 snake bites reported to the American Association of Poison Control Centers in 2007. Bites and envenomations were the 13th most common substances involved in human exposures as reported by the same group. There are basically two types of venomous snakes in the U.S.: Family - Crotalidae Pit Vipers - copperheads, rattlesnake, cottonmouth, sidewinder About 98-99% of all envenomations Occur more in warmer months but can occur at any time Bite reactions: Extensive local reaction with severe pain and extensive regional swelling that can occur in as little as 10-30 minutes. Coagu...
Source: PediatricEducation.org - August 24, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

What Are the Complications of Cardiothoracic Surgery?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Congenital diaphragmatic hernia (CDH) occurs in 1 / 2000-3000 live births. Its overall mortality has been hard to determine as many infants die in-utero or just after birth before transfer for surgical care. One study found that ~61% of fetuses with CDH are live born. Many of these fetuses had other congenital anomalies. Mortality after live birth is ~ 40-62%. There are 3 major types of CDH: Bochdalek hernia which occurs posterolaterally Morgagni hernia which occurs anteriorly Hiatus hernia Left sided Bochdalek hernias are the most common (85%). Treatment currently includes fetal surgical repair, post-natal ...
Source: PediatricEducation.org - August 17, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

What Forms of Vitamin K Exist?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Vitamin K is critical for prevention of Vitamin K Deficiency Bleeding (VKDB) formerly known as hemorrhagic disease of the newborn. Dr. Charles Townsend first described this entity in 1894. Vitamin K is necessary for the synthesis of prothrombin and Factors VII, IX and X. Vitamin K stores are low at birth and also are low in breast milk. VKDB has 3 presentation variants: Early Bleeding occurs in first 24 hours. Bleeding sites - intraabdominal, intracranial, intrathoracic, skin and subperiosteal Generally occurs with mothers who are taking anticonvulsants, warfarin or anti-tuberculosis medications Classical ...
Source: PediatricEducation.org - August 10, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

What Causes Macroglossia?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Children with Down syndrome have a number of potential medical problems that need to be screened for and current recommendations can be found from the American Academy of Pediatrics (see To Learn More below). These include congenital cardiac anomalies, atlanto-axial instability, hypothyroidism, and leukemia and its variants. Additionally, children with Down syndrome often have chronic otitis media and airway abnormalities because of smaller airways and hypotonia. Dental abnormalities are also common. Learning Point Macroglossia is not a common problem but the differential diagnosis is broad. Often macroglossia i...
Source: PediatricEducation.org - July 27, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

Does This Sacral Dimple Need to be Evaluated?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Skin dimples over the spine commonly referred to as sacral dimples are common minor congenital anomalies, estimated to occur in 3-8% of children. When a clinician sees a skin dimple, the possibility of occult spinal dysraphism (OSD) usually crosses the mind. OSD is a wide-range of skin-colored spinal column and neuraxis abnormalities that are caused by abnormal neurulation. OSD lesions include dermal sinuses, tethered cord, lipomyelomeningocoele, and diastematomyelia. OSD can present with a variety of abnormalities, but is also frequently asymptomatic and can present at any age. Skin abnormalities accompany 50-8...
Source: PediatricEducation.org - July 20, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

Why Does He Have Such a Dry Mouth?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Saliva is produced mainly from the submandibular salivary glands (70-75%) and the parotid gland (20-25%). It functions to protect the mouth, aid digestion, maintain tooth integrity and facilitate chewing, swallowing and speech. Dry mouth or xerostomia especially in children is usually a temporary condition often associated with dehydration or mouth breathing. But it can be a more chronic condition that can affect quality of life and overall health. Patients with chronic xerostomia may stop eating certain dry or sticky foods which may lead to malnutrition. It can also change taste, and impair chewing, swallowin...
Source: PediatricEducation.org - July 13, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

What Are the Presenting Problems of Staphylococcus in Neonates?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Staphylococcus sp. are gram-positive, catalase-positive cocci that cluster when viewed microscopically. There are 17 species indigenous to humans and 13 colonize humans. Staphylococcus aureus is the only species that produces coagulase. Staphylococcus sp. can be found in almost any environment including high salt, low oxygen, high heat and low moisture. Coagulase-negative Staphylococcus sp. are so common that newborn infants are colonized by 2-4 days of life usually with S. epidermidis and S. haemolyticus. Staphylococcus aureus produces many infections especially pneumonia and surgical wound infections. Humans ...
Source: PediatricEducation.org - July 6, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

Can I Prescribe a Cephalosporin If He Is Allergic to Penicillin?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Otitis media is a common problem in pediatrics. As approximately 50% of all otitis media is viral in etiology, antibiotics in many cases are unnecessary and potentially harmful to patients. Overprescribing of antibiotics can lead to bacterial resistance in the community and potentially to allergic reactions in patients. Allergic reactions to antibiotics can be difficult to diagnose as some initial reactions may present solely as a rash. Unfortunately, many viral infections may also cause rashes. These rashes may mistakenly be associated with the antibiotic. Thus, the patient may erroneously be labeled as antibio...
Source: PediatricEducation.org - June 29, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

What Causes Photophobia?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Corneal abrasions are common problems in children that can be caused from a variety of trauma. Children’s fingernails and toys are frequent culprits along with dust particles particularly under windy circumstances. A review of treatment for corneal abrasions and a brief differential diagnosis of painful eyes can be found at: To Patch or Not to Patch, That is the Question Learning Point Photophobia is excessive light sensitivity and can be caused by a variety of entities. The differential diagnosis includes: Ophthalmological problems Glaucoma, congenital Retinitis pigmentosa Drugs Atropine Ethosuximide M...
Source: PediatricEducation.org - June 22, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

We’re Taking A Short BreakEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The next PediatricEducation.org case will be published on June 22, 2009. Thank you, Donna D’Alessandro, M.D., Curator (Source: PediatricEducation.org)
Source: PediatricEducation.org - June 8, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

He Just Makes a Mess!Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Meatal stenosis is a common problem. It can occur in up to 10% of circumcised boys. It is also more common in circumcised boys. This may be due to chronic irritation of the delicate tissues of the meatus caused by exposure to urine in the diaper and mechanical irritation of the diaper itself. Families may not notice the problem until the child is toilet training or afterwards because they do not witness the urinary stream and its deflection. Another potential mechanism is frenular artery damage during circumcision which results in ischemia and subsequent stenosis. The history usually includes symptoms that the ...
Source: PediatricEducation.org - June 1, 2009 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: info

What Are the Common Metabolic Causes of Urolithiasis?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Metabolic causes of urolithiasis are increasing. The common metabolic causes of urolithiasis in children are below along with their percentages: Hypercalciuria - 30-50%, these are radiopaque on radiographs Hyperoxaluria - 20%, these are radiopaque on radiographs Hyperuricosuria - 2-10%, these are not radiopaque on radiographs Cystinuria - <1%, these are not radiopaque on radiographs Xanthinuria - <1%, these are not radiopaque on radiographs Patients presenting with urolithiasis should have a metabolic evaluation to help determine the etiology and possible treatments. Metabolic evaluation may include ...
Source: PediatricEducation.org - January 19, 2009 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

How Much Vitamin D is in Milk?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Vitamin D is an important vitamin for bone formation and mineral homeostasis. Vitamin D deficiency can cause hypocalcemia, hypophosphatemia, osteomalacia, rickets and tetany. Deficiency is caused by inadequate dietary intakes of Vitamin D, inadequate exposure to sunlight or patients with fat malabsorption or renal disease. Sunscreen blocks sunlight and an SPF (sun protection factor) of 8 blocks 95% of the sun, so there needs to be a careful balance between over- and under- sun exposure. Adequate sunlight exposure for infants is considered 30 minutes/week clothed in a diaper only, or 2 hours/week fully clothed ...
Source: PediatricEducation.org - January 13, 2009 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What is Mauriac Syndrome?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Patients with type 1 diabetes mellitus may have growth failure for many reasons including insulin deficiency, poor glycemic control, concurrent autoimmune diseases, and decreased caloric intake and/or eating disorders. Autoimmune diseases that are more common include Addison's disease, autoimmune gastritis, celiac disease and hypothyroidism. Prior to treatment with long-acting insulin, delays in growth and sexual maturity were common but generally modest. Even today with good treatment, patients may have subtle abnormalities of growth (both weight and height) due to abnormalities of the IGF-1 and growth hormone...
Source: PediatricEducation.org - January 5, 2009 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What is the Differential Diagnosis of Torticollis?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Torticollis or wry neck is a clinical sign and symptom where there is a lateral head tilt and chin rotation toward the opposite side. In infants, congenital torticollis caused by a contracture of the sternocleidomastoid muscle and is the most common cause. It is usually successfully treated with stretching exercises. Common causes of acquired torticollis in older children include cervical adenitis and viral myositis. History and physical examination are important in evaluating the potential causes. A definitive history of trauma with obvious muscle spasm in the neck and shoulder girdle and normal neurologi...
Source: PediatricEducation.org - December 24, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

How Far is 10,000 Steps?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Obesity is an increasing major problem in the United States. Its complications are numerous including heart disease, diabetes and musculoskeletal problems. Historically in the U.S. when more jobs were very physical, people could get their exercise simply by doing their daily work. This is still true today in parts of the world where carrying water, gathering firewood, doing laundry, building and hunting are daily activities. It is estimated that most adults only walk about 1,000-3,000 steps/day in their daily life. At 2000 steps per 1 mile this is only 0.5-1.5 miles/day. Therefore people need to walk more or do...
Source: PediatricEducation.org - December 24, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

200th Case for PediatricEducation.org!Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
We are pleased to announce that the case today is PediatricEducation.org's 200th case! Over the past 4 years, we have tried to offer a breadth of cases, which have aggregated into an unstructured curriculum of pediatric topics that closely parallels the structured curriculum of a pediatric residency, fellowship and continuing medical education programs. We appreciate your continued patronage. As always we are looking for suggestions for new cases, ideas to improve the digital library and we would also like to hear about how you are using the cases for self-education or teaching of students. Please send your comments to...
Source: PediatricEducation.org - December 16, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

How Common Are Subgaleal Hematomas?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Bleeding into the soft tissues of the head is a common problem associated with birth and usually does not require intervention. These include: A caput succedaneum is localized serosanguineous edema of the scalp that occurs between the skin and aponeurosis of the scalp. These swellings can cross suture lines and are usually due to pressure from the pelvis, uterus or vagina. A subgaleal or aponeuneuroic hematoma occurs between the aponeurosis of the scalp and the periosteum of the bone. The galea aponeurotica occurs from the occiput to the eyebrows and laterally to the temporalis fascia. It therefore can cross su...
Source: PediatricEducation.org - December 9, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

Are Leukotriene Modulators Effective for Treating Atopic Dermatitis?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Atopic dermatitis is a common skin condition that occurs in 10-15% of children. It is chronic, relapsing and has an immunological basis but the exact etiology is unclear. The clinical presentation varies from mild to very severe. In acute presentations the skin can have erythematous papules and/or vesicles that overly erythematous skin. There are frequently excoriations and erosions. In subacute presentations there will be erythema, excoriations and scaling of the skin. In chronic presentations the skin will have progressed to having thick plaques of skin, lichenification and/or fibrotic papules. One recent ...
Source: PediatricEducation.org - December 1, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What Are the Genetics of Cleft Lip and Palate?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Patients with clefting often need the services of a multispecialty team of providers. Each child is unique and may need some or more specialists including speech and audiology, nutrition, surgery (otolaryngology, plastic, dental/orthodontics), psychiatry/psychology, social work, and genetics. Problems associated with cleft lip and palate include: Dental and orthodontia problems Feeding difficulties Hearing loss - most commonly conductive Language disorders - expressive and receptive language Speech disorders - articulation, phonation and resonation disorders commonly caused by velopharyngeal insufficiency O...
Source: PediatricEducation.org - November 25, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What Do I Have To Be Worried About With Neonatal Lupus?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Neonatal lupus erythematosus occurs in 1 of every 20,000 live births, and is caused by passive transfer of maternal antibodies to the fetus. About 50% of patients with neonatal lupus have mothers who are asymptomatic and the other 50% occurs in mothers with systemic lupus erythematosus or Sjögren syndrome. In a prospective study of mothers with infants with neonatal lupus, the mothers themselves who were asymptomatic or had an unidentified autoimmune syndrome usually did not progress to have other rheumatic diseases. Learning Point The clinical manifestations of neonatal lupus include: Cardiac problems ...
Source: PediatricEducation.org - November 17, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What Causes Elevated Amylase?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion The eating disorders bulimia and anorexia can occur together and their general features are listed below. Patients with anorexia nervosa refuse to maintain their body weight at or above a minimally normal weight for age and height (basically less than 85% of expected). They have an intense fear of gaining weight or becoming fat, even though they are underweight. They also have a distorted view of their own body weight or shape and often deny the seriousness of being underweight. For women who are postmenarchal, amenorrhea often occurs. Patients with bulimia nervosa have recurrent episodes of binge eating. A bi...
Source: PediatricEducation.org - November 6, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What Are the Complications of Duchenne Muscular Dystrophy?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Duchenne muscular dystrophy is a progressive, muscle-wasting, lethal disease that affects about 1 in 3500 boys. It is an X-linked recessive disorder with ~1/3 of patients having a spontaneous mutation. The genetic abnormality causes an absence or marked deficiency in the quantity of dystrophin protein in muscles. Muscle cells without dystrophin are more easily damaged during contraction with muscle inflammation, necrosis and fibrosis occurring. Patients classically have proximal muscle weakness (neck flexor, anterior abdominal, hip and shoulder girdle muscles) that presents usually by late preschool/early schoo...
Source: PediatricEducation.org - November 4, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

How Do I Handle an In-flight Emergency?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Estimates of in-flight emergencies vary because there currently are no consistent standards for measuring them. Estimates range from 0.003% to 0.0005% (i.e. 1/333-1900 flights per year). Based on studies from the United States this translates into 13-33 emergencies/day. Luckily most in-flight emergencies are not serious and most do not require evaluation or treatment by ground personnel. Overall, vasovagal episodes such as dizziness, fainting or near fainting and hyperventilation are the most common. The most serious overall are cardiac, neurological and respiratory problems. Estimates of in-flight deaths in...
Source: PediatricEducation.org - October 27, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What Is The Differential Diagnosis of Hepatomegaly?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Liver masses in children include primary liver cancer, metastatic cancer from other sites, cysts and inflammatory masses. Primary liver cancer only constitutes 1-2% of all pediatric malignancies. Primary liver malignancies in infants and young children usually are caused by hepatoblastoma. In older children hepatocellular carcinoma is the most common. For intermediate ages both are common along with transitional cell tumors and primary sarcomas. Other malignant liver tumors include angiosarcoma, biliary rhabdomyosarcoma, undifferentiated sarcomas and rhabdoid tumor. Benign liver tumors include adenoma, focal n...
Source: PediatricEducation.org - October 21, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What Are the Most Common Food Allergies?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Food allergies are relatively common but it can be difficult to tease out if it is a true allergy, a food intolerance or is actually something else. Risk factors that increase the likelihood of food allergy include: Reactions that occur minutes to hours of the ingestion Accidental ingestion of same food that produces the same symptoms Onset of symptoms as an infant or young child Close family history of other allergic diseases such as allergic rhinitis, asthma, atopic dermatitis or food allergies The suspected food is known to be higher risk for producing allergic reactions Children with a possible food aller...
Source: PediatricEducation.org - October 13, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What Medications Are Recommended for Adolescents Who Are Quitting Smoking?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Tobacco use is a pediatric problem. In 2006, ~3.3 million adolescents between 12-17 years currently used tobacco products and 2.6 million were current cigarette smokers. Each day, ~ 4,000 adolescents and children < 18 years of age smoke their first cigarette. Unfortunately, nicotine dependence is established rapidly and many children and adolescents go on to continue to smoke. Counseling helps adolescents quit and continue to remain abstinent. Adolescents enrolled in tobacco cessation programs are 2 times more likely to quit and remain abstinent. Pediatric health care providers should discuss parental smo...
Source: PediatricEducation.org - October 7, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

Curators Note: Evidence-based Medicine Information Added to Each CaseEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Beginning October 6, 2008, each case in PediatricEducation.org will now include evidence-based medicine information in the To Learn More section. The National Guideline Clearinghouse is an automated search on the case topic. The Cochrane Database of Systemic Reviews does not allow automated searching so a link to its main search page is used instead. We hope you find this new feature helpful. Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D. Curators, PediatricEducation.org (Source: PediatricEducation.org)
Source: PediatricEducation.org - October 6, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

How Should Bike Helmets Be Fitted?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Bicycling and other wheeled sports are great exercise and fun family activities. But to maintain the fun, safety must be a consideration. There are ~540,000 emergency room visits for bicycle injuries every year. Of those visits, ~67,000 involve head injuries and ~27,000 require hospitalization. About 770 people died from bicycle injuries in 2006, mainly from head injuries. It is estimated that a bicycle helmet could prevent 45-88% of brain injuries. Unfortunately many people do not wear a helmet or it is improperly fitted. In a cross-section study of 8 communities in Texas in 2002 that evaluated helmet use fo...
Source: PediatricEducation.org - September 29, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What Other Abnormalities are Associated with Prune Belly Syndrome?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Prune Belly syndrome is characterized by various anatomical urinary tract anomalies, cryptorchism and deficiency of abdominal wall musculature. It has a characteristic distended abdomen with wrinkled skin which gives rise to the name. This syndrome was first described in 1839 by Frohlich. In 1950 Eagle and Barrett described 9 cases and later other physicians suggested Eagle-Barrett syndrome as an alternative eponym. The incidence is approximately 1:40,000 live births. Females can have an incomplete form of the syndrome but obviously cannot have cryptorchism. They may have other genital abnormalities such as vag...
Source: PediatricEducation.org - September 23, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What Else Causes Acute Pharyngitis That Isn't Group A Streptococcus?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Acute pharyngitis is a common problem accounting for 1-2% of all outpatient visits. Patients usually complain of pain to various degrees, fever and erythema of the pharynx. Acute pharyngitis is more common in the colder months of the year. The most important bacterial cause is Streptococcus pyogenes, or beta-hemolytic, group A streptococcus (GAS). It causes 15-30% of tonsillopharyngitis in school age children. GAS is often spread between family members with children being the reservoir. Common signs of GAS include erythema and exudates of the tonsils and pharynx, petechiae on the soft palate, anteriorcervi...
Source: PediatricEducation.org - September 8, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What Types of Foods Should Vegetarians Eat to Maintain Proper Nutrition?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Vegetarians have a diet pattern that emphasizes consuming plant foods (i.e. vegetables, grains and nuts) and avoiding flesh food (i.e. red meat, poultry, fish). Some vegetarians include milk and egg products in their diets and would be more accurately described as lacto-ova-vegetarians. Vegans are vegetarians who avoid all animal products including foods such as dairy products, eggs, butter, honey and gelatin. What constitutes being a vegetarian to one person, may have a different meaning for another person. In a national study, 2.5% of the participants (aged > 6 years of age) considered themselves to be vege...
Source: PediatricEducation.org - September 2, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

How Common is RhD Isoimmunization?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion RhD isoimmunization luckily has decreased in incidence since the introduction of RhD immunoglobulin (RhIg) in 1968. There are 3 major rhesus antigens on red blood cells. The D antigen determines if a person has a positive or negative blood grouping. An RhD-negative woman is at risk of developing RhD isoimmunization when exposed to RhD-positive antigens from her RhD-positive fetus through fetal-maternal hemorrhage. Usually her initial antibody response is mainly composed of IgM which is a large molecule and cannot cross the placenta. But after this IgG is produced which can cross the placenta. A subsequent exp...
Source: PediatricEducation.org - August 27, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

How Do You Treat Invasive Salmonella Infections?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Salmonella is a highly contagious organism causing an estimated 17 million cases of typhoid fever and 600,000 deaths yearly worldwide. It causes a spectrum of illness. Most commonly it causes gastroenteritis with diarrhea, abdominal cramps and fever. Bacteremia may be intermittent or continuous Focal infections such as meningitis or osteomyelitis occur in up to 10% of patients with bacteremia. Enteric fever is caused by Salmonella typhi and other Salmonella serotypes when there is a protracted bacterial illness. It may begin gradually with constitutional symptoms (i.e. anorexia, headache, lethargy and malaise...
Source: PediatricEducation.org - August 18, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

How Can I Make My Sexual Interview More Gender Neutral?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Sexuality and social and family functioning and relationships are important components of comprehensive medical care and should be discussed at every health supervision for children and adolescents. Homosexuality in children and/or their parents is common and pediatric health care providers should be aware of the specific needs of each child, adolescent and family. Some sexual definitions include: Sexual orientation is the sexual desire for a particular gender, or an intensive internal physiological desire for a particular gender. Homosexual, heterosexual and bisexual are examples of sexual orientation. Sexua...
Source: PediatricEducation.org - August 12, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What Drugs Can Trigger Malignant Hyperthermia?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Malignant hyperthermia is a medical emergency. It is caused by an abnormality where the metabolism of intracellular calcium is altered causing a hypermetabolic state. It is triggered by various drugs used for anesthesia. It may occur during anesthesia and in the post-anesthesia period. Symptoms may not be recognized though until hours later. Signs and symptoms of malignant hyperthermia include: Tachycardia/tachypnea Increasing temperature (may be a late sign) Body rigidity including trunk or total body Masseter muscle rigidity or trismus Myoglobinuria Increasing end tidal CO2 Mixed respiratory and metabolic a...
Source: PediatricEducation.org - August 4, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What Causes Congenital Cholesteatomas?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Cholesteatomas are an epithelial-lined sac that contains squamous debris that progressively expands, potentially causing morbidity and even mortality. They most often are acquired but can be congenital. Morbidity includes secondary infection of the lesion and/or middle ear structures, destruction of the ossicles with potentially permanent hearing loss, destruction of the skull bones, invasion into the cranial vault with compression of the brain and surrounding structures, and infection of the brain including abscess. Surgery usually is curative but recurrences of cholesteatomas do occur. One retrospective ca...
Source: PediatricEducation.org - July 29, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info

What Causes Sweaty Babies?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Discussion Sweating is made by the eccrine glands and is a normal physiologic response that helps to maintain body temperature. Hyperhidrosis is sweating beyond what is needed to maintain normal temperature regulation. It can be primary or secondary, and generalized, regional or focal, regional. Some studies report a prevalence of 1-2.8%, but this may be underreported. Hyperhidrosis can be not only socially a problem, but may not allow people to have careers in areas that contact paper, metal or electrical components. Hyperhidrosis can also damage clothing, shoes and furniture too. Sweating around the head particularly ...
Source: PediatricEducation.org - July 21, 2008 Category: Pediatrics Authors: Donna D'Alessandro, M.D. Source Type: info