What Causes Post-Inflammatory Hypopigmentation?
Discussion Hypopigmentation can be worrisome for many families because of cosmesis and the worry that “something is wrong.” The normal natural changes in skin-tone over the year due to different light exposure and wide variations within individuals is not something that many people are aware of. Post-inflammatory hypopigmentation is a common cause of hypopigmentation. Vitiligo is the most common cause of depigmentation. Vitiligo is an acquired, depigmenting disorder with typical lesions appearing as milky white macules with distinct margins that are not scaly. Hair (including eyebrows and eyelashes) can be dep...
Source: PediatricEducation.org - November 12, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is the Dutch Protocol for Gender Dysphoria?
Discussion Terminology related to gender∂has changed over time and with newer more specific terminology developing more consensus. Also terminology used by patients to describe themselves or their situation may be different than below. “Gender – denotes the public (and usually legally recognized) lived role as boy or girl, man or woman. Biological factors combined with social and psychological factors contribute to gender development.” Gender is not dichotomous and other terms such as third gender, agender or gender queer reflect this. “Assigned gender – refers to a person’s initi...
Source: PediatricEducation.org - November 5, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Frostbite After Cryotherapy?
Discussion Veruccae plantaris or plantar warts are caused by Human Papillomavirus which causes benign epidermal tumors that often have a cauliflower pattern on the foot that may be elevated or flush with the surrounding skin. Lesions may resemble calluses but the normal footprint pattern is disrupted. The lesions often have pinpoint hemorrhages that appear as black dots. In an immunocompetent individual, the lesions usually have spontaneous resolution within 2 years but the infection may spread to create additional lesions. The lesions may also cause pain or discomfort because of their size or location. There are numerous...
Source: PediatricEducation.org - October 29, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Are Bicycle Helmets Designed to Prevent Head Injuries?
Discussion Protective helmets are used for multiple occupational and recreational activities. They are designed to protect the head from the common problems associated with the activity. For example, hard hats for construction workers are meant to protect against superior and lateral objects contacting the head as something can fall from above or a worker may contact an object as they are moving. The helmet had a plastic suspension ring that sits on the head providing space between the plastic helmet and the head allowing for the striking force to be dissipated over that distance before the helmet contacts the head. Helmet...
Source: PediatricEducation.org - October 22, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is the Odds Ratio for Testicular Cancer after Cryptorchidism?
Discussion Cryptorchidism is the failure of one or both testes to descend from the abdomen into the scrotum. Congenital undescended testis (UDT)is common in young infants (1-4% in term infants and 45% in preterm infants) in that the testes will be palpable but remain high, but most testes will descend by 3-6 months and by 9 months of age only 1% remain undescended. The scrotum often appears underdeveloped. Sometimes the testes cannot be identified and is intra-abdominal at birth. Intra-abdominal testes are less likely to migrate to the scrotum and therefore are more likely to remain undescended. Acquired undescended test...
Source: PediatricEducation.org - October 15, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is Hemiephysiodesis?
Discussion Angular deformities of the lower extremities are common problems and can be idiopathic, congenital or acquired. Idiopathic knee deformities are usually managed by monitoring and family reassurance as these often improve with time or are minimal and do not cause problems. Those ≤ 10 degrees are considered non-problematic. Genu varus usually peaks between 1-3 years and if problematic can cause waddling gait, lateral thrust and ligamentous laxity. Genus valgus usually peaks around 3-6 years and if problematic can cause circumduction gait, anterior knee pain and patellofemoral instability. Treatment options are m...
Source: PediatricEducation.org - October 8, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is the Blood Culture Recovery Rate After Antibiotic Pretreatment?
Discussion Sepsis is an inflammatory response syndrome in the presence of an infection, it can be caused by bacteria, viruses or fungi. Bacteremia is the presence of bacteria in the blood. Studies from the US show an increased incidence of sepsis (0.56 to 0.89 cases/1000 children in all age groups) but a decreased fatality rate from 10.3% to 8.9%. The prevalence of severe sepsis in pediatric intensive care settings is reported in as many as 7.7% of admissions. Severe sepsis is more common when patients have co-morbities. Primary prevention includes immunization and appropriate precautions and procedures (i.e. catheter acce...
Source: PediatricEducation.org - October 1, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Hyperkalemia?
Discussion Potassium (K+) is an alkali metal (Group 1 of periodic table with Hydrogen, Lithium and Sodium) with an anatomic number of 19. Its chemical symbol K, comes from the medieval Latin, kalium which means potash (mainly potassium carbonate or potassium hydroxide), the substance it was first isolated from. Potassium is an important cation and it mainly resides in the intracellular fluid with only a small amount in the extracellular fluid. Potassium regulates cell volume, pH and enzyme functions. Hyperkalemia is defined as a potassium level> 5.5 mEq/L in children and> 6.0 mEq/L in newborns. Hyperkalemia incre...
Source: PediatricEducation.org - September 24, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Type of Conservative Treatments Can Help for Plantar Fasciitis?
Discussion The plantar fascia consists of 3 bands of dense connective tissue that originates in the medical calcaneal tubercle and inserts into the base of each of the 5 proximal phalyanxes in a fan-shaped distribution. It acts as a shock absorber and reinforces the medial longitudinal arch as the foot undergoes forward propulsion. The -itis in plantar fasciitis (PF) is a misnomer as it is not an acute inflammation but is a chronic degenerative process involving the plantar fascia aponeurosis of the foot usually at the medial tubercle of the calcaneous. Repetitive strain seems to cause microtearing which then causes a repa...
Source: PediatricEducation.org - September 17, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Should Be In A Mental Health Safety Plan?
Discussion IF YOU ARE IN A CRISIS SITUATION AND NEED HELP, call 1(800) 273-TALK(8255) there IS someone there who can help you, En Espanol 1-888-628-9454, or Text “HOME” to 741-741 . Other resources are available at http://www.suicidepreventionlifeline.org About 10-20% of children and adolescents have a mental health or substance abuse disorder. Suicide is the seconding leading cause of death in the US for ages 10-19 years old at ~2000/year. Unfortunately the numbers of trained mental health professionals in the US and most countries is inadequate to provide appropriate care. Emergency department (ED) visits ...
Source: PediatricEducation.org - September 10, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are Common Cross-reactivities with Other Allergens?
Discussion The most common allergic foods are cow’s milk (most common), egg, peanut, tree nut, soy, wheat, fish and shellfish. Egg, milk, soy and wheat tend to occur in young children and these are more likely to be outgrown over time. Peanut, tree nut, shellfish, and fish occur at all ages and are less likely to be outgrown. Peanut and tree nut allergies also tend to be more severe than other foods. Ninety percent of food fatalities were attributed to tree nuts and peanuts. In a study of anaphylaxis in schools, food was the most likely trigger (54%) with nuts and fruits being the most commonly identified foods. Co-f...
Source: PediatricEducation.org - September 3, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is the Difference Between Nightmares and Night Terrors?
Discussion Sleep disorders are common in all ages particularly with sleep deprivation in our increasingly busy world. Sleep problems are more common in patients with attention deficit hyperactivity disorder, epilepsy, headache and visual impairments. Sleep problems can cause cognitive and behavioral impairments including emotional regulation problems, increased seizures or headaches, and impaired attention and have been known to prolong recovery from various acquired brain injuries. Parasomnias are “undesirable events that accompany sleep and typically occur during sleep-wake transitions.” The term sleep terr...
Source: PediatricEducation.org - August 27, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Summer Break
PediatricEducation.org is taking a summer break. The next case will be published in on August 27th. In the meantime, please take a look at the different Differential Diagnoses, Symptom and Disease listed at the top of the page. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - August 6, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes School Failure?
Discussion “Literacy is traditionally meant as the ability to read and write. The modern term’s meaning has been expanded to include the ability to use language, numbers, images, computers, and other basic means to understand, communicate, gain useful knowledge, solve mathematical problems and use the dominant symbol systems of a culture.” The earliest written communication was in 3500-3000 BCE, with the earliest alphabet being from 1200-750 BCE. Although the percentage of the world’s adult literacy rate is increasing each decade by ~5%, “…from 55.7 per cent in 1950 to 86.2 per cent in...
Source: PediatricEducation.org - July 30, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How are Malformations of the Cerebral Cortex Grouped?
Discussion Cerebral cortex development is an extremely complex process overall. Our current understanding is incomplete and constantly changing as our understanding of genetics and the processes each gene controls emerges from scientific research. Neural cells are produced in the subventicular zone of the pallial or dorsal germinal epithelium. They then differentiate and migrate radially or tangentially to the cerebral cortex and organize themselves to function. Malformations of cortical development (MCD) is a heterogeneneous group of disorders that cause defective cortical development. These disorders are broadly catego...
Source: PediatricEducation.org - July 23, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common is Recurrent Kawasaki Disease?
Patient Presentation A 3.5-year-old female came to clinic with a 2-day history fever up to 101°F. The evening before she had complained of a sore throat but had no rhinorrhea, cough or rash. She was drinking reasonably well and was urinating frequently. She had been to a birthday party where an older child had had strep throat. The past medical history was positive for Kawasaki Disease diagnosed at 17 months of age and treated with intravenous immunoglobulin (IVIG) on day 6 of fever. Her echocardiograms had been negative and she was being appropriately monitored by cardiology. The family history was positive for heart...
Source: PediatricEducation.org - July 16, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is the Interval For Non-simultaneous Administration of Live Virus Vaccines?
Discussion Vaccines are a mainstay of infectious disease prevention and health promotion. Infants, children and adults benefit from vaccines the most when they are given on the recommended schedules. However there are times when this is not possible as children come to the physician a little early, or a little late, or had unavailable records and so received addition vaccine, etc. There are many questions that arise because of these timing issues such as the one above. Standard vaccine schedules can be reviewed here. Commonly administered vaccines includes: Live-attenuated vaccines Cholera Measles, mumps, rubella (MMR ...
Source: PediatricEducation.org - July 9, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

No Plant Oils for Cradle Cap?
Discussion During growth, plants first store their energy as carbohydrates but during ripening switch over to carbon-rich triglycerides. Triglycerides also occur in yeasts, molds and animal fats. A few higher plants store lipids in other forms. One example is the Jojoba which stores its oil as a lipid wax. Simmondsia chinensis (Jojoba) is a specialty-cultivated plant found mainly in the American Southwest and Mexican Northwest. Jojoba seed oil has> 50% of its weight as liquid wax esters that are used in personal care products and lubricants. Jojoba oil is naturally extracted from the seed or synthetically produced. Natu...
Source: PediatricEducation.org - July 2, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is the Prevalence of Somnambulism?
Discussion Sleep disorders are common in all ages particularly sleep deprivation in our increasingly busy world. A review of health problems caused by inadequate sleep can be found here. Sleep problems are more common in patients with attention deficit hyperactivity disorder, epilepsy, headache and visual impairments. Sleep problems can cause cognitive and behavioral impairments including emotional regulation problems, increased seizures or headaches, and impaired attention and has been known to prolong recovery from various acquired brain injuries. Somnambulism or sleepwalking is a parasomnia (which include confusional a...
Source: PediatricEducation.org - June 25, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Is the Scope of Practice for Pediatric Care for Chiropractic Doctors?
Discussion “Chiropractic is a health care profession concerned with the diagnosis, treatment, and prevention of disorders of the neuromusculoskeletal system and the effects of these disorders on general health.” Some people look at chiropractic care solely as spinal manipulative therapy (SMT) or manipulation. Chiropractic physicians also offer a variety of other treatments including nutritional advice, dietary or herbal supplements, therapeutic exercise, posture correction and behavioral counseling. Spinal muscle therapy or spinal manipulation is one of the most common complementary, integrative, and alternati...
Source: PediatricEducation.org - June 18, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is the Developmental Outcomes of Patients with 22q11 Deletion Sequence?
Discussion 22q11.2 deletion sequence (22q11) is the most common micro-deletion syndrome. Most deletions are de novo. It affects ~1 in 2000-4000 live births. As it is autosomal, it affects males and females equally. Childhood mortality is low and often associated with congenital heart defects. Its phenotypic expression is highly variable. Some of the most common medical problems are: Congenital heart defects especially conotruncal abnormalities Palatal problems especially velopharyngeal incompetence and/or cleft lip/palate Immunodeficiency especially T-cell lymphopenia, but also abnormalities of IgG production, autoimmu...
Source: PediatricEducation.org - June 11, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Should Fruits and Vegetables Be Washed?
Discussion Fruits and vegetables are great sources of nutrition and often are eaten raw. However, they can become contaminated during harvest, transportation, production, preparation and storage. Produce accounts for about half of all foodborne illness and about 20% of foodborne deaths. Outbreaks have been associated with all food sources including home gardens, local farms and large scale commercial food operations. Vegetables most associated with illness are leafy green vegetables, herbs and sprouts. Learning Point What are the best ways to keep raw fruits and vegetables safe? “Wash your hands with hot soapy water...
Source: PediatricEducation.org - June 4, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Is Considered a Minor Automobile Crash?
Discussion Airbags are supplemental (not primary) safety devices in motor vehicles that are intended to prevent injuries mainly to the head, neck, and torso. They are designed to provide the greatest protection when the occupant is seated properly and wearing a seat belt properly. Front airbags are designed to inflate within 50 milliseconds of impact in a moderate to severe crash. They usually will deploy for belted occupants at speeds of 16 miles/hour (mph) or more, but with newer sensors and algorithms will deploy at lower speeds if they detect unbelted occupants (i.e. 10-12 mph). Forward airbags will also deploy for imp...
Source: PediatricEducation.org - May 28, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is BACM?
Discussion Leg pain in children has a broad differential diagnosis and includes more innocuous problems such as growing pains and transient synovitis but also more serious problems including neurological diseases or malignancy. Occult or self-limited trauma are also common causes. A review can be found here. Limping can be painful or painless and has its own differential diagnosis which can overlap with leg pain. A differential diagnosis for limping can be found here. Muscle weakness also has its’ own differential diagnosis which can be found here. Learning Point Benign acute childhood myositis (BACM) has other names...
Source: PediatricEducation.org - May 21, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

His Tooth is Funny Looking. What is It?
Discussion Teeth are specialized anatomic parts of the human body that are developed between the ectoderm and ecomesenchyme in a complex process called odontogenesis. More than 300 genes have been identified that influence odontogenesis. Dental abnormalities can have significance for cosmesis, malocclusion, dental caries and periodontal diseases. It is not uncommon for more than 1 area to be affected. For example, Hutchinson teeth which are caused by congenital syphilis are smaller with wider spacing between the teeth within the arch, and also have a characteristic notching. Learning Point Some common dental problems that...
Source: PediatricEducation.org - May 14, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Quick Break
PediatricEducation.org is taking a quick break. The next case will be published in on May 14. In the meantime, please take a look at the different Differential Diagnoses, Symptom and Disease listed at the top of the page. Maybe even a few spring flowers outside your window too. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - May 7, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Flushing?
Discussion Flushing is usually thought of as a benign condition such as blushing, but can be quite irritating if it is frequent or persistent (i.e. menopausal hot flashes) or even pathologic (i.e. malignancy). “Flushing is a subjective and sensation of warmth that is accompanied by reddening of the skin anywhere on the body but favors the face, neck, and upper torso…. Flushing can be broadly divided into episodic or persistent. Episodic flashing is mediated by the release of endogenous vasoactive mediators or medications, while persistent flushing result in a fixed facial erythema with telangiectasias and cyan...
Source: PediatricEducation.org - April 30, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Hyponatremia?
Discussion Normal kidneys regulate water balance to maintain a plasma osmolality of 275-290 mOsm/kg normally. Thirst and arginine vasopressin or antidiuretic hormone (ADH) are the primary regulators of plasma osmolality. ADH is made in the hypothalamus and released by the posterior pituitary gland. ADH acts on the kidney’s distal collecting duct to increase water reabsorption. ADH is appropriately released in hypovolemic states, such as dehydration caused by gastroenteritis. ADH has an ~10 minute half-life and therefore can respond to rapid changes in volume status. Sodium balance is regulated by aldosterone (as part...
Source: PediatricEducation.org - April 23, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are Complications of Oropharyngeal Trauma?
Discussion Oropharyngeal trauma is common and ranges from minor contusions to severe trauma of the head and neck. Sudden movement while having a foreign object in the mouth is a very common scenario with falls or collisions being common mechanisms. Common objects include toys, sticks, pens/pencils, chopsticks, toothbrushes, and popsicle sticks. Many of these injuries cause minimal problems such as a contusion to lips (i.e. “fat lip”). In general, the more anterior the location the more common the injury and the less likely to have a severe injury (i.e. lips). Whereas posterior structures are more protected, bu...
Source: PediatricEducation.org - April 16, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Do You Fix A Broken Nail?
Discussion Distal digits, especially of the hand, are important as they provide support for pinching and grip, give tactile sensation and contribute to cosmesis. Trauma to the distal digit and nailbed ranges from significant trauma with digital crush injuries or amputation to minor broken nails causing only annoyance. Most injuries especially in children involve the hand especially the middle finger. The dominant hand is more common if the child has a hand-preference. Usually they occur indoors especially being caused by being pinched by a door. Significant trauma requires surgical intervention and may require specialty s...
Source: PediatricEducation.org - April 9, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Problems are Caused by Non-Nutritive Sucking Habits?
Discussion Facial growth is affected by the normal activities of breathing, sucking, chewing and swallowing. Sucking habits effects on facial structures “…depend[s] on the frequency, intensity and duration of the habits, the osteogenic development and the genetic endowment of the child.” Breastfeeding assists normal development of the facial structures (mainly maxilla, mandible and dental arches) by proper muscle activity and tongue positions. With bottle, finger, or pacifier sucking, there is overuse of the chin and cheek muscles, underuse of the orbicular oris and masseter muscles, and malpositioning ...
Source: PediatricEducation.org - March 26, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

A Diagnostic Dilemma: Sometimes You ’ ll Never Know
Patient Presentation A 9-year-old male came to clinic with a 1 month history of painful joint swelling. One month ago he started having right ankle pain that was intermittent but consistent. One day ago his right wrist, right ankle and bilateral knees had some swelling but no erythema or warmth. He says that he has pain in them when he moves but not when he is resting and he denies any joint stiffness or gelling. He also had 1-2 days of multiple red skin lesions on his extremities and trunk, not overlying the affected joints. The skin lesions do not come and go and do not itch. They are mainly discrete circular lesions wi...
Source: PediatricEducation.org - March 19, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Spring Break
PediatricEducation.org is taking a spring break. The next case will be published in on March 19. In the meantime, please take a look at the different Differential Diagnoses, Symptom and Disease listed at the top of the page. Maybe even a few spring flowers outside your window too. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - March 12, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What are Indications for Allergen-specific Immunotherapy?
Discussion Allergen-specific immunotherapy (AIT) is a disease modifying treatment for allergic disease. Sometimes referred to as desensitization, the premise is to expose the patient to small but regular amounts of a specific antigen thereby building tolerance within the patient to the allergen. AIT is often underused because of safety concerns and lack of appropriately trained health care providers and facilities to safely carry out AIT treatment. There are 4 main AIT treatments options currently: SCIT – subcutaneous immunotherapy Allergen is injected into the subcutaneous skin “Shots are effective in treati...
Source: PediatricEducation.org - March 5, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Do Deep Neck Infections Present?
Discussion Deep neck space infections (DNSI) are not very common (estimated to be 4.6/100,000) but extremely important to have a high index of suspicion for. The anatomy of DNSs is complex and covered by substantial amounts of superficial soft tissue making diagnosis difficult. Additionally, children often cannot give more precise or accurate histories and can be difficult to examine> Most infections in children are in those
Source: PediatricEducation.org - February 26, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is the Besinger Score?
Discussion Myasthenia gravis (MG) is a rare disease in the pediatric population. The incidence depends on the population studied but is estimated at 1-9/1 million/year. It was first described by William Heinrich Erb in 1879. The cause is autoantibodies against components of the post-synaptic membrane of the neuromuscular junction, usually against the acetylcholine binding receptor (AChR). It can occur at any age but is more common in the adult population. Juvenile patients (0-19 years) are divided into prepubertal (12 years) who have disease presentations similar to the adult population. In adults there are 5 grades: ocula...
Source: PediatricEducation.org - February 19, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Growth Charts Are Best?
Discussion “The value of growth assessment is thus its principal utility as a key screening tool in order to assess children’s general well-being, to identify faltering and excessive growth, to evaluate maternal lactation performance and infant feeding practices, and to manage her children with medical conditions known to adversely affect growth,….” Thus having assessment tools is important. Growth charts are assessment tools measuring height/length, weight, head circumference and body mass index. Some commonly used growth charts are: WHO child growth chart standards They were developed using lo...
Source: PediatricEducation.org - February 12, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is the Difference Between an Association and a Syndrome?
Discussion VATER association was first described in the 1970s with additional congenital malformations being added to the association so it is most often called VACTERL association. It is a highly heterogeneous, overlapping condition estimated to occur in ~1/10,000-40,000 births. The cause is unknown. In animal models, some signaling pathway gene mutations have phenotypes of VACTERL association. Experts suggest that patients having at least 2 components should be further evaluated (at least 3 for diagnosis) for VACTERL and other diseases in its differential diagnosis. There are more than 30 syndromes, mutations and diseas...
Source: PediatricEducation.org - February 5, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Should I Worry About This Telangiectasia?
Discussion Vascular stains are common problems that parents seek guidance about as they are often particularly worried that there may be an underlying problem or that it may be a long-term cosmetic problem. Fortunately many resolve or become less prominent or have treatment available. The term vascular stains includes all vascular malformations but commonly refers more directly to capillary malformations which are quite common. Some common vascular stains include: Nevus simplex Names: Angel’s kiss (glabella or forehead), salmon patch, stork bite (nape of neck), nevus roseus, fading macular stain Epidemiology: Very ...
Source: PediatricEducation.org - January 29, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Do I Counsel Families to Use Car Seats Safely in the Winter?
Discussion During the wintertime, everyone needs to bundle up to stay warm but too much clothing or using it improperly can cause problems. General rules for infant and children’s clothing is to have them wear one more layer of clothing than the adult is comfortable wearing in the same environment. Premature infants may need a second layer. (In hot weather a single layer for infants and children is enough.) Dress the children in thin, multiple layers. Here are a couple of examples: Infant Undershirt and diaper, socks or booties Pajamas or dressing gown Blanket sleeper, sleep sack or receiving blanket *Hat and mi...
Source: PediatricEducation.org - January 22, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Treatment is Recommended for Common Headaches?
Discussion Headache is pain in the scalp, forehead, orbits and temple. Facial and neck pain are usually excluded from this definition. It is a common problem with more than 6 million pediatric patients having migraine. Headaches can also have co-morbidities and more than 1 primary headache type can co-exist. The costs are high both economically and in the quality of life for the patients and families. A review of common headache types and indications for neuroimaging can be found here. Treatment is necessarily multi-pronged. Patients should understand their diagnosis so they can understand what reasonably can be expected...
Source: PediatricEducation.org - January 15, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are Cutaneous Lesions Associated with Occult Spinal Dysraphism?
Discussion Neural tube defects are a group of disorders that arise during embryogenesis. They include anenephaly, exencephaly, meningmyelocoeles and encephalocoeles and other malformations including occult spinal dysraphism. Occult spinal dysraphism (OSD) has incomplete fusion of the midline elements of the spine including the bony, neural, and mesenchymal tissues but the abnormalities are covered by skin (ectodermal tissues) and therefore are not obvious. OSD has a higher risk of tethered spinal cord syndrome or other neurological/neurosurgical problems. Normally the caudal end of the spinal cord, the conus medullaris, ha...
Source: PediatricEducation.org - January 8, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Holiday Break
PediatricEducation.org will be taking a holiday break and wishes our patrons a happy and healthy New Year. The next case will be published on January 8th. In the meantime, please take a look at the Archives and Curriculum Maps listed on the right side of the page. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - December 25, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is DIOS?
Discussion Cystic fibrosis (CF) is an autosomal recessive disorder caused by mutations in the cystic fibrosis transmembrane receptor (CFTR). It is found in the epithelium of the bronchi, intestine, pancreatic duct and biliary tree. It regulates chloride, bicarbonate and water secretion. The heterozygous state helps prevent against secretory diarrhea, but the homozygous state causes thickened secretions in the hollow tubes of the lungs and digestive tract. There are multiple mutations (> 2000) which have been currently classified into classes depending on their protein production and activity. CF patients generally are l...
Source: PediatricEducation.org - December 18, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Does Pediatric Sj ö gren Syndrome Present?
Discussion Sjögren Syndrome (SS) is named for Swedish ophthalmologist Henrik Sjögren who published a case series in 1933 describing patients with dry eyes and arthritis. SS is a “chronic autoimmune inflammatory exocrinopathy” that is characterized by lymphocytic infiltration of the lacrimal and salivary glands and has various degrees of systematic involvement. Keratoconjunctivitis sicca and xerostomia are the main clinical symptoms. Sicca is a Latin word meaning dry. Dryness of the eyes and mouth without evidence of autoimmune disease is called Sicca syndrome or Sicca complex. SS can be primary or se...
Source: PediatricEducation.org - December 11, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Do You Perform the Adams Forward Bend Test?
Discussion Scoliosis is a lateral and rotational curvature of the spine from a plumb line hanging from C7 to the floor. Idiopathic scoliosis is the most common form. A review of scoliosis and its differential diagnosis can be found here. Depending on the age, 2-4% of adolescents have a positive Adams Forward Bend Test when assessed and ~2% may have idiopathic scoliosis of> 10 degrees. Curve progression relates to the magnitude of the curve and the patient’s age. Thus increased risk of progression occurs in patients with higher curvature magnitude at diagnosis, females (earlier start of puberty and therefore poss...
Source: PediatricEducation.org - December 4, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Can I Give Cholera Vaccine?
Discussion Cholera is caused by more than 200 serogroups of Vibrio cholerae, a Gram-negative rod that is waterborne. Only two (serogroup O1 which causes about 99% of the cases, and O139) cause disease. There are biotypes of each of these serotypes. The only known hosts are humans. The organism colonizes the epithelial lining of the gut. Cholera toxin is produced by some species and if produced binds to specific receptors on host cells, activating a series of steps which cases massive loss of sodium, potassium, chloride, hydrogen carbonate, and fluids in vomitus and feces. A review of causes of diarrhea can be found here. ...
Source: PediatricEducation.org - November 27, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Can Fish Oil Help Reading?
Discussion Fats and fatty acids are essential for good human health. Saturated fats have hydrogen pairs linked to each carbon on the carbon backbone. They are solid or semi-solid at room temperature. Common examples are butter, lard, or hardened vegetable shortening. They are linked to higher cholesterol and triglycerides and only a small amount of them are recommended to be consumed in the diet. Unsaturated fats have one or more hydrogen atoms missing from the carbon backbone. They are liquid at room temperature. Monounsaturated fatty acids have one hydrogen pair that is missing from the carbon backbone. They are liq...
Source: PediatricEducation.org - November 20, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Long Do Late Preterm Infants Need Supplemental Feedings?
Discussion Premature infants have many problems to overcome because they just aren’t ready to live outside the uterine environment. Late premature infants are defined as birth between 34 0/7 weeks and 36 6/7 weeks gestation. In the U.S. this gestational age accounts for ~70% of all preterm births or ~300,000 births/year. Late preterm infants can have delayed oral feeding skills and failure to thrive along with increased hospital readmissions. Breastfeeding can be difficult as infants can have poor coordination and poor tone, along with decreased lactation in the mother. Learning Point Weight gain lags behind intraut...
Source: PediatricEducation.org - November 13, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes White Nails?
Discussion The nail matrix covers the area of the nail plate, and extends proximally in a crescent moon shape with the edges of the crescent extending proximally and inferiorly toward the underlying bone. The nail matrix is a multilayered epithelium that physiologically produces keratinization and gives rise to the nail plate. The distal matrix forms the lower 2/3s of the nail plate and the proximal matrix forms the upper 1/3 of the nail plate. the thickness of the nail plate is proportion to the matrix’s thickness. The nail plate’s free edge contour follows the shape of the nail’s lunula. Melanocytes occ...
Source: PediatricEducation.org - November 6, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news