How Does Gaucher Disease Present?
Discussion Gaucher disease (GD) was first described by Philippe Gaucher in 1882. It was the first lysosomal storage disease (LSD) described and is the comparison prototype for many variations and their treatment. There are about 50 LSD and more well-known ones include Fabry, Niemann-Pick and Pompe diseases. LSDs currently have more than 300 different enzymes or membrane proteins affected which cause central nervous system and visceral disease. Overall the frequency of LSDs in aggregate is 1:3000 – 7000 live births. GD has an estimated prevalence of 1:57,000 – 111,000. It is higher within the Ashkenazi Jewish po...
Source: PediatricEducation.org - December 9, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Causes Respiratory Failure?
Discussion The respiratory system is a complex system. The upper airways must remain patient. The lower airways must interface with the vascular system. The musculoskeletal system must provide mechanical function and the central nervous system must provide overall control. Respiratory failure occurs when the overall system cannot support the body’s necessarily ventilation, oxygenation or both. Children are at higher risk of respiratory failure. They have few intrinsic lung parenchyma problems, but have very small airways that increase the airflow resistance by themselves but then have to contend with problems such as...
Source: PediatricEducation.org - December 2, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How Is Hidradenitis Suppurativa Treated?
Discussion Hidradenitis suppurativa (HS) is a recurrent, chronic inflammatory disease of the hair follicles particularly in the apocrine gland-bearing areas of the axilla, inguinal, perianal, mammary and inframammary areas. Onset is usually after puberty, in the early 20s. It is more common in females than males. Prevalence is estimated to be 0.05- 4.1%. It can be associated with premature adrenarche, metabolic syndrome and obesity. The lesions are often pruritic, painful, and with malodorous purulent drainage. It often begins with comedomes and tender nodules, and can easily progress to painful abscesses with purulent f...
Source: PediatricEducation.org - November 25, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What is the Lifespan for a Child with Holoprosencephaly?
Discussion Holoprosencephaly (HPE) is a clefting problem of the brain. “[HPE] the result of incomplete or absent midline division of the embryonic forebrain into distinct cerebral hemispheres (prosencephalon) between the 18th and 28th day after conception.” There are four distinct subtypes: Alobar – both hemispheres are completely fused and are not separated into the left and right hemispheres. There is agenesis of the corpus callosum, arrhinencephaly and a single ventricle with fused thalami. Facial features are almost always affected. Semilobar – the cerebral hemispheres are fused anteriorly bu...
Source: PediatricEducation.org - November 18, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What is the Long-term Outcome of ACL Repair?
Discussion The anterior cruciate ligament (ACL) “is an intra-articular but extrasynovial collagenous structure with limited healing capacity that originates in the posteromedial aspect of the lateral femoral condyle and crosses into anteromedially to insert anterior into the intercondylar eminence of tibial articular surface.” It plays an important part as a mechanoreceptor particularly as a proprioceptor. Its main role is to prevent excessive anterior tibial translation, limits varus/valgus stress when the knee is in full extension and some rotary movements of the knee. There are ~120,000 surgeries per year m...
Source: PediatricEducation.org - November 11, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Does Non-Verbal Mean?
Discussion Children can be non-verbal for many reasons with most just not wanting to talk in a given situation for a short period of time (e.g. angry with a person, scared to give a speech at school, etc.). Children may have the ability to communicate verbally but for some reason it is physically impaired for a period of time. Selective mutism (SM) “… is characterized by an individual’s consistent failure to speak in social situations in which there is an expectation to speak (e.g., at school), despite speaking in other situations.” The lack of speech cannot be due to discomfort speaking in a give...
Source: PediatricEducation.org - November 4, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Indications for Dermatological Light Treatment?
Discussion Spider telangiectasia or spider angiomas have a central red lesion with radiating dilatation of the distal, end vasculature that resemble arachnid appendages. They are common lesions (up to 38% in one study of children, and 60% in pregnant women), often solitary or
Source: PediatricEducation.org - October 28, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

“ Bulking Up ” For Sports?
Discussion Athletes, whether recreational or competitive, who participate in weight sensitive sports commonly gain or lose weight to achieve a particular body type or to improve performance. Athletes in duration or aesthetic sports (such as distance running, diving, dance, etc.) attempting to lose weight to be able to move the body against gravity better. Sports that emphasize strength and power including combat sports (such as football, wrestling, mixed martial arts, body building, etc.) often have athletes attempting to gain weight and lean muscle mass to improve performance. This is felt to increase the strength-to-weig...
Source: PediatricEducation.org - October 21, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How Common is Lyme Disease Globally and in Urban Settings?
Discussion Lyme disease (LD) is caused by several genospecies of Borrelia burgdorferi senu lato that are transmitted by ticks of the Ixodes ricinus complex. In the U.S. and Europe it is the most common vector-borne disease. It is named for Lyme, Connecticut in the 1970s when it was “discovered,” but there are reports of LD-type disease in Europe since 1883. There are 18 distinct genospecies with B. afzelii, B. garinii and B. burgdorferi sensu stricto being the 3 most common ones causing human infection. There are many species of Ixodes ticks but only 4 commonly bite humans. Ixodes ricinus mainly in Europe, I, p...
Source: PediatricEducation.org - October 14, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Can Radiolucent Foreign Bodies Be Identified?
Discussion Foreign bodies are common problems for young children particularly ages 2-4 years who will mouth many objects and aspirate or swallow them. Children will also place foreign objects in other body orifices such as ears or noses. It is also not uncommon that young girls will inadvertently have toilet paper caught in the vaginal area during hygiene. Many of these foreign bodies may work their way out naturally not causing any problems, or may come to attention later because of chronic problems such as a foul-smell or discharge. Older children may tell adults that they have placed a foreign body in an orifice and thu...
Source: PediatricEducation.org - October 7, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Affects the Nutritional Quality of Plant-Based Milk Substitutes?
Discussion People today may be eating more plant-based products because of: Allergen avoidance – lactose or cow’s milk allergy, 14% of people with cow’s milk allergy will also have soy allergy. Cultural importance Contamination avoidance e.g. growth hormone or antibiotic residues in cow’s milk production Specific diseases, e.g. cholesterol/lipid issues Environmental impact Ethical or religious considerations Improved nutrition With population growth “[t]he demand for food is expected to grow by 70% until 2050….While the expected protein consumption is believed to grow by 80%.” ...
Source: PediatricEducation.org - September 30, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Pulmonary Embolism Risk Factors?
Discussion Pulmonary embolism (PE) is potentially life-threatening but fortunately rare event especially in the pediatric population. It was first described in children in 1861. PE is likely underreported because of minimal or non-specific clinical symptoms. The incidence is estimated at 0.05-4.2% with the 4.2% based on autopsy reports. It is probably also increasing as more central venous catheters (CVC) are used, and more children are surviving previously poor prognostic diseases. There is a bimodal distribution with cases
Source: PediatricEducation.org - September 23, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Is This a Fasciculation?
Discussion Benign fasciculations are very common and occur in up to 70% of the general population. They occur at different points in people’s lives. They can be brought out by stress, poor sleep hygiene and caffeine. Caffeine has numerous uses especially for regulating sleep and attention. However too much can cause restlessness, jitteriness and sleep deprivation too. The recommended amount of caffeine for a teenager is
Source: PediatricEducation.org - September 16, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How Good are Masks for Preventing Infection?
Discussion With continued exposure to respiratory pathogens and the emergence of novel respiratory pathogens, personal protective equipment (PPE) and procedures are important for decreasing occupational exposure to respiratory pathogens. PPE and procedures are particularly important when anti-infective treatments or vaccination are unavailable or have limited effectiveness. Medical masks are “[a]lso known as a surgical or procedure mask. As personal protective equipment, a facial mask is intended to protect caregivers and health-care workers against droplet-transmitted pathogens, or to serve as part of facial protect...
Source: PediatricEducation.org - September 9, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What is the Dosing of CBD Oil?
Discussion Cannabis sativa makes small fruits which are usually named “seeds” although they are not technically a seed. Hemp oil is derived from the hemp seeds by cold-pressing or other means of macerating or squashing the seeds. Cold pressed oil is high in polyunsaturated fatty acids including various omega-3 and linolenic acids and antioxidants. It is used by some people for its nutritional value and “[a]ccording to an old legend, Buddha (Prince Siddharta Gautama) founder of Buddism, was able to survive eating only one hemp seed each day for six years.” The seeds themselves do not contain any psyc...
Source: PediatricEducation.org - September 2, 2019 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Is Physical Activity the Same for Traditionally Schooled and Homeschooled Children?
Discussion Homeschooled children are a diverse group of students who are not participating in the traditional model of a children going off to a separate school location 5 days a week for instruction by educational professionals. If homeschooled, children may not be subject to all or some of the regulations for traditionally-schooled children regarding curricular measures, record keeping, reporting, and testing. Children in homeschooled environments also may not have access to other services that are provided through traditional schools such as special education services. Some research data shows positive academic and soci...
Source: PediatricEducation.org - August 26, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Does the General Pediatrician Do When There Are Concerns for a Rare Disease?
Discussion Bardet-Biedl syndrome (BBS) is a rare disorder. It is usually considered an autosomal recessive disorder but there is significant intra-familial variability. There are multiple genes (~20 currently) involved and it is believed that the phenotypic variability is due to “…differences in the total mutational load across different BBS associated genes….” It is a ciliopathy where mutation changes in proteins in the cilias causes problems in the cilia’s functioning particularly signaling. Cilia are important in signaling to maintain tissue and cellular homeostasis. Obviously screening o...
Source: PediatricEducation.org - August 19, 2019 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 19th. 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 5, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

The Dengue Dance?
Discussion Dengue is an important arboviral infection that affects about 40% of the world population. It is found mainly in topical and subtropical areas of the world mainly in developing countries but it range is spreading including the United States. A review of common arboviruses can be found here. It is a flaviavirus with 4 distinct serotypes named DENV-1 through DENV-4 and is spread by A. aegypti a day biting mosquito. Infection with one serotype confers immunity to that serotype but not the others. It does offer some protection for cross-infection but this only lasts a few months. Incubation period is 3-14 days with ...
Source: PediatricEducation.org - July 29, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Can You Do To Prevent Tinea Infections and Why?
Discussion Superficial fungal infections are very common. “Dermatophytes are molds that can invade the stratum corneum of the skin or other keratinized tissues derived from the epidermis, such as hair and nails. Organisms most commonly affect the scalp, feet, groin and nails.” Dermatophytes can be anthropophilic (human to human transmission), zoophilic (animal to human transmission) or geophilic (fomite to human transmission). Zoophilic dermatophytes are usually uncommon sources of human infection. Microsporum canis is the most common zoophilic dermatophyte and it can infect humans with close contact but this...
Source: PediatricEducation.org - July 22, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common Are Cerebrospinal Fluid Leaks After Minor Head Trauma?
Discussion Basilar skulls fractures are relatively common occurring in 4-20% of all skull fractures. Motor vehicle accidents, significant falls from heights and blunt trauma are the most common causes of basilar skull fractures. Basilar skulls fractures are even less common in children than adults. Complications can include meningitis, cerebrospinal fluid (CSF) leaks, cranial nerve injuries or even potentially death. With more significant trauma to the head and body, it is not surprising that complications are more likely. Nasoethmoid facial fractures have similar common mechanisms of injury including motor vehicle accid...
Source: PediatricEducation.org - July 15, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are Common Presentations for Budd-Chairi in Adolescents?
Discussion Budd-Chiari syndrome (BCS) is a rare liver disease caused by hepatic venous outflow obstruction (HVOTO). The obstruction can be anywhere from the small intrahepatic veins up to the inferior vena cava junction with the right atrium. The liver parenchyma itself is not directly affected but becomes compromised because of the increased hepatic sinusoidal pressure over time. The causes include: prothrombic events (35% of cases such as Protein C or Protein S deficiency, Factor V Leiden or antithrombin deficiency), myeloproliferative conditions, oral contraceptive use, and local factors. BCS can occur in any age but i...
Source: PediatricEducation.org - July 8, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is This Itchy Rash?
Discussion Atopic dermatitis (AD) has a prevalence of 3-5% in the overall U.S. population but is increasing with an estimated 10-15% lifetime risk in childhood. It is even more common in children of color with a prevalence in African-American/black children of 17% and Hispanic children of 14%. Health care utilization data also appears to support more severe disease in children of color also. Atopic dermatitis or eczema is a common dermatological skin problem which characteristically is a pruritic, papular eruption with erythema. Like most papulosquamous eruptions it often occurs in intertrigenous areas in people with alle...
Source: PediatricEducation.org - July 1, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Infectious Diseases are Important to Consider in Transplantation Patients?
Discussion Transplantation is not a common problem for primary care physicians but when a child’s disease has progressed to end-stage organ failure, transplantation can be the only treatment available. While the primary care provider usually is not involved in the daily management of patients before, during and after transplantation, they can be involved in many areas. These can include providing appropriate primary and acute care, ordering and obtaining necessary medical tests, medications and equipment, assisting with medical insurance, providing medical history and records to consultants, translating medical infor...
Source: PediatricEducation.org - June 24, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is the Morbidity Rate for Smoke Inhalation?
Discussion A recent systematic review of house fires in high-income countries found that the risk factors for unintentional house fire incidents included: more children under 5 years of age, more people in the home, more males in the home, adults who are not working, low-income, household smokers, non-privately owned housing, poor condition housing. Other risk factors are not having smoke detectors, but more importantly not having a working smoke detector. Risk factors for injuries or fatalities is similar to the the risk factors for incidents but also includes people who are vulnerable such as a disabled resident, someon...
Source: PediatricEducation.org - June 17, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common is Restless Legs Syndrome in Children?
Discussion Restless legs syndrome (RLS) is also known as Willis-Ekbom disease. RLS is a clinical diagnosis with criteria being: 1. An urge to move the legs usually accompanied by uncomfortable and unpleasant sensations in the lower extremities (Note: sometimes other body parts can be affected) 2. The urge to move begins or worsens when sitting or lying down 3. The urge to move is partially or totally relieved by movement (Note: relief by activity may not be noticable if severely affected but must have been previously present) 4. The urge to move the legs and any accompanying unpleasant sensations during rest or in activ...
Source: PediatricEducation.org - June 10, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Facial Nerve Palsy?
Discussion Facial nerve palsy has been known for centuries, but in 1821 unilateral facial nerve paralysis was described by Sir Charles Bell. Bell’s palsy (BP) is a unilateral, acute facial paralysis that is clinically diagnosed after other etiologies have been excluded by appropriate history, physical examination and/or laboratory testing or imaging. Symptoms include abnormal movement of facial nerve. It can be associated with changes in facial sensation, hearing, taste or excessive tearing. The right and left sides are equally affected but bilateral BP is rare (0.3%). Paralysis can be complete or incomplete at prese...
Source: PediatricEducation.org - June 3, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Temporomandibular Joint Problems?
Discussion The mandible normally grows in a symmetric downward and forward movement relative to the skull base. The condyle is the primary growth center. “The mandible is unique in that its 2 joints and growth centers function together as a single unit.” It is the last bone in the body to reach skeletal maturity. The mandible and its growth are important for maxillary growth and therefore many problems that affect the mandible affect the facial and skulls structures as well. These growth problems can be relatively insidious and therefore may need monitoring over longer periods of time such as patients with unde...
Source: PediatricEducation.org - May 27, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Macrocephaly?
Discussion “Macrocephaly is defined as [an occipitofrontal circumference or head circumference, OFC ] of> 2 standard deviations above the mean or above the 97th percentage for a given age, and gender, or when serial measurement shows progressive enlargement, crossing of one or more major percentiles, or when there is an increase in OFC> 2 cm/month in the first 6 months of life.” Megalencephaly is enlargement of the brain parenchyma. The OFC should be measured using a non-elastic tape which surrounds the head along the line of the glabella and posterior occipital protrusion. There are ethnic differences f...
Source: PediatricEducation.org - May 20, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are Barriers and Facilitators of Transitioning Youth to an Adult Health Care Provider?
Discussion Transitioning patients within or across health care facilities is a complex process. It is not a single step or point in time. For many patients the transition from pediatric to adult health care can be uncomplicated as patients and health care providers are ready for the transition and are seeking it. It should be a part of “developmental milestone” for adolescent visits. Asking adolescents about their future plans especially after high school or college often easily segues into this discussion easily. For other patients and families, there is anxiety and fear about the transition process. For yout...
Source: PediatricEducation.org - May 13, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Is This Sarcoidosis?
Discussion Sarcoidosis is rare and is even rarer in the pediatric age group. Sarcoidosis is seen in all ages with an estimated prevalence is 10-40/100,000 in the U.S. population. Pediatric sarcoidosis has an estimated incidence of 0.2/100,000 per year. For the pediatric age range it is more likely from 9-15 years of age. In adults it commonly presents between 20-39 years but bimodal distribution is also reported. Women are more likely to have sarcoidosis than men. African American females have the highest risk, and usually present slightly older, especially in the 4th decade of life. African American women are also more li...
Source: PediatricEducation.org - May 6, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Clinical Symptoms Can An Infant with Polycythemia Have?
Discussion 1. What are indications for an exchange transfusion? 2. What are potential risks of partial exchange or exchange transfusion? 3. What are causes of anemia in different age groups? Related Cases Disease: Polycythemia | Blood and Blood Disorders Symptom/Presentation: Abnormal Laboratory Test | Respiratory Distress Specialty: Hematology | Neonatology Age: Premature Newborn To Learn More To view pediatric review articles on this topic from the past year check PubMed. Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews. Infor...
Source: PediatricEducation.org - April 29, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are Some Potential Indicators of Human Trafficking?
Discussion Human trafficking is estimated to be the second largest criminal activity in the world after illegal arms trafficking. It affects all nations with an estimated 27 million people of all ages worldwide but only a small number are identified. It is defined by the United Nations as “the recruitment, transfer, harboring, or receipt of persons by means of threat or use of force or other forms of coercions, abduction, fraud, deception, the abuse of power, or a position of vulnerability to achieve the consent of a person, having control over another person, for the purpose of exploitation.” It includes comme...
Source: PediatricEducation.org - April 22, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Commonly Are Brain Tumors Seen in Spasmus Nutans?
Discussion Nystagmus is periodic eye movement that is involuntary where there is a slow drift of fixation. The slow drift can be followed by a fast saccade back to fixation. The pathological movement is the slow phase, but nystagmus is described by the fast phase (i.e. horizontal nystagmus, vertical nystagmus). Spasmus nutans (SN) is a movement disorder that is rare. The classic triad includes nystagmus, head bobbing or titubation, and torticollis, with these problems being in the absence of any ophthalmological or neurological condition. Onset is in the first year of life but ranges from 6-36 months. Time to resolution ...
Source: PediatricEducation.org - April 15, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common Are Brain Tumors Seen in Spasmus Nutans?
Discussion Nystagmus is periodic eye movement that is involuntary where there is a slow drift of fixation. The slow drift can be followed by a fast saccade back to fixation. The pathological movement is the slow phase, but nystagmus is described by the fast phase (i.e. horizontal nystagmus, vertical nystagmus). Spasmus nutans (SN) is a movement disorder that is rare. The classic triad includes nystagmus, head bobbing or titubation, and torticollis, with these problems being in the absence of any ophthalmological or neurological condition. Onset is in the first year of life but ranges from 6-36 months. Time to resolution ...
Source: PediatricEducation.org - April 15, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are Treatment Options for Pediatric Onycomycosis?
Discussion Onycomycosis is a fungal infection of the nails. It has a world-wide prevalence of 0.3% with some geographical variations such as in the U.S. it is 0.44%. It is an uncommon problem especially in children. It is very uncommon in those under 6 years and only very sporadic case reports in those under 2 years. The lower incidence is felt to be due to children’s faster nail growth, smaller surface to infect, reduced exposure to fungi, lower prevalence of tinea pedis and especially less cumulative trauma. Onycomycosis is more common in families (unsure if this is due to genetic factors or family members having m...
Source: PediatricEducation.org - April 8, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Does the Liver Do?
Discussion The liver is one of the largest organs in the body, weighing just over 3 pounds in an adult. It is found in the upper right abdomen, under the right dome of the diaphragm. Grossly, it has asymmetric lobes with the right being larger than the left. The lobes are separated by a fibrous connective tissue band that also anchors the liver in the abdominal cavity. The gallbladder is located on the inferior surface of the liver and stores bile, which is then released into the duodenum. Microscopically, the liver cells are arranged in lobules with canals carrying blood vessels and bile ducts. At any moment about 10-13% ...
Source: PediatricEducation.org - April 1, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Long Does Fecal Shedding Occur for Oral Vaccines?
Discussion Vaccination has reduced infectious disease morbidity and mortality since its introduction. Vaccines can be given intramuscularly, subcutaneously or orally. Oral virus vaccines currently used in the US include rotavirus, cholera, typhoid and adenovirus. Adenovirus vaccine is used in military personnel. As these are attenuated viruses there is concern for household contacts who are immunocompromised who may inadvertently be exposed to the virus through fecal shedding. Additionally, there is a concern that the attenuated virus may mutate and revert back to its wild-form and potentially cause disease. Injectable po...
Source: PediatricEducation.org - March 25, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Spring Break
PediatricEducation.org is taking a short break. The next case will be published on March 25. In the meantime, please take a look at the different Archives and Curriculum Maps 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 - March 18, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common Is Unintentional Cannabis Ingestion?
Discussion “[Cannabis] is a genus of flowering plant with three main varieties: sativa, indica and ruderalis.” It has been used for hundreds of years for hemp or fiber and also for psychoactive and medicinal effects. The active compounds are collectively called cannabinoids, of which delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the most abundant. The floral buds or calyxes of the plant have the most cannabinoids, but other parts of the plant are also used such as leaves. Hash oil, hashish (or resin) and marijuana (dried leaves) are the common products from strongest to least strongest products. ...
Source: PediatricEducation.org - March 11, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are the Types of Tracheoesophageal Fistulas?
Discussion Respiratory problems in infants can caused by many things including any type of obstruction from the nose to lung. Neonates and infants are particularly susceptible to changes in the size of the airway because of the physics of airflow resistance. Important reminders about infant airways: Resistance = 1/radius4 (Poiseuille’s equation) therefore even a 1 mm decrease in the airway circumferences increases the airflow resistance x16. Increased airflow causes less pressure along the walls, which can lead to collapse of the walls (Bernoulli’s and Venturi effects). Neonates have smaller lungs relative to ...
Source: PediatricEducation.org - March 4, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Is the Most Common Type of Cardiomyopathy?
Discussion Barth syndrome is characterized by a dilated cardiomyopathy, proximal skeletal muscle weakness, neutropenia and short stature that usually presents at birth or soon after. It is a rare X-linked recessive disease process caused by mutations in the TAZ gene. The TAZ gene codes for tafazzin which alters cardiolipin in mitochondria. Characteristic facies can be seen especially in infancy including a tall and broad forehead, prominent chin and full cheeks, larger ears, and deep-set eyes. Most patients present at birth or soon afterwards but some may not until later in life. Life expectancy is reduced with many childr...
Source: PediatricEducation.org - February 25, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common is Bipolar Disorder?
Discussion Bipolar disorder (BD) is a chronic, recurrent, affective disorder with fluctuations in energy and mood. “Bipolar disorder, previously known as manic depressive illness, is a severe chronic mood disorder characterized by episodes [note not just one instance] of mania, hypomania, and alternating or intertwining episodes of depression.” Affective disorders are classified based on their severity and extent, from unipolar to BDII to BDI. “Individuals with unipolar disorder present with depressive episodes only, and those with bipolar II or I disorder show increasingly pronounced episodes of mood ele...
Source: PediatricEducation.org - February 18, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Should You Do About Head Banging?
Discussion Head banging and body rocking are common habits that young children exhibit that can be worrisome or frustrating for parents but that do not cause harm to the child. In a normally developing child they occur around 6-9 months age, and generally resolve around 2-3 years with most behaviors gone by 6-8 years. Children usually do not cause harm to themselves, but it can cause furniture to move causing noise, or potentially the child could lose balance and fall off a bed, or strike an object unintentionally and hurt themself (hit edge of a bed just right in a way that causes a small bruise). The behaviors appear to ...
Source: PediatricEducation.org - February 11, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common is Dyscalculia?
Discussion Numerical understanding is imperative in everyday life. Even making coffee in the morning, a person considers whether she is making 1 cup or 2, and how much fluid will be in each cup. How many more days can she go without buying more coffee with the ground coffee left in the container? Other numerical skills such as telephone numbers, street addresses and locations, time and dates, and buying and selling of products and services occur all day long in people’s lives. What happens when those skills are not automatic? Dyscalculia or developmental dyscalculia (DD) is “a heterogeneous learning impairment...
Source: PediatricEducation.org - February 4, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are Common Causes of Blindness in Children?
Discussion According to the World Health Organization, about 1.3 billion people have some form of visual impairment. Most people with visual impairments are>50 years old, more are female than male, and more live in resource-limited areas than resource-rich areas. Most visual impairments are avoidable (80%) in all age groups with the leading causes globally and across ages being uncorrected refractive errors and cataracts. The most common causes of blindness are: Refractive errors, uncorrected Cataract Age-related macular degeneration Glaucoma Diabetic retinopathy Corneal opacity Trachoma The exact numbers vary by regi...
Source: PediatricEducation.org - January 28, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Complications Can Gastrostomy Tubes Have?
Discussion Gastrostomy tubes (GT or GTubes) have been used to support patients for about a century. They are placed between the abdominal skin and the stomach either percutaneously or surgically. The tubes can be a standard long tube with either a bumper or inflatable balloon internally and externally they have a retention piece to hold the GT in place. A button or low profile tube are similar but extend just beyond the skin. Reasons for GT placement include: Nutritional support Hydration maintenance Medication management Aspiration avoidance Gastric stasis decompression Obstruction bypass Quality of life improvement for...
Source: PediatricEducation.org - January 21, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are Potential Complications of Large for Gestational Birthweight?
Discussion Infant size at birth is determined mainly by genetics, but also pregnancy and environmental factors. Large for gestational age (LGA) is defined as a mean weight> 2 standard deviations above the weight for gestational age or above the 90th percentile on growth charts (or ~4000 g on WHO growth charts). Macrosomia is a term used for a term infant who is> 4000g. Risk factors for LGA infants includes: Male infant Maternal Genetic disposition Hispanic ethnicity Diabetic Multiparity or grand parity Obesity History of previous LGA infant Prenatal ultrasound is very helpful for antenatal management. First tri...
Source: PediatricEducation.org - January 14, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are The Potential Complications of a Tracheostomy?
Discussion In the past, indications for tracheostomy were often because of infection, but today are more often due to need for chronic airway support and/or ventilation. Many more children and infants are having tracheostomies placed. Decannulation rates for these children are low due to concomitant complex chronic disease such as neurological, pulmonary and congenital heart diseases. Co-morbidies are common with 3-4 being average, and frequently also including chronic technology such as gastrostomy tubes or ventriculoperitoneal shunts. Approximately 8% of children do not survive the hospitalization where the tracheostomy ...
Source: PediatricEducation.org - January 7, 2019 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Holiday Break
PediatricEducation.org will be taking a holiday break and wishes our patrons a Merry Christmas and healthy New Year. The next case will be published on January 7th. 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 24, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news