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

What Causes Hyperpigmentation?
Discussion Skin color is primarily due to genetic factors. Melanocytes are usually found in skin in the basal layer of the epidermis which is also where the melanin usually lies. There are a range of normal skin phenotypes that have been described by Fitzpatrick and range from I-VI: I – pale white skin, blond hair, blue eyed, does not tan, always burns II – fair skin, blue eyed, tans poorly, burns easily III – darker white skin, burns initially then tans IV – light brown skin, tans easily, burns minimally V – brown skin, tans darkly easily, burns rarely VI – dark brown skin, alway...
Source: PediatricEducation.org - December 17, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What are Some of the Causes of SGA?
Discussion Intrauterine growth retardation or fetal growth retardation is due to a pathological process that causes decelerated fetal growth velocity. Small-for-gestational age (SGA) is an infant with growth parameters below the normal range for gestational age. More commonly, SGA is defined as a birth weight
Source: PediatricEducation.org - December 10, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Does She Have SCID?
Discussion Severe-combined immunodefiency (SCID) is actually a group of inherited disorders with an absence or dysfunction of T, B and NK cells that results in severe dysfunction of the immune system. SCID is a primary immunodeficiency. SCID was thought to be a rare disorder but with the advent of neonatal screening the incidence in the US general population is estimated at ~1 in 58,000 live births, but with numbers higher or lower depending on the specific population. Patients often have failure to thrive, oral candidiasis, and diarrhea as infants as well as a variety of infectious diseases. They can also have interstit...
Source: PediatricEducation.org - December 3, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is Genomic Imprinting?
Discussion Silver-Russell syndrome (SRS) is a rare genetic syndrome first characterized by Silver in 1953 and Russell in 1954. Patients with SRS have characteristic growth patterns and clinical findings, although within an individual patient there are phenotypical differences. Patients are born small-for-gestational age (SGA) but have a relative macrocephaly. There is postnatal growth failure and difficulty feeding, with a very low body mass index. Body asymmetry (e.g. hemihypertrophy) and facial features (i.e. protruding forehead, triangular facies, micrognathia, dental anomalies, downturned mouth corners, and ear anomali...
Source: PediatricEducation.org - November 26, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is the Recurrence Rate for Guillian-Barr é Syndrome and Should She Get An Influenza Vaccine?
Discussion Guillian-Barré syndrome (GBS) is an acquired, acute, inflammatory, demyelinating polyneuropathy. It is the most common cause of acute and subacute flaccid paralysis in children. GBS causes about 0.4-1.3 cases per 100,000 persons/year in children. It can occur in any age group and the incidence increases among all age groups until a peak in the 50s. Both genders are affected and there may be a slight increase in males. GBS usually occurs 2-4 weeks after a prodromal gastroenteritis or respiratory illness. GBS causes autoantibody production against Schwann cells of the neuron and the axon itself. There is ...
Source: PediatricEducation.org - November 19, 2018 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

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