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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

What Causes Hypernatremia?
Discussion Hypernatremia is a serum sodium of> 150 mEq/L. Basic causes are too much sodium or too little free water. If body weight is normal or increased, there is an increase in total body sodium without an appropriate increase in total body water. Normally when the serum sodium is increased there is transient hypertonicity of the plasma which causes the thirst center to be stimulated and antidiuretic hormone (ADH) to be released. The thirst center tells the person to drink more water and ADH causes the kidney to retain free water. This normally will allow the plasma tonicity to go back to normal. Treatment is by tr...
Source: PediatricEducation.org - October 30, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is Usher Syndrome?
Discussion Over 7000 diseases are considered rare disorders according to the National Organization for Rare Disorders® (NORD, rarediseases.org). NORD is a patient advocacy organization dedicated to individuals with rare diseases and the organizations that serve them. They have information on about 1200 rare diseases on their website (https://rarediseases.org/for-patients-and-families/information-resources/rare-disease-information/). Hearing loss (HL) is not rare and is a common problem across the ages. It affects 360 million people worldwide which is about 5% of the population. There are many causes of hearing loss an...
Source: PediatricEducation.org - October 23, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Are the Health Needs of Incarcerated Youth?
Discussion In the US during 2011, ~60,000 youth were incarcerated at some time in a correctional facility. Boys are detained more than girls (86% vs 14% respectively in the US, 95% male in the United Kingdom in 2014) but girls have more health issues. There are racial and ethnic differences with 38-40% of detainees being black, 23% being Hispanic/Latino and 32% being white, and 5% other. For detained youth, 5% are for violent crimes, 22% for non-violent property crimes and the majority of the rest are for non-violent offices such as substance use. The average length of detainment is 3-4 months and unfortunately the rates o...
Source: PediatricEducation.org - October 16, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common Is Hereditary Angioedema?
Discussion Angioedema is edema that is non-pitting, self-limited occurring in non-dependent areas usually in an asymmetric distribution usually on the lips, face, hands, feet, genitals and also in the bowel. It usually develops over minutes to hours (often 1-2 hours) with resolution usually within 24-48 hours. Angioedema often occurs with urticaria but 20% of patients may have isolated angioedema. Acute allergic angioedema is often caused by drugs (including antibiotics and non-steroidal anti-inflammatory drugs), foods, infections, insects, various organic substances (i.e. latex, preservatives, formaldehyde, etc.), and oth...
Source: PediatricEducation.org - October 9, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Clinical Signs Can Be Associated With Benign External Hydrocephalus?
Discussion Hydrocephalus is an abnormal accumulation of cerebrospinal fluid (CSF) in the ventricles and/or subarachnoid spaces. External hydrocephalus is a communicating hydrocephalus often defined as the patient having a rapidly enlarging head circumference (HC) and enlargement of the subarachnoid spaces especially over the frontal lobes with normal or moderately enlarged ventricles. Benign external hydrocephalus (BEH) is a self-limited external hydrocephalus that occurs during infancy and resolves spontaneously in childhood, usually by age 2 years, that is felt to not cause significant problems. It was first described by...
Source: PediatricEducation.org - October 2, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Microcephaly?
Patient Presentation A 5-month-old male came to clinic for his health supervision visit and followup from his neonatal intensive care stay. He was born prematurely at 28 weeks gestation and his stay was complicated by a right sided Grade III intraventricular hemorrhage, a left-sided Grade IV intraventricular hemorrhage, neonatal seizures, respiratory distress and bronchopulmonary dysplasia, retinopathy of prematurity, acute kidney injury that had resolved, possible necrotizing enterocolitis incidents x 2, and herpes simplex encephalitis. He was on home oxygen, a nasogastric feeding tube because of aspiration risk and mult...
Source: PediatricEducation.org - September 25, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common Are Twins?
Discussion Twinning is the conception and development of more than one zygote during one pregnancy. Monozygotic (MZ) twins arise from one zygote that then splits to form two embryos so that the twins are necessarily of the same gender (male-male or female-female). Dizygotic (DZ) twinning arises from the development of two independent zygotes and therefore the genders may be the same or different (male-male, female-female or male-female). Increased risks of spontaneous DZ twinning includes increased maternal age, parity and gravity, family history including familial clustering, maternal obesity and overweight and smoking. ...
Source: PediatricEducation.org - September 18, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Publishing Our 600th Case Today
This week we are publishing our 600th Case for PediatricEducation.org! We started in September 2004 to write a case of the week and it is amazing to see how all the information adds up. We cannot have done it without you our patrons, so we thank you for all of your feedback and support. A very special, thank you to each of you. Donna M. D’Alessandro, M.D. and Michael P. D’Alessandro, M.D. Curators, PediatricEducation.org (Source: PediatricEducation.org)
Source: PediatricEducation.org - September 11, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Proteins Cause Cow ’ s Milk Protein Allergy?
Discussion Cow’s milk protein allergy (CMPA) is one of the most common food allergies. It is estimated to have an incidence of 2-7.5% in infants and a prevalence of 0.5% in breastfeed infants. The prevalence decreases with age at 1% in children> or = 6 years. CMPA does not have a laboratory test and therefore is a clinical diagnosis. It is defined as a “hypersensitivity reaction brought on by specific immunologic mechanisms to cow’s milk.” Generally symptoms present within the first month of life and involve 2 of more systems with 2 or more symptoms. Systems are dermatologic (including atopic der...
Source: PediatricEducation.org - September 11, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is Internet Gaming Disorder?
This study also found that “Internet gaming disorder, …, affects a small subset of the population exposed to online games, and does not appear to have increased in prevalence to the extent the [I]nternet usage has increased.” Data shows “[s]ignificant overlap in the neurobiology underlying both [gaming and Internet] addictions and substance use disorders have been found in animal models and human brain imaging studies.” People with IGD can have similar symptoms to people with substance abuse disorders including building tolerance for the activity (i.e. needing more) and having withdrawal sym...
Source: PediatricEducation.org - September 4, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What is the Genetic Inheritance of Alport Syndrome?
Discussion Alport Syndrome is a genetic disease classically associated with progressive renal disease often leading to end stage renal disease, variable sensory neuronal deafness and ocular findings (perimacular retinopathy). A. Cecil Alport built on the work of others evaluating families with nephritis and/or hematuria. However he very clearly describes the third generation of a family with an X-linked dominant pattern and also emphasizes the syndrome’s associated deafness. Alport writes: “It will be seen from this that nearly all the children of three generations of one family suffer from hematuria or nep...
Source: PediatricEducation.org - August 28, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

At What Height Do You Consider Preventative Treatment for Acute Mountain Sickness?
Discussion Acute mountain sickness (AMS) is a well-known problem for some people who travel to high altitude, especially altitudes> 2500 m (~8200 feet). Symptoms include headache, nausea or emesis, shortness of breath, dizziness, fatigue, difficulty sleeping and poor appetite. The incidence in adults ranges from 25% at 2975 m to up to 75% at 5896 m. The incidence in children is less clear but it appears that children are more susceptible at 45% for 16-19 year olds for similar altitudes. Risk factors are numerous including age, gender, obesity, ascent rate, altitude for sleeping, previous exposure to high altitude, previ...
Source: PediatricEducation.org - August 21, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Should Parents Teach Their Children About Stranger Safety?
Discussion Fortunately, when a child goes missing it is usually for short periods of time and is often because of miscommunication or expectations. Familiar examples are a child wandering away, or not returning at the proper time. Unfortunately, child abduction does occur. Data from the U.S. Department of Justice’s Office of Juvenile Justice and Delinquency Prevention provides the statistics below. Problems with definitions and reporting make these statistics more difficult to gather. ~340,500 children (43%) reported in 1999 as missing, were because of benign causes and no harm occurred to the child. Most were becau...
Source: PediatricEducation.org - August 14, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Can Parents Do To Promote Literacy?
Discussion Positive parenting has been shown to improve the overall health and well-being of children. Positive parenting includes: Respecting the individuality of the child and the adult in the relationship – accept the child for their strengths and weaknesses, encourage children to take risks, encourage their confidence in themselves Respecting that the individuals are part of a family and community – help children understand that they cannot have everything their way, that other people and the world they live in must be considered too. Even in a resource poor environment, data shows that positive parenting ...
Source: PediatricEducation.org - August 7, 2017 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 7th. 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 - July 31, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Conditions is Erythema Nodosum Associated With?
Patient Presentation A 12-year-old male came to clinic with a history of 3-4 days of painful bruising on his shin and lower arms. He had Streptocococcal pharyngitis diagnosed by rapid strep testing approximately 4 weeks previously and had taken all of his amoxicillin antibiotic per his parents. He had recovered without any problems until 3-4 days ago when his legs and arms started to have painful bruises along the shins and lower arms. They were raised, red/purple and painful mainly in the center of the lesions. He denied pain elsewhere nor any fever (Tmax was 99.5F), chills, sweats, weight loss, joint stiffness, abdomina...
Source: PediatricEducation.org - July 24, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common Are STIs?
Discussion Of the 30 different microbes which can be transmitted by sexual contact, 8 have the greatest incidence of transmitting disease. Four are curable (Chlamydia, Gonorrhea, Syphilis and Trichomoniasis) and 4 are incurable at present (Hepatitis B, Herpes simplex virus (HSV), Human immunodeficiency virus (HIV) and Human papillomavirus (HPV)). Sexually transmitted infections (STIs) are important as they can cause: Increased rates of acquisition of other STIs (ie HSV and syphilis increase the rate of HIV infection acquisition) Pelvic inflammatory disease and infertility Stillbirth and neonatal death Neonatal morbidity i...
Source: PediatricEducation.org - July 17, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

Do Children Grow Overnight?
Discussion Growth is an important vital sign for children. Normal growth patterns usually indicate healthy children and can be reassuring for both the parents and health care providers alike. Children are not usually measured very often by parents or health care providers and therefore the actual growth occurrence is not identified until after the event. Measuring small increments accurately also makes data collection difficult, along with the inconvenience of frequent serial measurements. A review of various growth parameters in children can be found here. Learning Point There is evidence that children do grow over very...
Source: PediatricEducation.org - July 10, 2017 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 July10. In the meantime, please take a look at the different Differential Diagnoses, Symptom and Disease Cases 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 - June 26, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Urinary Hesitancy?
Discussion “Hesitancy” denotes difficulty in initiating voiding when the child is ready to void,” according to the International Children’s Continence Society. It is not seen that often in pediatrics in isolation, but is commonly associated with other symptoms such as dysuria, frequency, abdominal or anal pain which may indicate common problems such as a urinary tract infection, vaginal/perineal irritation, or constipation. Communication problems can also confound the accuracy of the history as patients and families can have a difficult time describing the urinary problem they are experiencing or ma...
Source: PediatricEducation.org - June 19, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What are Indications for Continuous Positive Airway Pressure (CPAP)?
DiscussionObstructive sleep apnea syndrome (OSAS) is defined as a “disorder of breathing during sleep characterized by prolonged partial upper airway obstruction and/or intermittent complete obstruction (obstructive apnea) that disrupts normal ventilation during sleep and normal sleep patterns.” It is different than primary snoring which is snoring without apnea, sleep arousals, or problems with gas exchange. OSAS symptoms include snoring (often with snorts, gasps or pauses), disturbed sleep (often frequent arousals) and daytime neurobehavioral problems. Sleepiness during the day can occur but is less common in...
Source: PediatricEducation.org - June 12, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Do I Keep My Prescription Stimulant Safe At College?
Discussion Going away to college presents new and exciting opportunities for young adults. It also is an important time for transitioning many adult responsibilities to the young adult too. Keeping safe is important and safety tips for college can be reviewed here. Any medication can be abused. Prescription stimulants are no different. Normally prescription stimulants are used for treatment of attention deficit disorder, narcolepsy and treatment resistant depression. They can help increase alertness, attention, and energy, cognition, learning and memory. However for these reasons and because they are easy to obtain and r...
Source: PediatricEducation.org - June 5, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Adult Problems Can Start with Fetal Undernutrition?
Discussion Developmental origins of health and disease (DOHaD) is a scientific hypothesis that proposes that fetal nutrition has permanent effects on growth, metabolism, and structure. These changes, or biological programming, are felt to occur at critical periods in fetal development “…when developmental changes in the organism towards increasing complexity, greater plasticity, and more efficient functioning occurs rapidly and may be most easily modified either in favorable or unfavorable directions.” Fetal undernutrition has been studied more than overnutrition, and various nutritional components (prot...
Source: PediatricEducation.org - May 29, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Much Peanut Butter Should He Take?
Discussion Peanut allergy is an increasing problem with ~2% prevalence in the United States. It is also the leading cause of food-related death. The LEAP trial (Learning Early about Peanut Allergy trial) was a randomized trial of early introduction of peanut foods to try to prevent peanut allergy. It found a significant decrease in peanut allergy at 60 months of age with early introduction of peanut foods to infants. This finding occurred in participants with baseline negative skin testing (13.7% in peanut avoidance group versus 1.9% in peanut consumption group) or those with measureable peanut skin testing at study entry ...
Source: PediatricEducation.org - May 22, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes Anemia?
Discussion One of the most common problems in pediatrics is anemia. It is defined as “a lower than normal value for the related measurements of hemoglobin, hematocrit, and number of red blood cells”, usually 2 standard deviations below the normal for age. Normal hematological values change with age. For a discussion of which values are used click here. The most common type of anemia in childhood is iron deficiency which is commonly caused by inadequate stores (e.g. premature infant), inadequate intake (e.g. poor nutrition) or blood loss (e.g. menses). Anemia screening is recommended at age 9-12 months, and for...
Source: PediatricEducation.org - May 15, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

What Causes School Absenteeism?
Discussion School within society is an institution designed to provide learning opportunities to students under the direction of teachers. The curriculum is usually designed to provide academic content in formal subjects necessary for the adult world (such as instruction in mathematics, language, science, social studies, arts, physical education) but also other knowledge and skills for the adult world (i.e. personal safety, communication skills, working in teams, etc.). Specific schools may or may not offer specific courses of instruction such as religious education, learning disability education, gifted/talented education...
Source: PediatricEducation.org - May 8, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Good Are Ankle Rules for Determining If a Patient Needs An X-Ray?
This study supports that if the clinical examination indicates a low risk injury, then radiographs are not indicated. If the examination indicates a potential high risk injury, then the radiographs would be indicated because the clinical examination cannot discern well enough if a fracture is present or not. Use of the Low Risk Ankle Rule was evaluated in a Canadian study of 3-16 year old children. The study found a decrease in radiographs by 22% using the Low Risk Ankle Rules. Overall the sensitivity was 100% and the specificity was 53.1%. This study supports that if the examination indicates a low risk injury, then rad...
Source: PediatricEducation.org - May 1, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news

How Common is α -1-Antitrypsin Deficiency?
Discussion α-1-Antitrypsin Deficiency (A1AT) is a common single-gene mutation disease that is homozygous recessive. The normal allele is called M and the most common abnormal allele is Z. There are other alleles though. The gene codes for one of the primary protease inhibitors in the serum, thus those who are homozygous for the Z gene are sometimes referred to as “PIZZ” or “PIZ.” α-1-Antitrypsin is found in all body tissues but is especially important in the serum and lung. As noted it is one of the primary neutrophil protease inhibitors in the serum, and acts to neutralize these enzymes...
Source: PediatricEducation.org - April 24, 2017 Category: Pediatrics Authors: pediatriceducationmin Tags: Uncategorized Source Type: news