Do Epsom Salts Help?
Discussion Epsom salt is magnesium sulfate. It is named Epsom from the town in England, close to London where it was supposedly discovered. Magnesium is an important trace element. It is a co-factor for ATP metabolism, DNA and RNA synthesis and regulation, and multiple other enzymatic reactions. Hypermagnesemia is quite uncommon and usually would occur because of renal insufficiency or being iatrogenically produced. Hypomagnesemia is a serum concentration of < 0.75 mmol/L. Symptoms are often non-specific such as lethargy, anxiety, headache, decreased appetite, nausea and sleeping problems. Muscle spasms and muscle assoc...
Source: PediatricEducation.org - December 19, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What is Diastasis Recti Abdominis?
Discussion Ventral wall hernias are common. They can be congenital or acquired and it is estimated that approximately 25% of people will have one at some point in their life. True hernias have a fascial defect and therefore contents can protrude through and potentially become incarcerated and/or strangulated. Common ones include: Epigastric occurs between the sternum and umbilicus. It can appear midline or slightly off-center. In children they can spontaneously resole. Umbilical occurs around the umbilical structures. These again often spontaneously resolve. Spigelian occurs in anterior abdominal wall adjacent to the semi...
Source: PediatricEducation.org - December 12, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What is the Current Classification for Ehlers-Danlos Syndrome?
Discussion As with any potential problem there is a often a range from normal to abnormal and this is true for joint hypermobility. Generalized joint hypermobility is hypermobility in multiple joints with few or no other symptoms. Generalized hypermobility spectrum disorder (also known as joint hypermobility syndrome) has hypermobility along with other symptoms such as pain, reduced muscle strength, and decreased proprioception and balance. Other clinical entities with hypermobility include Ehlers-Danlos syndrome, Marfan syndrome, and osteogenesis imperfecta. In the office, a 5-point questionnaire with 2 or more “yes...
Source: PediatricEducation.org - December 5, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How is Endometriosis Diagnosed?
Discussion Endometriosis is classically defined as endometrial tissue occurring outside the uterine lining. It is a common cause of chronic pelvic pain and dysmenorrhea in adolescents. It can present differently in adolescents than adult women and usually can appear like many other common problems such as chronic constipation or gastrointestinal dysmotility. It is estimated that ~25-38% of adolescents with chronic pelvic pain have endometriosis. Use of clinical criteria versus laparoscopic documentation of disease makes the epidemiology of this problem more challenging. The cause is not wholly agreed upon but many believe ...
Source: PediatricEducation.org - November 28, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Is This Primary Exertional Headache?
Discussion Commonly occurring primary headaches include tension, cluster and migraine headaches. “Other primary headaches” are often situational. Patients can have more than 1 type of these “other” headaches along with more common headaches. Other primary headaches as a group tend to be self-limited with long remission periods. Some other primary headaches include: Thunderclap headache Explosive sudden onset with maximum intensity in less 1 minute and resolution within 5 minutes usually 43/100,000 persons in adults Primary or secondary Secondary causes include intracranial hemorrhage, stroke, thro...
Source: PediatricEducation.org - November 21, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are the Potential Benefits and Risks of Premasticated Foods?
Discussion Premastication is the prechewing of foods or medicines by another person before feeding to an infant. It is also used to pretaste or temperature test foods. It was a common practice for millennia, especially before modern food technology, as a way to transition an infant from a solely liquid based diet to a mixed diet mainly of solid food. Rates of premastication vary, with less developed countries having an increased incidence/prevalence (up to 50%) but it is not uncommon in developed countries (in the US 14% is reported). Saliva is also used to clean other people, treat cuts/itches or insect bites as well. Pla...
Source: PediatricEducation.org - November 14, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What is a Dilated Pore of Winer?
Discussion Dilated pore of Winer (DPW) was first described by Louis H. Winer in 1954 in his article entitled “The Dilated Pore, A Trichepithelioma.” It is a benign follicular tumor with particular histopathological characteristics. Its’ differential diagnosis includes: Comedomal acne Pilar sheath acanthoma – seen as a solitary papule with keratin plug on the central area of face Nevus comedomes – multiple dark comedomes with central dilated dark openings Epidermal inclusion cysts – more nodular with or without keratin plug where the keratin material has a foul odor Tricofolliculoma Basa...
Source: PediatricEducation.org - November 7, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Causes Anal Itching?
Discussion Pinworms are caused by the parasite Enterobius vermicularis. Humans are the only known reservoir and are infected by fecal-oral transmission of eggs or indirectly such as through contaminated clothing or bedding. It is commonly seen in children and can easily pass to family members, plus people can become easily reinfected. The incubation period is usually 1-2 months and eggs can survive outside humans for 2-3 weeks. Adult worms migrate at night from the anus to the perianal skin and vulvar areas causing anal or vulvar itching. The itching can cause sleep problems and scratching can cause secondary bacterial inf...
Source: PediatricEducation.org - October 31, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How Can a Consultation Be Made Better?
Discussion Most physicians go into medicine because they like people and want to help them and their families. Clinical patient care can also be fun, interesting, intellectually challenging and provide a creative outlet. All physicians will never know everything and need help with patient care problems that arise. That is when a patient should be referred for a consultation. Effective consultations have several important components which can be overlooked. When clear questions with background information are asked and the consultant provides specific clear recommendations answering the question but also planning for contin...
Source: PediatricEducation.org - October 24, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Which Side Are the Organs On?
Discussion Although externally vertebrates present with bilateral symmetry, this is not necessarily true internally for humans. Humans have a normal left-right asymmetry of their internal organs. For example, the right lung has 3 lobes and is slightly larger than the left lung with 2 lobes. The normal asymmetry is called situs solitus (SS). Complete reversal of the normal abdominal and thoracic organ positions is called situs inversus totalis (SIT). Variations on the laterality between situs solitus and SIT has been referred to by different names including situs ambiguous or heterotaxy. For this case, the term situs ambigu...
Source: PediatricEducation.org - October 17, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

When Should a Newborn Infant Start Tummy Time?
Discussion Tummy time (TT) is one of a newborn’s and young infant’s major physical activities. TT is when an infant is placed awake on a firm surface (such as a floor) in a prone position while supervised by an adult. This encourages the infant to elevate their head and push up with arms to elevate their upper torso. TT is encouraged to be done in short amounts of time several times a day and to increase the amount of time in this supervised position up to 30 minutes total per day. TT has been associated with gross motor movement and development and is a component of the World Health Organization’s and se...
Source: PediatricEducation.org - October 10, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

Fall Break
PediatricEducation.org is taking a fall break. The next case will be published in on October 10th. In the meantime, why don’t you look at a Random Case from the top of the page? You can also look at the different Differential Diagnoses, Symptom and Disease lists too. We appreciate your patronage, Donna D’Alessandro and Michael D’Alessandro, curators. (Source: PediatricEducation.org)
Source: PediatricEducation.org - October 3, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

What Are Treatments for Panic Disorder?
Discussion Panic disorder is “…one of the anxiety disorders and is characterized by repeated, unexpected panic attacks, involving physical symptoms such as racing heart, dizziness and chest pains, along with a fear of recurring attacks and changing behaviors to avoid further attacks.” It has both physical manifestations and mental ones including extreme fear such as mortal fear, loss of control and fear of alienation. It is most common in teenagers aged 15-19 and is very common with about 1% of teens experiencing attacks. A study of college students in multiple countries found a lifetime prevalence of 5%....
Source: PediatricEducation.org - September 26, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

When is Bruxism Bad?
Discussion Bruxism “is a masticatory muscle activity that may occur during sleep ([sleep bruxism, SB] characterized as rhythmic or non-rhythmic) and/or wakefulness ([awake bruxism, AB] characterized as repetitive or sustained tooth contact and/or by bracing or thrusting the mandible.)” Bruxism was first described in 1907. Bruxism studies are quite variable in their results given the lack of standardized diagnostic methods. Patients or family members will often report tooth grinding noises, and on physical examination there will be abnormal tooth wear, tooth mobility, hypertrophy of the masseter muscles and othe...
Source: PediatricEducation.org - September 19, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news

How Long Does A Cephalohematoma Take to Resolve?
Discussion Cephalomatomas occur relatively commonly in 0.2-3% of newborn infants. They are blood collections in the subperiosteal skull bones, usually in the parietal area. They are usually unilateral but can be bilateral. They do not transilluminate. They are felt to be caused by pressure or other trauma and occur in vaginal and cesarean deliveries, with presumed periosteal disruption leading to externally located bleeding (not on the brain side of the bone). The blood fills the space with some pressure building up and the blood acts to tamponade itself. The blood coagulates, slowly organizes and is reabsorbed. If reabsor...
Source: PediatricEducation.org - September 12, 2022 Category: Pediatrics Authors: Pediatric Education Tags: Uncategorized Source Type: news