A 17-month-old boy with intermittent fever, coryza, cough, diarrhea, decreased urine output, and rash of 1 week’s duration is brought to the emergency department. The father reports that the rash began as a single lesion on the forehead then spread to other areas. The lesions appear as little blisters, which later rupture and crust over.
Allergic rhinitis is one of the most common chronic conditions in childhood. It substantially affects patient quality of life, and its prevalence appears to be increasing. Here, Dr Shih-Wen Huang discusses issues related to diagnosis, including the risk factors, characteristic examination findings, causes, and allergy testing.
May is National Foster Care Month and a good time to review what pediatricians should know about children in foster care. The following is a summary of a handout based on a presentation titled “Health Needs of Children in Foster Care” given by Moira Szilagyi, MD, PhD, as part of the Pediatrics for the 21st Century Symposium Series at the American Academy of Pediatrics (AAP) 2009 National Conference & Exhibition.1
Case:A 16-month-old girl has had a worsening rash, decreased oral intake, and irritability for the past 2 days. Before the rash appeared, she had been hospitalized for 4 days for presumed bronchiolitis and acute otitis media and discharged with oral amoxicillin. Two days later, she was brought to another emergency department, where an intraosseous line was placed because of generalized edema and tachycardia, followed by transfer to our facility.
A 10-year-old African American boy with lumps in the mouth for the past 2 years. The lesions had increased in size and number. They were generally asymptomatic but would become painful and bleedwhen the child accidentally bit them.
A 5-year-old boy with mild developmental delay was taken to the local emergency department with a 2-day history of abdominal pain and nonbloody, nonbilious emesis. Acute appendicitis was suspected. A CT scan of the abdomen and pelvis revealed a 3-cm metallic foreign body in the intestines, with proximal bowel dilation and partial small bowel obstruction. The child was transferred to a tertiary care center for further evaluation.
For the second time in a week, a 6-year-old girl was brought to the hospital with poorly localized epigastric and periumbilical pain. The pain was crampy and when severe, the child would yell. There was no aggravating or relieving factor. She also had 8 to 10 episodes of nonbilious, nonbloody vomiting. At the previous hospital visit, the patient had similar complaints of vomiting and abdominal pain and was treated for constipation.
This full-term baby was born with malformations of the upper and lower extremities. The mother, a 21-year-old primigravida, had a normal spontaneous vaginal delivery and no prenatal or perinatal complications. A prenatal ultrasound examination at 32 weeks’ gestation was reported as unremarkable.
THE CASE: A 16-year-old athlete has had recurrent right knee pain for the past few months. A few months earlier, he had a minor injury to the knee, which caused minimal pain. However, the knee continued to hurt on and off, and he now feels “something inside the knee.” The parents are concerned that the pain will hinder his participation in sports. He has had no knee swelling or redness. He denies pain in any other joint.
Allergic rhinitis is one of the most common chronic conditions in childhood. It substantially affects patient quality of life, and its prevalence appears to be increasing.
