Q: During my training, most pediatric endocrinologists were using the "70/30 rule" or the "rule of fifths" to determine the insulin dosage for patients with new-onset diabetes. Now that I am in practice, I have heard that carbohydrate counting is a more accurate method of determining a child's insulin needs.
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among reproductive-aged women; the prevalence is about 5% to 10%.1 Like women with PCOS, affected adolescents often present with irregular menses, hirsutism, and acne. However, despite widespread agreement that the metabolic derangements of PCOS arise during puberty, the condition is diagnosed more often in adults than in adolescents.
Diagnosis of PCOS in adolescence is complicated by the following challenges:
How old does a child need to be before we can count on the accuracy of his or her response?
One of the most common illnesses we treat in general pediatrics is asthma—often in children who have not yet entered their teen years. While we ask the parents what symptoms they have noticed in their child, we don’t always ask younger children directly. How reliable are their answers?
THE CASE: A 5-month-old girl presented with left facial droop of sudden onset. The infant had nasal congestion for the past 2 days, but had been eating well. There was no recent history of rash, trauma, medication use, or drug allergies. Her medical history included left clavicular fracture that occurred at birth from a difficult delivery; she also had nasolacrimal duct stenosis.
A 10-year-old boy had a 3-day history of an itchy eye. His mother thought he had somehow cut his upper left eyelid.
The boy had no history of recent trauma or discharge from the affected eye. He denied eye pain, swelling, and changes in vision. He was afebrile and otherwise healthy. Previous medical history was noncontributory.
This full-term infant was born with malformed feet and toes. Physical examination findings were otherwise normal. The child weighed 3.1 kg (6.9 lb) at birth; her Apgar scores were 9 at 1 minute and 9 at 5 minutes. Her mother (21-year-old gravida 2 para 1) had an unremarkable antenatal history and a normal vaginal delivery. There was no family history of congenital anomalies.
A teenaged boy presented with this large, light brown pigmented macule that developed after he returned from a vacation with his family in Florida. He takes no medications and has been healthy.
THE CASE: A 5-month-old girl presented with left facial droop of sudden onset. The infant had nasal congestion for the past 2 days, but had been eating well. There was no recent history of rash, trauma, medication use, or drug allergies. Her medical history included left clavicular fracture that occurred at birth from a difficult delivery; she also had nasolacrimal duct stenosis.
A 10-year-old boy had a 3-day history of an itchy eye. His mother thought he had somehow cut his upper left eyelid.
This full-term infant was born with malformed feet and toes. Physical examination findings were otherwise normal. The child weighed 3.1 kg (6.9 lb) at birth; her Apgar scores were 9 at 1 minute and 9 at 5 minutes. Her mother (21-year-old gravida 2 para 1) had an unremarkable antenatal history and a normal vaginal delivery. There was no family history of congenital anomalies.
