Clinical Pediatrics

Atopic, seborrheic, and contact dermatitis can significantly reduce the quality of life of patients and their families. Although differing in specific aspects of their epidemiology, etiology, and pathobiology, all 3 dermatoses are common in the pediatric population, and they share a common treatment approach. Although effective and widely used to manage exacerbations of pediatric dermatitis, the use of topical corticosteroid remains a concern for some physicians and parents because of its potential for systemic absorption and adverse events associated with prolonged use. Newer additions to the dermatitis treatment algorithm, such as the topical calcineurin inhibitors, may provide an effective steroid-sparing treatment option. Adjuvant treatments, such as antihistamines, antifungals, and antibiotics, also can provide benefit in appropriate circumstances. As there is no cure for dermatitis, a comprehensive, multipronged management strategy of preventive measures, such as trigger avoidance and periodic pharmacologic treatment, will provide patients and caregivers with the best opportunity to successfully control the disease.

The transition and transfer from pediatrics to adult health care of youth with and without special health care needs has become a focus of professional organizations, health care insurers, national policy makers, and providers. To understand transition and transfer at a primary care practice level, all primary care pediatricians in Rhode Island were surveyed. Responses were received from 103 of 169 (60.9%) practicing pediatricians. Few responders had practice policies on transfer. Most reported that transition should begin later than recommended. Few practices communicated with adult providers at transfer. Most reported that health insurers were of little help in transfer. Many pediatric practices had young adults after age 22 and many with special needs. Responders reported adolescents left their practices by 1 of 6 methods. The survey indicates the need for further study of transition and transfer and the need for additional training and education if transfers are to be successful.

The utility of multicenter cognitive test methodology and resultant outcomes of supplementation with docosahexaenoic acid in healthy 4-year-old children was evaluated in a randomized, placebo-controlled, double-blind study. Subjects received 400-mg/d docosahexaenoic acid (n = 85) or matching placebo (n = 90) in capsules for 4 months. Cognitive tests included the Leiter-R Test of Sustained Attention, Peabody Picture Vocabulary Test, Day-Night Stroop Test, and Conners' Kiddie Continuous Performance Test. The relationship of docosahexaenoic acid levels in capillary whole blood from a subsample (n = 93) with scores on cognitive tests was evaluated. For each test, results indicated that changes from baseline to end of treatment were not statistically significantly different between the docosahexaenoic acid group and the placebo group. Regression analysis, however, yielded a statistically significant positive (P = .018) association between the blood level of docosahexaenoic acid and higher scores on the Peabody Picture Vocabulary Test, a test of listening comprehension and vocabulary acquisition.

This study analyzed parental perception of the impact of diarrhea on quality of life of their children. A standardized questionnaire was completed by 2023 parents in Germany with children with diarrhea who were younger than 2 years old. Parents stated the most worrying aspects of diarrhea. A health score was measured using a visual analogue scale (0 = worst health, 100 = best health). Clinical symptoms were quoted by 72% of parents as one of the most worrying dimensions, with duration/frequency of diarrhea and weight loss perceived most meaningful. Next were behavioral/physical symptoms (51%), with an inflamed bottom for mild disease and pain for severe cases being most meaningful. Parental concern is characterized by sympathy and anxiety for the child. The health score for the diarrheal episode was 54.6 for mild and 33.9 for severe cases. Parents perceive a high disease burden of diarrhea and clinically less meaningful aspects play a significant role.

The need for routine sepsis evaluation in patients who have experienced an apparent life-threatening event but lack signs of infection remains controversial. To assess their risk of a serious occult bacterial infection, records were reviewed of 95 infants in whom infections were discovered during their inpatient evaluation after an apparent life-threatening event. Noted for each patient was the presence of any suggestive findings that would have prompted a physician to consider the given type of infection in the differential diagnosis. Thirty patients had bacterial infections; all but 5 had suggestive findings. The exceptions included 1 patient with pneumonia and 4 with urinary tract infections. None of the remaining 25 patients had occult bacterial infections. In patients with an apparent life-threatening event who appear well and lack signs suggestive of a serious bacterial infection, it may be possible to forego routine sepsis evaluation beyond a chest radiograph and urine culture without risking a serious missed diagnosis.

Nutritional rickets has been on the rise in the United States. A chart review of patients with nutritional rickets from April 1995 to May 2005 was performed. Fifty-eight subjects were studied (62% males, 38% females, with an age range between 2 and 132 months). Of the subjects, 81% were African Americans and 14% were Arabic; 33% were Christians and 19% were Muslims. An increasing number of cases of nutritional rickets have been noted since 2000. Seventy-nine percent of patients with nutritional rickets presented at the emergency department, and in 69% of the cases, rickets was an incidental finding; 96% of patients were exclusively breast-fed, and none received multivitamin supplements. 25-OH vitamin D levels were below 5 ng/mL in 42% of the patients, all of whom were African Americans. We could document complete resolution of nutritional rickets in only 8 patients, and 3 of these patients showed sequelae of rickets.

Hyperbilirubinemia is a common cause for newborn hospital admission. Although the cause of hyperbilirubinemia is usually benign and self-limited, there is always a large differential diagnosis. Atypical presenting signs and symptoms, such as significant anemia or bleeding, should encourage further evaluation for underlying disorders, such as inherited coagulation defects. This article describes the case of a 5-day-old infant who presented to the emergency department with hyperbilirubinemia, anemia, and ecchymoses from birth trauma. His hospital course is described, along with a review on the background, evaluation, management, and complications of hemophilia A.

Pinworm infection is a very common diagnosis in young children that is not always confirmed through laboratory evaluation before empiric therapy is prescribed. This article describes a toddler who was treated several times for pinworms because small white worms were seen in her perianal area. Laboratory analysis of parasite material found in her diaper later confirmed a diagnosis of dipylidiasis. Because the signs of dipylidiasis and pinworm infection overlap and the treatments for these parasitic infections are different, the laboratory should clinically confirm suspected persistent or recurrent pinworms.

Soft tissue involvement is an unusual presenting feature for children with meningococcal infection. We describe 2 children, 1 with conjunctivitis and another with a thyroglossal duct cyst abscess associated with Neisseria meningitidis, and review previous reports of these entities to emphasize the broad spectrum of meningococcal disease and pertinent aspects of treatment and of prophylaxis of contacts.