Ahead of
the game
the game
It takes over 1 year for a child to be seen at developmental pediatrics. If a child screens positive or if there are concerns for autism, you could send them to this specialist first.
Speech and/or occupational therapy!
These are much faster specialties to establish with, and since it takes more than a year for a child with suspected autism to see the neuro-psych or developmental specialist, it is best to get them into ST/OT for treatment during that waiting time.
Lactulose! Safe for babies with constipation :)
This can be treated in children using bleach baths.
Eczema!
Put 1/4 cup of bleach in bathtub, 1-2 times per week until symptoms are under control, then 1x/week.
Without towel drying, apply skin emolient all over after the bath (CeraVe, Cetaphil, Eucerin, Aquafor).
If super severe, can do PO or topical steroid burst.
A 5 year old presents to the ED with a bug in their ear. Aside from calming the child, what is your first step in treatment?
Kill it with lidocaine flush!
First, you need the bug to stop moving, so the best method is to kill it by flushing the canal with lidocaine. Then, you can flush the whole bug out with water (do this instead of using tweezers because tweezers can break the bug into pieces!)
This dog is good at barking
Dobby
Laryngomalacia is the most common cause of stridor in the first month of life. When should infants with suspected laryngomalacia be referred to ENT?
Always!
Even if you suspect it is benign, children with stridor and suspected laryngomalacia should always be refered to ENT for flexible laryngoscopy to rule out GER and other more concerning causes of stridor.
Laryngomalacia presents around age 2-4 weeks, and resolves around 18-20 months. It is usually not present at birth. Stridor associated with laryngomalacia can be worse with feeding, crying, or lying down.
This supplemental treatment is helpful for inflammatory conditions such as ulcerative colitis and pouchitis.
Probiotics!
Probiotics are needed in these conditions to help support remission.
Probiotics also have a role in post-antibiotic diarrhea, traveler's diarrhea, and C. Diff.
Otherwise, there are no strong recommendations for the use of probiotics.
Found on the cheeks and anterior thighs of babies, or on the back of arms in adolescents and adults.
Keratosis pilaris. For babies, treat with good exfoliation and moisture. For adolescents, treat with OTC Amlactin or LacHydrin lotion (12% lactic acid lotion)
Pre-auricular pits plus decreased hearing on audiology exam can be associated with this syndrome.
Branchio-oto-renal (BOR) syndrome (Also known as Melnick-Fraser syndrome) is characterized by:
Brachial fistulae or cysts
Ear malformations which can include inner, middle, and outer ear
Renal malformations ranging in severity from hypoplasia to agenesis.
This dog is good at stealing things from the other dog.
Lucy
Parents are concerned about 8 year old child having new, repetitive movements of their face that seem to get worse when the child is anxious or tired. You suspect new-onset tics. What do you tell the parents for treatment?
Reassurance! New-onset tics are usually self-limiting and resolve over time. They can be brought on by fatigue and anxiety, so limiting factors that trigger anxiety and decrease fatigue will help.
Don't draw attention to the tics or they can worsen.
If severe, can refer to neurology for medication.
If bothering the child, can do "behavior reversal therapy" (Mary Bridge Psychology)
For patients experiencing significant constipation, this specific symptom should always prompt referral to GI.
Encoparesis. Any child who was previously potty trained that either voluntarily or involuntarily passes stool into clothing should be seen by GI for evaluation.
Other reasons to refer to GI when working up constipation: muscle weakness (eg. Duchenne's muscular dystrophy or other myopathy suspected), distension (Hirschprung's), growth problems, very anxious parents, or if constipation not resolving in a reasonable amount of time with trial of Miralax.
Raised violaceous lesions on the chin or preauricular area, +/- drainage or tracking, that does not resolve after a course of Augmentin.
Atypical (non-tuberculosis) Mycobacterium infection.
Acid-fast bacteria that are widespread in the environment (soil, water, food products, domestic and wild animals). Can cause skin and soft-tissue infections, do not improve or resolve with regular antibiotics and generally lead to kids being seen by ENT or derm. Can send fluid for PCR; TB skin test would be intermediate.
Treatment is surgical excision +/- antibiotics. Biaxin is the antibiotic if caught early in the course, otherwise would need input from ID.
This condition is often misdiagnosed as recurrent strep throat.
P-FAPA
Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis.
An auto-inflammatory condition that causes periodic fevers, sore throat, canker sores, and swollen lymph nodes.
According to Dr. Mosley, this is the best dog in the world.
Sasha.
But arguably, there are several other dogs who share the title of "Best Dog in the World". Including Lucy and Dobby and Willow and other dog friends not specifically named in this Jeopardy session.