Anticipate the future
The AAP recommends universal screening for autism (eg. MCHAT) at both 18 and 24 month visit or whenever parental concerns are raised.
What should you do?
Infants < 2 years of age with non frontal scalp hematomas are at risk for intracranial injuries. While some physicians would choose observation rather than CT for traumatic scalp hematomas in a well-appearing child, the injury in this infant is unexplained and the possibility of abuse should be explored.
How likely is it that this child will develop asthma by age of 6?
If the child has a negative API, it is unlikely that the child will develop asthma by 6 years of age
chorea
fever
Elevated CRP
Arthralgia
What is the most likely diagnosis?
Which routinely recommended immunization is contraindicated in this patient?
Rotavirus vaccine is a live attenuated virus vaccine and is contraindicated in children with SCID.
Marfanoid habitus
Developmental delay
Lens dislocation, which is downward and medial
What is the most likely diagnosis?
Homocystinuria is an AR disorder that results in elevated levels of homocysteine.
IQ low + lens dislocation downward
Which drug, if ingested, results in these findings?
What therapy do most children with this disorder require?
Most do not require any therapy, but you can consider IVIG in those with recurrent infections or markedly low IgG levels. Most have normal IgG levels by 3-4 years of age
What cardiac condition does this indicate?
Vit D (400IU/day) should begin in all exclusively breastfed infants in the first few days of life and continue until the infant is weaned to at least 33oz a day of vit D fortified formula or milk.
Full term, healthy breastfed babies should receive daily supplementation with 1mg/kg of elemental Iron starting at 4-6mo.
Skeletal survey should be done in children <2 years of age in whom physical abuse is known or suspected. These include quality views of the skull, chest/ribs, spine, and extremities. A "babygram" is not detailed enough to see subtle fracture. A follow-up skeletal survey in approx 2 weeks may detect additional injuries not seen on initial survey.
Difficulty walking
Chronic sinus infections and several hosp for pneumonia
Elevated a1 fetoprotein
what is the most likely diagnosis?
Is an AR disorder with the ataxia occurring early in life, but telangiectasia not become noticeable until after 5 years of age. These children have elevated a1 fetoprotein.
What is the likely diagnosis?
Is an AR disorder with deafness at birth and prolonged QT interval
A child should be able to sit with support at 6months of age and with no support by 7 months of age.
"Kinky hair disease"
X linked recessive
When should he be allowed to play?
No return to play the same day! He must have physical/cognitive rest until he is asymptomatic without medication. Then he may attempt gradual resumption of activities, with cessation if symptoms return.
What is the most likely diagnosis?
X linked disease with a classic triad: thrombocytopenia, eczema, and susceptibility to encapsulated bacterial and oportunistic infections.
What is the most likely diagnosis?
Tdap is routinely recommended at 11-12 years of age. After this, a Td booster every 10y is recommended unless a dirty wound has occurred.
Is AD, achilles tendonitis or tenosynovitis may be the first clue in a teenager. Angina and symptomatic coronary disease occur in the 2nd decade.
What do you suspect?
Young children are more likely to have a fracture than sprain. If tender over the distal fibular growth plate, it is likely to be a Salter-Harris type I fracture even if the x-ray is normal.
Due to sensitization to proteins primarily hevein. Cross reactivity can occur with papaya, kiwi, banana, potato, avocado and chestnuts.
What is the most likely murmur?
Very common in childhood. Usually has a musical quality. It is the most common innocent murmur in children beyond the newborn period.