Public health officials are underscoring the tragedy of severe influenza infections and deaths in children, adding a palpable sense of urgency for immunization in an era when some parents are suspicious of vaccine efficacy and safety.
Abdominal pain is a common pediatric chief complaint with a diversity of etiologies. Many are benign, but some have the potential for devastating consequences if a timely diagnosis is not made. Understanding and practicing a comprehensive approach facilitates consideration of more serious pathology while allowing for a focused diagnostic plan. This two-part series guides the clinician to a practical clinical approach to pediatric abdominal pain.
Migraines occur in young children, but may be challenging to diagnose. Migraines can have a great impact on pediatric patients’ quality of life with school absence and limitations on extracurricular activities. Treatment of pediatric migraines or possible migraines is difficult secondary to the lack of evidence for effective therapies in pediatric patients. Treatment includes traditional therapy with dopamine receptor antagonists (DRAs), nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, and combination therapies. Newer therapies include magnesium, valproic acid (VPA), and peripheral nerve blocks. The authors review the clinical presentation of migraines in children, guidelines for diagnosis, and therapeutic options.
Tachypnea has long been considered to identify which children with acute fever and cough might benefit from antibiotic treatment, especially in resource-limited parts of the world. Now, with declining rates of vaccine-preventable infections with Haemophilus influenzae and pneumococcus, new data suggest that approximately 90% of febrile, tachypneic, coughing (but still well enough for outpatient treatment) preschoolers do fine without antibiotics.
Ultrasound has emerged as a critical tool for use at the bedside to guide not only diagnosis but treatment strategies as well. The first part of this article focuses on the uses and limitations of cardiac ultrasound in the acute setting. Part II will include discussion of cardiac arrest, congenital abnormalities, pneumothorax, pleural effusion, and pneumonia.
Our smallest patients are the most vulnerable to medication errors. An awareness of potential vulnerabilities when prescribing in this population is essential. The authors discuss when medication errors are particularly likely, common types of errors, and strategies to minimize the potential for errors.
In a population-based study from Switzerland, the authors found that recanalization treatment (intravenous thrombolysis or endovascular treatment) overall was safe without significant side effects or increased mortality compared to standard care.