Case-based diagnostic challenges in young children

To help clinicians better understand some of the medical situations they may encounter and how to diagnose them, Healio Family Medicine provides diagnostic challenges and treatment tips on a variety of conditions and maladies that can occur in young children.

A 5-year-old boy with abdominal pain and fever

A previously healthy 5-year-old boy presents to the ED with a 2-hour history of abdominal pain and fever to 103°F. Upon awakening the same morning, he appeared well and was without complaint. He developed fever at school and was sent home. Subsequently, he had several episodes of diarrhea and nonbloody, nonbilious emesis. Read more

Previously healthy 2-year-old presents with sore throat and limp

A previously healthy 2-year-old girl presents to the ED with the chief complaint of a sore throat and pain in the right lower extremity. The history of the chief complaint began 2 weeks earlier when she had symptoms of a mild upper respiratory tract infection. However, the pain in her right knee only began 2 days earlier. Read more

A 3-year-old with blisters on the ha nds, feet, elbows, knees and buttocks

A 3-year-old boy with no medical history presents to urgent care clinic with a 2-day history of “blisters all over.” His mother states that he has generally been feeling unwell for about 3 to 4 days with cough and general malaise. His oral intake has been slightly decreased, but he does not complain of pain with eating. His mother reports tactile temperatures but no documented fevers. His mother has not given him any medications, and his immunizations are current. Other children in his day care class were out last week with a “rash.” Read more

A 13-month-old girl with pre-auricular swelling

A 13-month-old girl was admitted for evaluation and treatment of right pre-auricular swelling with pain. The onset was about 6 days earlier when the baby’s family noticed some erythema in the same area while combing her hair. At that time, she was seen by her primary care provider, who prescribed trimethoprim-sulfamethoxazole (Bactrim, Roche). However, the problem worsened and the patient was referred to the pediatric clinic where cefdinir (Omnicef, Abbott Laboratories), a second-generation cephalosporin, was added to her treatment. Again, there was no improvement. Read more

A 5-year-old boy with cellulitis

A 5-year-old boy was admitted to the hospital last month for evaluation and treatment of cellulitis of the penis. He woke up with the swelling, complaining of pain the day of admission and was evaluated by his primary provider who sent him for a urology consult. Treatment was started with topical mupirocin (Bactroban, GlaxoSmithKline) and oral cefuroxime axetil (Ceftin, GlaxoSmithKline). Read more