Last fall, I went into the hospital to get my regular Solumedrol and IVIG treatment that I had been getting for about 3 years. After the treatment, I usually get a bad headache that sometimes lasts for a few days, but this time, it was different. I was discharged from the hospital on Friday, and on Saturday my headache was worse than normal, and I had new pain in my knee and back. I went to the Urgent Care because Advil and Tylenol were not working. They prescribed Vicodin, and other than me acting a little crazy and getting some short-term relief, the headache was still very bad.
That Monday, we called my doctor. He said to wait it out and maybe it was a virus. When we called back on Tuesday, he prescribed a higher dosage of steroids to take for a few days to see if that helped. Several times, we discussed going to the ER but I didn’t want to go because I knew it would mean a spinal tap.read more »
Undocumented Parents and Children with Medical Conditions: How a Health Care Provider’s Letter can Help
Have you ever been asked to write a letter describing a child’s medical condition for immigration purposes? Are these families holding out false hope or is there truth to the idea that children with special health care needs might qualify a member of the family for special immigration status? The answer is complicated. In this article, I will review three methods by which undocumented immigrants may seek legal permanent residence status in the United States. I will also explain how a letter from a physician detailing a child’s medical condition may support their application.read more »
Fifty years ago, in 1964, President Johnson declared The War on Poverty, and among the other programs like Social Security and Food Stamps, Project Head Start was launched to address the research findings that showed the impact of poverty and education on overall well being of families and children’s future success. In the last 50 years Head Start has grown into a highly esteemed child development program that addresses not only the school readiness skills of children, but also the social, health and educational needs of the whole family. The Head Start goal is to address the needs of the entire family in order to give them an opportunity to enter kindergarten ready to learn and empowered to succeed on par with their more privileged peers.read more »
Free and Appropriate Public Education in the Least Restrictive Environment: Some Special Education Basics
FAPE in the LRE. As with just about any other area of specialization, working within the world of special education comes with a whole new set of confusing acronyms to learn.
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Vein of Galen malformations (VOGMs) are rare congenital malformations of blood vessels in the brain. In these VOGMs, the arterial blood coming from the heart flows directly into the veins without first passing through a capillary bed. This effect is known as an arteriovenous shunt. These shunts can have serious consequences on the development of the brain, heart and lungs. In this article, we will briefly review the epidemiology, symptoms, treatment and outcomes of children with VOGMs.read more »
Last week I presented the case of an 18-month-old girl with limp for 5 days and refusal to walk for one day. She was crying more with diaper changes, and had some tenderness over the lumbar spine. Initial spinal films were negative, so she was sent home. However, upon phone follow-up the next day, she had continued symptoms. Readers were asked two questions:
1. What’s in your differential?
2. What’s your next step?
Thank you to everyone who sent their thoughts to our email address and those of you that shared your differential on our Facebook page.
This child had discitis! Other diagnoses in the differential can be thought of in groups, including infectious (osteomyelitis, muscle abscess, septic hip, pyelonephritis, etc.), inflammatory (arthritis), musculoskeletal (trauma, including non-accidental trauma, disc degeneration or prolapse) and neoplastic. These are just some of the diagnoses in the differential, but I thought I would take this opportunity to teach a little about discitis, which is rare in children, but a serious disease. Thanks to Dr. Andrea Marmor for inspiring me to present this case.read more »
You are the attending physician in Pediatric Urgent Care. An 18 month old girl presents with a limp for the last 5 days, and then refusal to walk for the last day. Her parents report that she has been more fussy and clingy. She has no past medical history, and was born on time. She doesn’t take any medicines or have any known allergies. She hasn’t had any fevers, and has been eating well. No URI symptoms or vomiting/diarrhea. She is being potty-trained, but is still in diapers, and seems to cry more with diaper changes.read more »
Fetal Alcohol Syndrome (FAS), a condition characterized by a triad of 1) growth restriction, 2) characteristic facial dysmorphisms and 3) developmental impairment of the central nervous system. FAS represents only the most apparent amongst a set of diagnoses associated with fetal alcohol exposure, "only the tip of the iceberg." Collectively, they are called the Fetal Alcohol Spectrum Disorders (FASDs) and together they represent the leading preventable cause of neurodevelopmental disability.read more »
The pink plastic box that Cynthia Kim, MD, EdD, opens at the bedside of a young patient at UCSF Benioff Children’s Hospital San Francisco looks like it might contain art supplies. But inside is everything she needs to provide an ancient form of pain relief. Kim is one of three physicians within the UCSF Department of Pediatrics trained to perform acupuncture on hospitalized patients, making UCSF one of a very few academic medical centers to offer this complementary treatment to both inpatients and outpatients.read more »
A gastrostomy is now a common procedure and finding in many hospitalized pediatric patients. A gastrostomy tube (GT) is a tube inserted through the abdominal wall that can deliver nutrition, liquids and/or medications directly into the stomach. It can also be used to decompress the stomach.read more »