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 »
As an immigrant to the United States from a third world county, I have always been confused by a parent’s decision to delay or refuse vaccines. With new outbreaks of measles and meningitis in the United States, the rippling effect of vaccine refusal is now a reality. For those of us who have traveled to or lived in third world countries, we know the scarcity of resources and the need for national immunization campaigns. Mothers, fathers and hundreds of children wait in Haiti for hours in the smoldering heat after a half-day of travel to obtain their vaccinations. On the American Board of Pediatrics Examination, we still are asked about smallpox even though it was declared globally eradicated in 1980, before many pediatric residents were even born. In fact, UNICEF reports that globally, more than 30 million children are unimmunized either because: 1) vaccines are unavailable, 2) health services are poorly provided or inaccessible, or 3) families are uninformed or misinformed about when and why to bring their children for immunization.read more »
Growth is a basic life function of all organisms, and disruption in growth is problematic. Pediatricians are experts in childhood growth and disorders of normal growth and development. Failure to thrive (FTT) is when a child has impairment in normal growth over time, relative to standard growth charts, after taking into account age, ethnicity and gender. It is a problem in the field of pediatrics as old the specialty itself.read more »