The history is the most important tool for identifying a psychiatric disorder. The initial focus in conducting the history is to establish rapport and to ensure the child’s safety. Safety should always be assessed and should include risk of suicide,…
An irritable infant is a challenge to the caregiver and medical provider and is a common presenting complaint in early infancy. An irritable infant is defined here as a patient younger than 1 year of age who, according to the…
With advancing genomic technology, disorders previously identified to be unique phenotypes are now recognized as sharing common pathways or developmental mechanisms. The clinical diagnostic paradigm is evolving to a “genomic” first approach and is less reliant on the detailed phenotype…
The etiology of intellectual developmental disabilities includes a wide spectrum of disorders that may present at different periods of development (infantile, juvenile, adult) and with different trajectories ( Fig. 28.1 ). Some are static encephalopathies (cerebral palsy, hypoxic-ischemic encephalopathy), while…
Definitions Intellectual disability (ID) has replaced the older term mental retardation (MR), reflecting a more enlightened and progressive attitude toward individuals with disabilities, both physical and cognitive. ID is characterized by significant limitations in intellectual functioning and in adaptive behavior…
The term disorders of sex development (DSD) replaces the former terms intersex and hermaphroditism ( Table 26.1 ). The most common presenting symptom of DSD is atypical (ambiguous) genitalia at birth. Other presenting signs and symptoms include lack of some…
Prepubertal Vaginal Bleeding The source of abnormal vaginal bleeding during prepubertal childhood is much more likely to be the vulva or vagina rather than the uterus. There are unique characteristics making history and physical examination effective in narrowing the diagnostic…
The most serious causes of acute scrotal swelling are testicular torsion and incarcerated inguinal hernia, both of which necessitate immediate surgical correction. Consequently, a prompt, careful approach to a painful or inflamed scrotum is essential. The differential diagnosis of scrotal…
Hematuria is a common issue faced by primary physicians who care for children. While it can cause great anxiety in the patient and family when it presents as gross hematuria, rarely does hematuria alone herald a serious illness during childhood.…
Proteinuria can be detected by various means, and the most common is the dipstick test, a calorimetric assay that spots only albumin and not low-molecular-weight proteins. In addition, false-positive dipstick assessment can be seen with highly concentrated urine, alkaline urine,…