Vulvitis
Prepubertal girls have a relative lack of estrogen and are thus prone to vulvitis. It is characterised by an inflamed, irritated vaginal orifice, often with a foul itchy discharge.
There can be pain or discomfort on micturition. It can be caused by:
• poor hygiene
• threadworms
• excessive...
Scrotal Problems in Pediatric
Acute enlargement or pain in the scrotal area is an important clinical sign as it may signal a surgical emergency. Boys with either of these symptoms need to be seen promptly because of the risk of testicular torsion. Testicular torsion may result in infarction of the testis...
Penile Problems in Pediatric
Phimosis
Phimosis is a tightness of the foreskin so that it cannot be drawn over the glans. It is most logically defined as either physiological or pathological. Physiological phimosis occurs because of the inability to retract infantile foreskin, owing to congenital adhesions...
Hypertension in Pediatric Emergency
Transient hypertension can occur in a child as a result of stress, fear or pain. Blood pressure (BP) measurements repeated on several different occasions (at least three) are required to diagnose hypertension. The cuff bladder should cover at least 3/4 of the child’s arm length,...
Hematuria in Pediatric Emergency
Hematuria is the presence of red blood cells in the urine. The presence of 10 or more RBCs per high-power field is abnormal. Urinary dipsticks are very sensitive and can be positive at less than five RBCs per high-power field. In the emergency department it is important in...
Nephrotic Syndrome in Pediatric Emergency
Nephrotic syndrome is a clinical disorder characterised by edema, proteinuria (>3g per day), hypoalbuminemia and hypercholesterolemia. Minimal change glomerulonephritis accounts for 80–85% of nephrotic syndrome in childhood. Complications include infections, thrombosis and...
Urinary Tract Infection (UTI) in Pediatric
The urinary tract is a common site of infection in children. The annual incidence is up to 1% in girls, but less common in boys. Radiological abnormalities are present in about 40% of children with UTIs, the most common being reflux. Asymptomatic bacteriuria in schoolgirls...
Diabetes in a mildly ill child
Assessment
Occasionally an astute clinician makes the diagnosis of diabetes mellitus in a mildly ill child, with <3% dehydration, no acidosis and no vomiting. Baseline investigations should be carried out, as in the child with ketoacidosis. The diagnosis of diabetes mellitus...
Diabetes Melitus in Pediatric Emergency
Thirty per cent of children with diabetes present with vomiting and secondary dehydration from the development of acidosis and ketosis. Diabetic ketoacidocis is a medical emergency. The clinical presentation may vary from polydipsia and polyuria or abdominal pain and vomiting...
Hypoglycemia in Pediatric Emergency
There should be a low threshold for performing a Dextrostix test in the acutely unwell child in the Emergency Department. Beyond the neonatal period, hypoglycemia is defined as a blood glucose less than 2.5 mmol/liter. In children who have had a seizure, hypoglycemia can be...
Adrenal Crisis in Pediatric Emergency
An adrenal crisis is a physiological event caused by an acute relative insufficiency of adrenal hormones. It may be precipitated by physiological stress, such as infection or surgery in a susceptible patient. It should be considered in patients with:
• congenital adrenal hyperplasia
• hypopituitarism...
Jaundice Icteric in Pediatric Emergency
Jaundice in early infancy
There are many causes of jaundice in early infancy. It is clinically defined as the yellow colouration of the skin and sclera. The best approach is to define it, if it is unconjugated or a conjugated jaundice, as this will dictate the approach to...
Diarrhea and Vomiting in Pediatric Emergency
Most diarrhea and vomiting in children is due to infective gastroenteritis ) but not all. It may be the presentation of a urinary tract infection (UTI), meningitis, appendicitis, intussusception or systemic illness. In the unwell child, especially if anuric, consider hemolytic uremic syndrome (hemolytic...
Constipation in Pediatric Emergency
Constipation is defined as hard stools that are difficult to pass. Defecation may be painful and may be less frequent than normal. There is a wide range of normal stool frequency: normal breastfed infants may have a stool following each feed or only one every 7–10 days; bottle-fed...
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