American Academy of Pediatrics

This is a rare anomaly that, in this case, caused the infant to present in extremis. Quick recognition of the fact that the cause was cardiac, not sepsis, led to proper care. This anomaly is unusual in that the subclavian origins were distal to the arterial duct, which, while the ductus was closing, caused hypoperfusion, hypoxic lower body acidosis, and near death. This is truly a “ductal dependent lesion.”

Mpox is an enveloped double-stranded DNA virus belonging to the Orthopoxvirus genus in the Poxviridae family. This family also includes variola, cowpox, and vaccinia viruses. In November 2022, the World Health Organization recommended using the name mpox instead of monkeypox

Presented here are three patients who have a common chief complaint. All three cases have discussions on presentation, the differential diagnosis, and management that collectively serve as a Review article. Following the three cases, an expert weighs in in a short commentary with 5 questions for CME credit.

A previously healthy 20-month-old boy with no personal or family history of coagulopathy presents with a fourth episode of severe oropharyngeal bleeding.

A right hand–dominant 14-year-old high school quarterback presents to the clinic for acute-onset right-sided elbow pain, which occurred during an intense throwing drill at football practice. Since then, he has started feeling a popping sensation with throwing. He does not have a history of elbow pain and denies bruising or swelling before this episode. He has not noticed any loss of accuracy or range of motion while throwing. Of note, the patient plays the quarterback position year-round for multiple traveling teams and consistently uses weighted footballs during practice to improve his throwing distance.

The Intergovernmental Panel on Climate Change has reported that the prevalence of vector-borne diseases has increased in recent decades and that the prevalence of malaria, Lyme disease, dengue, and, in particular, West Nile virus infection are expected to increase further if control measures are not strengthened. ( 1 )( 2 ) This review article summarizes the epidemiology, various clinical manifestations, and management strategies of these vector-borne diseases with increasing prevalence both in the United States and worldwide.

A 3-week-old boy, born at term via an uncomplicated vaginal delivery at an urban hospital, presents to a pediatric emergency department (ED) with a 3-day history of purulent umbilical discharge that is now resolved and a new 1-day history of fever (maximum temperature, 100.4°F [38°C]). His umbilical discharge was spontaneous and intermittent and had prompted 2 other health-care encounters. The first was a call to a telehealth service on day 1 of illness, who advised them to clean the umbilicus with chlorhexidine. The second was to the ED on day 3 of illness, where he was well-appearing and during the visit his father recorded a video of the umbilical discharge, although this video was not viewed by the ED physician and the discharge was not present at the time the physician examined him (Video). He was diagnosed as having a possible umbilical granuloma and was discharged with an...

A 12-year-old girl with a recent diagnosis of systemic lupus erythematosus (SLE) presents to the emergency department (ED) with 1 week of central “stabbing” chest pain and severe fatigue. She denies orthopnea and shortness of breath but reports she must sit to rest after walking only short distances due to her fatigue. In the ED, her vital signs show a heart rate of 70 beats/min, normal oxygenation, and elevated blood pressures in the 160s/90s (mm Hg). Her mentation is appropriate. Her height is 62.2 in (158 cm), weight is 107.6 lb (48.8 kg), and BMI is 19.9, which are consistent with previous growth trends in the 75th percentile. Apart from 2 weeks of joint pain and fatigue before her new SLE diagnosis, she was generally healthy without other medical problems and actively engaged in sports. On examination her lungs are clear bilaterally with no increased work of breathing. Cardiac examination...

Brief resolved unexplained events (BRUEs) are frequently encountered in infants younger than 1 year. By definition, these events require the infant to be asymptomatic and at baseline at the time of presentation, with no significant abnormalities on examination and no discernible explanatory diagnosis. Research has shown that less than 5% of BRUE cases are attributable to serious underlying conditions, with no increased mortality risk and no increased risk of sudden infant death syndrome. Despite these findings, approximately 63% of patients with BRUEs are hospitalized and up to 82% undergo diagnostic tests, which predominantly result in false-positive findings. Such results may lead to unnecessarily prolonged hospital stays, additional tests or consultations, and increased parental anxiety. The management of a patient who has experienced a BRUE can be challenging for providers and parents alike. Although risk is known to be low in these infants, providers may be compelled to explain the event and provide reassurance. Caregivers oftentimes are concerned that the events may reoccur and be a harbinger of a missed diagnosis. Shared decision-making can be used to explain risk and the benefit of additional testing and hospitalization. This family-centered strategy can align care with the family’s values, provide reassurance, and decrease decisional conflict.

Presented here are three patients who have a common chief complaint. All three cases have discussions on presentation, the differential diagnosis, and management that collectively serve as a Review article. Following the three cases, an expert weighs in in a short commentary with 5 questions for CME credit.