American Academy of Pediatrics

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.

The American Academy of Pediatrics recently affirmed that clinicians must provide confidential and comprehensive pregnancy options counseling to teens. Therefore, it is important that clinicians be familiar with when and how to diagnose pregnancy, the psychosocial and physical changes that occur in pregnancy, and how to provide timely and comprehensive pregnancy options counseling.

An 11-week-old boy born at 29 weeks’ gestation presents to the emergency department (ED) with a 1-day history of blood-streaked stool. The patient started having frequent loose stool with mucus throughout the day. He was sleeping more but tolerating feeds well, with no irritability, vomiting, or worsening reflux. He had no fever at home and no sick contacts.

Age-appropriate conversations about sexual orientation and gender identity with youths and their families by health-care professionals are essential to support the health of all youths and combat mental health disparities, bullying, and higher rates of suicide among LGBTQIA+ youth. As mental health providers, we integrate best practices at the intersection of mental health and pediatrics. We offer strategies for health-care providers to proactively discuss sexual orientation and gender identity and to create a safe place for these discussions.

Vomiting and weight loss are often associated with gastrointestinal etiologies, and hypernatremia is often thought of as an indication of dehydration or iatrogenic hypernatremia. We discuss the importance of considering alternate etiologies, such as intracranial masses, especially when these signs and symptoms present together.

A previously well 14-year-old Chinese girl from Singapore presents with lack of pubertal development (absence of breast development, no vaginal discharge, no menarche, and no pubic or axillary hair development). She does not complain of any neurologic or constitutional symptoms. Her appetite remains normal. There is no polydipsia, polyuria, polyphagia, or symptoms of thyroid disease. She is the only child of nonconsanguineous parents. There is no family history of endocrinopathies or delayed puberty. Her mother had her menarche at 12 years old.

After completing this article, the reader should understand both the environmental and individual risk factors that contribute to environmental heat illness in general, recognize the presentation of various heat-related illnesses, and be able to properly treat environmental heat illnesses.

A 2-year-old girl presents to the primary care office for a health supervision visit and is found to have poor growth and rickets. Her parents report poor oral intake, increased fussiness and sweating, and refusal to bear weight. She was able to crawl and pull to stand by 12 months but had regression of these milestones after 18 months. She consumes 15 to 18 oz of cow milk each day and eats a variety of table foods. She has had no vomiting, diarrhea, or dehydration. The family recently moved from another country, and previous growth charts are not available. Family history is notable for short stature in her mother, but accurate parental height measurements could not be provided. There are no family members with rickets, poor growth, osteopenia, or recurrent fractures. Initial laboratory testing reveals a low serum bicarbonate level, hypocalcemia, and hypophosphatemia (Table 1). Concern for an...

Vision assessment is essential for early detection of conditions that may cause vision loss in young children. The American Academy of Pediatrics recommends vision assessment starting at birth and continuing as part of routine health supervision checks. Early identification through screening before age 7 years can reduce certain causes of blindness, such as amblyopia, by up to half. Starting in the newborn period, screening during health supervision checks provides early opportunities to diagnose a variety of vision concerns and should routinely occur in all children through adolescence. Because of challenges obtaining full cooperation from young children and infants, vision screening consists of multiple components, including medical history, physical examination, and tools such as acuity testing and instrument-based screening.

A 33-day-old term boy with a medical history of ABO incompatibility (infant A+, mother O–, direct antiglobulin test negative) and hyperbilirubinemia requiring phototherapy and normal newborn screening presents with ongoing hyperbilirubinemia. The patient was born at 38 weeks after an uneventful pregnancy. His birthweight was 3,800 g (81st percentile), and he required intensive phototherapy for 24 hours before discharge from the newborn nursery. He was exclusively breastfed, stooling daily, and voiding normally. At a follow-up primary care visit on day 11 after birth he weighed 3,780 g (52nd percentile) and was noted to be significantly jaundiced. On day 12 after birth, his bilirubin level was found to be 20.8 mg/dL (355.76 µmol/L), direct bilirubin level was 0.30 mg/dL (5.13 µmol/L), and he was readmitted for phototherapy. At the time of discharge, his jaundice was notably improved, with a bilirubin level of 17.1 mg/dL (292.48 µmol/L). On day 31 after birth...