Stories about: Pediatric Dose

Clinical Consult: Headaches in children

How to treat headaches in childrenHeadache is exceedingly common in pediatric practice and a significant source of parental worry (“Could it be a brain tumor?”). A detailed patient history and exam should seek to differentiate between primary and secondary headache and identify any “red flags.” Imaging is performed when there is an indication the headache could be attributed to a structural brain lesion. A diagnostic workup is not needed if the history is reassuring and the exam normal. …Read More

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Lyme disease: What to know, how to treat and when to refer

Image of the deer tick, which transmits Lyme disease
Lyme disease is transmitted by the deer tick.

We asked pediatric infectious disease specialist Catherine Lachenauer, MD, of the Boston Children’s Hospital Division of Infectious Diseases, to answer some frequently-asked questions about Lyme disease in children. Here’s what she had to say:

How common is Lyme disease and what are some early symptoms?

Lyme disease is the most common tick-borne infection in the US. The number of reported cases has been rising over the years.

One of the best recognized and earliest symptoms of Lyme disease is the erythema migrans, or EM rash, that may appear within the first month (usually within the first two weeks) following the tick bite.  The EM rash occurs at the site of the bite, typically as a circular red rash that enlarges over the course of several days.  Often, there is clearing as the rash enlarges such that it appears as a “bullseye,” although it may also be a solid, or confluent, rash.  Patients may also have non-specific, flu-like symptoms including fever, headache, joint aches and fatigue, as early symptoms of Lyme disease.

A tick needs to be attached for at least 48 hours to transmit the Lyme-causing bacteria

What are some later-stage symptoms of Lyme disease in children?

Most symptoms of Lyme disease occur in three stages: early localized, early disseminated and late-stage disease.

In the early localized stage, usually within one to two weeks following the tick bite, a single EM rash may appear. Patients who are not diagnosed and treated with antibiotics in the early localized stage, they may go on to have symptoms of early disseminated disease. …Read More

From EKGs to echos: How broadly should kids be screened for heart problems?

Heart-screenings-athletes

Every three days, a young athlete somewhere in the United States collapses and dies due to an undetected heart problem. It’s a tragedy that Gian Corrado, MD, who works in Sports Medicine at Boston Children’s Hospital, has seen unfold firsthand. He was an undergraduate playing pick-up basketball when one of his teammates died suddenly on the court.

“It’s uncommon,” he says, “but it’s not so uncommon that it may not touch you. It happens, and we have no effective, efficient way to screen for it.”

There is a lot of interest in using heart screening in young athletes to reduce sudden death risk . The NCAA’s chief medical office recently suggested that it may be useful to routinely perform electrocardiograms (EKGs) and possibly other cardiac tests on some collegiate level athletes. A January 2016 opinion piece on this issue in the New York Times drew a lot of attention. Cardiac screening has also been proposed for other groups, such as children starting certain types of medications.

But there’s widespread debate in medical circles about such broad usage of EKGs. Why is this so controversial? If it’s such a valuable test, why doesn’t everyone get routine EKGs? …Read More

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Clinical Consult: Celiac and other gluten-related disorders

Celiac-Weir

Interest in gluten—and in particular, avoiding it — continues to be on the rise. The gluten-free market has become a billion dollar business as more and more adults and children trial this restrictive diet. Many go gluten-free as a lifestyle choice.

However, many turn to a gluten-free diet for medical reasons and for relief of specific symptoms. It is estimated that roughly 10 percent of the population have gluten-related disorders. Figuring out whether an individual needs to be gluten-free and where she lies on the spectrum of gluten-related disorders can be hard, but is an important endeavor. …Read More

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