Pediatrics Subject Collection: Musculoskeletal System

Injuries and Chronic Conditions of the Knee in Young Athletes [ARTICLES]

Atanda, A. — 2009-11-01

Objectives Objectives Introduction Case #1 Case #2 Case #3 Case #4 Case #5 Case #6 Other Considerations Suggested Reading After completing this article, readers should be able to: Recognize the physical findings that are consistent with internal derangement of the knee. Differentiate among bony, ligamentous, and cartilaginous injuries of the knee based on physical findings. Discuss the criteria for orthopedic consultation for a knee injury. Know which types of knee injuries require magnetic resonance imaging for evaluation. ...

Motor Competence and Physical Activity in 8-Year-Old School Children With Generalized Joint Hypermobility [ARTICLES]

Juul-Kristensen, B. — 2009-11-01

OBJECTIVE: Because the criteria used for diagnosing between generalized joint hypermobility (GJH) and musculoskeletal complaints, as well as relations between GJH and an insufficient motor development and/or a reduced physical activity level differ, the prevalence of GJH varies considerably. The aim of this study was to survey the prevalence of GJH defined by a Beighton score at [≥]4, [≥]5, or [≥]6 positive tests of 9 and benign joint hypermobility syndrome (BJHS) in Danish primary school children at 8 years of age. A second aim was to compare children with and without GJH and BJHS regarding motor competence, self-reported physical activity, and incidence of musculoskeletal pain and injuries. METHODS: A cross-sectional study of 524 children in the second grade from 10 public schools was performed. A positive response rate was obtained for 416 (79.4%) children, and 411 (78.4%) children were clinically examined and tested for motor competence, whereas questionnaire response to items comprising musculoskeletal pain and injuries, in addition to daily level and duration of physical activity, corresponded to 377 (71.9%) children. RESULTS: In total, 29% of the children had GJH4, 19% had GJH5, 10% had GJH6, and 9% had BJHS, with no gender difference. There was no difference in daily level and duration of physical activity and in frequency of musculoskeletal pain and injuries between those with and without GJH. Children with [≥]GJH5 as well as with [≥]GJH6 performed better in the motor competence tests. CONCLUSION: Motor competence and physical activity are not reduced in primary school children at 8 years of age with GJH or BJHS. It is recommended that a potential negative influence on the musculoskeletal system over time, as a result of GJH, be investigated by longitudinal studies.

Index of Suspicion [ARTICLES]

George, R. P. — 2009-10-01

Case 1 Presentation Case 1 Presentation Case 2 Presentation Case 3 Presentation Case 1 Discussion Case 2 Discussion Footnotes Case 3 Discussion A 3[1/2]-year-old boy, who lives in the southeastern United States, is referred for evaluation of eosinophilia that was detected on laboratory tests performed during a routine health supervision visit. A few days ago, he had loose stools, without blood or mucus, associated with low-grade fever. He has no history of significant illness, allergies, respiratory symptoms, weight loss, sick contacts, or travel. He is not taking any medications. He lives with his mother, aunt, three siblings, four cousins, and two dogs in a rural area that has city water ...

Differentiating PFAPA Syndrome From Monogenic Periodic Fevers [ARTICLES]

Gattorno, M. — 2009-10-01

OBJECTIVES: To analyze whether there were clinical differences between genetically positive and negative patients fulfilling periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome criteria and to test the accuracy of the Gaslini diagnostic score for identifying patients with PFAPA syndrome with higher probabilities of carrying relevant mutations in genes associated with periodic fevers. METHODS: Complete clinical and genetic information was available for 393 children with periodic fever; 82 had positive genetic test results, 75 had incomplete genetic test results, and 236 had negative results for MVK, TNFRSF1A, and MEFV mutations. Current diagnostic criteria for PFAPA syndrome were applied. RESULTS: Of 393 children, 210 satisfied PFAPA syndrome criteria; 43 carried diagnostic mutations (mevalonate kinase deficiency: n = 33; tumor necrosis factor receptor-associated periodic syndrome: n = 3; familial Mediterranean fever: n = 7), 37 displayed low-penetrance mutations or incomplete genotypes, and 130 demonstrated negative genetic testing results. Genetically positive patients had higher frequencies of abdominal pain and diarrhea (P < .001), vomiting (P = .006), and cutaneous rash and arthralgia (P = .01). Genetically negative patients had a higher frequency of exudative pharyngitis (P = .010). Genetically undetermined patients showed the same pattern of symptom frequency as genetically negative patients. The Gaslini diagnostic score was able to identify 91% of genetically positive patients correctly, with a global accuracy of 66%. CONCLUSION: The Gaslini diagnostic score represents a useful tool to identify patients meeting PFAPA syndrome criteria and at low risk of carrying relevant mutations in genes associated with periodic fevers.

The "Fear Factor" for Surgical Masks and Face Shields, as Perceived by Children and Their Parents [ARTICLES]

Forgie, S. E. — 2009-10-01

Objective: The goal was to determine whether young children and their parents prefer physicians wearing clear face shields or surgical masks. Methods: Eighty children (4-10 years of age) and their guardians were recruited from a pediatric emergency department. A survey and color photographs of the same male and female physicians wearing face shields and surgical masks were distributed. The parents were asked to decide which set of physicians they would prefer to care for their children and with which set of physicians they thought their children would be most comfortable. The children then were asked to decide which set of physicians they would prefer to take care of them and why. The children also were asked whether they found any of the physicians frightening and, if so, why. Results: Fifty-one percent of parents preferred the pictures of physicians wearing face shields, and 62% thought that their children would choose the physicians in the face shields because their faces were visible and therefore less frightening. However, 59% of children stated that either set of physicians would be fine and neither was frightening; if given a choice, 49% would choose physicians in face shields. Conclusions: Physicians and parents have a perception that surgical masks are frightening to all children. Our study has shown that this perception is not completely true. Face shields may be a better choice, however, because both parents and children would prefer this option.

Index of Suspicion [ARTICLES]

Reirden, D. H. — 2009-09-01

Case 1 Presentation Case 1 Presentation Case 2 Presentation Case 3 Presentation Case 4 Presentation Case 1 Discussion Case 2 Discussion Case 3 Discussion Footnotes Case 4 Discussion A 15-year-old boy presents with pain, swelling, and limited movement of his right elbow for 4 days. He denies other joint involvement, trauma, headache, diarrhea, visual disturbances, or dysuria but has experienced night sweats. He had streptococcal pharyngitis and a mononucleosis-like illness 3 months ago. He has no pets, and his only travel occurred more than 1 year ago when he visited Mexico. He is not sexually active. Naproxen helped initially, but his symptoms have worsened. Physical examination reveals ...

Kawasaki Disease at the Extremes of the Age Spectrum [ARTICLES]

Manlhiot, C. — 2009-09-01

OBJECTIVE: We sought to determine outcomes of Kawasaki disease (KD) and to explore factors associated with poor clinical outcomes for patients diagnosed outside the age range of 1 to 4 years. METHODS: A retrospective review of data for all patients seen between January 1990 and April 2007 was performed. Patients were stratified into 5 groups on the basis of age at diagnosis. RESULTS: A total of 1374 patients were identified; 61 (4%) were <6 months of age at diagnosis, 114 (8%) 6 months to <1 year, 854 (62%) 1 to 4 years, 258 (19%) 5 to 9 years, and 87 (6%) >9 years. Patients <1 year of age and those >9 years of age were more likely to have coronary artery abnormalities than were patients diagnosed between 1 and 4 years of age. Patients diagnosed between the ages of 5 and 9 years were at the lowest risk. Patients at both extremes of the age spectrum were more likely to present with <4 of the classic KD features, but only those <6 months or >5 years of age were at increased risk of being diagnosed >12 days after illness onset. Patients <6 months of age had lower albumin levels, and those <1 year of age had higher white blood cell and platelet counts, all of which are known predictors of coronary artery abnormalities. Patients >9 years of age were less likely to receive intravenous immunoglobulin treatment. CONCLUSION: Outcomes for children diagnosed with KD at either extreme of the age spectrum are suboptimal, although the associated factors are different.

Lower Extremity Disorders in Children and Adolescents [ARTICLES]

Smith, B. G. — 2009-08-01

Objectives Objectives Clubfoot Metatarsus Adductus Flatfoot Idiopathic Toe Walking Tibial Torsion Femoral Anteversion References Suggested Reading After completing this article, readers should be able to: Recognize and distinguish congenital clubfoot from metatarsus adductus. Understand treatments and approaches to pes planovalgus or flatfoot. Describe the natural history of torsional lower extremity deformities in children. Discuss the differential diagnosis of idiopathic toe walking in children. Clubfoot Objectives Clubfoot ...

Metabolic Bone Disease of Prematurity [ARTICLES]

Vachharajani, A. J. — 2009-08-01

The incidence of metabolic bone disease (MBD) in preterm infants has been declining due to advances in nutritional care. Although the terms osteopenia and rickets have been used in the literature, MBD of prematurity is the preferred terminology for this condition. Despite the use of human milk fortifiers and commercial infant formulas specified for this population, MBD remains an important cause of morbidity in preterm infants. This review focuses on the physiology of intrauterine bone growth, the development of MBD in preterm infants, the various risk factors for MBD, pitfalls in diagnosis, prevention, and treatment of MBD. The use of speed of sound (SOS) ultrasonography and dual-energy X-ray absorptiometry (DXA) in the diagnosis, management, and prognosis also is discussed.

Prevalence of Transient Hyperphosphatasemia Among Healthy Infants and Toddlers [ARTICLES]

Huh, S. Y. — 2009-08-01

OBJECTIVE: To describe the prevalence and clinical characteristics of transient hyperphosphatasemia (TH) in a cohort of healthy infants and toddlers. METHODS: We performed a secondary data analysis of healthy infants and toddlers enrolled in a study examining the epidemiology of vitamin D deficiency. From 2005 to 2007, children aged 8 to 24 months were enrolled during well-child visits at an urban primary care pediatric clinic. At enrollment, we collected data regarding sociodemographic and clinical characteristics. We measured serum levels of alkaline phosphatase (AP), 25-hydroxyvitamin D, parathyroid hormone (PTH), calcium, magnesium, and phosphorus. We placed participants into 1 of 3 categories on the basis of serum AP levels: normal (AP: 110-400 U/L), intermediate (AP: >400 to 1000 U/L), and TH (AP: >1000 U/L). We used Fisher's exact test and analysis of variance to evaluate differences in characteristics among the 3 groups. RESULTS: Nine (2.8%) of 316 children had an AP level of >1000 U/L (mean: 2165 U/L). Sixteen children (5.1%) had an intermediate serum AP level (mean: 544 U/L). Mean weight-for-age, length-for-age, and weight-for-length z scores were similar across all 3 AP groups. Compared with the 291 children without TH, children in the intermediate AP and TH groups had similar mean serum levels of 25-hydroxyvitamin D, PTH, calcium, magnesium, and phosphorus. CONCLUSIONS: TH seems to be a relatively common condition among healthy infants and toddlers. TH was not associated with anthropometric measures, vitamin D status, PTH, or serum minerals. Recognition of this benign condition is important to avoid unnecessary investigations.