Cerebral Palsy

Key Points Cerebral palsy describes a group of disorders affecting movement, balance, and posture that are caused by a variety of static conditions affecting the brain.Occurs in about 2 in 1,000 live births annually; major risk factor is preterm birth.Diagnosis is often made between 12 and 24 months of age based on a combination of history/risk factors, abnormal muscle tone, abnormal reflexes, developmental delay, and poor feeding.Treatment is team based and will generally include a primary care physician, orthopedist, physical therapist, orthotist, and more. Family/caregiver involvement is critical.

Dysmenorrhea

Key Points Dysmenorrhea (ie, painful menses) is a frequent cause of school absenteeism in girls.Primary dysmenorrhea typically occurs 1 to 2 years after menarche.Common causes of secondary dysmenorrhea including sexually transmitted infections (STIs), pelvic inflammatory disease, endometriosis, outflow tract obstruction, and endometrial polyps or fibroids.A careful history and physical examination are sufficient to diagnose primary dysmenorrhea.Secondary dysmenorrhea may require additional evaluation, including STI testing, imaging studies, and referral to a specialist.

Abdominal Pain

Key Points Functional abdominal pain disorders are the most common causes of recurrent abdominal pain in pediatrics.The Rome IV criteria in 2016 for functional abdominal pain have eliminated the requirement of "no evidence for organic disease"; it now is defined as > 2 months of pain, ≥ 4 times per month, and after appropriate medical evaluation the symptoms cannot be attributed to another medical condition.History and physical examination are the only evaluations required most of the time in a child with abdominal pain.

Proteinuria

Key Points Proteinuria on routine screening of children without symptoms most often is either orthostatic or transient, not pathological. Orthostatic (postural) proteinuria is most common. Transient proteinuria can result from stressors such as fever or vigorous exercise. Persistent (fixed) proteinuria can be asymptomatic, signaling underlying glomerular or tubular renal disease.

Vitamin D Inadequacy

Key Points Treatment Insufficiency or deficiency: 2,000 to 5,000 IU/d, adjusted for ageIf adherence is an issue: 50,000 IU/wk or onetime dose of 200,000 to 400,000 IUPrevention: 400 to 600 IU/d Differential Diagnosis Phosphate or calcium deficiency, disorders of vitamin D metabolism, renal disease Epidemiology Increasing incidence of vitamin D inadequacy

Vomiting

Key Points Vomiting is common in children, with both acute and chronic illnesses.Vomiting is an active process, to be distinguished from passive regurgitation.Not all vomiting comes from the gastrointestinal tract.Be alert to dehydration and electrolyte abnormalities.

Henoch-Schonlein Purpura

Key Points Henoch-Schönlein purpura (HSP) is the most common form of vasculitis in children.It is a small-vessel vasculitis mediated by immunoglobulin A–containing immune complexes and characterized by nonthrombocytopenic purpura, abdominal pain, arthralgia, and renal disease.Diagnosis of HSP is clinical, and no laboratory tests are specific for HSP.Treatment is supportive. Patients with severe abdominal and joint pain may be treated with steroids.Steroids do not prevent renal disease in patients with HSP.Patients with nephritic or nephrotic syndrome have a much higher risk of developing chronic kidney disease and should be referred to a nephrologist.

Weight Loss

Key Points When considering weight loss, consider the possibility of an error in recorded weights.Obtain a thorough dietary history. Consider inaccuracy, especially if an eating disorder is possible.A basic workup should be performed before attributing the loss to mental health. Consider the following assessments: complete blood cell count, comprehensive metabolic panel, C-reactive protein, erythrocyte sedimentation rate, tuberculin test, rapid plasma reagin test, HIV test, tissue transglutaminase plus immunoglobulin A, thyrotropin plus free thyroxine, stool guaiac test/culture/ova/parasites, and urinalysis.Close follow-up is mandatory. Admission criteria if an eating disorder is considered can include less than 75% of the ideal body weight, a supine heart rate less than 50 beats/min, a temperature less than 35.6°C, a systolic blood pressure less than 90 mm Hg, arrhythmia, and orthostatic vital signs.If findings from the workup are negative, attempts to increase caloric intake are insufficient, and an eating disorder is not suspected, refer the patient to a registered dietitian and/or a gastroenterologist.

Enuresis

Key Points Primary monosymptomatic nocturnal enuresis (PMNE) is common in and often outgrown by children. Psychological effects on the child are the main reason for treatment.A thorough history and physical examination are needed to accurately characterize the type of nocturnal enuresis in order to form the most effective treatment plan.Both the bedwetting alarm and desmopressin are widely considered first-line therapy in the treatment of PMNE.

High Altitude Illness

Key Points Individuals traveling to high altitudes (usually to ≥2,500 m) are at risk of developing high altitude illness (HAI), especially if ascending quickly.Acclimatization and slow ascent are the most effective ways to avoid HAI.Acetazolamide is prevention and treatment.High altitude illnesses typically respond to descent, oxygen therapy, or both.