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[ { "from": "human", "value": "Yes, we are alternating ibuprofen and Tylenol every few hours throughout the day which is why the main concern is him getting some rest at night. Delta 8 and 9 are legal in our state. I'm mainly worried about the whole brain still developing at his age thing." }, { "from": "gpt", "value": "if his pain is bad enough he could get a nerve block with a catheter. would make the pain basically gone and he could keep it pretty numb for 3-5 days till a lot of the inflammation is down.You could try paracetamol and ibuprofen first. If his pain is uncontrolled with that then chat to his doctor about your concerns. Opiates can be entirely appropriate for acute pain. Im not sure of the evidence for cannabis for acute pain, especially in children." } ]

[ { "from": "human", "value": "My pediatric urologist wants to put my child under general anasthetics at 6 monthsI am worried about negative impacts this might have on brain development is it possible to have a successful surgery done at 3 years old instead?" }, { "from": "gpt", "value": "3 year old kids get extremely stressed about surgery and will remember both the period before and the pain afterwards. It can be very traumatizing for them.A 6 month old will have no clue what's happening and won't remember.The available evidence suggests that a one off exposure to a general anaesthetic will not have long term implications for neurodevelopment. However your concerns are very valid and you should discuss it further with your paediatrician." } ]

[ { "from": "human", "value": "This! When my kid was 6 months old all he needed to feel better was to nurse. At 3 nothing worked!" }, { "from": "gpt", "value": "It depends on what surgery your child is having on whether it can be delayed that much. What is it?" } ]

[ { "from": "human", "value": "Chordee" }, { "from": "gpt", "value": "He'll be more uncomfortable after surgery at age 3 than at age 6 mo, but there's really not a solid indication to fix that early. For things like undescended testicles, those should be done sooner." } ]

[ { "from": "human", "value": "Was this inappropriate?26M. I recently had a flashback to when I was 15.5 y/o and had regular visits with my pediatric endo. I only have TID, no other autoimmune disorders but my pediatric endo always checked my testicle size during every 3-6 month checkup. Is this appropriate? I'm trying to figure out if this is the norm" }, { "from": "gpt", "value": "Most pediatric endocrinologists check the testicles to see the volume and stage sexuality maturity.Endocrinologists also are heavily focused on hormones, so its well within their training to make sure youre testicles were growing appropriately.What's TID? What were you seeing an endocrinologist for?" } ]

[ { "from": "human", "value": "Sorry, type 1 diabetes" }, { "from": "gpt", "value": "Well apparently high sugar levels can damage your testes, so perhaps? Hard to say" } ]

[ { "from": "human", "value": "Possible seborrheic dermatitis?Pediatric patient 10M, height 4ft, 80lbs, white/black, healthy and has no medical issues, no meds, etc. I was thinking it was just a serious case of dry scalp as it was starting to peel. He's been itching it quite a bit while at school. I mentioned this to the pediatrician and was told to use selenium sulfide (Head & Shoulders), so that is why the scab appears that greenish/blue color. It is raised pretty high. My concern is if he keeps scratching it could lead to an infection. Does this appear to be seborrheic dermatitis? if not what else could it be? Thank you." }, { "from": "gpt", "value": "1 marginal quality image. Seborrheic dermatitis could appear this way as could psoriasis, tinea capitis and many other conditions." } ]

[ { "from": "human", "value": "Thanks, Doc. It definitely could be tinea capitis. I'll keep treating it with selenium sulfide until my appt with the pediatrician next week." }, { "from": "gpt", "value": "You might consider dampening the scalp, using a salicylic acid shampoo and let it stay in place 5-10 minutes, then rinse it off. This may loosen the scale." } ]

[ { "from": "human", "value": "Thank you, Doc. So salicylic acid should work better than selenium sulfide? Selsun Blue and Head and Shoulders have both.Correct, I have been rubbing it in gently and washing it out after 10 minutes." }, { "from": "gpt", "value": "There is no evidence that one active ingredient in these shampoos works better than another for seborrheic dermatitis. I was making a suggestion to help remove the adherent scale." } ]

[ { "from": "human", "value": "Pediatric neurology help. Sudden onset Anisocoria (1.3mm) in 3 siblingsMy 4.5, 2.5, and 6 week old all have Anisocoria. The first 2 measure 1.3mm difference, the third has not been seen.My 4.5 year old was referred after he didnt pass the vision screen at pediatrician (they turn off lights and the kids look in the box with birds chirping.) My 2.5 year old failed same test and was referred. It is noticeable by naked eye with the 6 week old. The older two have previously passed the eye test in years prior. This is the first appointment for both that they failed.My 4.5 year old went to a pediatric eye doctor and he said he couldnt find any other issues. He said he has seen it come and go in kids and even switch eyes. I cant find anything like that on Google. Nothing about it being genetic. He said 1 in 10,000 chance that its a neurological issue because no other symptoms present. My 2.5 year old will go on 10/20. My 4.5 year old will go for follow up on 10/31.I dont know what other actions to take. It is unsettling this popped up in all of them with no answers." }, { "from": "gpt", "value": "I'm not an opthalmologist, but if three children in the same household developed this as a sudden onset issue in the same time period it seems reasonable to consider an environmental trigger or exposure. New medicines in the house?" } ]

[ { "from": "human", "value": "My 10 year old had an allergic reaction Sunday night and still has welts. Is it normal for his body to heal like this?My 10 year old son had an allergic reaction while asleep Sunday night and woke up with his trunk covered in welts. He was taken to his pediatrician and prescribed 4mg Dexamethasone, 2 tabs first day and 2 two days after.His only known allergy are peanuts (severe).He is still getting new welt outbreaks and does not seem to be getting better, but physically feels fine minus the itching.Thanks for your help." }, { "from": "gpt", "value": "The most common causes of hives in a pediatric population is actually a viral illness. If you don't think he's having other allergic symptoms, this could be the culprit." } ]

[ { "from": "human", "value": "5.5 Year Old Severe ConstipationTLDR: 5.5 year old is severely constipated, complaining of major stomach pain, trouble swallowing, and nausea. Shes waking up through the night coughing and crying in pain. Doctors are suggesting 5 cap fulls of miralax and 2 ex-lax a day - Im concerned this is not good for her. Thoughts?Hello! I feel like Im new to the constipation world, but weve honestly dealt with it for awhile now without me knowing how bad this is. My daughter is now 5.5 and we are about 5 months into a severe constipation epsiode. Its taken doctors awhile to help figure out how bad this is, but here we are. Shes struggled with constipation on and off ever since she was born (at 4 months old she would pass stool the size of hard boiled eggs), but I didnt know how bad it truly is. She has always pooped once or twice a day for most of her life, its just the consistency and size of the stool that I was ill-informed about. Here is where we are at now: Since November, she has been complaining that as soon as she eats or drinks, her throat feels tight, feels that shes going to throw up, and her stomach hurts so bad. Ive taken her to the ER twice, doctors at least once a week, and have had multiple X-rays. The X-rays consistently show tons of stool. We officially started doing a clean out method about 2.5 weeks ago doing mirilax, milk of magnesia, and ex-lax. Shes been pooping 5 or more times a day, passing lots of ribbon size or huge logs. But her complaints are continuing and shes eating less and less. She is not afraid of pooping and has no problem making it to the bathroom which is good. Weve missed a lot of school (kindergarten) for this and shes only 35 poundsI cant imagine what this is doing to her long term. The X-ray 2 days ago showed that shes still completely backed up right at the exit of her stomach, her stomach isnt digesting her food well, and her stomach is extended. The pediatric GI suggested to do 5 mirilax cap fulls a day and 2 ex-lax still, for up to 3 months. I just dont feel like this is safe for her, how little she is, how little shes eating, and how much pain this is causing her. Im no doctor, which is why Im turning here. Of course the stomach aches are now worse and shes in tears on and off all day. I, personally, have IBS with diarrhea so I have no experience on how to deal with this and asking for all the tips. We have been dairy free for a month, and Im not yet going to try gluten free because I do want her tested. We have only been talking to a pediatric GI on the phone through our regular doctor because her appointment is still a month and a half away (we had to wait almost 2.5 months to get in), so further testing hasnt started yet as to why we are in this mess." }, { "from": "gpt", "value": "I would agree 100% with the pediatric GI given what you say here. Long-term constipation like this causes her bowels to dilate (become larger) at baseline. That distension causes her to have less sensation of when she needs to go. Those nerves in her gut can retrain themselves, but it takes months, so it's important that she get fully cleaned out and stay that way while the retraining happens.If the dairy-free diet is helping, you can continue, but if you don't see a huge difference, it's fine to re-introduce dairy. Most pediatric constipation isn't due to a food intolerance.https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/Constipation.aspx" } ]

[ { "from": "human", "value": "Pediatrics, please!Hello! Worried Mom here.Patient is 5 years old (almost 6). He weighs 35ish pounds and is in the 90th percentile for height. He is a picky eater, but there has been no loss of appetite.His symptoms are diarrhea. I believe this is from lactose intolerance (his dad has the same issue) because the worst episodes are after he consumes anything that could contain lactose.What I am concerned about are the dark circles beneath his eyes that have developed lately. These two symptoms (diarrhea and the dark circles) pull up neuroblastoma when I Google (I know, no Googling). I had a friend whose child had this so it hits a little closer to home, but I know its rare.He has an appointment Monday. Should I push for tests? Or is it probably just lactose intolerance and allergies/lack of sleep and I am just freaking out as a Mom?I do have health anxiety that is being dealt with by a professional- counselor and medication - but every time my children are sick I always jump to cancer.Thanks for any advice!" }, { "from": "gpt", "value": "More concerning that he's not hydrated well, or very tired. Neuroblastoma, just...no. Not up high on the differential at all." } ]

[ { "from": "human", "value": "What to expect from a pediatric UTI examFemale Age 5 Weight 42 lbs Symptoms started this morning Occasional burning sensation when urinating Frequent urge to urinate No current medications Exam scheduled for tomorrow morningJust wondering what to expect by the exam. Mostly which areas will be examined and the manner in which it is done. I want to be able to protect my daughter and be able to spot any predatory behaviors." }, { "from": "gpt", "value": "I'm assuming you're asking whether a genital exam will happen. May depend on the physician. Some girls that age will complain of \"burning\" with urination and not have a UTI, but instead have a yeast infection or vaginal irritation that is causing the symptoms, so I do often do a genital exam unless they have symptoms like fever that make me more certain about a UTI.Genital exam in a prepubescent female would consist of often getting into a frog-leg or \"butterfly\" position while lying down or sitting back. The doctor may spread the labia majora slightly to get a view of the urethra and assess for redness or discharge. There should be no touching of other structures.If you don't feel safe with your pediatrician, time to find a new doctor. A good doctor should always welcome you asking questions and asking for an explanation before they do an exam." } ]

[ { "from": "human", "value": "Thank you for the very helpful reply! Im glad you specified what the exam would consist of that was exactly the response I was looking for.Its not so much that I dont feel hes safe or a good doctor, more that I want to be aware. I feel that asking someone involved in the situation with more knowledge than I puts them in a position of power where they could just claim what theyre doing is normal.But again its less the doctor and more about me being suspicious, paranoid, and protective." }, { "from": "gpt", "value": "No problem!" } ]

[ { "from": "human", "value": "Pediatric impetigo or something else?Age: 5Weight: 43 lbsRelevant health background: Hes very picky with eating due to some sensory aversions, so he ends up eating a bit of a lopsided diet and barely eats any proteins. He takes multivitamins with iron and no other regular medications. We are in the US, and he is up to date on his vaccines.Maybe relevant maybe not: We live in an area that has brown recluse and black widow spiders. I havent personally seen any. This also began his very first week of Kindergarten. A cough accompanied it, but to be honest my son has a cough 80% of his life.TIMELINESept 2 - My son comes home from Kindergarten and tells me he has a bug bite and his leg hurts. I dont think anything of it, were driving when he tells me this so I dont immediately look.That evening, I see it when giving him a bath. It looks like a bug bite. I put a bandaid on it.Sept 3 - The bug bite is irritating him. Hes scratching at it, I replace the bandaid and give him neosporin.Sept 4 - When I remove the bandaid, the wound has grown considerably. This is the first time I take a photo. Now Im wondering if this was a spider bite. I put some neosporin on and leave it without a bandage Photo: https://imgur.com/a/rB1KJ7BSept 5 - The next day, it looks a bit larger, and with some dots surrounding it. https://imgur.com/a/QdcVImZSept 6 - No change, didnt photographSept 7 - We go to the zoo and he immediately begins complaining about his legs being soooo tired. He was excited to go to the zoo so this was unusual. He whined the whole time and insisted on being carried (hes 5, this is not typical). When we get in the car, he immediately falls asleep. This is important because he had not napped in THREE YEARS. He dropped his naps when he was 2 and never napped since. When we get home, his legs look a lot worse. Not only that, the little bumps around the area have begun popping up all down his back, shoulders, everywhere. https://imgur.com/a/bbCGtFVSept 8 - We visit his pediatrician. He takes one look and diagnosis impetigo. Hes very confident in this. Prescribes topical antibiotic and oral antibiotic for a week. Said he was fine to return to school as long as the wounds werent weeping.Sept 9-16 - The rapid progression stops almost immediately and it begins to heal after about 48 hours on antibiotics. Things are looking good! All my fears of flesh eating bacteria and so on start to go awaySept 21 - Another small sore pops up on the same leg, near his hip. Im immediately suspicious of it, and dont want it to progress, so we go back to the pediatrician the same day.She says it doesnt look anything like the others, and to just keep using the antibiotic ointment, but to add a daily bleach bath (1/4 cup bleach in a tub of water) to help ward off the bacteria living on the skin. She says impetigo is just staph or strep that found its way into a wound and is irritating it, so we just need to keep his skin clean. So we start that.MAYBE RELEVANT - She notes his tonsils are large and does a rapid swab for strep, which is negativeSept 28ish - He has a scrape. Its on the OTHER leg. Hes adamant that he fell and scratched it. We believe him and leave it alone.Oct 1 - Its considerably larger but he also keeps scratching it so were not sure what to think.Oct 2 - We took a walk today and he began complaining that his legs are sooo tired (I cannot stress enough what a hyper boy he is his legs are NOT tired). We go home and that other leg looks IDENTICAL to how the original looked. I go to the urgent care and insist on a skin swab, which they do but since theres no pus, they cannot guarantee accurate results. They prescribe 10 days of Cephalexin but say theyre just not convinced its bacterial. They said it just doesnt look like anything they can readily name.https://imgur.com/a/cObh69dI am worried because it seems to be jumping around his body, made worse by walking/warmth, and hurting his legs more than topical wounds should. I also cant shake that the cough is still there.I also feel dismissed when I repeatedly ask if the cough and exhaustion could be related to his wounds.What do YOU think?" }, { "from": "gpt", "value": "Cephalexin is unlikely to be successful at treating a Staphylococcal impetigo. Treating that requires either Bactrim or clindamycin." } ]

[ { "from": "human", "value": "So do you feel it looks/sounds like impetigo? If it is, would the swab they took today tell me what bacteria its originating from?" }, { "from": "gpt", "value": "The photos remind me of a bullous impetigo in which the bullae have opened. A culture of the affected skin without fluid from an intact bulla would not show this; the diagnosis is a visual one. Non-bulbous impetigo is Streptococcal, but bullous impetigo is Staphylococcal and one must always treat for MRSA." } ]

[ { "from": "human", "value": "(Almost) 4yo Boy, Many Symptoms, No AnswersBorn 3/2019.Waking up at night from a dead sleep with leg pain for nearly a year now. Happens once or twice a month usually. Right leg more frequently. Chalked up to growing pains. When he wakes up, give him Tylenol, get the heating pad out and wrap his legs. Rub his back and he falls asleep. Seems fine in the morning. Sometimes has complained of pain during the day, but could be a ploy for medicine. Points to his shins, knees, and thighs as sources of pain.Complains of headaches occasionally (I've never even heard the word, \"headache\" come out of his older brother's mouth). Goes away with Tylenol.Was vomiting a lot last year. I started tracking and the average was 1.5x a month. No fever or other symptoms; would complain of nausea, boot, then be back to normal within an hour. Went to pediatrician on 8/19/22, she recommended we go to the ER because we could get all testing done rapidly and at once. Went to ER, had bloodwork done (normal at the time, no cancer markers), was diagnosed with cyclical vomiting syndrome. Debated on whether to do a CAT scan or MRI, opted to not. Has only vomited 1x since then, was this past October. Not much nausea or vomiting since.Swollen lymph node in armpit and back of neck, both on left side. Just discovered armpit one today. Neck node has been enlarged for over six months. No biopsy, superficial exams by multiple doctors, all advise this is normal and not a concern. Soft, movable, and less than 2cm in size. Hasn't grown.He often just looks pale compared to the rest of the family (we are white, British decent), but could be chalked up to recent rainy weather and being stuck indoors for winter. He also seems thinner than the rest of us, just bonier than his older brother was. Always craves sweets. Weight and height are good, around 70th percentile.I found swelling in the back of his knee four weeks ago. Right posterior, left of the popliteal fossa, about the size of an avocado pit. Puffy, not hard. Took him to the pedi two weeks ago, and she said likely a cyst, but referred me to an orthopedic surgeon for further evaluation. Have appointment this Friday to get it checked (she said probably an ultrasound). She also checked him for a wet cough that he's had for over two months. Said she heard crackling in his lungs, prescribed inhaler, doesn't seem to be helping, will have a follow up next week to check his lungs again. Cough is annoying, but not really impacting day-to-day activities. Still very active and happy kid.Went on a long walk today and he woke up again with knee pain, said only right one hurts. Did the usual late-night treatment and now he's asleep.I am debating on whether to take him to the ER again. Our firstborn was healthy as a horse, never in the ER and sick with typical symptoms. I don't want to be too overzealous with an appointment coming up, but all of these symptoms just have my mom radar screaming there's something really wrong with him. I assume the ortho won't do another blood panel at the time, so it'll be a referral if they find something wrong. I just don't know if I want to keep dragging out discovery appointments for the next few weeks vs. going to the ER and asking for the gamut of tests.Any feedback at all is appreciated. We have a PPO and are financially stable, so cost isn't an issue." }, { "from": "gpt", "value": "I've usually noticed that when your mom radar is screaming, it's better to take your kid to the ER. The symptoms you have mentioned could be due to a viral infection, but I'm still perplexed as to why the doctors decided against the CT or MRI and did they perform abdominal Ultrasound?. Also , cyclic vomiting syndrome can cause dehydration, lethargy , pallor, and muscle weakness. I hope he's taking his fluids well." } ]

[ { "from": "human", "value": "The ER doc and a random physician's assistant both advised against the CT (radiation unnecessary) and MRI (would require sedation) because it would be invasive and likely unnecessary given the results of the blood panel we got this past August. He already had the swollen neck lymph node by that point, but it was dismissed as normal. No one spoke of an abdominal ultrasound at all.He hasn't had a vomiting episode in a while, which I'm grateful for, but he is a very finicky eater. Often says he's not hungry or full, but I try not to stress because his weight and height have been increasing on the right trajectory and he's at the 70th percentile.The tone I perceive from doctors is that I'm overreacting because this is my \"baby\" and there's nothing wrong with him, but it's just such a stark contrast to his older brother. I think I'm pretty laid back overall as a mom, but this has me questioning myself. Thanks for the two cents." }, { "from": "gpt", "value": "You are welcome. Usually, CVS is triggered by a stressor or a food . Has your pedi advised you to keep a diary to identify it ?" } ]

[ { "from": "human", "value": "Nope, same deal, no mention of keeping a diary. I was essentially told that he'd probably grow out of it, not to worry if he wasnt losing weight. Based on your matrix, I would define it as mild now. He recovers fast and the issues were really confined to early/mid 2022." }, { "from": "gpt", "value": "Maybe he was under some kind of stress at that time , you never know with young kids. But it's good that it's resolved now. The enlarged lymph nodes , in my opinion , need to be investigated, most probably it's due to a viral or bacterial infection, and there's no harm in repeating tests so if antibiotics are needed , they can be given at the right time." } ]

[ { "from": "human", "value": "I'm just a layperson, but I feel like if it was me I'd 100% rather random people/doctors think I'm crazy than my child feel like I don't hear them/don't care that they're complaining of pain or sickness." }, { "from": "gpt", "value": "It's a very helpful matrix for cyclical vomiting syndrome. Though it's more relevant to the doctor treating the patient , I think it also provides good information to the patient or on your case parents." } ]

[ { "from": "human", "value": "We were prescribed Topiramate, but I haven't had to use it since October 2022." }, { "from": "gpt", "value": "Topiramate has a very good response in pediatric CVS." } ]

[ { "from": "human", "value": "I have really appreciated your responses so far! Do you have any thoughts about the knee swelling/cyst and night pains?" }, { "from": "gpt", "value": "Night pains could be growing pains, or it could be the popliteal cyst or lymph node compressing a nerve. Usually, with an enlarged popliteal lymph node / cyst and neck ( cervical ) lymph node , I'll go for complete blood work and monospot test ( to detect mononucleosis/ Epstein Barr Virus ). Chronic bacterial and viral infection can lead to the enlargement of lymph nodes in kids ( also called lymphadenopathy ). It also happens in upper respiratory infection ( and if your pedi wants to explore further , I think they should go for a chest X-ray). Another thing that I'll always do will be the abdominal palpation to rule out enlarged spleen. In your kid's case , I'm still leaning towards the infection because he's otherwise healthy." } ]

[ { "from": "human", "value": "He was home for most of the covid lockdown years (we were in California and very restricted), so he was never sick or exposed to immune stressors for over two years. It seems like since he started daycare in late 2021 it's been nonstop illness. We've had head colds, stomach viruses, covid, flu, roseola, hand foot mouth, etc, you name it. Would this onslaught of viruses cause lymphadenopathy? Could it cause unexplained vomiting too? The vomiting occurred without fever and far enough from the stomach viruses and roseola to not be linked, I think.We decided to skip the ER and will see his pediatrician this week. I'll ask about the spleen/mono and push for more tests to explain the swelling nodes. Thank you so much for at least putting me at ease regarding worst case scenarios. Let me know if you'd like an update after we get results. I have no idea why you were so helpful to an internet stranger, but I sure do appreciate it!" }, { "from": "gpt", "value": "Thank you so much for your appreciation. As a physician , it is my duty to help a patient in any way I can. You are right about the non exposure of viruses during lock down, because kids didn't have the opportunity to develop any immunity to them, and hence, the flu is more severe than before. I'll definitely appreciate an update, and I hope everything will turn out alright.Different physician, but I am not concerned about the leg pain. The lymph nodes need to be investigated at some point soon, but not necessarily tonight. You relate reassuring characteristics about them.The big tell for leg pain is whether they want them rubbed or not. Pathologic leg pains don't get better with touch, and kids flinch away: tumors, fractures, arthritis, osteomyelitic infection, chronic inflammation, all of that is not something that gets better with being rubbed. I don't think I've ever seen something worrisome in the legs causing pain that was better with rubbing." } ]

[ { "from": "human", "value": "This is so very heartening to hear! I opted to skip the ER today. Will see pediatrician this week to re-examine the cough/lymph nodes. I'll wait for the ortho appointment this Friday. He definitely wants those legs rubbed!" }, { "from": "gpt", "value": "I will be thinking of you and hoping for the best. Please let us know how it works out." } ]

[ { "from": "human", "value": "Thank you, will do! Did you happen to see the comment above about Celiac Disease? My mother has it, I do not, but I do have issues with carbs in general. Would a sensitivity like that account for the leg pain and immune response? Vomiting and paleness?" }, { "from": "gpt", "value": "Celiac can certainly present in a variety of ways. We used to look for a very limited constellation of symptoms, but then it became recognized that -- for example -- it can come with constipation, not just diarrhea.My comment was intended to be reassuring about pathology in the legs themselves. I think what you related is reassuring from that perspective. Whether he could have cramping from an electrolyte imbalance or nutritional deficiency secondary to celiac disease? It should be possible. Thankfully there is relatively definitive testing to rule in or out.I hope you get some answers for your little tyke soon." } ]

[ { "from": "human", "value": "ENT surgeons - would you do pediatric supraglottoplasty and/or remove adenoids?My baby is almost 5 months old, scheduled next week for endoscopy & bronchoscopy - the ent surgeon wants blanket consent going in for supraglottoplasty and removal of adenoids if indicated.On sleep study around 2.5 months ago, baby had a significant number of hypopneas (approx 27 times per hour) and 5 apneas (total) without a decline in O2 sats for either. Oxygen and carbon dioxide levels remained stable/good throughout duration of study. (Baby was not on supplemental oxygen during the study.)Baby has no noisy breathing, no feeding concerns (weight has gone from < 1 percentile at birth to currently 7th percentile) and is hitting all developmental milestones.Baby was IUGR, born at 5.5 lbs at 38 weeks. Released from hospital on day 3. Baby had trouble holding o2 sats at 2 weeks old, and was put on oxygen. Has remained on .5 liter since. A pulmonologist and the ENT doing the procedures both said the baby could come off of oxygen based on the sleep study, however the pulmonologist who initiated oxygen treatment in the hospital wants to continue until after the procedure.Since the study, baby is sometimes off of oxygen during the day and o2 levels hold stable. I also see significantly less startle during sleep. In my opinion, his condition is improving, and if I understand correctly a high number of babies outgrow apnea and laryngomalacia (what theyre looking for, not currently diagnosed).Looking for outside thoughts on this before deciding how to proceed." }, { "from": "gpt", "value": "There's not enough information to definitively say what the correct course is, and we can't look at any further evaluation that has been done. Your child has severe sleep apnea based on the reported AHI, has an oxygen requirement, and by definition had failure to thrive while being <5th percentile for weight. One thing not commented on in this post at all is how feeding has been going, if there is tiring during feeding, desaturations during feeding, and how noisy the baby is when agitated and how noisy when sleeping. These can also all point to whether laryngomalacia is a potential cause.These all indicate at the very least that an evaluation of the airway is necessary, and it is reasonable if there are significant issues to correct those issues and minimize the need for further procedures." } ]

[ { "from": "human", "value": "Thank you for replying!I tried to address some of those things in my post. It sounds like I wasnt clear, so Ill try again.Ive been told by 2 different doctors that he no longer has an oxygen requirement, however the initial doctor who began the oxygen wants to keep him on it until the scopes.Baby is not failure to thrive. He was born less than 1 percentile due to IUGR. He is currently in the 7 percentile. He has been growing and gaining weight consistently along his curve. Weve seen GI and several nutritionists and feeding specialists (the specialists here see in co-managing groups) and everyone is very happy with how he is feeding and how he is gaining.He does not have, and has not had, any feeding issues. No tiring during feeds. No sweating. No desats during feeds. He has a bit of reflux, which GI said is normal and needs no treatment.There is no noisy breathing when agitated. He is not noisy during sleep.The impression Ive gotten is that laryngomalacia is being looked at as a possibility due to apnea. I also understand that typically oxygen drops during these events, and his did not. I think I was seeking some opinion on this in my post, though I wasnt clear. Can apnea be the only symptom of laryngomalacia requiring treatment?I absolutely think the scopes are necessary. Im totally on board with looking. I think this is why Im feeling challenged in giving blanket consent to cutting going in, though. To me, based on the research Ive done, it doesnt sound like he has other symptoms of laryngomalacia.I was hoping I might get additional insight here, and perhaps even find other pathways to research and explore. I appreciate you taking time to respond!" }, { "from": "gpt", "value": "Generally laryngomalacia is associated principally with noisy breathing and feeding difficulties. It is possible to have severe enough laryngomalacia that the loss of tone is resulting in the apneas/cessations of breathing, this would be called sleep-dependent laryngomalacia which is becoming increasingly recognized in the last few years.The true fact of the matter is there is a 5 month old with severe sleep apnea who is working on growing. Sleep apnea has significant impact on children and can impair development.It is also unclear if a scope examination has been done while the baby is awake (through the nose) to see if there is any evidence of laryngomalacia as this can often be apparent at bedside as well. The caveat to this would be sleep dependent laryngomalacia wouldn't be (because baby isn't asleep)When I was at a children's hospital and worked with some people that did blanket consents like that, it didn't always mean that the surgery would be performed, only if there were findings concerning enough to warrant the intervention. You have the option to talk to the surgeon and ask they call you before performing the procedure or discussing what they find. I've done that with plenty of folks. That being said, a supraglottoplasty is very well tolerated overall and those kids do tend to do much better." } ]

[ { "from": "human", "value": "Dr.'s office is closed but I plan to call them tomorrow to verify... but I'm curious. My kiddo, 9F 29kg was prescribed pills instead of suspension because there is a shortage here, but it seems like she was prescribed an adult dose- 875mg every 12 hours, which works out to just over 60mg per kg per day. This seems to be roughly double the recommendation for children under 12.... source here: https://www.drugs.com/dosage/amoxicillin.html#Usual_Pediatric_Dose_for_Tonsillitis_PharyngitisThe diagnosis is scarlet fever, rapid strep test came back positive. I'm considering giving her half a pill tonight, or maybe just waiting until tomorrow when I can verify dosing with the doc. Do I have other options? Is there a better site for dosing information? I don't want to be the stereotypical \"dr Google\" but I know how EHR's work and I wonder if the system goofed when the med was switched from pediatric suspension to pill form, and I don't want to give my kid unnecessary diarrhea or whatever other nasty side effects might come from too strong a dose." }, { "from": "gpt", "value": "They may have missed that we max out the dose of amoxicillin at 500mg twice daily or 1000mg once daily. I think it's fine for her to take a single dose of the 875mg tonight, then call them in the AM to see if you can get 500mg tablets instead.https://www.cdc.gov/groupastrep/diseases-hcp/scarlet-fever.html" } ]

[ { "from": "human", "value": "Please can anyone tell me what is in the predmed given before UK pediatric surgery -to help calm and sedate my 5yr old before GA. Thank youAgeSexHeightWeightRaceDuration of complaintLocationAny existing relevant medical issuesCurrent medicationsInclude a photo if relevant" }, { "from": "gpt", "value": "I'm not in the UK but in Germany, yet I doubt the colleagues use vastly different medicines.We typically use the short-acting benzodiazepine Midazolam, which is also available as a sirup (ideal for kids). Alternatively, Clonidin can be used." } ]

[ { "from": "human", "value": "Can I still visit a pediatric doctor although i am 2121F. Height: 159 cm. Weight: 47kgs. South Asian. Although i am 21 i literally look like a 12 year old. I look very skinny and petite. I almost always have been since age 7-8. I won't say i eat the healthiest diet in the sense i most of the time remove onions and tomatoes out, other than that I eat ample amount of food. I literally am not gaining any body mass other than my tummy lol. I have a very thin and petite body frame. I was thinking of approaching a pediatric doctor unless it didn't improve till 18/19 but then COVID hit, can I still visit one, or that won't be appropriate given I am 21 now. Or should I visit some other doctor?PS.: I also got my thyroid levels checked and it were normal. What could be the cause? Where do I start from" }, { "from": "gpt", "value": "If you have a pediatrician as your primary care doctor, they may continue to see you until some point. If you dont have one, setting up with a pediatrician makes no sense and most would decline to start with you. Size and appearance are not the distinction between pediatric and adult medicineas pediatricians are fond of saying, kids are not just small adults. You should see an internal medicine or family medicine doctor.Your BMI is within the healthy range. Are your parents and other relatives thin? If so, without any symptoms its very likely just genetics." } ]

[ { "from": "human", "value": "Was I molested by my pediatrician? / Is this normal for a pediatric exam?This is going to be all over the place so I'm sorry for that.All I remember was being 14 and being at the pediatricians. I kept saying no. My Mom was in the room and kept saying yes. So my underwear was down and my knees were bent and I was sobbing and my male pediatrician spread my labia just to \"look\" (with his hands). I was sobbing and saying no and I was ignored.I've talked to various crisis types of hotlines including RAINN and personally found them of no help." }, { "from": "gpt", "value": "An external genital exam is part of a normal physical exam in child. I seriously doubt your pediatrician was doing this exam for some sexual purpose. However, I wouldn't force an exam like this on a crying kid, particularly an older kid with a sense of agency, unless it was medically necessary.Many pediatricians will limit their external GU exam on older girls to simply looking externally at labia, to assess pubarche. Doing an external while spreading labia is less common a \"check up\", unless there's a specific complaint like discharge, itching, rash, whatever. On the other hand, boy will typically have their testicles palpated looking for masses, hernias, varicocele, and assessing normal testicular development.Nobody here can say if the specifics of what your pediatrician were definitely appropriate in the circumstances, but an external GU exam isn't uncommon, and isn't \"molestation\" in and of itself. But it's something where assent from a 14 y/o girl should be obtained." } ]

[ { "from": "human", "value": "Sorry in advance for the long post!My 8 year old son has had significant trouble with bowel training since initiation of potty training in general. What I believe started as an aversion to pooping due to distraction or not wanting to miss out on anything exciting while he was on the toilet, evolved into chronic constipation and an aversion secondary to pain. This was initially treated with Miralax and pushing fluids. However, he continued to have various amounts of poop in his underwear on almost a daily basis, and struggled with having regular bowel movements, alternating between small pebbles to impossibly large logsBecause he spends half of his time with his father and half with myself, there have been some inconsistencies in addressing this. I recently had a long discussion with his father and we decided to give an impaction appropriate dose of Miralax to encourage complete emptying and then start on a consistent maintenance dose at both houses. Admittedly, we had both dropped the ball on this. My concern now is that my son has recently had a couple of episodes of full on incontinence while out running errands. When I talked to him about always letting me know he has to go so we can find a restroom, he explained that he does not feel and urge to go, and only realizes what has happened when he feels it in his pants. I recognize that prolonged constipation can decrease urge sensation and believe this is what has happened. I do think this is still a tiny bit related to not wanting to stop what hes doing and sit on the toilet for the appropriate amount of time to have a big poop. All of that background is basically to ask, should I seek out a pediatric GI specialist? Or is this something that can be solved by going back to the potty training basics (timed toileting and having him sit on the toilet for a while). Is Miralax an appropriate choice for his age/symptoms? Does this warrant a consult with a therapist? Of note, I am aware that some of these symptoms can be a trauma response, however I am very confident that is not the case with him. Despite our divorce, my ex remains a caring father to both of our children, and neither child is left in the care of any suspicious characters. Any guidance would be greatly appreciated!" }, { "from": "gpt", "value": "Probably appropriate to see a peds GI at this point. The starting outcome will likely be Miralax and timed toileting, but it's good to make sure nothing else is going missed." } ]

[ { "from": "human", "value": "what to expect at pediatrics?16yo female. went to the doctors complaining about stomach issues, they took my bloods and done a checkup and nothing came back wrong.they made an appointment in the hospital for the pediatrician and im quite nervous." }, { "from": "gpt", "value": "A talk with you and your parent, and a physical exam. Any particular thing youre worried about?" } ]

[ { "from": "human", "value": "Pediatric lower back painMy son broke his hip 4 months ago. He was non weight bearing for over 2 months. His doctor released him 2 weeks ago. His PT said his left side is super weak and lost muscle mass. He has a slight limp which the doctor said would get better with time. My question is, when he tries to run eventually his lower back starts to hurt. Could this be just from weak hip/ back muscles or some kind of muscle imbalance throwing things off? We are keeping a look out for hip AVN but OS told us that would cause hip pain and groin pain, not back pain. Any insight be help.Please" }, { "from": "gpt", "value": "Could certainly be the weakness in his leg altering his biomechanics. That said, how did he break his hip? If there is any concern for a back injury that went unnoticed, discuss with his doctor." } ]

[ { "from": "human", "value": "We had a sledding accident. Im pretty sure they did a full trauma work up at the hospital. All sorts of X-rays. Couldnt they have seen something then? It all started after he started trying to run and stuff, which is why it makes me think its muscular imbalance?" }, { "from": "gpt", "value": "Yes, I'd be very surprised if they didn't catch something more serious. The back pain should improve as his gait and running stride normalize, which PT can help with." } ]

[ { "from": "human", "value": "Good sub for pediatrics?The sub r/pediatrics isnt for medical questions. Im trying to find one thats appropriate.Ive got a sick four year old who has been fighting a sinus / ear infection for weeks, even after seeing four different doctors. So Im looking for a group with some potential SMEs or at least other parents who have been down this road." }, { "from": "gpt", "value": "Yes, there are a number of pediatricians, peds-EM docs, and a neonatal NP active on this sub." } ]

[ { "from": "human", "value": "Worried about my dads cardiac cath resultsMy father is a stubborn mule of a man, and I need to know if Im right in pushing this issue until he gets the care he needs. I am a pediatric ICU nurse, so adults are not my thing.My dads history: 63yo male, normal BMI, moderate physical activity 5 days a week, former smoker x 30+ years (quit in 2017 when my son was born). He takes Repatha, losartan, baby aspirin, and ambien (he works nightshift & sleeps during the day). Generally healthy and active, only pmhx is high cholesterol (we are Cuban and he eats a very high fat diet and a lot of red meat), and two stents placed in 2017. Extremely extensive family cardiac history as follows (this is tough to keep track of so bear with me):His father: quadruple bypass, 5 TIAs then full carotid blockage, heart attack = died in 10/2014His mother: quadruple bypass, years later had MI & stroke = died 4/28/2008Brother #1: quintuple bypass in his 40s... died of heart attack in his sleep 5/2019 @ age 58Brother #2: stent in his 40sSister: MI (widow maker) & triple bypass 4/2019Brother #3: 3/2023 bilateral carotid 90% blockages, persistent A-fib.And those are just his immediate family. That history extends to every branch of uncles & cousins as well. They should give us a discount for buy two get two bypass at this point.My dad recently went for his annual cardiac appt and failed his stress test (he was unable to complete it) so they had him go for a cath. That revealed 100% blockages in several areas (diagram drawn by his doc here: https://imgur.com/a/0adwYqA ) but they didnt perform any interventions. The doc said theyd have to compare this cath to the one he had in 2017 to see the changes and decide how to proceed, but that he felt ok just watching things for now. His next appt is in June, and my dad seems to think all is well. He said oh it went fine, they told me my body made other pathways for the blood to flow. Ugh.I am alarmed. Cardiac isnt my specialty, but wouldnt this warrant a double bypass? Isnt his personal and family history enough to be more proactive with intervention? I was very close with my uncle and he passed away in his sleep just months after a normal cardiac exam. I dont want the same to happen to my dad, and Im concerned that hes heading towards a major event. Any insight? Am I right to want to push him to follow up on this immediately? Thank you." }, { "from": "gpt", "value": "So obviously your dad has significant coronary artery disease. The family history at this point (which is ridiculously extensive) doesn't really matter since we know his anatomy.It looks like his left main coronary artery and left anterior descending artery (LAD) are open. His right coronary artery is blocked but past this it presumably backfills from the LAD through enlarged (collateral) vessels that wrap around the apex of the heart. This is why he had a positive stress test - with enough exertion the oxygen demand is too high for the left side to keep up.Almost all of the benefit for a coronary bypass procedure is with patients who have significant narrowing of the left main coronary artery or both of the immediate downstream arteries. These feed a large portion of the heart muscle, and not just your dad but anyone does poorly if they are blocked.However when these are open, which is the case here, the benefit is less clear and this is doubly true in the absence of significant symptoms. A left sided graft may not even stay patent in this setting, since there is competitive flow down the LAD. We would not usually do a bypass just for right coronary disease, the benefits do not appear to outweigh the risks in this scenario.The other blockages are being backfilled by the open arteries, and unless he develops new symptoms then medical management is at least as effective and safer. It isn't that the blockages aren't a concern, it is whether bypassing them is beneficial. In this case if it were my dad I would prefer aggressive medical management and lifestyle changes as much as possible." } ]

[ { "from": "human", "value": "This is an incredibly thorough reply, thank you for taking the time to explain all of that. My clinical brain cant function because all I can think about is getting another phone call and it being about him.So if Im understanding correctly, it sounds like the collateral vessels are more effective than I assumed. Hes a pretty active guy, is there danger if the left side cant meet the metabolic demands of the heart during exertion? Any risk of right sided ischemia?Ill be joining him at his appointment to take notes and make sure hes compliant with those lifestyle changes. He still thinks this is all routine and not a big deal. Your reply is helping me catch my breath a bit, so thank you again." }, { "from": "gpt", "value": "Yes the collaterals are presumably well-developed. The danger from over exerting himself through exercise isnt of much concern, he would be symptom limited well before there was irreversible damage. Other issues like sepsis could put some strain on the heart but unlikely to cause any sizable infarct.He needs to really maximize the medical management - strict risk factor control with high-intensity lipid lowering therapy (doesnt matter if cholesterol is high) and tight monitoring of blood pressure. If there is a hint of diabetes one of the newer agents also would be good.The medicines actually work quite well combined with lifestyle changes. CABG and stent are more bailout procedures if a lot of heart muscle is threatened by very narrow arteries, which is not the case here." } ]

[ { "from": "human", "value": "Pediatric low Creat level - Doctor ignoringMy 3 year old daughter went in for her check up/blood work, and has a .3 level of Creat and and 240 alphosi test results. The doctor is entirely unconcerned about this, but what Im reading on line makes me worried. Should I be concerned? If yes, what are immediate next steps I can take.Thank you in advance, Worried Parent" }, { "from": "gpt", "value": "I cannot think of a situation in which a low creatinine in an otherwise healthy child would worry me." } ]

[ { "from": "human", "value": "Is there anything to be concerned about with the high level of the alkphosi?" }, { "from": "gpt", "value": "Probably not, but thats something to ask the pediatrician" } ]

[ { "from": "human", "value": "NAD but I understand that higher alkphos in children is considered normal because of bone growth. Could be the kiddo just had a growth spurt. Alkphos is an enzyme found in bones, liver,kidneys, digestive tract. Def talk to your pediatrician so they can ease your worries." }, { "from": "gpt", "value": "Those are both normal results for a patient her age. The doctor is ignoring them because your lab likely has a reference range that's for adults, not kidsThe creatinine level roughly reflects the muscle mass. Normal for kids is always low. If it's \"normal\" for a kid, I look twice and think about things.High alk phos (alkaline phosphatase) level in kids is almost invariably correlated with a low Vitamin D level. It's more typical these days to have a low Vitamin D than not, at least for kids. Maybe it's all the sunscreen plus much less non-screen time. Fewer sunburns but lower sunshine. I don't know that we have good guidelines for what to do with vitamin D levels these days, but if you wanted to pursue something, that would be it. Or give her a multivitamin with at least 400 IU of Vitamin D and consider rechecking in the spring.I'm curious, though -- we usually don't check these labs as part of routine blood work. There's the CBC or hemoglobin level, and lead, and then lipids and diabetes (but only for children at particularly high risk). Do you know what the physician was looking for, or why they were checking extra things?" } ]

[ { "from": "human", "value": "Dont worry- I totally believe in them and support vaccination.Im an infant/toddler nanny, and have been working with them for over 20 years. Today I encountered something new.The Little One I take care of (18 month F) got a couple of shots today. The pediatrician advised her parents not to use Motrin or Tylenol for fever or discomfort unless her temp goes over 103.5 or she absolutely cant sleep. The reason given was having a fever and letting it do its thing means she will have a greater immune response from the vaccines. (These were standard 18 month shots- not the COVID vax, for what its worth. She has gotten the first 2 COVID shots- waiting on the 3rd next month.)I have never heard this before. Can anyone weigh in on this? Sounds crazy to me, but Im not a doc." }, { "from": "gpt", "value": "Current data is a bit conflicting from studies Ive read, but I generally caution against prophylactic use of antipyretics because there is some evidence that it blunts the immune response.Use of antipyretics about 4-6 hours post-vaccine have shown mixed results in terms of immune response but generally patients still gain immunity. Id rather have a happy patient and family that returns for all vaccines than tell them not to give Tylenol/ibuprofen. I try to make sure they wait 4-6 hours though before the first dose if it is needed. We have multiple doses of most childhood vaccines, so its likely there wont be an issue with immunity, even with Tylenol/ibuprofen post vaccine." } ]

[ { "from": "human", "value": "Thank you so much. Ive just never heard this before, and Im always open to learning! We obviously want her to get the best results she can from them, but we also dont want her to be needlessly uncomfortable. She made it through to nap time comforted with snuggles and her favorite lunch, and we plan on letting her play in the tub this afternoon to soak the bandaids off her legs.Thats another question- is there a legit reason to put bandaids on after shots? Ive never seen more than the tiniest drop of blood on a bandaid after a child gets a vaccine, but they are so hard on their legs. They stick super hard, and she tends to get little welts where the bandaids were. She also cries now anytime she sees bandaids bc they hurt so much to take off.Are they needed? Is it to prevent infection? To put pressure on the injection site? We would MUCH rather just have the tiny drop of blood on her pants than go through this every time- but if theres a legit reason Id love to know about it.Thanks for taking the time to give an answer. Its much appreciated!" }, { "from": "gpt", "value": "No, no good reason for the bandaids other than the drop of blood and to prevent them from messing with the area immediately after.It's not evidence based. https://journals.lww.com/ebp/Fulltext/2021/03000/Does_premedication_with_ibuprofen_affect_the.19.aspxThose meds can reduce immune response but not uniformly and the immune response is still enough to be protective at minimum. There's no basis for that fever number that she picked. Delayed acetaminophen or ibuprofen given after the vaccine rather than with the vaccine appear to have a lesser effect." } ]

[ { "from": "human", "value": "Just to clarify your last sentence- does delaying the dose lessen the effect of the med I terms of comfort/fever reduction? Or lessen the effect of how the vaccine impacts the immune system?We try to use other methods of soothing her in general when we can, but sometimes shes uncomfortable enough that it seems warranted. (We went with her favorite lunch and lots of snuggles between the shots and nap, and are planning on letting her play in a warm bath after nap if she wants.)Thank you for weighing in. I appreciate it!" }, { "from": "gpt", "value": "I think there was a trend to lessening the effect on the immune response, but again, the immune response was still adequate regardless. I'd give my kid the tylenol after a vaccine. In my local children's hospital they do as well. I find the evidence saying not to give it is weak and mostly refers to giving it at the time of vaccination" } ]

[ { "from": "human", "value": "Thanks!Edit: added question to the top." }, { "from": "gpt", "value": "Benzoyl peroxide is a rare allergen but a common irritant and can cause irritant contact dermatitis. As long as the latter does not occur, it is an excellent biocide." } ]

[ { "from": "human", "value": "Thank you. Would you have insight into how often benzoyl peroxide wash would typically be used in a situation like ours?" }, { "from": "gpt", "value": "No examination details or images included, so no comment appropriate." } ]

[ { "from": "human", "value": "I hope this works for photos. Ive never used Imgur or posted a photo on Reddit before. The labeled photos are from tonight when the dots have pretty much dried up and are the best they get after a bleach bath. The other two are of times when the folliculitis is more flared up. Let me know if there is anything else for a physical exam you would want. Thanks!Edit: looks like the photos require being over 18 to view. Two are of his bottom, this is probably why, though I censored what was necessary." }, { "from": "gpt", "value": "Mild folliculitis present. Using the benzoyl peroxide wash a few times a week may maximize efficacy and minimize irritation." } ]

[ { "from": "human", "value": "Would you indulge another question? Just curious if selsun blue would be a viable option as an occasional body wash for my sons situation given its anti-fungal properties. (Im thinking the benzoyl peroxide will be sufficient, but just curious.)" }, { "from": "gpt", "value": "Selenium sulfide is an antifungal agent but does not have antibacterial activity as far as I know. Not a good choice." } ]

[ { "from": "human", "value": "3 months later, doctors hypothesize TTPm seeking medical advice for my mother. She has her internal med and cardiologist following. She is now seeing a hematologist. We are interested in any additional advice or suggestions that can help with her diagnosis.My mother (62F) has a history of RA. She contracted COVID four times. Once was before she received the vaccine and three times after. It is our understanding that her medication caused the vaccine to be ineffective. With each COVID diagnosis, she received the antibody infusion.My mother was then diagnosed with AFib. She took Eloquist for over one year and had an ablation in October. In November, she had a watchman placed, was taken off of Eloquist, and began taking Plavix. She also takes 80mg ASA.After one week, she began to develop spots around her ankles that resembled petechiae. Her doctor advised her to continue Plavix. The spots then became larger and spread above her knee. After 1.5 weeks of taking the medication, she discontinued Plavix and began Brilinta bid.The spots started to look more solid, and one week after switching medication, the doctor advised her to cut back on Brilinta to qd.The sores on her legs were somewhat better off and on, but during this time, they spread as high as navel. The cardiologist advised her to discontinue Brilinta and resume Eloquist. She also took a round of Augmentin which caused her legs to look better.Since that time, the spots have remained on her legs, and after days in which she is walking quite a bit, the spots sometimes become solid and encompass the entirety of her lower legs.She has now been off of blood thinner for two weeks. Seeing little to no progress, her cardiologist and internal med doctor have now referred her to a hematologist to assess for TTP.After the watchman placement, my mother has routinely had labs drawn each week. She has also had a platelet function analysis. Labs have remained WNL.She has recently started seeing the hematologist. He ordered additional lab work in which the results should be back at the beginning of the coming week. He explained to my mother that she seems to be healthier than most patients who have been diagnosed with TTP although some of her symptoms seem to correlate with that of TTP as well as another disorder that is typically only diagnosed amongst pediatric patients.The hematologist also explained that recently, he has observed many different disorders and symptoms that were not observed prior to COVID, and considering that my mother had COVID four times, this could be one of those occurances.Im curious as to if any of you have recommendations or if any of you have encountered anything similar. Any suggestions are greatly appreciated. Thank you so much in advance for your help!" }, { "from": "gpt", "value": "It would be helpful for you to post the labs results but if her cbc is normal as you're pointing out above then it's extremely unlikely for this to be TTPThe pictures you showed look like a vasculitis" } ]

[ { "from": "human", "value": "6 year old re-cauterized day 5 post tonsillectomyMy 6 year old had her tonsils and adenoids taken out on April 6th, she was what I thought, healing well. In good spirits, never complaining of anything more than a little pain . Popsicles nonstop, ice cream too. Tuesday night, after a full 5 days post operation, she wakes up and starts vomiting blood. We panic, call 911, go the nearest pediatric hospital. They tell us well have to recauterize. Cue second round of fear for the night. I couldnt imagine putting her through anesthesia again in less than a week. Thankfully it went well, and the left side had active bleeding in one spot which they cauterized and the right side had some tiny vessels that the doctor recauterized too. They kept her for another 8 hours for observation and she was doing well. I guess now were all so traumatized, including her, that it could happen again. She hates the taste of Tylenol but pediatrician warned about Motrin possibly triggering the bleeding. Of course, she prefers Motrin. Im writing this terrified of it recurring and praying it wont.Im so terrified of her hemorrhaging again and I dont know how to calm myself. I was told it would be rare to happen again but it was rare to even happen the first time. Were officially 7 days post initial procedure and Im wondering at how many days post op can i be confident that shes healed?Any possible words of encouragement or advice would be so very appreciated." }, { "from": "gpt", "value": "Its not that uncommon after tonsillectomy actually, I agree unlikely to recur and should be ok. Did they check her blood counts to know how much she had bled?" } ]

[ { "from": "human", "value": "Ive got her lab results with me but unsure of what its telling me." }, { "from": "gpt", "value": "Fairly common , frankly not a big deal that is just bad luck. Rate of postoperative bleed is 1%, so chance it happens again very rare.You can get a rebleed at 7-10 days but rare. After that it becomes extremely unlikely" } ]

[ { "from": "human", "value": "Thanks for your comment. The pediatricians drilled it in our heads that it was rare that it happened in the first place, even at 5 days. But I cant help but shake the feeling that even though its rare to happen again, we were already one of the rare ones it happened to the first time around. They made it seem as its way more unlikely for it to happen to children and more common in adults. When we saw her vomiting fresh blood we thought we were going to lose her.Will the recauterization of the spot where they found her active bleeding (noted as left superior tonsillar fossa) reset the clock on healing the whole area? Diffuse oozing in the right, clots bilaterally were also listed on our discharge papers." }, { "from": "gpt", "value": "In 25 years of practicing ENT Ive only seen one re-bleed.The cautery sets the clock back just in that one specific spot. Theres no evidence postop bleeding is more common in adults, thats an old wives tale.Big picture here, this was a small setback your child will be fine." } ]

[ { "from": "human", "value": "11 month old with fatty liver11 month Male Multivitamin with iron 6 weeks premature Uncircumcised 29 inches 24.5 lbsOn March 30 he woke up with a fever. We headed to urgent care and they diagnosed him with UTI. Got a call from them a week later saying to follow up with his pediatrician. While there she said his bacteria numbers werent high enough to indicate a UTI but its possible we just caught it super early. She said she was going to do research and possibly want further testing. She ended ordering a renal ultrasound. The findings of the ultrasound indicated that his renal system is unremarkable! But his liver is showing echogenicity and fatty infiltration of the liver. What could cause this? Should I be worried about it?" }, { "from": "gpt", "value": "Some infants have fatty liver on US or CT scans done for other reasons, as in your case. There's no consensus on what to do in this situation, but I tend to just follow it, because it often goes away. We think it's often a consequence of fetal environment, and has some association with maternal obesity, maternal gestational diabetes, and also seems to happen more often to preterm babies. But overall, the problem hasn't been well studied. In the setting of a recent infection, there's also a decent chance it's a consequence of the immune response (although it's usually from a gastroenteritis with things like adenovirus, not a UTI).These cases come to my clinic every now and then and most of the time it resolves. I usually do two things: repeat the ultrasound in a few months, and get a blood test (called a CMP) to look at the liver numbers.We don't know how this relates to long term risk for fatty liver, which has more significant health consequences. Some people have genetic causes for fatty liver, and it can start at a young age, but this is fairly rare, and not the cause of fatty liver in infants in most cases. Either way, it's worth keeping tabs on it to see if it goes away over time." } ]

[ { "from": "human", "value": "Should I look into dietary changes? He breastfeeds 5+ times a day and has a meal 3x a day. The meals typically consist of a protein, fruit/veggie and some form of starch (sweet potato, wild rice, veggie pasta). He drinks probably 1 cup of water a day." }, { "from": "gpt", "value": "Likely not necessary in the short term. But I would still discuss with a pediatric gastroenterologist." } ]

[ { "from": "human", "value": "what is this rash on my toddler1.5 year old, male, 24 pounds,I just noticed this rash on both my sons feet legs and bum. theres been no change in detergent, or soap. Hes recently been on antibiotics for an ear infection but broke out in a full body rash on day three of amoxicillin. so they switched him to azithromycin and same thing happened. hes been on cipro/ dex. drops since wednesday. what the heck is going on. why is he covered in rashes? he doesnt seem to notice. acting fine, no fever, not itching. Any ideas? Picsedit: sorry the pic kind of sucks but 1. hes a toddler and does not sit still 2. the flash dulls the color of the rash" }, { "from": "gpt", "value": "Does this rash cover his whole body? It looks like Roseola to me, which is a very common viral infection in pediatric patients." } ]

[ { "from": "human", "value": "no not this time. but the other 2 times it did. googling roseola - thats exactly what his rashes have looked like.i had brought him in to ER with a fever of 39.7 (went to 40.5) and lethargy, which is when they said he had quite a bad ear infection (membrane retracted with ++ pus) he hasnt been tugging on his ear or anything. could that have been an accidental finding and the fever was actually the roseola? i understand its hard to say over the internet but thought id ask" }, { "from": "gpt", "value": "Exactly. We see this in the ER all the time. Roseola is infamous for making the ear drums look infected when they're actually not. I suspect his fever was from the Roseola, and he was falsely diagnosed with an ear infection at that time given his constellation of symptoms. The rash infamously comes after the fever breaks. It's not itchy or uncomfortable for the child." } ]

[ { "from": "human", "value": "that is so interesting!!! a coworker actually suggested this but i basically brushed it off, but it makes sense! so maybe hes not allergic to penicillin and azithro after all.its been about a week with on and off rashes. is that normal? i keep taking him back to the doctor thinking its the meds" }, { "from": "gpt", "value": "I highly doubt he's truly allergic to either :)" } ]

[ { "from": "human", "value": "Good to know!! he doesnt seem bothered by the rash at all! He does still have a bit of a rash though and its been like 7 days since it first showed up. its kind of comes and goes tho is that normal for roseola?" }, { "from": "gpt", "value": "Hand foot mouth is a possibility too.As an ER pediatrician, I ignore whatever urgent care diagnosis was given regarding ears. They usually suck at examining them, and think every flushed ear drum in a kid with fever/crying is infected. That, or frequently find that they're outright liars, and couldn't have possibly seen the TM, because of the enormous amount of wax (or even foreign bodies) that is in the way. The people doing these evaluations and making these diagnoses are almost never pediatricians, and usually aren't even physicians." } ]

[ { "from": "human", "value": "Advised by nurse line to give my 3 month old a glycerin suppository?Male. 3 months. 15 pounds.possibly milk dairy allergy. He usually goes 1 to 2 times a day but hasnt gone in 4 days. He is exclusively breastfeed. I started a probiotic 5 days ago that I discontinued since he hasnt gone. He has been having diarrhea for weeks everyday so this is a big change. Hes been passing gas and fussy starting today whenever he passes gas.I called our pediatrician hotline and was told to use 1/4th if a suppository for him. Im a little hesitant but cant get in touch with his doctor until Monday." }, { "from": "gpt", "value": "Exclusively breastfed infants can go up to 9 days between poos. If he is eating, not vomiting and passing wind I dont know why you would give him a suppository" } ]

[ { "from": "human", "value": "why does everything feel fake?history: im 16M, have no existing medical issues, nor am i using any medications, and i dont smoke, drink, or do drugs.occurrences: this has been getting progressively worse the past month, at first it was only something i could notice but it never really bothered me, but now it makes taking tests, reading (even this), and programming really difficult without full concentration. it kindof comes in waves where i can read whole chapters with no problem to having to re read a sentence multiple times to understand it (this happened in my ism test where i got stuck on a really easy problem because it felt like whenever i read one part of it, part before it disappeared). sometimes it gets so bad to where i get dizzy spells in the middle of class, and other times when im about to sleep it feels like im \"slipping\" and jump up (not the kind where you feel like your falling in a dream and wake up). also the past few days its kindof always been on very slightly.when it gets bad it feels like passing out without actually passing out, you know how you technically CAN see, but dont really understand anything? it feels like that, or like those pictures where you cant identify anything, or waking up suddenly from a deep dream, and my mind goes blank and i feel like im \"spiraling\", and it feels like im about to fall through the world? i dunno how to explain it, but i usually get jumpscared by it and it brings me back to normal, but if i focus i can point things out and describe things. another way i can describe it is it feels like im looking through my peripheral vision at all times, theres a certain lack of clarity to what everything looks like, and sometimes when im reading it feels like im being sucked into the monitor, if i really focus i can read, but it feels trying to read on a rocky boat, yeah i CAN do it, but im not really understanding it because im too focused on reading the words. sorry if im explaining this poorly, i dont really know what it is or whats causing it, im thinking its a mix of brain fog and anxiety? i wouldnt say im an anxous person but idk, and it feels kindof similar to the brain fog i get when i drink coffee, and ideas would be apreciated!" }, { "from": "gpt", "value": "Needs detailed in person. Pediatric psychiatric evaluation." } ]

[ { "from": "human", "value": "3 months later, doctors hypothesize TTPIm seeking medical advice for my mother. She has her internal med and cardiologist following. She is now seeing a hematologist. We are interested in any additional advice or suggestions that can help with her diagnosis.My mother (62F) has a history of RA. She contracted COVID four times. Once was before she received the vaccine and three times after. It is our understanding that her medication caused the vaccine to be ineffective. With each COVID diagnosis, she received the antibody infusion.My mother was then diagnosed with AFib. She took Eloquist for over one year and had an ablation in October. In November, she had a watchman placed, was taken off of Eloquist, and began taking Plavix. She also takes 80mg ASA.After one week, she began to develop spots around her ankles that resembled petechiae. Her doctor advised her to continue Plavix. The spots then became larger and spread above her knee. After 1.5 weeks of taking the medication, she discontinued Plavix and began Brilinta bid.The spots started to look more solid, and one week after switching medication, the doctor advised her to cut back on Brilinta to qd.The sores on her legs were somewhat better off and on, but during this time, they spread as high as navel. The cardiologist advised her to discontinue Brilinta and resume Eloquist. She also took a round of Augmentin which caused her legs to look better.Since that time, the spots have remained on her legs, and after days in which she is walking quite a bit, the spots sometimes become solid and encompass the entirety of her lower legs.She has now been off of blood thinner for two weeks. Seeing little to no progress, her cardiologist and internal med doctor have now referred her to a hematologist to assess for TTP.After the watchman placement, my mother has routinely had labs drawn each week. She has also had a platelet function analysis. Labs have remained WNL.She has recently started seeing the hematologist. He ordered additional lab work in which the results should be back at the beginning of the coming week. He explained to my mother that she seems to be healthier than most patients who have been diagnosed with TTP although some of her symptoms seem to correlate with that of TTP as well as another disorder that is typically only diagnosed amongst pediatric patients.The hematologist also explained that recently, he has observed many different disorders and symptoms that were not observed prior to COVID, and considering that my mother had COVID four times, this could be one of those occurances.Im curious as to if any of you have recommendations or if any of you have encountered anything similar. Any suggestions are greatly appreciated. Thank you so much in advance for your help!" }, { "from": "gpt", "value": "It would be helpful for you to post the labs results but if her cbc is normal as you're pointing out above then it's extremely unlikely for this to be TTPThe pictures you showed look like a vasculitis" } ]

[ { "from": "human", "value": "Low alkaline phosphatase and low ALT(SGPT)My Child, 6 years old,18kg, male, kept complaining about sore legs (mostly around knees) for the last 4-5 years. Talked to our Gp about it few times only to be told is due to growth.It could happen all of sudden and last for a week every day or evening and then he is ok for few more weeks and then starts again. We also had months of no pain too. It is very irregular.Pain stops only after giving him pain medication along with massage.Sometimes is so bad that he is shaking from pain.We also went abroad to an private orthopedic pediatrician. Checked him and also said is probably due to growth and that is very common.Few weeks ago had another episode. He would also wake up during the night because of this pain just like before. Decided to se our gp again and asked for a referral to a specialist. It will most likely take months to get an appointment. In the mean time we did some blood tests.Results came and I'm scared. Google gives me the worst scenario for low alkaline phos. And low ALT (SGPT). I will see our gp in few days but im very concerned. Should i be that worried? He also has low eosinophils and low (0) Basophils.What other blood tests should we ask to do until we get the specialist appointment." }, { "from": "gpt", "value": "The low alkaline phosphatase and low ALT (SGPT) levels may suggest an underlying inflammatory process, perhaps JIA.I recommend a referral to a pediatric rheumatologist.The low eosinophil count may be related to his immune system response to inflammation." } ]

[ { "from": "human", "value": "Thank you for your answer. I called the gp to talk about the results until I see her next week. Shes telling me results are ok and should not be worried at all. She is actually telling me that low reading of alk phosphatase and Alt is no concern and would have been a problem if it was high.I kept insisting by telling her that it must be a reason for these to be low. She did not know what to say.I will insist for a referral anyway which will take months? but should i be asking for another set of blood tests in the meantime but this time to check magnesium, zinc and b6 or b12? Could this be a cause for his pains?" }, { "from": "gpt", "value": "High levels can indicate liver or bone issues, yes, but low levels could still warrant further investigation, especially if your child is experiencing ongoing pain.Nutrient deficiencies, while they can cause muscle and joint pain, are only one of many potential causes" } ]

[ { "from": "human", "value": "Could her delayed growth be a byproduct of the IUGR? Or is it more likely shes just not taking in enough calories per feed? Additionally, are there any questions that youd recommend I ask the pediatric GI doc? Thanks so much!" }, { "from": "gpt", "value": "Both. IUGR babies are prone to have poor growth. Most continue to have slow growth in the months after birth, often leading to GI interventions such as increasing nutrient density of formula. This is to make up for the nutrient deficit present that an average infant's daily intake typically cannot surpass on its own.While the vast majority (80%) of IUGR and/or SGA (small for gestational age) do catch-up to reach sizes comparable to other children, this typically takes about two years. Many factors affect growth and stature, including any medical problems that led to her being small. For instance, this nutrient deficit and propensity to growth failure tend to be worse in infants who were also preterm (at 37+1 weeks, your daughter was born just two days further along than what we would consider \"late preterm\").The main things you can control and monitor at this point are her nutritional intake and feeding habits. For now, the baby's goal is to be improving in her percentiles, not worsening. I recommend working with the GI team on this goal. They will likely have you see a pediatric dietitian as well to help figure out how many calories she should be getting.Don't despair - this is more common than you would think. It doesn't mean you're doing anything wrong. You are working very hard and doing everything you can right now. Getting more hands on deck by bringing in a specialist's perspective only means more people in your daughter's corner trying to get her growing better.Most babies born with IUGR do catch up their growth by this age, so I agree with your pediatrician's concern. Increasing the concentration (\"fortifying\") her formula is a great first step, but it's worth seeing the pediatric GI to make sure there isn't something else going on. I'd suggest keeping track of about how much she eats in a 24-hour period as well, so the doctor can assess whether she's getting enough calories." } ]

[ { "from": "human", "value": "Pediatric question: For an 8mo baby with hypotonia and delayed gross motor milestones, how much could diagnosing the cause impact the PT/OT she is already receiving?We are talking about an IUGR baby who was born 0.03rd percentile at 38 weeks and is now 13th percentile weight, still has low BMI and diagnosed at 6mo with overall hypotonia. Currently working with PT in person weekly and OT via video-chat weekly.Skills being worked on in PT/OT include:rolling front to back (emerging, working on efficiency)rolling back to front (she never does this unassisted)weight-bearing on elbows in tummy time (often lifts arms and arches back)weight-bearing on hands in tripod sitting positionshifting weight and reaching while in prone/various seated posesbuilding lower abdominal strength with targeted exercisessensory brushing and joint compressionsimproving one and two hand grabsreconditioning oral aversion (from extensive craniosacral mouth work and tongue tie revision w/ post-surgical exercises around 4-5 months old)eating solid foods (baby will touch foods, but never bring to mouth, accepts spoon feeding enthusiastically)neck and shoulder stretches for mild torticollisIm probably leaving something out, but this is an idea of our therapy focus. We live in an area with only one pediatric neurology practice, so we cannot begin to diagnose or rule out anything until our scheduled visit in 2 months.My questions are: Is the therapy we are doing appropriate regardless of diagnosis? How could delaying diagnosis until 10 months (or later) affect her long term outcomes? Would there be any reason for us to travel out of state to a larger facility if we could be seen sooner (on our own dime, eight hours away)?TLDR: Is diagnosis of the cause of mild to moderate infant hypotonia urgent when PT/OT is already underway?" }, { "from": "gpt", "value": "A proper pediatric neurological evaluation will better guide PT/OT, as well as if any other necessary treatments if the underlying cause is treatable." } ]

[ { "from": "human", "value": "UTI or Kidney Infection?My daughter 14F, 57, 150lbs, was diagnosed with a UTI at the ER on Thursday afternoon. It caused her to have hot/cold flushes and high HR, which is what brought us to the ER. She has been taking antibiotics twice per day, starting Thursday afternoon. NITROFURANTOIN MONO-MCR 100 MG CAPSULE. She has horseshoe kidney, which is why Im worried. Pediatric nephrology sent her urine from the ED for more tests and they came back this morning to MyChart.Urine Culture Your Value 20,000-29,000 cfu/ml Enterococcus faecalis Flag AUrine Culture Your Value 10,000-19,000 cfu/ml Mixed Contaminants X2Friday night she felt awful and had shakes for an hour. We called the Capital Blue nurse hotline and she said that its just my daughters body fighting the infection and she needs more time for the antibiotics to kick in.Its now Sunday afternoon and she is feeling bad again with a low fever (she didnt have a fever before). She doesnt feel well enough to get up and shower.Is there anyone who can offer help until we can call the nephrologist Monday morning?The ER doc dismissed her high HR and hot/cold body flushed as a panic attack, so now when she starts to feel bad she starts to panic. She has finals tomorrow and has an after school commitment starting this week. I need to figure out what is wrong and help her feel better." }, { "from": "gpt", "value": "Is her temperature over 100.4?Macrobid (nitrofurantoin) will treat enterococcus very well. However macrobid will not treat kidney infections, only bladder infections. If her temperature was truly >100.4 she may need another antibiotic. You can wait till tomorrow to call your nephrologist to check in." } ]

[ { "from": "human", "value": "Is a prolonged QT wave on one EKG significant? (Pill overdose)Could my incident of one abnormal EKG I received as a teenager following pill overdose need to be reported to docs 10+ years later/in the future?Or if since then I have had 2 other EKGs and a 48-hour holter monitor and only found tachycardia, am I clear? The specific abnormality was a \"borderline prolonged QT wave, poss / positive for RVH.\" Context and other lesser abnormalities to follow.I am currently 29F with sinus tachycardia, fibromyalgia, bipolar disorder. I requested hospital records of my pediatric suicide attempt because my parents and current psychiatrist are not sharing consistent information with me about my diagnosis(es) and prior care, and I would like to get more help. I was never told that I had particular diagnostic tests run or that any came back abnormal, and I want to know whether these should be chalked up to error/a fluke/exclusive to that overdose, or whether it's something I should've reported to my doctor when my tachycardia was being investigated or should report in my future medical histories or if I were to have more concerning cardiovascular complications.As a 14-year-old, I attempted suicide by ingesting 50 ibuprofen and an unknown # of Sonata, best estimate ~10 pills. The ibuprofen # could be higher technically, since I was still taking it when I lost memory/began to hallucinate. The tox screen was also positive for caffeine.14 F 110 lbs, 5'3\", on 0.5 mg Risperdal, 25 mg Zoloft, unknown if any particular mental disorder diagnosis was made at that time, \"asthma,\" white, no drug/alcohol use.I was taken to a hospital and an EKG, head CT, and labwork were done ~4 hrs after ingestion. I presented with normal exam/vitals/labwork in the first 6 hours except for visual and auditory hallucinations and ataxic gait. After about 4 hours I was transferred to the children's hospital ER. While the initial ER noted no new symptoms and stated my EKG was normal, I did see that shortly before I was transferred my BP went from 115/80 -> 114/55.Cardiac Consult:The children's hospital notes by 2 different care team providers state that my EKG by the outside hospital had a borderline prolonged QT and poss / positive for RVH. They repeated my EKG 7 days later, and the consulting cardiologist said they were happy to report this present EKG came back completely normal. He did state that I was \"admitted to [the] eating disorder program,\" so I hope misunderstanding why the EKG was being performed wouldn't affect his conclusion? He also offered to do an exercise treadmill test if they desired. Another note by a care team provider said they recommended I do an outpatient stress test after discharge, but I don't believe my parents ever had it done.Other noted abnormalities post-ER EKG after I was transferred to children's:1/6 systolic murmur, diastolic BP was hypotensive for 12 hrs (98/38, 101/35, 94/45, for example), bpm was 70 - 130, 2+ pulses on extremities, somnolence - at one point only arousable with painful stimuli and then immediately falling back to sleep - and a lot of vomiting later on. Seems like I went back to baseline by about 18 hrs post-ingestion.I think my parents and doctors were so worried about my mental state that they didn't even touch on the physical symptoms. Do I need to consider them at all? Or is it fair to assume that the EKG was a result of the overdose or emergency situation, but that it wouldn't have any long-term ramifications?Throwaway due to sensitive details." }, { "from": "gpt", "value": "An abnormality on an EKG one time in the context of a medication overdose is not worrisome, especially as it normalized later. This is an expected consequence of the medication overdose, as were your symptoms." } ]

[ { "from": "human", "value": "Im not going to lie -- between these heart rate numbers, her complaining about \"heart pain\" when she was younger, and otherwise being healthy and on-target (if slightly smaller than average) for height/weight/BMI...Im concerned. But I'm not a medical doctor. So here are my questions to those of you that are:Should I be concerned? If so, how concerned should I be?If this is concerning, what steps need to be taken? Do we need to take her back to her primary doctor and get a referral to a pediatric cardiologist? Should we insist that she be allowed to (as needed) walk during runs in cheerleading practice / school?Aditional Info and DetailsMy little sister does pee-wee cheerleading, and they start every practice by running 2 laps around a football field, which is ~1/2 mile (i.e., ~0.8 km). She is not quite \"sprinting\", but is running the whole time at (Id guess) 80-90% of her maximum running speed (with no walking breaks). When she ran it earlier tonight, at the end of the 2nd lap her Fitbit watch said her heart rate was 213 beats per minute. Her heart felt like it was literally beating of her chest, and she said that she felt like she was about ready to pass out.From what I could find online, 213 BPM for a 10-11 year old girl could be dangerously close to her maximum heart rate, though (especially at that age) maximum heart rate is somewhat variable.Ive also measured her resting heart rate a few times (e.g., after sitting down watching tv for 30+ minutes) and it has been in the 100-110 BPM range, which from what I could find online is not unheard of, but is pushing the upper limit of \"normal\". These measurements were in the evening (close to bedtime, before taking the 50 mg trazodone). I ran the numbers and, at this point, all the vyvanse from her morning dose has been converted into dextroamphetamine, which (on average) has gone through ~1 half-life (~50% has been metabolized, assuming a 1:1 metabolic conversion for Vyvanse --> dextroamphetamine).Note: to check the Fitbit's accuracy, one of these times I also measured her heart rate manually using my (surprisingly effective) homemade double-walled stethoscope. Over a 30-second interval, the fitbit pegged her at between 99-102 BPM, and I counted 50 heartbeats (meaning 100 BPM), so the measurements it takes seem accurate.She isnt the most \"active\" person -- left to her own she would sit and watch TV and play on a tablet all day -- but between cheer (3x 2-hours practices + 1 game every week), dance (2x 1-hour classes every week) and school (PE, recess) she gets at least an hour or 2 most days whether she likes it or not. And she certainly isn't overweight -- this growth chart suggests she is in the ~30th percentile for weight and ~25th percentile for height. This BMI calculator for girls puts her BMI at the 53.6 percentile (z=+0.09)." }, { "from": "gpt", "value": "Agree with /u/muchtwojaded. Normal resting heart rate for her age/size, and the >200 HR with exercise isn't concerning to me. Sounds like she gets a good amount of healthy exercise, more than many kids her age.Nothing here sounds dangerous. If she's not complaining of symptoms with exercise, I wouldn't do any kind of workup." } ]

[ { "from": "human", "value": "Is it PPA or is there something wrong with my 9 week old son?I want to mention that Im not a FTM. This is my second baby. My first didnt sleep consistently through the night until 2.5. But I really feel like this isnt normal and no one is taking me seriously.Around 2 weeks he started refusing to sleep on his back. Weve had to resort to bedsharing(not what I want to be doing) and he still will only sleep in 30-60 min max increments. He breathes through his mouth a lot. And sounds like a pug when he breathes sometimes. He will stop breathing for a few seconds and then wake himself up with coughing/gagging noises. He frequently gags/chokes when breastfeeding as well. My pediatrician thinks the breathing is normal and that hes working us by crying when we put him to sleep on his own (told us to keep putting him on his back in his crib and hell figure it out. But he screams immediately).Hes had his tongue and lip tie removed a month ago. Chiropractor appointments. Hes on reflux meds. And Ive been dairy and soy free (was having green mucousy diapers) for 2 months. All of this has greatly improved his colic/fussiness- hes usually happy now. But not his sleep.My last resort is maybe an pediatric ENT. But idk what they would even do. Everyone keeps telling me his breathing is normal but I just have a feeling its not. I dont want to waste anyones time.Ill link a video of him breathing and screenshot of his owlet sock showing oxygen lvl and how frequently hes waking (orange is awake). I really really appreciate any advice." }, { "from": "gpt", "value": "See the pediatric ENT.The breathing sounds to me like he may have a \"floppy\" airway and could have a condition called laryngomalacia or tracheomalacia. It's fairly common, often does not require medical intervention, and typically improves with age, but you should have him evaluated particularly given the nighttime coughing and awakenings, which are likely because of the condition causing temporary drops in oxygen (as you saw on the owlet) resulting in the body's response of cough/awakening to bring oxygen back up. The pediatric ENT can use different techniques to determine whether this (or another) condition is present and responsible for the symptoms.Interestingly, children with this condition are sometimes recommended to sleep on their stomachs as it helps relieve the upper airway obstruction caused by the floppy larynx and/or trachea, so by refusing to sleep on his back, your son might just be telling you what his airway needs right now. The ENT will provide guidance on how your child should best sleep as well as any other recommended modifications to help with the condition.If bedsharing, practice safer co-sleeping techniques as much as possible as described here. Most important is firm mattress, no pillow/blankets present that could possibly obstruct the face during sleep, no smoking, drinking, or siblings." } ]

[ { "from": "human", "value": "NAD, but came here to say my child had Laryngomalacia as an infant. He was a squeaky breather but ceased showing signs at 18 months. I hope you get answers soon, OP." }, { "from": "gpt", "value": "Do not take your baby to a chiropractor. Chiropractors are not medical professionals, and they are especially not pediatric professionals. They are at best harmless and at worst lethal.I am not a pediatrician, I have no idea how reliable or useful Owlet monitoring is (I suspect not very), and that minimal video doesn't sound concerning to mebut I can barely hear and I am again not a pediatrician.This is something to discuss with your baby's pediatrician. If the doctor involved is not concerned, it's probably okay. If you're still very concerned, you could try getting a second opinion from another pediatrician, including bringing all of this information." } ]

[ { "from": "human", "value": "Can I ask my doctor to request pharmacare to cover Zofran?26F, 195 lbs, white, current meds are Mirena IUD, cipralex, wellbutrin, and pantoprazole. Current diagnosis of IBS.For the last four years or so have been dealing with awful and disruptive GI problems. Rectal bleeding, diarrhea, distention, nausea, vomiting, pain etc. Blood work has only ever shown anemia, which I've dealt with before, and calprotectin, fecal occult, and scopes have all been given, only finding is enlarged internal hemorrhoids but not so large to warrant a banding procedure.I saw my doctor today as nausea and vomiting were controlled by pantoprazole for almost a year, but nausea and vomiting has worsened, and I've been having increased pain localized to LRQ that will stop me in my tracks, and feels like a rolling intense cramp, or intense pressure. She wrote me a prescription for Zofran, and it was $272 for 90 tablets. I have provincial coverage, but since I'm not a pediatric patient or undergoing chemo or radiation I'm not eligible for coverage.Could I ask my doctor to petition pharmacare to get me coverage and explain that I've already been on meds that have failed to control problems? How likely is it that can be covered" }, { "from": "gpt", "value": "Zofran has been off patent for a little while now, ask for the generic, it should be at least half that price" } ]

[ { "from": "human", "value": "I did get the generic , don't know what I would have done if got the name brand" }, { "from": "gpt", "value": "Yea right, interesting. 10 wafers generic in australia is around $14 so youre still getting a solid premium over there" } ]

[ { "from": "human", "value": "1 year old sudden loss of visionOn Thursday, my 15 month olds babysitter noticed that she wasnt making eye contact like normal. At home, I noticed the same thing. Normally, if I look at her and smile she smiles back. But it looked like she was looking right past me. Along with that, she was not tracking objects with her eyes.I took her to the pediatrician on Friday who was concerned and wanted her to see an ophthalmologist right away. So we did that, she had a full eye exam with her eyes dilated and there was nothing wrong (like far sightedness or strabismus etc) with her eyes. The ophthalmologist was concerned too and called a neurologist who wanted us to go to the ER so we could be admitted into neurology over the weekend.The ER did a lot of blood work, a spinal tap for fluid (I cant remember the name- Im sorry.) and the doctors there just generally said they were stumped.We are on day 2 of being in the pediatric neurology unit. Shes having an EEG done for 24 hours and hopefully an MRI today. The neurologist says hes fairly confident she isnt having seizures but wants to cover everything.I hope one or both of those things gives us an answer but in the mean time all I have to do is think. What could possibly have caused this loss of vision seemingly overnight? She responds to sounds but not objects. Shes had hundreds of lights (from nurses doctors etc) flashed right in her eyes and she does nothing like youd expect. They shined a light in my eyes to show me how abnormal it was that she did nothing because I instinctively moved my eyes.Also... no falls, no high fevers, no recent illness, her birth was normal, shes developmentally normal.Does anyone have any idea of what this could be?" }, { "from": "gpt", "value": "Sorry to hear about your daughter. It is hard to know the cause without all the test results at the current time, especially the MRI, as this seems to be something less common. If she looks well in other aspects (except for the vision loss), and has already been evaluated by a pediatrician, ophthalmologist, and a pediatric neurologist, you are doing everything you can, and it seems that everything necessary is being done. Vision requires normal eyes, normal optic nerves connecting the eyes to the brain, and normal function of the visual cortex of the brain, and of course normal response to vision requires good function of the rest of the brain. Generally most problems affecting the eyes affect only one eye at a time, and can be seen by the ophthalmologist (either anterior chamber problems such as cataracts or posterior chamber issues such as retinoblastoma). Problems affecting the optic nerves (e.g optic neuritis) are more often seen in older kids (e.g with multiple sclerosis) and are very rare at 15 months. Rarely, there can be problems near where the optic nerves come together just behind the eyes (optic chiasma) when masses (eg. craniopharyngioma)/cysts push on them and can cause visual loss. It is also rare for things to affect the visual cortex of the brain. I suspect that the MRI will be of help. If it does find something, it might need other specialists (e.g. neurosurgeon) to provide further information on management." } ]

[ { "from": "human", "value": "Are there different sized tools for transvaginal ultrasound?Female, Canada, 27.I think I'm expecting to get a transvaginal ultrasound sound done today, my first ever. Problem is that although I'm an adult, my body has stunted growth and I also barely have any experience putting something in there. I've only put something in there long ago that's really small and the last was like 2 days ago when I had my pap exam. She used the pediatric sized tool and even that was on the painful side. So I'm really nervous about the upcoming one because I'm worried it will damage me if they don't see where to stop at. Will they be able to see where to stop the end of it and do they've different sized ones?" }, { "from": "gpt", "value": "The probes used for transvaginal ultrasound aren't that big, and are smaller diameter than a pediatric speculum like you would have had used for the Pap smear. Another thing you can do if you're comfortable with it is ask to insert the probe yourself, since it's more comfortable for many people." } ]

[ { "from": "human", "value": "13 year old athlete EKG results - Sinus bradycardia and Intraventricular conduction delayMy 13 year old is 5'11, 188lbs, was complaining of chest pain on the 29th that every time he took a deep breath it hurt. No pain when breathing normally, pain located almost directly in the middle of his sternum and a little to the left. He does play sports year-round - Football and wrestling. I cannot get an appointment until Monday with a cardiologist and I am having a hard time understanding what this means!" }, { "from": "gpt", "value": "Would need to see the actual ECG. This may be the auto-interptetation by the machine. They are notoriously wrong." } ]

[ { "from": "human", "value": "1 year old Male, question about delayed passage of meconium as a newbornMy son (1yoM) has had chronic constipation since early infancy, beginning when he was exclusively breastfed. After no success with dietary remedies, ped prescribed Miralax, which has significantly improved his constipation. But it has not gone away, so ped had a barium enema performed. This test was normal, but he was referred to pediatric GI since the constipation has remained, and GI said that Hirschprung's is not ruled out and is wanting to conduct further testing.My question - part of why they're suspicious of Hirschprung's is that my son did not pass any meconium/poop at all from the time he was born until he was 4 days old. I understand this is very delayed passage of meconium. However, he was an out of hospital birth, and my mom, who was present at the birth, is sure that meconium was passed during delivery, because she said the amniotic fluid coming out as he was born was brown. The midwives never mentioned this. Obviously my mom is no medical professional, but I don't want to be raising false alarms with the doctors by reporting that he did not pass meconium if in fact he did during labor.So - if he passed meconium during labor, and then did not poop at all for four days, then passed a large volume of meconium, would this be considered normal, or still qualify as a risk factor for Hirschprung's? I've struggled to get a clear answer from his doctors, and I want to be sure that he isn't getting more testing than he needs due to me misreporting information." }, { "from": "gpt", "value": "Even if he did pass it during delivery, not having further meconium passage within the first 4 days after birth is abnormal. Sounds like further workup would be warranted." } ]

[ { "from": "human", "value": "displaced acute supracondylar humeral fracture with dorsal and radial displacement - 1/16/23My daughter fell off the monkey bars today. She landed on her back and elbow. I could immediately tell it dislocated. I called rescuer and they put a splint. I took her to the ER and they did X-rays. Based on the X-rays they said she had a displaced acute supracondylar humeral fracture with dorsal and radial displacement - the pediatric orthopedic was not available to come in but the PA said she spoke to him on the phone and they determined she needed surgery. I really dont want her to have surgery unless its absolutely necessary. Shes only 5 years old. Please help. Id like another opinion. Is there another non-surgical option? We were admitted and will stay the night in the hospital." }, { "from": "gpt", "value": "She absolutely needs surgery. Its a very small surgery in the realm of orthopaedics. It will be 2 or 3 pins placed through the skin and then a cast or splint applied. Theyll be able to take the pins out in the office after it heals. The only type of supracondylar fracture thats amenable to non-operative treatment are those that are non-displaced. If you elect for non-operative treatment for this fracture pattern, your daughter will have permanent, long-term elbow dysfunction." } ]

[ { "from": "human", "value": "I (23F) keep sleeping through my doctors appointments due to a sleep disorder.Caucasian, 95lbs, 54. Diagnosed PTSD, Anxiety, Depression, Essential Tremor, Hypoglycemia. Taking 150mg Oxcarbazepine 2x/Day, .5mg Clonazepam 1x/Day. Vape nicotine and cannabis.Im currently dealing with several medical issues but am unable to get them treated/diagnosed because I sleep all day, every day. The sleep issues have been ongoing and worsening over the past decade.I sleep 16+ hours every day, cannot sleep at night, nothing and no one has been able to wake me up (incl. medical professionals in a hospital setting, my partner, assorted alarms, resetting my sleep schedule, etc)I had an appointment with my PCP on the 26th at 8 AM that I had to pull an all nighter for to be able to go to. I got an abnormal EKG reading and needed labs. They proceeded to try to draw blood..but my veins are tiny (they used pediatric needles) and kept collapsing, so they requested I come back today (the 28th) at 10 AM, extra hydrated and rested (they said my not sleeping couldve been partially to blame for labs difficulty).Well, thats about 2 hours past my bodys chosen bedtime, so I accidentally fell asleep (and woke up at 8 PM today).Everyones getting frustrated with how many appointments Ive missed (myself included). If I continue to miss appointments (especially therapy) I could be labeled as non-compliant, which could royally fuck everything up.How can I make my appointments? How can I treat my condition myself enough so that Im able to get professional care (for this and other issues)? At the very least, how can I show/prove that Im invested in my care despite my repeated missed appointments?" }, { "from": "gpt", "value": "Taking a sedative (clonazepam) whilst also smoking a sedative (cannabis) certainly wont help you to not fall asleep." } ]

[ { "from": "human", "value": "[26][F] I have moved to a new state and have WA State Health Insurance. Questions about choosing my PCP.I previously had a PCP who helped with various issues but mainly helped me with my medication management for my mental health issues. We have found what works for me (see 'Current Medications' below) but I want to have a PCP that is versed with medication for mental health issues in case changes are needed to be made (It took many years, several doctors, and many different medications to come to my current Rx and I am very thankful to my previous doctor for helping me get to such a point). But I also am 26 and am more aware of my women health needs and want to be sure I'm addressing those and staying healthy. I also have an IUD that needs removal soon, at which I will likely get another inserted.I was assigned a doctor that works at a \"Pediatrics Associates\" place with the credentials (MSN, ARNP, NP-C). I am confused as to why I was assigned to go somewhere for pediatrics, as it was my understanding that it was for children, though I am not discounting my assigned PCP's credentials. I looked into other PCPs that were on the directory and found an MD in Family Medicine and Obstetrics. Seeing this doctor would be a further drive for me but it intrigues me since I have never been to an OBGYN. Since I am getting older and leaning more into health women's health, should I request to begin seeing this PCP instead? -- Note that requests for doctor changes are allowed. -- or does the assigned doctor seem to have plenty credential/ knowledge for me to establish care?Hope this doesn't seem undermining at all, I just want to make sure I'm making a good decision since I will likely establish long term care with my next doctor!TIA :)Height: 5'4\"Weight: 110-120 lbRace: Asian AmericanPrimary Concerns: Vaginal Health & Mental HealthExisting Medical Issues: Diagnosed ADHD, MDD, GAD. Prone to overproduction of yeast leading to BV or Yeast InfectionsCurrent Medications: Venlafaxine 150 mg, Vyvanse 60 mgOccasional drinks weekly. No smoking. No drugs." }, { "from": "gpt", "value": "Yeah, no idea why you would have been assigned someone who works in a pediatric office. I'd switch to the family medicine MD." } ]

[ { "from": "human", "value": "Childs swollen elbow normal?4.5 years old 37lbs 43in.My daughter fell and hurt her left arm on Sunday evening. We took her to urgent care early Monday morning. Got X-rays and there are no fractures. They determined it was a Nursemaids Elbow and tried a few times to reset it, but they werent sure they were successful because she was resisting, even though we were (safely) restraining her (the absolute worst worst WORST for my heart omg).They told us that we should bring her to an pediatric orthopedic doctor today if she wasnt using it by the end of the day (yesterday, Monday).I did notice her using it a little bit more, though not much. She complained it hurt for the rest of the day (when she went to wash her hands and used it to push down on the soap dispenser, she screamed out in pain).Today she woke up and I noticed its a bit more swollen than her other elbow. Shes still complaining that it hurts and is using her other hand to hold her arm close to her body, but she turned a page in a book with it as I typed this, which is way more than shes done in the past day and a half.Im not sure if its just from being a bit manhandled by two different doctors trying to reset her elbow yesterday, and so we should let it be, or if its worse and I should take her to the orthopedic doctor this morning." }, { "from": "gpt", "value": "I would definitely take her to get checked by the pediatric Ortho. The injury is not consistent with nursemaids and these are typically very easily reduced. Worth a second look for sure." } ]

[ { "from": "human", "value": "Could they have seen it in an X-ray? They didnt show us the X-ray, but said there were no fractures." }, { "from": "gpt", "value": "The elbow can be tricky in kids. Sometimes they hide fractures very well there and we may not see them initially on x-ray." } ]

[ { "from": "human", "value": "Pediatric Dentist ? 5yo needs dental work.My son 5M 55lbs no medications or health concerns besides this one.Hoping theres a pediatric dentist on here? My son has a tooth thats got an abscess on the gum above it. That tooth has to be pulled and he also needs a crown on another tooth that has a bad cavity. He doesnt do well at the dentist and they suggested IV sedation for him.They do this in their office (pediatric dentist plus dentist anesthesiologist) which I found unsettling and wanted to know if thats normal? Is this general anesthesia like where hed be intubated? I always thought that needed to be done in a hospital setting.I already feel like the worlds worst mother so I know its my fault for letting his teeth get so bad. So adding this anxiety to my guilt. Just worried about his safety and if an emergency should arise we wouldnt already be in a hospital.My next question is that they didnt schedule it until mid October and thats over a month and a half wait with an abscessed tooth. Im afraid its going to get much worse in that time. They prescribed an antibiotic but Is there anything I can do at home to keep it from getting worse?If anyone has any advice for this terrified mom I would truly appreciate it." }, { "from": "gpt", "value": "You probably won't find a pediatric dentist on here (this is AskDocs, not AskDentists).IV sedation isn't the same as full general anesthesia where he'd be intubated. They'll use IV medication to calm him down and make him sleepy, but he'll still be breathing on his own. WIth proper monitoring (cardiorespiratory monitor, O2 saturations, etc) this is very safe. Similar to the sedation that's given for many people to get their wisdom teeth removed.Besides ensuring good brushing and taking the antibiotic, not much you can do to keep this from getting worse. Stuff happens, don't beat yourself up." } ]

[ { "from": "human", "value": "My 6 year old is sick every other week. I need advice.I need advice! My 6 year old is in kindergarten and has had strep, pink eye, and bronchitis every other week! He's well for a week then gets hit with a new fever, and sick again. I am not sure what to do. Care is the worst around us and we are on a waiting list for a pediatric ENT for possibly getting his adenoids out. Anything I may be missing or what I can do? It breaks me how sick he is all the time and the amount of school he keeps missing." }, { "from": "gpt", "value": "How are his growth and development? Every child has been getting sick constantly for about 9 months, so probably he is just like every other child. But without any information no one can say." } ]

[ { "from": "human", "value": "Low alkaline phosphatase and low ALT(SGPT)My Child, 6 years old,18kg, male, kept complaining about sore legs (mostly around knees) for the last 4-5 years. Talked to our Gp about it few times only to be told is due to growth.It could happen all of sudden and last for a week every day or evening and then he is ok for few more weeks and then starts again. We also had months of no pain too. It is very irregular.Pain stops only after giving him pain medication along with massage.Sometimes is so bad that he is shaking from pain.We also went abroad to an private orthopedic pediatrician. Checked him and also said is probably due to growth and that is very common.Few weeks ago had another episode. He would also wake up during the night because of this pain just like before. Decided to se our gp again and asked for a referral to a specialist. It will most likely take months to get an appointment. In the mean time we did some blood tests.Results came and I'm scared. Google gives me the worst scenario for low alkaline phos. And low ALT (SGPT). I will see our gp in few days but im very concerned. Should i be that worried? He also has low eosinophils and low (0) Basophils.What other blood tests should we ask to do until we get the specialist appointment.Thank you!" }, { "from": "gpt", "value": "The low alkaline phosphatase and low ALT (SGPT) levels may suggest an underlying inflammatory process, perhaps JIA.I recommend a referral to a pediatric rheumatologist.The low eosinophil count may be related to his immune system response to inflammation." } ]

[ { "from": "human", "value": "21 year old female with GI issues for years but they keep getting progressively worseI cant remember if I always had these issues, but I remember being 12 years old and starting to have very consistent diarrhea. All throughout middle school and high school I had mostly diarrhea BMs, with a few episodes of constipation. I always assumed it was how my family ate. Around 18 it got worse. I started to become constantly nauseous and lost over 50 pounds from throwing up and diarrhea. I went to the doctor but they told me change my diet. Since moving out last year and making changes to my diet to be healthier and adding more probiotics and fibers, nothing has changed and it feels like its getting worse. Now I have constant painful gas that bubbles in my stomach and honestly smells so bad. Im embarrassed to leave the house most days in fear my coworkers will notice. My joints have started to have unbearable pain, mostly in my hands and hips. I get sick once a month and it leaves me bedridden at least one day. I feel like my body is falling apart on me.I drink lots of water and try to keep my diet to standard to help my stomach, but Im not sure what else to do. I recently aged out of pediatrics and am unable to find any doctor near me that both accepts new patients and takes my insurance. I just feel so lostIve never had a diagnosis before other than for mental illnesses. Ive considered it being stress, and while it does get worse when Im stressed, its always like this no matter what my mental state is.For family history, we have no diagnosis of IBS or Crohns, but my mother had really bad undiagnosed stomach issues and died from breast cancer. All the women in my family have had breast cancer. My sister has diagnosed rheumatoid arthritis (she is 30, was diagnosed at 26)" }, { "from": "gpt", "value": "Have you been tested for celiac disease? You should see a GI doctor if your PCP isn't doing any meaningful work-up. There are many possible causes" } ]

[ { "from": "human", "value": "Is antibiotic resistance some thing I have to worry about?I have a daughter who is four years old. She has no pertinent or obvious health problems, except for a lingering cough she had for about eight months after we had Covid last year. She is almost 4 feet tall and about 55 pounds. She has been having recurring vaginal discharge for over a year now. She has been on amoxicillin, Cefdinir, and keflex. Finally, after so long of not having any answers, they finally sent her to a pediatric gynecologist. She did an internal swab and found the strep bacteria. But, after a phone call with her, she told me that all of the antibiotics she has taken so far should have killed the bacteria. Each time she took antibiotics it was for 10 days.She prescribed her another, fourth kind of antibiotic, and said that if this doesnt kill it, that she will have to have a check up inside her vagina under sedation. I am not against this procedure, but now I have become a little worried about antibiotic resistance. If these previous antibiotics were supposed to kill the bacteria and she took them for 10 days, is this a bad sign? Or is it really possible that these three different kinds of antibiotics that she took for 10 days each didnt really kill the bacteria? Id love another doctors opinion on the matter." }, { "from": "gpt", "value": "It's probably fine.It's not clear to me she has an infection that needs antibiotics." } ]

[ { "from": "human", "value": "Would a swab that shows strep not indicate antibiotics?" }, { "from": "gpt", "value": "If you swab a human's orifice, it will grow bacteria.Whether that bacteria is the cause of an infectious pathology is a different question.Are you talking about group A or group B strep?" } ]

[ { "from": "human", "value": "Any pediatric GIs who are familiar with intussusception? Or something that presents as such symptomatically?Any pediatric GIs who are familiar with intussusception?My 15month old son who was full term at birth was diagnosed with a small bowel intussusception when my husband and I brought him to the emergency room yesterday, 12/21/2022. The ultrasound report read, There is a 1.1 x 0.9 cm small bowel small bowel intussusception in the left hemiabdomen near the umbilicus. No evidence of ileocolic intussusception in the right lower quadrant. No free fluid in the abdomen or pelvis.After this was found on ultrasound, after 2 hours, an ultrasound was repeated, and the intussusception was gone.I have to say I wasnt surprised by this diagnosis, and I am GLAD that it was found on ultrasound.Since my son was six weeks old, he has experienced what I intuitively thought was GI distress. He would scream inconsolably, turn red in the face, and grunt as if he were trying to bear down. This wasnt infrequent; it was all happening all the time. Every week we would visit the pediatrician and an urgent care 1-3 times. At these visits, they would tell my husband and me that it was colic or gas or fussiness. We tried different formulas with cutting everything out of my diet because he was getting breastmilk too. We tried gas drops, bicycles, probiotics, and the colic holds we were shown. You name it; we tried it.After six months of torture for my little guy, I finally said ENOUGH was ENOUGH, and I brought him to the emergency room. The imaging at the emergency room showed that he had a lot of gas in his abdomen, and it was recommended that we try a hypoallergenic formula. (Before this, my son was getting breastmilk supplemented with formula.) We switched to Similac alimentum. Once we discovered that all of the formula we had given our little guy was recalled, we changed to Nutramigen. Since being on the hypoallergenic formula, the CONSTANT crying and screaming had subsided but hadnt completely gone away.He would have bouts of inconsolable screaming that would last 20 minutes, and then he would calm down. Sometimes he would have bouts of screaming that would last 20 minutes, calm, and then crescendo into more extended periods of crying with bearing down, turning red in the face, shaking, and vomiting.With that said, I am looking for some guidance. Has any pediatric GI seen or heard of small bowel intussusception reoccurring for this time? The Emergency Room doctor said he couldnt answer this question because he sees the acute visit of patients. He recommended that we follow up with a pediatric GI surgeon and our pediatrician.I spoke with the pediatric GI Nurse Practitioner, and she said they do not perform surgeries on small bowl intussusceptions. She said that they only perform surgeries on small to large bowl intussusceptions. She also said that this should subside when he is 5 -- she said this as if I could look forward to relief for him in 3 1/2 years!!The pediatric GI Nurse Practitioner and the Emergency Room Physician told me that I should bring him to the ED anytime he presented the way he did when I brought him in when he was diagnosed. This cant is the answer. This is not sustainable for us or our child. Since he was 15 months old, we have brought him into the ED, pediatricians office, and urgent care countless times for the same issues. It just so happens that they FOUND the cause THIS time.I would like to know if anyone has guidance or familiarity with this. Some questions I have are, has anyone ever seen a re-occurring intussusception? If this is re-occurring, is our only option to keep bringing him to the ED? Could something else be missing? Who else should I talk to? What else should I do?I am so frustrated with all the conflicting information and advice I have been given over the last 15 months. I feel so discouraged and not heard.I am so worried and heartbroken seeing my son constantly go through this.Any suggestions would be helpful. I am following up with our pediatrician, and hopefully, they will FINALLY put in a referral to a pediatric GI. I am a registered nurse, so I have a general background in the medical field." }, { "from": "gpt", "value": "Transient small bowel intuss is a common finding in kids with belly pain or GI distress.No, it essentially never needs intervention.Kids get it all the time when they have stomach bugs. You just don't have an ultrasound on their belly the whole time.This may or may not be related to his prior issues of belly pain at all.A possible, but unlikely possibility is some sort of pathologic lead point that causes recurrent intuss. Like a Mekels, a real bad Peyer's patch, vascular anomaly, or even less commonly malignancy. I know of these being implicated more so for recurrent ileocecal intuss, but I suppose there's no reason they can't occur higher up.I think referral to peds GI is appropriate.Another possibility is Deitls crisis. It's recurrent, transient UPJ obstruction that causes episodes of pain, similar to intuss. It's rare, but also underdiagnosed, because nobody fucking knows about it. Small kids that have it are actually experiencing renal colic, but can't communicate it, and are presumed to have actually have abdominal pain. It's something to consider in the child with chronic episodic belly pain that self resolves and has no other symptoms." } ]

[ { "from": "human", "value": "Pediatric Psych patient dosage9 F Caucasian 93 lbs 4ft 6?My daughter was prescribed Lexapro 5 mg and everything I'm reading online says it's not for children under 12. I reached out to her pediatrician and he says to contact them because it's their expertise. I've been trying but am not getting through. In the mean time, is this something I should hold off on giving her or is the dosage small enough?" }, { "from": "gpt", "value": "Its likely safe but there is limited evidence to show efficacy (limited number of trials). Id hold off until you speak to psych, 1-2 days while you wait to speak to a psychiatrist for more clarification wont make a difference. It takes 6 weeks of consistent use before you really start to see much in the way of improvement to begin with, for most patients." } ]

[ { "from": "human", "value": "Thank you for your reply! She was given it starting on Saturday and seemed to do fine. I did end up getting through to someone and they said it was fine to give because she had been monitored while on it. I can't find any info as to why it's not recommended for children under 12 but they seem to find it appropriate, so I'm going to assume it should be?" }, { "from": "gpt", "value": "They dont recommend against it. Its just the lack of evidence and a strong benefit/risk analysis that prevents them from recommending it in patients under 12 at this point." } ]

[ { "from": "human", "value": "(Pediatrics) 24 month old white female with discordant bone age. 31\" tall, 21 pounds. No meds, no surgeries.(Pediatrics) 24 month old white female with possible short stature. 31\" tall, 21 pounds. No meds, no surgeries.My 2 year old hasn't been getting very tall as she's gotten older. She's dropped to the first percentile for height. Her first pediatrician wasn't overly concerned, but we saw a new pediatrician and she was concerned and had her x-rayed. I got the report back, but the doctor is out of the office so I won't be able to talk to her until next week.The radiology report says:FINDINGS: A single radiograph of the hand was provided for evaluation of bone age. The patient's chronological age is 24 months. The hand bone age according to the tables of Greulich and Pyle is approximately 2 years. The wrist bone age most closely approaches that of 1 year and 3 months. The standard deviation for the patient's chronological age is 4.64 months. No structural abnormalities are identified.IMPRESSION:Discordant bone age between the hand and wrist, but both are within 2 standard deviations of chronological age per the age and gender matched standards of Greulich and Pyle.Is the discrepancy worrisome?https://flic.kr/p/2nS9y6S" }, { "from": "gpt", "value": "Worrisome probably isnt the right term. It isnt indicative of anything dangerous.It can sometimes indicate a hormonal issue that requires endocrine referral.But will also say that pediatric endocrinologists and radiologist often disagree on bone ages.Bone ages are pretty subjective. Basically they x-ray the hand in a specific way and then compare it to a book with known bone ages and say eh, I think it looks like this one the most." } ]

[ { "from": "human", "value": "Disagree in what way? Just generally, or does one group tend to say bone age is more/less advanced than the other?" }, { "from": "gpt", "value": "Just generally. I dont do bone ages but have heard a few endocrinologists say I never listen to radiologys reads on bone ages. Then they proceed to do it themselves." } ]

[ { "from": "human", "value": "6 year old with hallucinations currently hospitilized. Is this autoimmune encephalopathy?Age: 6Sex: MaleLocation: New England, USAMy child has been in the hospital over the last week for suspected autoimmune encephalitis. I brought him to the ER on 4/11 per instruction from his pediatrician due to visual hallucinations. He was admitted after neurology came to the ER for a consult. The hallucinations have not been improving with treatment as of yet (4 days of IV steroids & 1 day of IV IG, see below for more specifics). I've been advised 90% of the labs will take a couple of weeks to get back. Is there anything else we should be considering? He's the happiest kid, he absolutely loves school and his friends and teachers and he can't wait to go home. He knows what he's seeing isn't real and I wish I could make it go away. Any insight/advice would be so appreciated. He's been a trooper throughout this process but it's not easy wondering every day what is going on. I can provide additional information if needed/requested.Assessment/Plan: Child is a 6 y.o. 5 m.o. male with PMH of hypnagogic hallucinations and asthma who presents for evaluation of 2 days of daytime hallucinations. Given acute onset of worsening visual hallucinations that started with nighttime awakenings on 4/7 and then progressed to daytime visual hallucinations on 4/10, we are concerned for autoimmune encephalitis. LTM EEG with left parasagittal and temporal spike wave epileptiform discharges, suggestive of underlying brain irritability. However, patient is very well appearing with no other classic features of autoimmune encephalitis- no encephalopathy, no weakness, no abnormal movements. Given that he is very well appearing and is not demonstrating significant decline from day to day, we will plan to first obtain CSF and brain MRI with contrast prior to starting immunosuppression. If CSF is bland, we would likely still recommend treating with immunosuppression given clinical concern and patient meeting diagnostic criteria for autoimmune encephalitis.EEG is abnormal but no definite seizures. Frequent and sleep activated left temporal and parasagittal spike and wave epileptiform discharges. Brain MRI normal. LP overall bland with 1 nucleated cell in tube 1, 2 nucleated cells in tube 2. Other labs pending but does have ANA positive at 1:320.Has been on IV steroids since 4/14 with no improvement in visual hallucinations. Will plan to continue steroids for total 5-day course and discuss case with our neuroimmunology colleagues. (This plan changed after neuroimmunology consult, began tapering steroids after 4th day to begin IV IG)Treatment:s/p 4-days of high dose IV methylprednisolone (30mg/kg daily)prednisone taper: 1mg/kg (max 60mg) prednisone tapering over 6 weeks (can roughly cut in half every 7 days) Week 1: 30mg daily Week 2: 15mg daily Week 3: 10mg daily Week 4: 5mg daily Offstart IVIG today for 2-days- IVIG 2g/kg divided over 2 days. Started on 4/17 treatment was well-toleratedResulted workup:EEG abnormal with frequent abundant spike wave epileptiform dischargesEEG continued to demonstrate frequent abundant left parasagittal and temporal spike wave epileptiform discharges -EEG from 4/12 -Frequent to abundant left parasagittal spike wave epileptiform discharges that occurred both independently and in brief 1-3 Hz runs lasting <10 seconds (BIRDS) -Occasional to abundant left temporal spike wave epileptiform discharges that occurred both independently and in brief 1-1.5 Hz runs lasting <10 seconds (BIRDS)quick brain MRI normalsedated brain MRI with contrast normal, incidental finding of likely arachnoid cystReassuring CBCd, BMP/Mg/Phos, LFT'sESR and CRP normalTSH elevated to 7.44, free T4 normal at 1.1B12 and folate normalRPR non-reactiveRhinovirus positiveCeruloplasmin normalUrine tox negativeUA normalANA positive 1:320, speckledSerum copper within normal rangeCSF opening pressure 15CSF cell count and total protein normalAnti-TPO antibodies negativeHIV 1/2 negativeCollected and pending: [] CSF culture [] CSF HSV PCR, CSF VZV PCR, CSF VZV IgM [] CSF oligoclonal bands, IgG index, beta-2 microglobulin, flow cytometry, cytology [] CSF autoimmune encephalopathy panel [] CSF anti-Glycine-R antibody [] Serum Glycine Receptor IgG [] Myelin oligodendrocyte glycoprotein [] 24 hour urine copper [] 24 hour urine porphyrins [] Double stranded DNA antibodies [] Antiphospholipid antibody panel [] Thyroglobulin antibody [] Serum MaTa Autoantibody test [] SPEP panel [] MS profile, serum and CXF [] IgG index/synthesis rate, serum and CSF [] EBV serology [] VZV IgG, IgM [] HSV PCR, HSV type 1,2 antibody [] Serum encephalopathy panel [] Mycoplasma IgM, IgG [] Lyme screen with reflex to immunoblot [] HSV PCR, serumMENTAL STATUS EXAM: Appearance: appropriately dressed Behavior: cooperative, eye contact good and pleasant Psychomotor Activity: normal Musculoskeletal: moves all extremities; no abnormal movements Station/Gait: normal Speech: regular rate, regular rhythm and regular volume Language: normal comprehension Mood: happy Affect: full range Thought Process: logical, linear and goal-directed Associations: no loosening of associations Thought Content: no delusions and no obsessions Perceptions/Experiences: visual hallucinations Orientation/Sensorium: alert Memory: immediate recall intact. Attention/Concentration: intact to observationImpression: Child is a cheerful and pleasant 6 yo boy, from X attending Kindergarten at X. He has a hx of mild OSA, hypogogic/hypnopompic hallucinations since early on, asthma, no prior past psychiatric history, presenting for worsening hallucinations since 4/10, admitted for medical work up on etiology. Psychiatry consulted for diagnostic clarification, support and medication management.4/14/23: Patient continues to be calm and cooperative, behaviorally appropriate for a 6-year-old boy. Continues to experience visual hallucinations, yesterday night described as \"monsters,\" which patient is understandably afraid of. Most of patient's hallucinations are visual, vivid, and neutral with minimal emotional involvement. No auditory hallucinations. No clear seizure activity on EEG, other than minor blinking, clinical signs of seizure disorder not noted on physical exam. Pt age, onset, and symptoms are not typical of a primary psychotic disorder or normal development. We agree with pediatric neurology and primary team that the origin of hallucinations are organic. No emotional or behavioral dysregulation. Thus, we do not recommend scheduled psychotropic medications at this time. Pediatric neurology assess patient has underlying brain irritability from EEG findings (left parasagittal and temporal spike wave epileptiform discharges), likely secondary to encephalitis, as opposed to seizure disorder." }, { "from": "gpt", "value": "What were the CSF cell counts, protein, and glucose?" } ]

[ { "from": "human", "value": "3y(f) Seeing Pediatric Pulmonologist - What to Expect and Genetic TestingMy (37F) daughter (3F) will be seeing a pediatric pulmonologist next week for suspected asthma. Her pediatrician has diagnosed it as \"mild or intermittent\" but from my observations, it is not mild and is getting worse. It was thought she had recurrent croup but we now suspect those croup episodes have actually been asthma attacks/flares. They only occur during viral illness, but each time she is sick she ends up in respiratory distress and needs an ER/hospital visit. She is prescribed albuterol, flovent, and decadron. Pediatrician agreed to allow us to only use flovent at onset of illness so it is not daily use.I don't know if there will be genetic testing performed, but I did sign a form agreeing to genetic testing.My question is, should I be thinking this is something beyond asthma and possibly genetic? Should I push for imaging and/or genetic testing?" }, { "from": "gpt", "value": "Peds ER doctor here, sounds very much like asthma. No, genetic testing is not done routinely at all, i suspect they make everyone sign that form before coming in so that they can streamline the process if they need to test patients for anything." } ]

[ { "from": "human", "value": "Pediatric Abilify weaning schedule?Hi Reddit Docs, My 8yo (9 in April) son has been on Abilify for about a year, up to 15mg. Long story short we dont feel that it is making a difference and in fact hes getting worse, more physical/aggressive, even violent at times. Especially since we added clonidine again. (In addition hes being treated by a physician who specializes in ADHD, not a psychiatrist. He was diagnosed by a psychologist with ADHD, depression, and motor coordination development disorder. I had to see this Dr because he was diagnosed during the height of the pandemic and no psychiatrist was available. Basically threw different combinations of Vyvanse, guanfacine, clonidine, and Adderrall at him, hes currently on Adzenys, Abilify and just came off clonidine. Finally got him some Lexapro a few months ago and his baseline mood has improved but the outbursts are worse. Ive been trying again to get a psychiatrist with no luck. I currently have an emergency intake visit scheduled in 4 days with a social worker who is supposedly going to get us a faster referral visit.) What is the recommended taper schedule to come off the Abilify? Wanting to make sure current provider is giving us accurate info. Thank you!" }, { "from": "gpt", "value": "I am not sure what the guidelines for treating children are where you reside but to me this seems like a hodgepodge of medication. I would personally be very concerned to write out so many medications (some of which counteract each other).My first question would be what was the main problem with your son before he got medicated? Why did you seek help? Is there family history of psychiatric illness?The tapering really depends on the patient and the symptoms experienced. One could recommend to reduce 5mg every week (so 15mg, 10mg and finally 5mg before stopping). This can be further adjusted depending on any side effects. This can be also adjusted more finely if you have an oral solution instead of tablets." } ]

[ { "from": "human", "value": "Pediatric4 y/o female, turning 5 next month. No significant PMH. Complaining of pin point pain around umbilical area that hurts more when I breathe in and out. Also complaining of GERD symptoms described it perfectly without knowing obviously when I eat my food and drink too, it goes down to my belly and then comes back up and I have to swallow it again.Started complaining of both these symptoms over the last 24 hours.No bulge can be noticed or palpated, even when coughing or taking deep breaths.What could this be?" }, { "from": "gpt", "value": "Gastric or duodenal ulcer, GERD, constipation. Would talk to pediatrician about it. Can do a trial with famotidine if it sounds like reflux to them with a more thorough history. If its a one off episode its unlikely to be anything to worry about if it self resolves. Look for food triggers and anything that helps or makes it worse in the mean time." } ]

[ { "from": "human", "value": "Pediatric burnsMy daughter is 4 years old and was burned with hot water earlier today. She was taken to our local emergency room within about 20 minutes of the accident. The burns are on her chest/belly area covering approximately 65% of the front. The doctor did not specify but I believe it's 2nd degree burns as the top layer skin has came off. The er gave hycet plus gave her a prescription for hycet and silvadene cream. They gave some thin blue towels of hold over the burn area with instructions to not begin the cream or put anything else on it until it stops leaking fluid from the burn. Now she has blue towel fuzz stuck to the burn area and I was told not to wet the wound nor cover with anything else. I don't want to go against the er doctors instructions but I just have a bad feeling that this is going to end up infected. Do these instructions sound correct? Is there anything else I should be doing? Given the burn is on her chest I'm not sure I'm allowed to include a photo but if the mods allow it." }, { "from": "gpt", "value": "This burn would likely meet criteria for inpatient management based on the described size and severity of the burn. Im surprised they would send you home. You should be able to lightly rinse the fibers off but every time you rinse it and if you have any abrasion, you risk destroying the epithelialization of new skin. There is a balance between dressing changes and allowing time for healing. Additionally moisture can increase the risk of infection. Generally speaking the fuzz is likely harmless, so you would have to use your judgement as to whether it needs to be removed based on the amount attached and any soiling or other factors present.If there is a significant amount, Id recommend a return to the emergency room for further management and discuss admission to the inpatient service or transfer to a burn center for further care. Burns often require more significant care than just the initial skin damage, especially if a significant portion of the trunk has been burned. In pediatric patients it is even more imperative to get proper care to ensure proper healing and limit future difficulties secondary to poor healing.They can be managed at home for minor burns, but if you are not comfortable with the care and it has not been described in enough detail that you feel comfortable, return to the ED. Your child will thank you in the future if you get proper care now. Its unfortunate that this may require an additional trip to the emergency room, but I wish you the best and hope your child has a speedy recovery.You may wish to try a different emergency room for a second opinion if you did not feel like you received adequate care at the first one." } ]

[ { "from": "human", "value": "Pediatric lupus?My 11 y/o daughter had three weeks of low grade fever, headache, body ache, fatigue, nausea and low appetite. Multiple negative tests - covid (including antibody), mono, strep, flu, RSV. Had a positive urinalysis for bacteria and blood - did a round of Bactrim but the symptoms remained. Current meds for asthma - symbicort, xopenex as needed, singular.Doc ran some more blood tests - looks like some were autoimmune tests. Can I get some interpretation of these ANA titer results? Recommend seeing a pediatric rheumatologist?" }, { "from": "gpt", "value": "That's quite a high ANA titer (means very positive). Time to see a peds rheum.This is not the place to push Lyme pseudo-medicine." } ]

[ { "from": "human", "value": "Definitely in a tick borne illness area - Lyme tests are in these results too - but she was only reactive on one of the bands. I think that means shes negative?" }, { "from": "gpt", "value": "That means she's negative. Please don't listen to the internet panic about Lyme disease. It's easy to test for and straightforward to treat." } ]