American family physician
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American family physician · Dec 2024
ReviewAnemia in Infants and Children: Evaluation and Treatment.
Anemia affects more than 269 million children globally, including 1.2 million children in the United States. Although anemia can present with numerous symptoms, children are most often asymptomatic at the time of diagnosis. Anemia in infants and children most often arises from nutritional iron deficiency but can also be a result of genetic hemoglobin disorders, blood loss, infections, and other diseases. ⋯ Normocytic anemia is classified by reticulocyte count and can reflect hemolysis (high reticulocyte count) or bone marrow suppression (low reticulocyte count). Macrocytic anemia is less common in children and is typically a result of nutritional deficiencies or poor absorption of cobalamin (vitamin B12) or folate. Pediatric hematology referral might be beneficial for patients who do not respond to treatment, and referrals are critical for any bone marrow suppression that is diagnosed.
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American family physician · Dec 2024
ReviewAcute Abdominal Pain in Children: Evaluation and Management.
Acute abdominal pain in children is a common presentation in the clinic and emergency department settings and accounts for up to 10% of childhood emergency department visits. Determining the appropriate disposition of abdominal pain in children can be challenging. The differential diagnosis of acute abdominal pain, including gastroenteritis, constipation, urinary tract infection, acute appendicitis, tubo-ovarian abscess, testicular torsion, and volvulus, and the diagnostic approach vary by age. ⋯ Ultrasonography, including point-of-care ultrasonography, for the evaluation of acute abdominal pain in children is the preferred initial imaging modality due to its low cost, ease of use, and lack of ionizing radiation. In addition to laboratory evaluation and imaging, children with red-flag or high-risk symptoms should be referred for urgent surgical consultation. Validated scoring systems, such as the Pediatric Appendicitis Score, can be used to help determine the patient's risk of appendicitis.
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Keloid and hypertrophic scars are a result of aberrant wound healing responses within the reticular dermis. They are thought to be secondary to the formation of a disorganized extracellular matrix due to excessive fibroproliferative collagen response. Prevention of these scars focuses on avoiding elective or cosmetic procedures such as piercings in patients at high risk, reducing tension across the lesion, and decreasing the inflammatory response. ⋯ Surgical revisions can be successful when tension-reducing techniques are used and when combined with other treatments such as postoperative steroid injection, laser ablation, and radiation therapy. For keloid prevention, corticosteroid injections administered 10 to 14 days postsurgery is superior to injections administered before or during surgery. Radiation therapy is considered safe with low cancer risk and can be used alone or in combination with other therapies.
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Bone stress injuries (BSIs) are a spectrum of overuse injuries caused by an accumulation of microdamage, from high physical demands on normal bone or normal physiologic loads on structurally compromised bone. They typically result from overuse in younger patients but are also caused by pathologic bone conditions, including relative energy deficiency in sport, which features decreased bone mineral density. Stress fractures, representing 20% of BSIs, are the most severe type and feature discernable sclerosis or fracture lines on imaging. ⋯ Severity of BSI (grade) and location (low- vs high-risk of complications) guide the management approach. Injuries in low-risk sites are treated conservatively, whereas fractures in high-risk sites warrant consultation with sports medicine or orthopedics. Femoral neck BSIs, especially when tension-sided, require urgent surgical consultation.