American family physician
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Jaundice is an indication of hyperbilirubinemia and is caused by derangements in bilirubin metabolism. It is typically apparent when serum bilirubin levels exceed 3 mg/dL and can indicate serious underlying disease of the liver or biliary tract. A comprehensive medical history, review of systems, and physical examination are essential for differentiating potential causes such as alcoholic liver disease, biliary strictures, choledocholithiasis, drug-induced liver injury, hemolysis, or hepatitis. ⋯ Measuring fractionated bilirubin allows for determination of whether the hyperbilirubinemia is conjugated or unconjugated. Ultrasonography of the abdomen, computed tomography with intravenous contrast media, and magnetic resonance cholangiopancreatography are first-line options for patients presenting with jaundice, depending on the suspected underlying etiology. If the etiology of jaundice is unclear despite laboratory testing and imaging, liver biopsy may be required to establish the diagnosis, prognosis, and management of the disease.
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American family physician · Jan 2025
ReviewEarly Childhood Concerns: Counseling on Sleep Issues, Thumb-Sucking, Picky Eating, School Readiness, and Oral Health.
Common early childhood concerns and behaviors include sleep issues, thumb-sucking, pacifier use, picky eating, school readiness, and oral health. Family physicians must recognize when these indicate an underlying disorder and offer constructive and evidence-based strategies to support healthy child development and family well-being. Behavioral interventions and education to address sleep issues can alleviate stress and decrease fatigue for the whole family. ⋯ Readiness to begin school depends on child, family, and societal factors, and needs an individualized approach that emphasizes inclusion while ensuring person-centered success. Reading and participation in early childhood educational programs improve literacy and classroom preparation. Oral health is an important part of childhood well-being; preventive care, including fluoridation, should begin when the first tooth has erupted.