Pediatr Ann
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Ten pearls (and pitfalls) in the management of the jaundiced newborn: Remember to take a history. Ask about jaundice in previous siblings and check family ethnicity. Don't ignore jaundice in the first 24 hours--it is considered pathologic until proven otherwise. ⋯ However, any infant who is still jaundiced beyond age 3 weeks must have a measurement of direct bilirubin. Don't ignore severe jaundice. If the bilirubin is sufficiently elevated, kernicterus can occur in a healthy, breast-fed infant.
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The classification and pathophysiology of headache syndromes in children and adolescents is reviewed. The most important issues are classifying the headache type and determining the etiology of the child's headache. This is best accomplished with a thorough history and physical examination, coupled with selected laboratory tests. The pathophysiology of the underlying headache as reviewed usually will allow the choice of appropriate treatment modalities.
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A child's pain is plastic and complex. In order to more effectively alleviate suffering, emphasis must shift from an exclusive focus on the source of tissue damage to a more comprehensive focus that includes factors that modulate pain. Evaluating a child's pain requires an integrated approach. ⋯ Pain assessment, like pain management, is a continuous process. Pain intensity rating scales should be used so children can provide a direct rating of their pain intensity and pain effect. Patients should receive some guidance about how to use the information from rating scales to develop consistent and objective criteria to know when children require analgesics and then to evaluate the effectiveness of those medications.
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Fluid administration in children with meningitis should be conservative in an attempt to minimize cerebral edema and electrolyte disturbances that frequently complicate the course of meningitis. Since these complications have been shown to correlate with poor neurologic outcome, it is believed that appropriate fluid management will minimize the morbidity and mortality associated with bacterial meningitis in children.