The regular response of iron-deficiency anemia to adequate amounts of iron is an important diagnostic and therapeutic feature.

Oral Iron:

Oral administration of simple ferrous salts (e.g., sulfate, gluconate, fumarate) provides inexpensive and satisfactory therapy. No evidence shows that addition of any trace metal, vitamin, or other hematinic substance significantly increases the response to simple ferrous salts. One problem encountered with administration of oral iron to young children is that liquid FeSO4has an unpleasant taste, but sometimes the taste can be camouflaged by mixing with flavored syrup. Other, better-tasting preparations are available over the counter, but these are much more expensive than simple liquid FeSO4. Aside from the unpleasant taste, intolerance to oral iron is uncommon in young children, although older children and adolescents sometimes have gastrointestinal complaints. Problems with constipation can be minimized by increasing water and fiber intake. For some children, abdominal discomfort can be minimized by administering iron with food, recognizing that this may decrease iron absorption to some extent.

The therapeutic dose should be calculated in terms of elemental iron; ferrous sulfate is 20% elemental iron by weight. A daily total dose of 4–6 mg/kg of elemental iron in 3 divided doses Continue reading »

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Brain abscesses can occur in children of any age but are most common in children between 4 and 8 yr and neonates.

CAUSES.
The causes of brain abscess include embolization due to congenital heart disease with right-to-left shunts (especially tetralogy of Fallot), meningitis, chronic otitis media and mastoiditis, sinusitis, soft tissue infection of the face or scalp, orbital cellulitis, dental infections, penetrating head injuries, immunodeficiency states, and infection of ventriculoperitoneal shunts.

PATHOLOGY.

Cerebral abscesses are evenly distributed between the two hemispheres, and ?80% of cases are divided equally between the frontal, parietal, and temporal lobes.. An abscess in the frontal lobe is often caused by extension from sinusitis or orbital cellulitis, whereas abscesses located in the temporal lobe or cerebellum are frequently associated with chronic otitis media and mastoiditis.

ETIOLOGY.

The responsible bacteria include streptococci (S. milleri, S. pyogenes group A or B, S. pneumoniae, S. faecalis), anaerobic organisms (gram-positive cocci, Bacteroides spp., Fusobacterium spp., Prevotella spp., Actinomyces spp.), and gram-negative aerobic bacilli (Haemophilus aphrophilus, H. parainfluenzae, H. influenzae, Enterobacter, E. coli, Proteus spp.). Citrobacter is most common in neonates. One organism is cultured in the majority of abscesses Continue reading »

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Very low intake of vitamin C over time may lead to the deficiency disease scurvy.

Age of Onset:

In infants and young children, the usual age of onset of clinical manifestations of scurvy is 6–24 months.

Early Symptoms:

The early symptoms are rather general and include low-grade fever, irritability, tachypnea, digestive disturbances, loss of appetite, and generalized tenderness, particularly in the legs, which is noticeable when the diaper is changed. The pain results in pseudoparalysis, with the hips and knees semi-flexed and the feet rotated outward.

Other Clinical Features:

Edematous swelling along the shafts of the legs may be present; in some cases, there is subperiosteal hemorrhage at the end of the femur .

A “rosary” at the costochondral junctions and depression of the sternum are other typical features.

Changes in the gums are most noticeable after teeth have erupted and are manifested as bluish purple, spongy swellings of the mucous membrane, especially over the upper incisors.

Anemia, which is seen primarily in infants and young children, may be related to impaired ability to use iron or folate.

Other clinical manifestations seen in infants as well as in older children and adolescents include Continue reading »

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