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Dysuria in Children

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481. Acute Abdomen and Pregnancy (Treatment)

(CT) examination is substantially below this level. [ ] During pregnancy, perform medically indicated diagnostic radiographic procedures when needed; when possible, however, consider other imaging procedures not associated with ionizing radiation instead of radiography. [ ] Because of the possible association of antenatal radiation exposure with childhood cancer, [ ] use ionizing radiation only when medically necessary, and minimize that exposure when possible without compromising patient care (...) for urolithiasis is approximately 1:1600. [ , ] For patient education information, see the , as well as and . History and physical examination Findings in urolithiasis include the following: Pain, usually in the flank - Almost always the presenting complaint Nausea and vomiting Dysuria Urgency Fever Gross hematuria History of a prior episode - In 25% of patients [ , ] Costovertebral angle tenderness - Almost always present Abdominal tenderness - Sometimes observed Workup Patients with urolithiasis may have

2014 eMedicine Surgery

482. Epididymitis (Diagnosis)

a selective approach to antibiotic therapy in pediatric epididymitis. They suggest treating all young infants, regardless of urinalysis results, and older boys who have a positive urinalysis or culture. It is also recommended to presumptively treat sexually active adolescents with epididymitis for sexually transmitted infections. This study excluded boys with recent urologic surgery and known lower urinary tract anomalies. [ ] Antibiotics Empiric coverage varies with the patient's age and sexual history (...) between older and younger patients with epididymitis?. Investig Clin Urol . 2017 May. 58 (3):205-209. . Cristoforo TA. Evaluating the Necessity of Antibiotics in the Treatment of Acute Epididymitis in Pediatric Patients: A Literature Review of Retrospective Studies and Data Analysis. Pediatr Emerg Care . 2017 Jan 17. . Boettcher M, Bergholz R, Krebs TF, Wenke K, Treszl A, Aronson DC, et al. Differentiation of Epididymitis and Appendix Testis Torsion by Clinical and Ultrasound Signs in Children

2014 eMedicine Emergency Medicine

483. Encephalitis (Diagnosis)

, children, and adults are much more likely to have localizing CNS infection almost exclusively due to type 1, in a bimodal distribution of patients aged 5-30 years or older than 50 years. St Louis encephalitis and WNE are more common and are most severe in patients older than 60 years; conversely, LAC is more common and is most severe in children younger than 16 years. EEE and WEE disproportionately affect infants while EEE disproportionately affects children and elderly persons. Previous Next (...) those in children, are treated with antimicrobials) and of the 2 most common causes of encephalitis—the arboviruses and the potentially curable HSV. † Wait 4 hours after glucose load. AFB—acid-fast bacillus; CSF—cerebrospinal fluid; EEE-eastern equine encephalitis; HSV—herpes simplex virus; RBC—red blood cell; TB—tuberculosis; WBC—white blood cell. Contributor Information and Disclosures Author David S Howes, MD Professor of Medicine and Pediatrics, Residency Program Director Emeritus, Section

2014 eMedicine Emergency Medicine

484. Urinary Tract Infection (Overview)

Poor feeding Vomiting Irritability Infants and children aged 2 months to 2 years Infants with UTI may display the following symptoms: Poor feeding Fever Vomiting Strong-smelling urine Abdominal pain Irritability Children aged 2-6 years Preschoolers with UTI can display the following symptoms: Vomiting Abdominal pain Fever Strong-smelling urine Enuresis Urinary symptoms (dysuria, urgency, frequency) Children older than 6 years and adolescents School-aged children with UTI can display the following (...) . Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J . 2008 Apr. 27(4):302-8. . Hoberman A, Chao HP, Keller DM, Hickey R, Davis HW, Ellis D. Prevalence of urinary tract infection in febrile infants. J Pediatr . 1993 Jul. 123(1):17-23. . Downs SM. Technical report: urinary tract infections in febrile infants and young children. The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement. Pediatrics . 1999 Apr. 103(4):e54

2014 eMedicine Pediatrics

485. Somatoform Disorder: Somatization (Follow-up)

medical outpatient visits. [ ] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [ ] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms. Somatization in children consists of the persistent experience (...) is the major factor in the pain symptom. [ ] Recurrent abdominal pain (RAP) is the most common recurrent pain complaint of childhood. RAP has been defined by intermittent pain with full recovery between episodes lasting more than 3 months. [ ] Epidemiological studies suggest that RAP effects 8-25% of school-age children aged 9-12 years, is more prevalent among girls, and accounts for 2-4% of pediatric office visits. [ ] An estimated 10% of these patients have documented physical illness, with one third

2014 eMedicine Pediatrics

486. Toxicity, Marine - Ciguatera (Overview)

Painful paresthesias of the extremities Paradoxical temperature reversal (eg, cold objects feel hot and hot objects feel cold; classic symptom) Dental pain (teeth feel loose) Pruritus Arthralgias Myalgias Weakness Ataxia, vertigo Respiratory paralysis Coma In children, irritability may be the only presenting neurologic symptom. Cardiovascular findings may reflect the following: Bradycardia Hypotension Pulmonary edema Other general symptoms include the following: Dysuria Chills Sweating Painful (...) , Harvard Medical School Dana A Stearns, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center Disclosure: Merck Salary Employment John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals John T VanDeVoort, PharmD is a member of the following medical

2014 eMedicine Pediatrics

487. Toxicity, Marine - Ciguatera (Follow-up)

Painful paresthesias of the extremities Paradoxical temperature reversal (eg, cold objects feel hot and hot objects feel cold; classic symptom) Dental pain (teeth feel loose) Pruritus Arthralgias Myalgias Weakness Ataxia, vertigo Respiratory paralysis Coma In children, irritability may be the only presenting neurologic symptom. Cardiovascular findings may reflect the following: Bradycardia Hypotension Pulmonary edema Other general symptoms include the following: Dysuria Chills Sweating Painful (...) , Harvard Medical School Dana A Stearns, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center Disclosure: Merck Salary Employment John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals John T VanDeVoort, PharmD is a member of the following medical

2014 eMedicine Pediatrics

488. Urinary Tract Infection (Follow-up)

kidney disease in children. Pediatr Nephrol . 2012 Mar. 27(3):363-73. . . Zorc JJ, Levine DA, Platt SL, Dayan PS, Macias CG, Krief W, et al. Clinical and demographic factors associated with urinary tract infection in young febrile infants. Pediatrics . 2005 Sep. 116(3):644-8. . Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F, et al. Does this child have a urinary tract infection?. JAMA . 2007 Dec 26. 298(24):2895-904. . [Guideline] Committee on Quality Improvement, Subcommittee (...) renal scarring and that this renal scarring was significantly associated with a delay in the initiation of antimicrobial therapy. [ , ] According to AAP guidelines for the treatment of initial UTIs in febrile infants and children aged 2-24 months old, antibiotics can be given orally or parenterally, with the choice of route based on practical considerations. [ ] Oral antibiotics should not be used in a child who is acutely ill or toxic, has persistent vomiting, or has moderate to severe dehydration

2014 eMedicine Pediatrics

489. Toxicity, Seafood (Follow-up)

, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center Disclosure: Received salary from Merck for employment. Chief Editor Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin Timothy E Corden, MD is a member of the following medical societies (...) resolve within 24 hours, although a late-presenting and extended course is not uncommon. GI symptoms generally consist of diaphoresis, abdominal cramps, nausea, vomiting, profuse watery diarrhea, and dysuria. GI symptoms are usually reported to occur prior to neurological symptoms. Interesting, however, is that the predominance of GI or neurologic symptoms seems to vary according to regions, with GI-predominant illness seen in the Caribbean, while neurologic symptoms predominate in the Indo-Pacific

2014 eMedicine Pediatrics

490. Toxicity, Seafood (Diagnosis)

, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center Disclosure: Received salary from Merck for employment. Chief Editor Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin Timothy E Corden, MD is a member of the following medical societies (...) resolve within 24 hours, although a late-presenting and extended course is not uncommon. GI symptoms generally consist of diaphoresis, abdominal cramps, nausea, vomiting, profuse watery diarrhea, and dysuria. GI symptoms are usually reported to occur prior to neurological symptoms. Interesting, however, is that the predominance of GI or neurologic symptoms seems to vary according to regions, with GI-predominant illness seen in the Caribbean, while neurologic symptoms predominate in the Indo-Pacific

2014 eMedicine Pediatrics

491. Toxicity, Marine - Ciguatera (Diagnosis)

Painful paresthesias of the extremities Paradoxical temperature reversal (eg, cold objects feel hot and hot objects feel cold; classic symptom) Dental pain (teeth feel loose) Pruritus Arthralgias Myalgias Weakness Ataxia, vertigo Respiratory paralysis Coma In children, irritability may be the only presenting neurologic symptom. Cardiovascular findings may reflect the following: Bradycardia Hypotension Pulmonary edema Other general symptoms include the following: Dysuria Chills Sweating Painful (...) , Harvard Medical School Dana A Stearns, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center Disclosure: Merck Salary Employment John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals John T VanDeVoort, PharmD is a member of the following medical

2014 eMedicine Pediatrics

492. Urinary Tract Infection (Diagnosis)

Poor feeding Vomiting Irritability Infants and children aged 2 months to 2 years Infants with UTI may display the following symptoms: Poor feeding Fever Vomiting Strong-smelling urine Abdominal pain Irritability Children aged 2-6 years Preschoolers with UTI can display the following symptoms: Vomiting Abdominal pain Fever Strong-smelling urine Enuresis Urinary symptoms (dysuria, urgency, frequency) Children older than 6 years and adolescents School-aged children with UTI can display the following (...) . Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J . 2008 Apr. 27(4):302-8. . Hoberman A, Chao HP, Keller DM, Hickey R, Davis HW, Ellis D. Prevalence of urinary tract infection in febrile infants. J Pediatr . 1993 Jul. 123(1):17-23. . Downs SM. Technical report: urinary tract infections in febrile infants and young children. The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement. Pediatrics . 1999 Apr. 103(4):e54

2014 eMedicine Pediatrics

493. Urinary Tract Infection (Treatment)

kidney disease in children. Pediatr Nephrol . 2012 Mar. 27(3):363-73. . . Zorc JJ, Levine DA, Platt SL, Dayan PS, Macias CG, Krief W, et al. Clinical and demographic factors associated with urinary tract infection in young febrile infants. Pediatrics . 2005 Sep. 116(3):644-8. . Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F, et al. Does this child have a urinary tract infection?. JAMA . 2007 Dec 26. 298(24):2895-904. . [Guideline] Committee on Quality Improvement, Subcommittee (...) renal scarring and that this renal scarring was significantly associated with a delay in the initiation of antimicrobial therapy. [ , ] According to AAP guidelines for the treatment of initial UTIs in febrile infants and children aged 2-24 months old, antibiotics can be given orally or parenterally, with the choice of route based on practical considerations. [ ] Oral antibiotics should not be used in a child who is acutely ill or toxic, has persistent vomiting, or has moderate to severe dehydration

2014 eMedicine Pediatrics

494. Toxicity, Seafood (Treatment)

, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center Disclosure: Received salary from Merck for employment. Chief Editor Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin Timothy E Corden, MD is a member of the following medical societies (...) resolve within 24 hours, although a late-presenting and extended course is not uncommon. GI symptoms generally consist of diaphoresis, abdominal cramps, nausea, vomiting, profuse watery diarrhea, and dysuria. GI symptoms are usually reported to occur prior to neurological symptoms. Interesting, however, is that the predominance of GI or neurologic symptoms seems to vary according to regions, with GI-predominant illness seen in the Caribbean, while neurologic symptoms predominate in the Indo-Pacific

2014 eMedicine Pediatrics

495. Somatoform Disorder: Somatization (Treatment)

medical outpatient visits. [ ] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [ ] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms. Somatization in children consists of the persistent experience (...) is the major factor in the pain symptom. [ ] Recurrent abdominal pain (RAP) is the most common recurrent pain complaint of childhood. RAP has been defined by intermittent pain with full recovery between episodes lasting more than 3 months. [ ] Epidemiological studies suggest that RAP effects 8-25% of school-age children aged 9-12 years, is more prevalent among girls, and accounts for 2-4% of pediatric office visits. [ ] An estimated 10% of these patients have documented physical illness, with one third

2014 eMedicine Pediatrics

496. Toxicity, Seafood (Overview)

, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center Disclosure: Received salary from Merck for employment. Chief Editor Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin Timothy E Corden, MD is a member of the following medical societies (...) resolve within 24 hours, although a late-presenting and extended course is not uncommon. GI symptoms generally consist of diaphoresis, abdominal cramps, nausea, vomiting, profuse watery diarrhea, and dysuria. GI symptoms are usually reported to occur prior to neurological symptoms. Interesting, however, is that the predominance of GI or neurologic symptoms seems to vary according to regions, with GI-predominant illness seen in the Caribbean, while neurologic symptoms predominate in the Indo-Pacific

2014 eMedicine Pediatrics

497. Somatoform Disorder: Somatization (Diagnosis)

medical outpatient visits. [ ] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [ ] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms. Somatization in children consists of the persistent experience (...) is the major factor in the pain symptom. [ ] Recurrent abdominal pain (RAP) is the most common recurrent pain complaint of childhood. RAP has been defined by intermittent pain with full recovery between episodes lasting more than 3 months. [ ] Epidemiological studies suggest that RAP effects 8-25% of school-age children aged 9-12 years, is more prevalent among girls, and accounts for 2-4% of pediatric office visits. [ ] An estimated 10% of these patients have documented physical illness, with one third

2014 eMedicine Pediatrics

498. Menstruation Disorders (Diagnosis)

, Roche AF, Kulin HE, Lee PA, Himes JH, et al. Age at menarche and racial comparisons in US girls. Pediatrics . 2003 Jan. 111(1):110-3. . Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child . 1969 Jun. 44(235):291-303. . . World Health Organization multicenter study on menstrual and ovulatory patterns in adolescent girls. II. Longitudinal study of menstrual patterns in the early postmenarcheal period, duration of bleeding episodes and menstrual cycles. World (...) of inherited bleeding disorders in women with menorrhagia. Lancet . 1998 Feb 14. 351(9101):485-9. . Ragni MV, Bontempo FA, Hassett AC. von Willebrand disease and bleeding in women. Haemophilia . 1999 Sep. 5(5):313-7. . Werner EJ, Broxson EH, Tucker EL, Giroux DS, Shults J, Abshire TC. Prevalence of von Willebrand disease in children: a multiethnic study. J Pediatr . 1993 Dec. 123(6):893-8. . Shankar M, Lee CA, Sabin CA, Economides DL, Kadir RA. von Willebrand disease in women with menorrhagia: a systematic

2014 eMedicine Pediatrics

499. Hypercalciuria (Treatment)

al. Prevalence and spot urine risk factors for renal stones in children taking topiramate. J Pediatr Urol . 2013 Jan 31. . . Vachvanichsanong P, Malagon M, Moore ES. Recurrent abdominal and flank pain in children with idiopathic hypercalciuria. Acta Paediatr . 2001 Jun. 90(6):643-8. . Alon US, Berenbom A. Idiopathic hypercalciuria of childhood: 4- to 11-year outcome. Pediatr Nephrol . 2000 Sep. 14(10-11):1011-5. . Escribano J, Balaguer A, Martin R, Feliu A, Espax R. Childhood idiopathic (...) degree of hematuria and back or abdominal pain and is also sometimes associated with voiding symptoms. Microcrystallization of calcium with urinary anions has been suggested to lead to injury of the uroepithelium in children with hypercalciuria. Consequently, when taking the history of the illness, attempt to identify symptoms relating to the urinary tract, paying special attention to the following signs and symptoms: Dysuria Abdominal pain Irritability (infants) Urinary frequency Urinary urgency

2014 eMedicine Pediatrics

500. Hematopoietic Stem Cell Transplantation (Treatment)

hampered by small numbers. [ ] Patients treated with chemotherapy alone have achieved remission, but overall survival has been poor. [ , ] In a comparison allogeneic transplant versus chemotherapy in children with Phl + ALL (UK Medical Research Council trial for childhood ALL [MRC ALL 97] program from 1997-2002), 3-year survival was reported as 60% compared with 36%, respectively. [ ] Children with induction failure (M2 or M3 bone marrow status at the end of 1 mo of therapy) were found to have very (...) Leukocyte adhesion deficiency Indications for HSCT in specific diseases Acute myeloid leukemia Allogeneic HSCT is the treatment of choice for all children with acute myeloid leukemia (AML) with a human leukocyte antigen (HLA) ̶ matched sibling in their first complete remission (CR1). In adults, this is reserved for those with high-risk features in their CR1. In adults with standard or good risk features, stem cell transplantation is reserved for their second complete remission (CR2). HSCT is the only

2014 eMedicine Pediatrics

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