Pediatrics in Review
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(Pediatrics in Review. 1997;18:175-178.)
© 1997 American Academy of Pediatrics

Index of Suspicion

Susan M. Nuber, MD*
Rebecca C. Brady, MD{dagger}
Najla N. Falaki, MD
* Cumberland, MD

{dagger} University of Cincinnati Medical Center, Cincinnati, OH
Camp Springs Medical Center, Temple Hills, MD

   Case 1 Presentation
 
A 5-year-old boy is brought to your office because of difficulty in swallowing. His mother, an intensive care unit nurse, states that he gags so vehemently that she is afraid he is going to aspirate. He had difficulty swallowing as an infant, but the problem was not severe enough to bring to the attention of a physician. He seemed to get much better as he got older, having had no swallowing problems as a toddler. He has had five such episodes recently, the last two being the most severe. In addition, he is a very slow eater. His mother wonders if his tonsils are so large that they are obstructing his throat.

On examination, the boy is at the 25th percentile of both height and weight. (Both parents and his older sister are between the 50th and 60th percentiles of height and weight.) His pulse is 72 beats/min and respirations are 18 breaths/min. He is a pleasant, very active child whose development is normal. His tonsils, although slightly enlarged and cryptic, do not appear to be large enough to interfere with swallowing. He has clear, symmetric breath sounds without wheezes or crackles and good cardiac tones in regular rhythm without murmurs. His abdomen is free of enlarged organs and masses.

A specific radiologic procedure reveals the source of his problem.


   Case 2 Presentation
 
A 6-week-old girl is brought to the emergency department with a 3-day history of decreased oral intake, clear rhinorrhea, and drainage from both eyes. She has been free of fever, cough, vomiting, and diarrhea. Her parents and four siblings, including her twin, all have been well.

The baby was born prematurely at 33 weeks' gestation. Her mother received little prenatal care, and the pregnancy was complicated by pre-term labor and oligohydramnios. She and her twin spent approximately 3 weeks in . . . [Full Text of this Article]






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Copyright © 1997 by the American Academy of Pediatrics.