Ambulatory Pediatrics

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Ambulatory Pediatrics
2015-07-23 17:15:26
Ambulatory Pediatric Questions

Pediatric Ambulatory Questions
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  1. What is a normal hearing level in children?
    • Hearing loss is defined by the pure tone threshold:
    • Normal hearing has a threshold of 0-20 dB
    • Mild hearing loss from 20-40 dB
    • Moderate hearing loss from 40-60 dB
    • Severe hearing loss from 60-80 dB
    • Profound hearing loss greater than 80 dB
  2. What is the natural history of the uncircumcised foreskin?
    • 4% are fully retractable at birth
    • 50% are fully retractable at 1 year
    • 80% by 2 years
    • 96% by school age
    • 100% by 17 years

    • Manual retraction does not expedite retraction
    • No special care is needed
  3. What age has the highest risk for SIDS?
    2-4 months. In the NICHD study (1988), the median age for SIDS deaths was 11 weeks (~3 months), the peak incidence was between 2 and 4 months, and 90 percent occurred before 6 months of age.
  4. What are the three treatment options for labial adhesions?
    • 80% of labial adhesions resolve spontaneously within 1 year of diagnosis, and nearly all resolve by puberty.
    • Therefore, treatment can be reserved for patients who are symptomatic or have extensive adhesions or for patients whose parents are very concerned about physical appearance.
    • The most frequently recommended treatment is topical estrogen (estradiol or conjugated estrogen applied once or twice daily for 4-6 weeks).
    • The success rate is reported to be 46% to 100%
    • Rare adverse reactions include breast enlargement or tenderness, labial engorgement, and vulvar hyperpigmentation.
    • Myers et al studied topical betamethasone as an alternative to estrogen with the hopes of eliminating these adverse effects. They found that 1 to 3 courses (4-6 weeks each) of twice daily topical 0.05% betamethasone successfully treated labial adhesions 68% of the time. There were no adverse events related to this treatment
    • Myers JB, Sorensen CM, Wisner BO, Furness PD, Passamaneck M, Koyle MA. Betamethasone cream for the treatment of pre-pubertal labial adhesions. J Pediatr Adolesc Gynecol. 2006;19(6):407-411
  5. When is retinoblastoma usually detected?
    • The average age at the time of diagnosis is 2 years in unilateral cases and 1 year in bilateral cases.
    • Leukocoria and strabismus are the most common presenting findings.