Domestically Acquired Aural Myiasis in a Tennessee Girl.

We present the rare case of a 12-year-old girl from Tennessee with domestically acquired aural myiasis.

Diaper Use Increases the Risk of Buttock and Perineal Abscesses.

OBJECTIVES: Over the last decade, there has been a notable increase in the incidence of abscesses. Children in the diaper-wearing age group are disproportionately affected, and most of these abscesses occur in the buttock and perineal region. Using case-control methodology, we sought to determine if diaper use itself is an independent risk factor for abscess formation. METHODS: Cases were patients, at least 2 years of age but less than 4 years, who presented to the emergency department with a complaint of a buttock or perineal abscess. Age-matched controls presented to the emergency department for unrelated reasons. Caregivers of subjects responded to a survey regarding diaper use (toilet trained, for sleep only, or all day), type and brand of diaper, and diaper hygiene-related factors. RESULTS: We enrolled 465 patients (93 cases, 372 controls). Fully toilet trained children were less likely to have buttock and perineal abscess than their sleep-only and all-day diaper-wearing peers. Limiting diaper use to naptime and overnights (sleep only) did not confer protection against abscesses. Diaper hygiene-related factors did not affect the risk of abscess formation. Female sex was also identified as a strong risk factor for buttock and perineal abscess formation. CONCLUSIONS: Diaper use is a potentially modifiable risk factor for buttock and perineal abscess formation in young children.

Oral Mucosal Envenomation of an Infant by a Puss Caterpillar.

The term "puss caterpillar" describes the larva of at least two Megalopygidae species common to North America. Accidental contact with the hairs (setae) is intensely painful, and serious systemic effects have been reported. We describe the envenomation of an infant through the face and oral mucosa, resulting in severe discomfort, limited oral intake, and vomiting, but no other untoward effects.

Alkalosis-induced respiratory depression from infantile hypertrophic pyloric stenosis.

We report an infant with apnea due to infantile hypertrophic pyloric stenosis. The distinct mechanism of compensatory respiratory depression of severe metabolic acidosis is implicated.

Radius fracture from an electrical injury involving an electric guitar.

Electrical injury ranges widely from simple shock and mild burns to more extensive superficial injury, internal injury, and mortality. Bony fracture from electrically-induced tetanic muscle contraction is a rare but recognized injury. We report the case of a 14-year-old boy who suffered a minor burn and radius fracture related to an electrical injury involving his electric guitar. An interesting pattern is emerging from available case reports of similar injuries.

"Traumatic tap" proportion in pediatric lumbar puncture.

OBJECTIVES: To determine the frequency of "traumatic" or "bloody" tap when pediatric lumbar puncture is performed by a physician who has completed training and performs the procedure frequently. METHODS: The author identified 100 sequential patients presenting to a pediatric emergency department requiring lumbar puncture for clinical indications. Demographic information, cerebrospinal cell counts, and other relevant data were later obtained by retrospective chart review. Cell count results were categorized according to several previously used criteria: greater than 400, greater than 1000, and greater than 10,000/unsuccessful. RESULTS: One procedure yielded only a small amount of bloody fluid on which no cell count was performed. The remaining 99 procedures yielded red blood cell counts less than 1000. CONCLUSIONS: The proportion of bloody or traumatic results from pediatric lumbar puncture reported from pediatric training centers is typically in the 20% to 30% range. This represents an overestimation of a more ideal proportion possible when the procedure is performed by a physician who has completed training and performs the procedure frequently.

Penetrating missile-type head injury from a defective badminton racquet.

Injuries occurring during badminton are rarely serious and primarily involve the lower extremities. We report an instance wherein a patient suffered serious brain injury related to playing with a defective badminton racquet. The possibility of similar injuries following the separation of the racquet head and shaft from the handle needs to be disseminated.

Gridding: a form of folk medicine for respiratory illness.

Gridding and other folk remedies are commonly employed for respiratory illnesses. Pediatric health care providers need to be aware of such practices and their potential complications.

Sources of knowledge transfer among primary care pediatric health care providers.

OBJECTIVES: The authors sought to understand which informational sources pediatric health care providers perceive as most influential in how they stay current with health care innovations. METHODS: Rochester, New York, area pediatric health care providers were surveyed using a self-administered questionnaire. Two items pertained to the health care provider's ability to interpret primary research, and 9 items pertained to the influence and relative importance of various sources of information. RESULTS: A 61% response rate was obtained. Most (83%) respondents felt adequately trained to interpret primary research, fewer (31%) felt they have the time to do so. Almost all respondents (92%) felt that American Academy of Pediatrics (AAP) guidelines were a major influence, and 44% felt that AAP guidelines were the single most influential source of information in how they altered their practice over time. CONCLUSIONS: In the setting of time constraints, and the volume and complexity of published therapeutic research, AAP guidelines are playing an increasing role in knowledge transfer.

Why pediatric health care providers are not using homeopathic antidiarrheal agents.

OBJECTIVES: Several randomized, controlled trials have demonstrated the efficacy of homeopathic agents for use in childhood diarrhea. However, this therapeutic innovation is not being routinely adopted. We chose to study the degree of adoption as well as the perceived reasons for failure to adopt homeopathic antidiarrheal agents by pediatric health care providers. Additionally, we sought to determine if these agents are likely to be adopted in the future. DESIGN: This study was a self-administered survey, including a standardized scale of innovativeness. SUBJECTS: Subjects for this study were pediatric health care providers, and interventions consisted of abstracted results of two randomized, controlled, double-blinded studies reporting on the efficacy of homeopathic antidiarrheal agents. OUTCOME MEASURES: Outcome measures consisted of reports of the current treatment approach to childhood diarrhea, innovativeness, perceptions homeopathic antidiarrheal agent efficacy, and barriers to use, before and after reading the abstracts. RESULTS: We obtained a 61% response rate. Only 3% of surveyed respondents use homeopathic antidiarrheal agents. Lack of experiential knowledge, awareness, concerns of effectiveness, and safety were the greatest barriers to adoption. More respondents felt that homeopathic antidiarrheal agents were efficacious after reading supportive abstracts, but this did not increase their willingness to use these agents. Adoption did not correlate with individual innovativeness. CONCLUSIONS: The use of homeopathic antidiarrheal agents for childhood diarrhea is a minimally adopted innovation. Lack of correlation between adoption and individual innovativeness may suggest that this innovation is unlikely to be adopted in the future without intervention. Current barriers to adoption reveal that a stronger evidence base, and efforts to increase awareness and experiential knowledge, would be necessary to increase adoption. The results reported in this paper are discussed in the context of current theories on knowledge translation in medicine.

Febrile myoclonus.

Febrile myoclonus is a poorly understood and rarely reported phenomenon. We report a case with particular characteristics that continue to help define this benign disorder.

Referred shoulder pain preceding abdominal pain in a teenage girl with gastric perforation.

Referred shoulder pain is an important yet potentially distracting sign of serious intra-abdominal illness. A case is presented wherein shoulder pain preceded by several hours the onset of abdominal pain in a teenage girl with gastric perforation. The range of causes of gastric perforation and the pathophysiology of referred shoulder pain are discussed.

"Don't jump on the bed".

Jumping on the bed is a common childhood behavior. However, little is known about the potential for traumatic injury sustainable as a consequence of this behavior save for an understanding of the risk of injury related to falling from a bed, and a growing body of literature related to trampoline injuries. We report a case of a "grid" wire puncture injury that required a minor incision to affect removal. Parents should know about the possibility of this injury secondary to jumping on the bed, and pediatricians should know that the grid wires have hooked ends that may require incision to facilitate their removal.

Efficacy of a pediatric emergency department-based influenza vaccination program.

BACKGROUND: Influenza vaccination effectively reduces influenza-related morbidity in children but is underused. The pediatric emergency department is a potential intervention point for increasing influenza vaccination in children. OBJECTIVE: To assess the effectiveness of a pediatric emergency department-based influenza vaccination program. DESIGN: A prospective, randomized, controlled clinical trial. PARTICIPANTS: We recruited subjects from persons seeking pediatric emergency care at a large tertiary care hospital during influenza vaccination season in 2002. Eligible subjects were themselves or had a household member at increased risk for influenza complications, according to Advisory Committee on Immunization Practices guidelines. INTERVENTIONS: We randomly assigned subjects by family to the "vaccine offered" group or the "education only" group. We educated both groups about influenza illness, the risks and benefits of influenza vaccination, and how to receive influenza vaccination outside the study. We offered influenza vaccination to the "vaccine offered" group and later obtained telephone reports of the postinfluenza-season vaccination status of both groups. RESULTS: Four hundred thirty-seven subjects completed the study (238 from the "vaccine offered" group, 199 from the "education only" group). At follow-up, the percentage of influenza-vaccinated subjects in the "vaccine offered" group was greater than in the "education only" group. This was true for pediatric patients (57% vs 36%) (relative risk, 1.59; 95% confidence interval, 1.16-2.16) as well as for their accompanying adult and child family members (75% vs 34%) (relative risk, 2.19; 95% confidence interval, 1.64-2.92). CONCLUSION: A pediatric emergency department-based influenza vaccination program increases vaccination of targeted children and family members who use the emergency department during influenza vaccination season.

Wood's lamp employed as a provocative technique to identify pseudoseizures.

We present a case of a 12-year-old female who presented to the emergency department with ictal phenomena suggestive of pseudoseizures. A Wood's lamp was successfully employed to induce the stereotypic phenomena and thereby identify the ictal events as nonepileptiform. Use of the Wood's lamp has not previously been reported as a provocative stimulus to induce pseudoseizures. Given its noninvasive nature and ready availability, the Wood's lamp should be considered for identification of pseudoseizures.