Pediatric Primary Care Case Studies (102 page)

7.
Follow up.
Follow up with a telephone call to check on the child’s progress.

Sara’s mom asks what she can do about her being sick. You tell her that one of the most important measures she, Sara, and the other members of her family can do is simple handwashing with soap and water. Everyone needs to do this after using the bathroom and before eating any food. You recommend that she also check with the head of the daycare to see how they are cleaning the toys and equipment at the center. Proper cleaning of supplies and equipment will help keep all of the children healthy.

You tell her to make sure Sara continues to eat and drink as much as she is comfortable with. She shouldn’t give her juice, soda, or any sweetened drinks, and she should avoid fatty foods like chips, french fries, or ice cream; fried foods like chicken nuggets; or any sweets like candy or cookies. She may want to eat smaller portions, more frequently, rather than three meals a day. Her mother should try giving her foods like fresh fruits, cooked vegetables, cereal, bread, rice, pasta, yogurt, and some lean meats like chicken. The foods she has eaten today are the right ones and should help her recover quicker.

The diarrhea should stop in a day or so. If it continues for a total of 6 days, she should call you back because you will want to see Sara. She should also call back if her fever is higher than 101 degrees or if she is acting unusual, more “tired” or “weird.” If she seems worse, won’t eat or drink, or only voids once or twice a day, she should call right away so that you can see her as an urgent visit.

Sara’s mother asks how she can keep her from getting sick all the time. What will you tell her?

You tell her that children Sara’s age often have minor illnesses, especially if they are around other children. Once she is back to her normal self, the best way to keep Sara healthy is to make sure she gets the rest she needs and that she eats a variety of healthy foods—fruits, vegetables, breads, grains, and protein like milk, cheese, yogurt, nuts, and meat. She doesn’t have to eat all of these every day, but she should provide her with good foods. Sara should avoid fried foods and fatty foods like french fries and chips, and avoid sugary drinks and soda. She should also limit the amount of juice Sara drinks to about 8 ounces a day. She should limit sweets too, but it’s fine if she has a cookie, ice cream, or sweet once every day or two. Finally, she should make sure Sara and everyone else in the family washes their hands often.

Key Points from This Case

1. History is essential for accurate diagnosis of gastroenteritis.

2. Viral enteritis is the most common cause of gastroenteritis in children.

3. Telephone consultation may be appropriate for the management of many cases of acute, self-limited gastroenteritis, but close follow-up is critical to assess outcome.

4. Risk factors for dehydration must be considered in making decisions about assessment and treatment.

5.
Oral rehydration following diarrhea and vomiting promotes more rapid healing than parenteral therapy alone.

6. Parenteral therapy may be appropriate for children at high risk for dehydration and/or children with severe dehydration; resume oral rehydration as soon as possible.

7. A normal diet should be resumed as soon as possible after replacement fluids have been administered.

8. Handwashing and healthful diets are key factors in preventing gastroenteritis in children. Patient, parent, and community education should emphasize these factors.

REFERENCES

American Academy of Pediatrics. (2004). Statement of endorsement: managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy.
Pediatrics, 114(2)
, 507.

American Academy of Pediatrics. (2008).
Diarrhea, vomiting, and water loss (dehydration).
Retrieved December 12, 2008, from
http://patiented.aap.org/AtoZIndex.aspx?letter=D

Amiriak, I., & Amiriak, B. (2006). Haemolytic uraemic syndrome: an overview.
Nephrology, 11(3)
, 213–218.

Berkun, Y., Nir-Paz, R., Ami, A. B., Klar, A., Deutsch, E., & Hurvitz, H. (2008). Acute otitis media in the first two months of life: characteristics and diagnostic difficulties.
Archives of Disease in Childhood, 93
(8), 690–694.

Bhutta, Z. A., Nelson, E. A., Lee, W. S., Tarr, P. I., Zablah, R., Phua, K. B., et al. (2008). Recent advances and evidence gaps in persistent diarrhea.
Journal of Pediatric Gastroenterology and Nutrition, 47
(2), 260–265.

Bishop, W. P. (2006). The digestive system. In R. M. Kliegman, K. J. Marcdante, H. B. Jenson, & R. E. Behrman (Eds.),
Nelson essentials of pediatrics
(5th ed., pp. 579–624). Philadelphia: Elsevier Saunders.

Brook, I. (2005). Pseudomembranous colitis in children.
Journal of Gastroenterology and Hepatology, 20
(2), 182–186.

Colvin, J. M., Bachur, R., & Kharbanda, A. (2007). The presentation of appendicitis in preadolescent children.
Pediatric Emergency Care, 23
, 849–855.

Davidson, M., & Wasserman, R. (1966). The irritable colon of childhood (chronic nonspecific diarrhea syndrome).
Journal of Pediatrics, 69
, 1027–1038.

Defilippi, A., Silvestri, M., Tacchella, A., Giacchino, R., Melioli, G., Di Marco, E., et al. (2008). Epidemiology and clinical features of
Mycoplasma pneumoniae
infection in children.
Respiratory Medicine, 102
(12), 1762–1768.

Dennison, B. A. (1996). Fruit juice consumption by infants and children: a review.
Journal of the American College of Nutrition, 15
(5 Suppl), 4S–11S.

Fischer, T. K., Viboud, C., Parashar, U., Malek, M., Steiner, C., Glass, R., et al. (2007). Hospitalizations and deaths from diarrhea and rotavirus among children <5 years of age in the United States, 1993–2003.
Journal of Infectious Diseases, 195
, 1117–1125.

Ghishan, F. K. (2004). Chronic diarrhea. In: R. Behrman, H. B. Jenson, & R. M. Kliegman (Eds.),
Nelson textbook of pediatrics
(17th ed., pp. 1276–1281). St. Louis, MO: WB Saunders.

Heyman, M. B., & AAP Committee on Nutrition. (2006). Lactose intolerance in infants, children, and adolescents.
Pediatrics, 118
(3), 1279–1286.

Ho, M. S., Glass, R. I., Pinsky, P. F., Young-Okoh, N. C., Sappenfield, W. M., Buehler, J. W., et al. (1988). Diarrheal deaths in American children. Are they preventable?
Journal of the American Medical Association, 206
(22), 3281–3285.

Hornby, P. J. (2001). Central neurocircuitry associated with emesis.
American Journal of Medicine, 111
, 106S–112S.

Jenson, H. B., & Baltimore, R. S. (2006). Infectious diseases. In R. M. Kliegman, K. J. Marcdante, H. B. Jenson, & R. E. Behrman (Eds.),
Nelson essentials of pediatrics
(5th ed., pp. 445–577). Philadelphia: Elsevier Saunders.

King, C. K., Glass, R., Bresee, J. S., Duggan, C., & Centers for Disease Control and Prevention. (2003). Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy.
Morbidity and Mortality Weekly Report, 52
(RR-16), 1–16.

Kleinman, R. E. (2005). Chronic nonspecific diarrhea of childhood.
Nestlé Nutrition Workshop Series, Paediatric Programme, 58
, 73–84.

Lewis, T. V., Badillo, R., Schaeffer, S., Hagemann, T. M., & McGoodwin, L. (2006). Salicylate toxicity associated with administration of Percy medicine in an infant.
Pharmacotherapy, 26
(3), 403–409.

Lopez, A. D., Mathers, C. D., Ezzati, M., Jamison, D. T., & Murray, C. J. L. (2006). Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data.
Lancet, 367
, 1747–1757.

Patel, M. M., Widdowson, M.-A., Glass, R. I., Akazawa, K., Vinje, J., & Parashar, U. D. (2008). Systematic literature review of role of norovirus in sporadic gastroenteritis.
Emerging and Infectious Diseases.
Retrieved December 27, 2008, from
http://www.cdc.gov/EID/content/14/8/1224.htm

Paulson, E. K., Kalady, M. R., & Pappas, T. N. (2003). Clinical practice. Suspected appendicitis.
New England Journal of Medicine, 348
(3), 236–242.

Payne, D. C., Stockman, L. J., Gentsch, J. R., & Parashar, U. D. (2008). Rotavirus. In: Centers for Disease Control and Prevention,
VPD Surveillance Manual
(4th ed., chap. 9). Retrieved December 27, 2008, from
http://www.cdc.gov/vaccines/pubs/surv-manual/chpt13-rotavirus.htm

Petersen-Smith, A. M., & McKenzie, S. B. (2009). Gastrointestinal disorders. In C. E. Burns, A. M. Dunn, M. A. Brady, N. B. Starr, & C. G. Blosser (Eds.),
Pediatric primary care
(4th ed., pp. 795–844). St. Louis, MO: WB Saunders.

Pickering, L. K., Baker, C. J., Long, S. S., & McMillan, J. A. (Eds.). (2006).
Red book: 2006 report of the Committee on Infectious Diseases
(27th ed.). Elk Grove Village, IL: American Academy of Pediatrics.

Pickering, L. K., & Snyder, J. D. (2004). Gastroenteritis. In R. Behrman, H. G. Jenson, & R. M. Kliegman (Eds.),
Nelson textbook of pediatrics
(17th ed., pp. 1272–1276). St. Louis, MO: WB Saunders.

Salazar-Lindo, E., Miranda-Langschwager, P., Campos-Sanchez, M., Chea-Woo, E., & Sack, R. B. (2004). Lactobacillus casei strain GG in the treatment of infants with acute watery diarrhea: a randomized, double-blind, placebo controlled clinical trial.
BMC Pediatrics, 4
, 18.

Simakachorn, N., Tongpenyai, Y., Tongtan, O., & Varavithya, W. (2004). Randomized, double-blind clinical trial of a lactose-free and a lactose-containing formula in dietary management of acute childhood diarrhea.
Journal of the Medical Association of Thailand, 87
(6), 641–649.

Strand, T. A., Chandyo, R. K., Bahl, R., Sharma, P. R., Adhikari, R. K., Bhandari, N., et al. (2002). Effectiveness and efficacy of zinc for the treatment of acute diarrhea in young children.
Pediatrics, 109
(5), 898–903.

Surawicz, C. M. (2003). Probiotics, antibiotic-associated diarrhoea and
Clostridium difficile
diarrhoea in humans.
Best Practice and Research: Clinical Gastroenterology, 17
(5), 775–783.

Thomas, T. J., Pauze, D., & Love, J. N. (2008). Are one or two dangerous? Diphenoxylate-atropine exposure in toddlers.
Journal of Emergency Medicine, 34
(1), 71–75.

Turck, D., Bernet, J. P., Marx, J., Kempf, H., Biard, P., Walbaum, O., et al. (2003). Incidence and risk factors of oral antibiotic-associated diarrhea in an outpatient pediatric population.
Journal of Pediatric Gastroenterology and Nutrition, 37
(1), 22–26.

Vernacchio, L., Vezina, R. M., Mitchell, A. A., Lesko, S. M., Plant, A. G., & Acheson, D. W. K. (2006). Characteristics of persistent diarrhea in a community-based cohort of young US children.
Journal of Pediatric Gastroenterology and Nutrition, 43
(1), 52.

Chapter 26

Three Cases of Oral Trauma

Prashant Gagneja
John Peterson

Oral trauma frequently occurs during the life of a young child and adolescent. Often, the consequences of this trauma are minor and may even go unnoticed. However, many injuries to the teeth can have long-lasting significance. It is the purpose of this chapter to present three common dental trauma scenarios and their management.