Algorithm for Work-up of Pediatric Anemia

Here is a simple algorithm for the workup of pediatric anemia. Hope it helps. This handout is from a lecture that I recently presented at the 2012 AAFP Scientific Assembly. (NOTE: Click on the "simple algorithm" link above to download the algorithm. The image below is low resolution).

Teaching A Child to Ride A Bike

Ok... I know what you're thinking: what in Sam Hill does "teaching a kid to ride a bike" have to do with medicine? Well, we do have a pediatric obesity epidemic in the good old USA, and I figure that anything we can do to encourage kids to get outside and enjoy some fresh air must be a good thing. That's the official excuse.

Here's the real reason: I've been spending the last two weeks trying to teach my 5-year-old daughter how to ride a bike and I've been saying to myself between bouts of extreme dyspnea, "There must be an easier way!" Imagine a middle aged man profusely sweating while trying to hold up a frightened 5 year old who is wobbling like a drunk dude with meniere's disease on a bicycle!

Anyway, I failed again today! It ended when she fell off and scraped her hand on the pavement. She was frustrated and slightly tearful. So I went inside, wiped the sweat from my face, and looked for help on YouTube...

AND LO AND BEHOLD! THE SOLUTION! GENIUS!
(Especially since I don't have to run like a sweaty pig behind her)!

THE SECRET TIPS:

1. Lower the seat so that her feet can rest comfortably and flat on the ground
2. TAKE OFF THE PEDALS
3. Let her just practice scooting and balancing first!

AWESOME! I'm so excited to try this out tonight!

I always knew the best teacher are able to break down complicated skills into manageable bits. By simply lowering the seat and taking off the pedals, my daughter will be able to learn to balance first without worrying about pedaling, catch her own falls without having me always running beside her, and learn to do starts by herself. Lowering the seat and taking off the pedals! Simply genius!

Tips on Neonatal Jaundice

(SOURCE: Wikipedia)

Neonatal jaundice! Should I start bili lights or not? AHHHHHHH! Nomograms! Charts! Calculating lab draw times! Assessing risk factors! There has to be an easier way to do this. We are in a technological age aren't we? For goodness sake, we have computers that can calculate the prime derivative of thirty billion electrons playing hop scotch in Andromeda! All I want is for the computer to do some pretty basic math and plot it on a simple nomogram! Ok...

Check this website out: www.bilitool.org. Makes all the calculations MUCH easier... And... You're welcome!

Booster Now Recommended for Menactra

This is an awesome tip that I learned from Dr. Ernestine Lee (who is the Assistant Director here at Florida Hospital Family Medicine Residency): A booster is now recommended for Menactra at age 16. Here is an excerpt of the CDC's recommendations:

All 11-12 years olds should be vaccinated with meningococcal conjugate vaccine (MCV4). Now, a booster dose should be given at age 16 years. For adolescents who receive the first dose at age 13 through 15 years, a one-time booster dose should be administered, preferably at age 16 through 18 years, before the peak in increased risk. Adolescents who receive their first dose of MCV4 at or after age 16 years do not need a booster dose.

Teenage Shot Schedules

Here is how I manage my teenage shots to cut down on the number of visits to the doctor:

Visit 1:
   HPV #1
   tDaP
   Follow-up in 2 months

Visit 2:
   HPV #2
   Hep A #1 (if not already given)
   Follow-up in 6 months

Visit 3:
   HPV #3
   Hep A #2

Fungus Loves Baby Bottoms

Fungus love moist environments (i.e. a baby's bottom). Most diaper rashes will go away simply by leaving the diaper off (which is my recommendation for really bad diaper rashes). I still use anti-fungal creams (like Lotrimin), but keeping the bottom dry work wonders.

Just a fever, doc, nut'in else!

For folks who present with only fevers or malaise, check for a urinary tract infection. In the elderly, UTIs commonly present as just malaise. For children, fever is frequently the only symptom.

Children with vague abdominal pain and fever

Strep throat often presents atypically in young children. Sometimes, the only symptom that I will get is some vague abdominal pain. Other common symptoms such as fever, sore throat, or headache are frequently absent. On exam, the abdomen is benign and the throat may only be mildly inflamed. For these kids, I usually check a rapid Strep test and send a throat culture to the lab. I have been surprised many times!

Obviously, a urinary tract infection is also in the differential.