Paediatric problems: illustrated

Presentations of haemangioma, atopic eczema, rhabdomyosarcoma and precocious puberty.

Haemangioma

Haemangioma

This little girl developed a very prominent lesion from two weeks of age. It increased in size over the next few months. She was referred and formally assessed because of the position of the lesion. Her vision was unaffected.

These vascular tumours are benign and may regress spontaneously. Many require no treatment, but in this case, it was considered appropriate. She was treated quite successfully with beta-blockers in the form of timolol gel.


Cochlear implant

Cochlear implant

This boy had pneumococcal meningitis at the age of one year and required life-saving treatment with IV gentamicin. It is unclear whether the drug, or the illness, had a major effect on the child’s hearing, but it resulted in significant sensorineural hearing loss. He subsequently underwent cochlear implant surgery and has managed very well since.


Atopic eczema

Atopic eczema

One of the most common problems that we see in young children is atopic eczema. It affects up to 15-20% of children and although many cases are mild, many children will have moderate or severe problems.

This boy has the classic appearance of flexural eczema on the back of the knees, with inflammation and signs of chronic irritation. Management generally involves avoiding irritants, frequent use of emollients, and intermittent use of topical steroids and antibiotics when secondary infection is present.


Flat feet

Flat feet

Many children are brought to the surgery by concerned parents worrying about the child’s flat feet. A variety of symptoms are attributed to this, but in fact, most cases are a benign variation of normal, requiring no treatment.

Cases associated with significant pain need proper assessment, especially in the presence of certain other conditions, such as connective tissue disorders and various congenital problems, such as spina bifida.


Rhabdomyosarcoma

Rhabdomyosarcoma

This little boy had an enormous tumour. At birth, his mother immediately noticed a firmness in one of his buttocks. Excision biopsy confirmed the diagnosis of embryonal rhabdomyosarcoma.

He had chemotherapy, but the tumour was very aggressive. This image was taken at about eight months of age. He died before his first birthday.


Zoster

Zoster

Chickenpox is by far the most common manifestation of infection with varicella zoster virus in childhood, although some children manifest the infection as herpes zoster as well. The characteristic vesicular/blistering rash is the same as that seen in adults.

This baby has clear shingles, which developed five months after a chickenpox infection. Luckily, he was not too troubled by the infection, which settled with no after-effects.


Precocious puberty

Precocious puberty

This three-year-old was brought in by her rather distressed mother, who was concerned that her little girl seemed to be growing pubic hair and developing breasts. The child was investigated and found to have central precocious puberty. She has been successfully treated for several years with regular depot injections of an LHRH analogue.


Balanitis

Balanitis

Young boys are often brought to the surgery with minor inflammation of the penis. Most need no specific treatment and simple reassurance is adequate. Occasionally, a more significant infection can occur. This five-year-old had pus dripping from his penis. He was treated with antibiotics and subsequently underwent circumcision for a tight phimosis.

  • Dr Phil Marazzi is a GP in Surrey

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