What Causes Macroglossia?

Patient Presentation
A 3-year-old male with Down syndrome came to clinic for a pre-surgical evaluation for placement of pressure-equalizing tubes and tonsillectomy and adenoidectomy.
The child had had 6 episodes of acute supprative otitis media over a 9 month period and had other episodes before this time. He had no recent illnesses other the last otitis media episode 2 weeks previously. The past medical history revealed a child who was diagnosed with Down syndrome at birth. A neck radiograph and echocardiogram were normal. Thyroid testing and complete blood counts had been normal 3 months previously. He had an orchiopexy at age 12 months and had no problems with anesthesia. He had a history of very loud snoring associated with upper respiratory infections and the parents reported mouth breathing often at other times. The family history showed no problems with anesthesia or bleeding in the family.

The pertinent physical exam showed an interactive male with normal growth parameters when plotted on a Down syndrome growth chart. His vital signs were also normal. HEENT revealed Down facies, small palate with enlarged tonsils (size III) and a relatively large tongue. He had normal dentitia and no palpable masses in the mouth. Bilateral tympanic membranes had scaring and an air-fluid level with pus approximately 1/2 way up the tympanic membranes. Neck was supple with no thyromegaly or masses other than shoddy anterior cervical adenopathy. Cardiac, lung, and abdominal examinations were normal. Neurologically there was generalized hypotonia.

The diagnosis of a child with Down syndrome and chronic supprative otitis media was confirmed. There were no obvious contraindications to general anesthesia at that time. The resident physician staffing the patient noted the relatively enlarged tongue, and asked the attending physician about potential causes. Together they came up with Down syndrome, Beckwith-Wiedemann syndrome, hypothyroidism, diabetes, trauma, masses, hypotonia and a relatively small palate/airway as causes. They discussed that this child had a relatively small mouth/airway, large tonsils and hypotonia in addition to having Down syndrome. All of these probably contributed to the relatively large tongue. The patient most likely did not have hypothyroidism as a cause because of the previous negative testing. The two physicians later in the day did a brief PubMed search and found an article with an expanded differential diagnosis for macroglossia.

Discussion
Children with Down syndrome have a number of potential medical problems that need to be screened for and current recommendations can be found from the American Academy of Pediatrics (see To Learn More below). These include congenital cardiac anomalies, atlanto-axial instability, hypothyroidism, and leukemia and its variants. Additionally, children with Down syndrome often have chronic otitis media and airway abnormalities because of smaller airways and hypotonia. Dental abnormalities are also common.

Learning Point
Macroglossia is not a common problem but the differential diagnosis is broad. Often macroglossia is due to a genetic abnormality or relative enlargement due to adjacent structure size or impingment upon the tongue. The differential diagnosis of macroglossia includes:

True macroglossia

  • Congenital

    • Genetic
      • Autosomal dominant inheritance
      • Beckwith-Wiedemann syndrome
      • Behmel syndrome
      • Blomstrand chondrodysplasia
      • Down syndrome
      • Gangliosidosis
      • Lipoproteinosis
      • Mucopolysaccharidoses
      • Muscle hypertrophy, idiopathic
      • Simpson-Golabi-Behmel syndrome
      • Trisomy 22
      • Zimmerman-Laband syndrome
    • Masses
      • Thyroid, lingual
      • Hemangioma
      • Lymphangioma
  • Acquired

    • Infectious

      • Actinomyces sp. (Ludwig angina)

      • Amebic dysentery
      • Candidiasis
      • Pneumonia
      • Rheumatic fever
      • Smallpox
      • Syphilis
      • Typhoid
      • Tuberculosis
    • Metabolic/endocrine

      • Hypothyroidism

      • Diabetes including transient neonatal diabetes mellitus
    • Neoplastic

      • Carcinoma

      • Hemangioma
      • Lymphangioma
      • Plasmacytoma
    • Nutrition

      • Scurvy

      • Pellagra
    • Other

      • Amyloidosis

      • Acromegaly
      • Giant cell arteritis
      • Iatrogenic
      • Neurofibromatosis
      • Pemphigus vulgaris
      • Sarcoidosis
      • Uremia
    • Trauma

      • Biting

      • Hemorrhage
      • Intubation
      • Radiation therapy
      • Surgery
    • Neoplastic

      • Carcinoma

      • Hemangioma
      • Lymphangioma
      • Plasmacytoma

Pseudomacroglossia – causes abnormal positioning and therefore the tongue appears large

  • Habitual posturing
  • Enlarged tonsils and/or adenoids
  • Low palate with decreased oral cavity volume
  • Abnormal maxillary or mandibular dental arches
  • Severe mandibular deficiency
  • Hypotonia
  • Neoplasms causing displacement

Questions for Further Discussion
1. What potential airway problems would a child undergoing anesthesia have?
2. What dental problems are associated with macroglossia?
3. What surgical treatments are available for macroglossia?

Related Cases

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for these topics: Mouth Disorders and Down syndrome.

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

American Academy of Pediatrics Policy Statement. Health Supervision for Children with Down syndrome. Pediatrics 2001;107:442-449. Available from the Internet at: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;107/2/442 (cited 7/9/09).

Thrasher III RD, Allen GC. Macroglossia. eMedicine.
Available from the Internet at http://emedicine.medscape.com/article/873658-overview (rev. 11/2007, cited 7/9/09).

Johns Hopkins University. Online Mendelian Inheritance in Man.
Available from the Internet at http://www.ncbi.nlm.nih.gov/omim/ (cited 7/9/09).

ACGME Competencies Highlighted by Case

  • Patient Care
    1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
    2. Essential and accurate information about the patients’ is gathered.
    3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
    4. Patient management plans are developed and carried out.
    6. Information technology to support patient care decisions and patient education is used.
    8. Health care services aimed at preventing health problems or maintaining health are provided.
    9. Patient-focused care is provided by working with health care professionals, including those from other disciplines.

  • Medical Knowledge
    10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
    11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.

  • Practice Based Learning and Improvement
    12. Evidence from scientific studies related to the patients’ health problems is located, appraised and assimilated.
    13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
    15. Information technology to manage information, access on-line medical information and support the healthcare professional’s own education is used.
    16. Learning of students and other health care professionals is facilitated.

  • Interpersonal and Communication Skills
    19. The health professional works effectively with others as a member or leader of a health care team or other professional group.

    Author
    Donna M. D’Alessandro, MD
    Professor of Pediatrics, University of Iowa Children’s Hospital

  • Does This Sacral Dimple Need to be Evaluated?

    Patient Presentation
    A 15-month-old male came to clinic for his well child care after transferring from another institution. His mother reported that she was still anxious that the “hole” in his bottom hadn’t seemed to improve. She had been told that it “would go away” but that it hadn’t. He had normal development including gross and fine motor. The past medical history was negative. The family history was negative for any gastrointestinal, urological or neurological problems. The review of systems was negative for any urinary frequency, urgency or defecation problems.

    The pertinent physical exam showed a happy toddler who was busy walking and climbing around the room. His vital signs were normal including his growth parameters. His examination was normal and the mother pointed out the “hole” in his gluteal cleft which was a 3 mm dimple that the bottom could be easily seen. It was oriented vertically to the skin and was 20 mm from the anus. There were no skin changes or masses noted. He had a normal neurological evaluation including normal deep tendon reflexes in the lower extremities, normal cremasteric reflex and down going Babinski reflexes bilaterally. The diagnosis of a benign coccygeal dimple was made. The mother was counseled that the dimple probably would not go away, but that it may become less noticeable as the child grew and was unlikely to cause any problem.

    Discussion
    Skin dimples over the spine commonly referred to as sacral dimples are common minor congenital anomalies, estimated to occur in 3-8% of children. When a clinician sees a skin dimple, the possibility of occult spinal dysraphism (OSD) usually crosses the mind. OSD is a wide-range of skin-colored spinal column and neuraxis abnormalities that are caused by abnormal neurulation. OSD lesions include dermal sinuses, tethered cord, lipomyelomeningocoele, and diastematomyelia. OSD can present with a variety of abnormalities, but is also frequently asymptomatic and can present at any age. Skin abnormalities accompany 50-80% of OSD.

    Other presentations of OSD include:

    • Skin
      • Dimples/pits
      • Dermal sinuses
      • Hypertrichosis
      • Lipoma or other mass
      • Pigmented lesions
      • Skin tags or tail-like appendages
      • Vascular lesions – hemangioma, telangectasis
      • Other – Aplasia cutis congenita
    • Infectious
      • Signs of infection such as skin erythema or induration
      • Meningitis
    • Neurological
      • Abnormal urination/defection
      • Spasticity
      • Paresthesia
      • Weakness
    • Orthopaedic
      • Congenital dislocation of the hip
      • Leg length discrepancies
      • Pes cavus
      • Scoliosis
      • Talipes

    Learning Point
    Cutaneous markers of OSD are more likely to be associated with OSD if they are above the gluteal cleft (truly sacral in location) because they are more likely to be contiguous with the dura. Those that are within the gluteal fold are much less likely to be contiguous with the dura and are much more likely to be a normal variant. However it can be difficult to clearly distinguish all variations and therefore the clinician considering whether or not to further evaluate a patient must consider the individual circumstances.

    Some indications that a skin dimple may be simple or low risk include:

    • Position – within the gluteal fold or coccygeal position
    • Single dimple
    • < 5 mm diameter
    • Base of dimple is visible
    • Dimple is oriented straight down (i.e. caudal) not cephalically (i.e. toward the head)
    • No other dermal abnormalities or masses
    • Distance < 2.5 cm from anus
    • Normal neurological examination

    Evaluation for potential OSD for usually includes spinal ultrasound in infants and magnetic resonance imaging of the lumbar spine for older children. In 2005, the Royal College of Radiologists revised protocol for imaging says “[i]solated sacral dimples and pits may be safely ignored (< 5 mm [in diameter], < 25 mm from anus). Ultrasound of the neonatal lumbar spine is the initial investigation of choice if there are other stigmata of spinal dysraphism, associated congenital abnormalities or a discharging sinus".

    Questions for Further Discussion
    1. What are the indications for neurosurgical consultation for potential OSD?
    2. What is the natural history of delayed diagnosis or unrepaired OSD?
    3. How is a pilonidal cyst associated with sacral dimples?
    4. What syndromes are associated with spinal dysraphism?

    Related Cases

    To Learn More
    To view pediatric review articles on this topic from the past year check PubMed.

    Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

    Information prescriptions for patients can be found at MedlinePlus for this topic: Tailbone Disorders

    To view current news articles on this topic check Google News.

    To view images related to this topic check Google Images.

    Ackerman LL, Menezes AH. Spinal congenital dermal sinuses: a 30-year experience. Pediatrics. 2003 Sep;112:641-7.

    Robinson AJ, Russell S, Rimmer S. The value of ultrasonic examination of the lumbar spine in infants with specific reference to cutaneous markers of occult spinal dysraphism.
    Clin Radiol. 2005 Jan;60(1):72-7.

    Schenk JP, Herweh C, Gunther P, Rohrschneider W, Zieger B, Troger J. Imaging of congenital anomalies and variations of the caudal spine and back in neonates and small infants. Eur J Radiol. 2006 Apr;58(1):3-14.

    Khan AN, Trumbull I, McDonald S, Subih D, Al-Okaili rR Spinal Dysraphism/Myelomeningocele. eMedicine.
    Available from the Internet at http://emedicine.medscape.com/article/413899-overview(rev. 1/14/09, cited 7/1/09).

    ACGME Competencies Highlighted by Case

  • Patient Care
    1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
    2. Essential and accurate information about the patients’ is gathered.
    3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
    4. Patient management plans are developed and carried out.
    5. Patients and their families are counseled and educated.
    8. Health care services aimed at preventing health problems or maintaining health are provided.

  • Medical Knowledge
    10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
    11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.

  • Practice Based Learning and Improvement
    13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.

  • Interpersonal and Communication Skills
    18. Using effective nonverbal, explanatory, questioning, and writing skills, the healthcare professional uses effective listening skills and elicits and provides information.

    Author
    Donna M. D’Alessandro, MD
    Professor of Pediatrics, University of Iowa Children’s Hospital

  • Why Does He Have Such a Dry Mouth?

    Patient Presentation
    An 11-year-old male came to clinic for his health supervision visit. He had a history of cerebral palsy, severe mental retardation, epilepsy, seasonal allergic rhinitis and various orthopaedic problems.
    He recently had his anti-convulsants changed because of increased seizures and since the change his seizures had been well controlled with only one seizure every other day.
    His mother had also re-started his systemic medication for his seasonal allergic rhinitis recently and noted that usually he did a lot of mouth breathing too.
    She was concerned because she had noticed that he recently had and more thick saliva and a drier mouth than he usually did.

    The pertinent physical exam showed a small male who was wheelchair bound, with obvious mental retardation but was alert to his environment. His mother was able to understand many of his wants and needs but the healthcare provider could not.
    He had a head circumference of 10%. He did not appear dehydrated.
    His nose had slightly swollen nasal turbinates.
    His mouth had thick, dried saliva at the corners and a general dry mouth without ulcerations. There were two obvious caries in the lower posterior right molars.
    He had hypertonia in the upper and lower extremities.
    Skin examination showed some very minor irritation at the edges of his ankle-foot orthoses and at the edge of a right wrist splint.

    The diagnosis of a school-ager with multiple medical problems and xerostomia was made.
    The health care provider told the mother that the most common reason for the increased dried secretions was the combination of the increased anti-convulsants and the institution of the anti-histamines, along with mouth breathing.
    Since he was well controlled on these medications, the health care provider did not want to change the medication.
    However, as the patient had obvious caries, she recommended to see the dentist who could treat the caries and provide guidance regarding a saliva substitute or other options.
    The patient’s clinical course showed that the dentist fixed the caries, changed the dental routine to include a fluoride mouth wash and use of a mouth moisturizing gel. His mother was happy with the results.

    Discussion
    Saliva is produced mainly from the submandibular salivary glands (70-75%) and the parotid gland (20-25%). It functions to protect the mouth, aid digestion, maintain tooth integrity and facilitate chewing, swallowing and speech.

    Dry mouth or xerostomia especially in children is usually a temporary condition often associated with dehydration or mouth breathing. But it can be a more chronic condition that can affect quality of life and overall health. Patients with chronic xerostomia may stop eating certain dry or sticky foods which may lead to malnutrition. It can also change taste, and impair chewing, swallowing, and swallowing. It can also cause fissures in the skin or oral mucosa and contribute to dental caries and other oral infections.
    Children with multiple medical problems, especially those using multiple medications are at high-risk for xerostomia.

    Learning Point
    Causes of xerostomia include:

    • Dehydration – one of the most common causes in children
    • Mouth breathing
    • Chemotherapy
    • Radiation
    • Tobacco use
    • Salivary gland removal

    • Diseases
      • Alzheimer’s disease
      • Cystic Fibrosis
      • Diabetes
      • Graft-vs-Host Disease
      • Hepatitis C
      • HIV/AIDS
      • Mikulicz syndrome
      • Mumps
      • Parkinson’s disease
      • Psychiatric symptom
      • Rheumatoid arthritis
      • Sjogren’s syndrome
      • Stroke
      • Thyroid disease

    • Medication side effects – the most common cause of xerostomia in dental practices
      • Acne medications
      • Anorexiant
      • Anti-anxiety medication
      • Anti-cholinergics
      • Anti-depressants including tricyclic and selective serotonin reuptake inhibitors
      • Anti-convulsants
      • Anti-emetics
      • Anti-histamines
      • Anti-hypertensive
      • Anti-obesity
      • Anti-parkinsonian
      • Anti-psychotics
      • Bronchodilators
      • Decongestants
      • Diuretics
      • Muscle relaxants
      • Narcotics
      • Sedatives
      • Urinary incontinence medications

    Questions for Further Discussion
    1. What causes hypersalivation?
    2. List the risk factors for dental caries?

    Related Cases

    To Learn More
    To view pediatric review articles on this topic from the past year check PubMed.

    Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

    Information prescriptions for patients can be found at MedlinePlus for these topics: Mouth Disorders and Medicines.

    To view current news articles on this topic check Google News.

    To view images related to this topic check Google Images.

    Illingworth RS. Common Symptoms of Disease in Children. Blackwell Scientific Publications: Oxford. 1988:177-78.

    Cassolato SF, Turnbull RS. Xerostomia: clinical aspects and treatment. Gerodontology. 2003 Dec;20(2):64-77.

    Curzon ME, Preston AJ. Risk groups: nursing bottle caries/caries in the elderly. Caries Res. 2004;38 Suppl 1:24-33.

    Nokta M. Oral manifestations associated with HIV infection. Curr HIV/AIDS Rep. 2008 Feb;5(1):5-12.

    MedicineNet.com. Dry Mouth. WebMD.
    Available from the Internet at http://www.medicinenet.com/dry_mouth/article.htm (rev. 2009, cited 6/24/09).

    ACGME Competencies Highlighted by Case

  • Patient Care
    1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
    2. Essential and accurate information about the patients’ is gathered.
    3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
    4. Patient management plans are developed and carried out.
    5. Patients and their families are counseled and educated.
    7. All medical and invasive procedures considered essential for the area of practice are competently performed.
    8. Health care services aimed at preventing health problems or maintaining health are provided.
    9. Patient-focused care is provided by working with health care professionals, including those from other disciplines.

  • Medical Knowledge
    10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
    11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.

  • Practice Based Learning and Improvement
    13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.

  • Interpersonal and Communication Skills
    19. The health professional works effectively with others as a member or leader of a health care team or other professional group.

  • Professionalism
    22. Sensitivity and responsiveness to patients’ culture, age, gender, and disabilities are demonstrated.

  • Systems Based Practice
    24. Cost-effective health care and resource allocation that does not compromise quality of care is practiced.
    25. Quality patient care and assisting patients in dealing with system complexities is advocated.

    Author
    Donna M. D’Alessandro, MD
    Professor of Pediatrics, University of Iowa Children’s Hospital

  • What Are the Presenting Problems of Staphylococcus in Neonates?

    Patient Presentation
    A 25-day-old female was transferred to a regional children’s hospital after a 3 day history of right submandibular swelling.
    Originally she was seen again by her local pediatrician who gave her 1 dose of ceftriaxone and then began Amoxicillin-Clavulanic acid twice a day.
    She was re-seen the following day without any change in the size of the mass and was seen in the morning of the next day.
    The mother noted that the swelling had increased in size this morning and now had overlying reddening of the skin.
    The infant also seemed to be fussier but had no problems feeding or breathing. The infant was begun on Vancomycin and Unasyn for suspected Methicilln-resistent Staphylococcus aureus (MRSA).
    A computerized tomography of the neck showed a 2.6 cm lymph node with a necrotic center.

    The past medical history showed a full-term infant without prenatal or natal complications. She had seen the pediatrician at 5 days and 10 days of life and was growing well. The family history was negative for underlying immune diseases. The review of systems was negative.
    The pertinent physical exam showed a very fussy female with normal vital signs except for a temperature of 38.1° Celsius.
    HEENT was normal except for a 4×3 cm right-sided mass that was hard and appeared fixed to underlying tissues. It was underneath the mandible and spread toward the clavicle and was tender to palpation.
    No other lymph nodes were palpated including inguinal, axillary and supraclavicular nodes.
    Lungs were clear and no increased work of breathing was noted. Abdomen was normal including no hepatosplenomegaly.
    Skin had no other erythema or rashes. The rest of the examination was normal.

    The work-up included a white blood count of 14.6 x 1000/mm2 with increased neutrophils and monocytes. Her C-reactive protein was 0.9 mg/dl (normal < 0.5)

    The diagnosis of a right submandibular lymph node abscess was made. The patient’s clinical course revealed her continuing on the intravenous antibiotics for the next two days. She did not have significant resolution so she was taken to the operating room where anincision and drainage of the abscess was performed with drain placement.
    She had significant improvement by the following day and the drain was removed.
    She was discharged later that night and was completely well at a follow-up two weeks later by the otolaryngologist.

    Discussion
    Staphylococcus sp. are gram-positive, catalase-positive cocci that cluster when viewed microscopically. There are 17 species indigenous to humans and 13 colonize humans. Staphylococcus aureus is the only species that produces coagulase.
    Staphylococcus sp. can be found in almost any environment including high salt, low oxygen, high heat and low moisture. Coagulase-negative Staphylococcus sp. are so common that newborn infants are colonized by 2-4 days of life usually with S. epidermidis and S. haemolyticus.

    Staphylococcus aureus produces many infections especially pneumonia and surgical wound infections. Humans can be colonized with it especially in mucous membranes and the perineum and axilla.
    Those with nasal carriage can also transiently carry the organism on their hands, thus increasing the risk of transmission to others. MRSA is resistant to all beta-lactamase antibiotics and possibly to other antibiotics in other classes.
    MRSA is common in hospitalized and institutionalized patients and unfortunately is spreading to more communities. The most common comm
    y-acquired MRSA infections are skin and soft tissue infections but pneumonia and invasive disease does occur.
    Community MRSA strains are often still susceptible to common antibiotics such as doxycycline, clindamycin, gentamicin, and trimethoprim-sulfamethoxazole but local sensitivities vary between communities.

    Learning Point
    A nursery outbreak of Staphylococcus was first reported in 1904. Since then, epidemic waves occur on ~20 year cycles (with the background of sporadic and endemic infections).
    Neonates especially those in intensive care units, have a higher rate of infection than other infants. Data has shown that smaller, more premature infants and those with instrumentation also have higher rates of infection.
    Coagulase-negative Staphylococcus is also known to co-infect with Candida sp..

    Common presentations of Staphlococcal infections in neonates include:

    • Bacteremia** and sepsis
    • Skin and soft tissue infections** – skin, wound, abscess, lymphadenitis
    • Bone and joint – osteomyelitis, arthritis
    • Endocarditis and portal vein thrombosis
    • Meningitis
    • Peritonitis – abdominal abscess
    • Pneumonia – empyema, lung abscess
    • Urinary tract infection

    ** most common

    Treatment for serious methicillin-sensitive Staphylococcus aureus (MSSA) usually requires intranvenous therapy with at least a beta-lactam antibiotic such as nafcillin or oxacillin as most S. aureus strains are resistant to pencillin and ampicillin.
    Vancomycin is a commonly used alternative but judicious use is needed to help stem emergence of vancomycin-resistant strains of MSSA. Specific choice of antibiotics depends on local sensitivities and the clinical scenario.
    Consultation with an infectious disease expert may be necessary.

    Scrupulous attention to hand-hygiene practices are necessary to prevent spread particularly within institutions. Eradication of nasal carriage is sometimes attempted but is difficult to actually do; it is not routinely advised.
    Other treatments such as catheter removals, dressing changes, IVIG and antibody administration are also used in some cases.

    Questions for Further Discussion
    1. What are your local MRSA versus MSSA sensitivity patterns?
    2. What are the rates of neonatal Staphylococcus sp. infections in your local nursery?

    Related Cases

      Specialty: General Pediatrics | Infectious Diseases |Otolaryngology

      To Learn More
      To view pediatric review articles on this topic from the past year check PubMed.

      Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

      Information prescriptions for patients can be found at MedlinePlus for these topics: Staphlococcal Infections and MRSA.

      To view current news articles on this topic check Google News.

      To view images related to this topic check Google Images.

      Healy CM, Palazzi DL, Edwards MS, Campbell JR, Baker CJ. Features of invasive staphylococcal disease in neonates. Pediatrics. 2004 Oct;114(4):953-61.

      Fortunov RM, Hulten KG, Hammerman WA, Mason EO, Jr, and Kaplan SL. Community-Acquired Staphylococcus aureus Infections in Term and Near-Term Previously Healthy Neonates. Pediatrics. 2006;118;874-881.

      Venkatesh MP, Placencia F, Weisman LE. Coagulase-negative staphylococcal infections in the neonate and child: an update. Semin Pediatr Infect Dis. 2006 Jul;17(3):120-7.

      American Academy of Pediatrics. Staphlococcal Infections, In Pickering LD, Baker CJ, Long SS, McMillan JA, eds. Red Book: 2006 Report of the Committee on Infectious Diseases. 27th edit. Elk Grove Village, IL: American Academy of Pediatrics; 2006;598-610.

      ACGME Competencies Highlighted by Case

    • Patient Care
      1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
      2. Essential and accurate information about the patients’ is gathered.
      3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
      4. Patient management plans are developed and carried out.
      5. Patients and their families are counseled and educated.
      7. All medical and invasive procedures considered essential for the area of practice are competently performed.
      8. Health care services aimed at preventing health problems or maintaining health are provided.
      9. Patient-focused care is provided by working with health care professionals, including those from other disciplines.

    • Medical Knowledge
      10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
      11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.

    • Practice Based Learning and Improvement
      13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.

    • Systems Based Practice
      24. Cost-effective health care and resource allocation that does not compromise quality of care is practiced.
      25. Quality patient care and assisting patients in dealing with system complexities is advocated.
      26. Partnering with health care managers and health care providers to assess, coordinate, and improve health care and how these activities can affect system performance are known.

      Author
      Donna M. D’Alessandro, MD
      Professor of Pediatrics, University of Iowa Children’s Hospital