Abdominal pain is a common reason for pediatric patients to present to the emergency department. Pain assessment is especially challenging when patients are unable to communicate due to their developmental stage or medical conditions. Preverbal and nonverbal children are at increased risk for complications of delayed or missed diagnosis. Inadequate pain control is also a concern in this vulnerable population. This review provides guidance for assessment of abdominal pain in preverbal and nonverbal children, focusing on behavioral measures, which are more applicable and reliable in these patients, and on the effective use of parental input. Recommendations are given for a graduated approach to pain management, including nonpharmacologic and pharmacologic options.
Tranexamic acid (TXA) is an antifibrinolytic medication with multiple routes of topical and systemic administration that can be used to treat acute hemorrhage across a broad range of clinical scenarios. Pediatric data are more limited than the adult literature, which benefits from larger, higher-quality studies; however, TXA remains a potentially effective, safe, and versatile option for temporizing bleeding and limiting blood loss in children. This review discusses the evidence on TXA use in traumatic hemorrhage, traumatic brain injury, posttonsillectomy bleeding, epistaxis, oral and gingival bleeding, lower airway bleeding, and traumatic hyphema.
Although they are rare, pediatric cervical spine injuries can be severe and life-threatening. To detect these injuries while avoiding further harm, emergency clinicians must recognize high-risk signs and mechanisms and consider physiology based on patient age. This review presents evidence-based recommendations for prehospital management, imaging decisions, and emergency department management of pediatric cervical spine injuries.
Pediatric penile problems range from congenital anomalies to acquired and emergent conditions. Acquired conditions can result from various causes, including infectious and inflammatory conditions, hematologic conditions, strangulation conditions, trauma, and surgical injuries. This review provides an overview of the presentation, diagnosis, and management of pediatric penile problems that may present to the emergency department. Recommendations are given for evaluation and management, with emphasis on pain relief, restoration of normal anatomy, and timely treatment. Guidance is also provided on indications for emergent urologic consultation. Optimizing outcomes for pediatric patients with penile conditions requires addressing key challenges, including effective pain and anxiety management, thoughtful use of imaging, and careful evaluation for possible abuse.
While indications and techniques for thoracostomy are well studied in adults, pediatric-specific evidence remains limited for emergency department-based thoracostomy and especially thoracotomy. The ability to perform urgent interventions for life-threatening pleural space pathologies is essential for all emergency clinicians. This issue reviews the clinical indications for thoracostomy and thoracotomy in pediatric patients, outlines procedural considerations for these techniques, and discusses potential complications in the emergency department. Advancements in the field are also highlighted, including emerging approaches to reduce procedural delays and improve patient outcomes.
Children with medical complexity represent a growing population in emergency medicine, and many of these children depend on medical technology. This issue provides an evidence-based framework for the emergency management of children with 3 commonly encountered technologies: tracheostomies, enteral feeding tubes, and cerebrospinal fluid shunts. Distinct risks, including obstruction, dislodgement, infection, and mechanical failure, are discussed. Strategies for early recognition, stabilization, and incorporation of caregiver input are reviewed to improve outcomes and reduce medical errors. By understanding technology-specific complications and emphasizing collaborative care, emergency clinicians can deliver safer, more effective treatment for this high-risk pediatric population.
Prolonged pediatric fever is most often due to a self-limiting infectious illness, but can sometimes be a sign of much more serious disease. The care of children with prolonged fever can be challenging, since there is significant variation in the definition of prolonged pediatric fever, and evidence-based decision support tools to guide evaluation and management of children with prolonged fever are limited. This issue constructs a framework for initial emergency department evaluation and management of children with fever lasting ≥5 days and fever of unknown origin lasting ≥8 days.
Pediatric dehydration is a top concern that leads parents to bring their children into the emergency department for evaluation. Rehydration therapy should be tailored to the severity of illness, available resources, and the child's clinical status. Although accurately determining the fluid deficit can be challenging, guidance is provided for use of scoring systems to estimate the degree of dehydration. Recommendations are given for first-line oral rehydration therapy, and for rehydration through intravenous, intraosseous, or subcutaneous methods when oral rehydration is not an option. A thoughtful, goal-directed approach that emphasizes timely rehydration, caregiver education, and careful follow-up can improve outcomes.
While most cases of neonatal rashes are benign and self-limited, certain neonatal skin conditions require prompt diagnosis and targeted treatment to prevent severe morbidity and mortality. Recognition of high-risk neonatal rashes and early intervention can significantly improve patient outcomes. Categorizing the rash can help delineate a differential diagnosis and determine whether the presentation and physical examination have features of a high-risk rash. This issue offers a strategic approach to the evaluation of neonatal skin conditions and offers guidance for differentiating benign findings from those that should raise concern and lead to further evaluation and management.
Public health programs have helped decrease the prevalence and sequelae of measles, mumps, rubella, and varicella; however, misinformation regarding vaccinations and recent disruptions to vaccination programs have caused outbreaks to occur. Emergency clinicians must be able to readily identify the characteristic presentations of measles, mumps, rubella, and varicella, with the goals of optimizing supportive care, limiting the spread of disease, and giving appropriate precautionary advice for complications to patients and their families. This issue provides a review of the clinical features, differential diagnoses, potential complications, and treatment options for measles, mumps, rubella, and varicella.
Colitis presents as an inflammatory diarrhea that is often accompanied by abdominal pain. The differential diagnosis of colitis is broad and depends on the presenting symptoms and age of the patient. Although infectious colitis in an immunocompetent child is often self-limited, complications of colitis can be serious, and early recognition can expedite critical medical interventions and surgical consultation. This issue provides an evidence-based approach to the evaluation and management of colitis and associated acute complications in adolescent patients in the emergency department.
Febrile seizures are a common presentation to emergency departments. While established guidelines exist, variation in the management and treatment of febrile seizures persists across emergency departments. This issue reviews the definition of pediatric febrile seizure and discusses the presentation, differential diagnosis, management, and prognosis. Anticipatory guidance for families and disposition considerations are also provided.
Pediatric status epilepticus requires prompt recognition and treatment in the emergency department. When left untreated, status epilepticus can lead to neuronal death, neuronal injury, and alteration of neuronal networks, depending on the type and duration of the seizures. This issue reviews the International League Against Epilepsy definition of status epilepticus and provides recommendations for the evaluation and management of pediatric patients presenting to the emergency department in status epilepticus.
Hematuria is a common finding in the pediatric population. The differential diagnosis for pediatric hematuria is wide, ranging from isolated benign causes to serious progressive renal or urologic diseases. Emergency clinicians must be able to identify high-risk features that raise suspicion for a serious underlying pathology while limiting unnecessary workup. This issue reviews key considerations in the evaluation and initial management of pediatric hematuria in the emergency department, including evidence-based recommendations on initial laboratory and imaging choices.
Pediatric sexual abuse is a widespread problem impacting children and adolescents across all ages, races, ethnicities, and socioeconomic groups, and it is a topic that emergency clinicians caring for children need to be familiar with. A structured, multidisciplinary approach to the assessment, diagnosis, treatment, and follow-up of these patients is essential. This issue provides a comprehensive review of the current definitions, assessment techniques, diagnostic considerations, and management strategies for children who have experienced sexual abuse.
Traumatic wounds and lacerations are common pediatric presenting complaints to emergency departments. Although there is a large body of literature on wound care, many emergency clinicians base management of wounds on theories and techniques that have been passed down over time. Therefore, controversial, conflicting, and unfounded recommendations are prevalent. This issue reviews evidence-based recommendations for wound care, including wound cleansing and irrigation, anxiolysis/sedation techniques, closure methods, and postrepair wound care.
Children with skin and soft-tissue infections (SSTIs) commonly present to the emergency department, and while most of these infections are mild, some can be severe, with high morbidity and mortality. Emergency clinicians must be able to recognize frequently encountered SSTIs and be prepared to treat them appropriately. This issue reviews the various etiologies and patient presentations of common SSTIs, including purulent, nonpurulent, and necrotizing infections. Findings on the history and physical examination that can differentiate SSTIs from mimics are discussed, and evidence-based recommendations are provided for management.
Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease. Children may present to the emergency department during the initial presentation of JIA or due to disease-related complications. Differentiating JIA from emergent causes of joint pain, including severe infections and malignancies, can be challenging. This issue reviews the clinical presentation of JIA, provides guidance for differentiating JIA from conditions with similar presentations, and offers recommendations for management of JIA and JIA-related complications in the emergency department.
When children and adolescents present to the emergency department with sports-related injuries, it can be challenging to differentiate apophyseal injuries from other common injuries such as fractures or muscle or ligament injuries. Recognition of apophyseal injuries can help facilitate optimal healing, prevent future injury, and minimize unnecessary testing. This issue reviews the major anatomic areas of apophysitis, presents guidance for activity modification and return precautions, and indications for when it is appropriate to refer patients for specialty care.
Headaches are a common reason for pediatric visits to the emergency department. Emergency clinicians must distinguish between common and dangerous secondary causes of headache and primary headache disorders such as migraine and tension-type headaches. This issue discusses the diagnosis of primary headaches by history and physical examination, the options for first-line treatment of primary headache and for severe or refractory migraines, and procedural interventions that may be considered when other therapies have failed. Guidance is provided for patient and family education regarding triggers, lifestyle modifications, and nutraceutical prophylaxis.
