The paper describes the case of a 4-year-old boy who recovered from surgery and a mild respiratory infection and developed a skin rash initially mistaken for chickenpox but later diagnosed as PLEVA (pityriasis lichenoides et varioliformis acuta), a benign, self-limiting condition that was treated with antihistamines and sun exposure. It completely resolved within six weeks and left only a few temporary hypopigmented patches.
The paper describes the case of a 4-year-old boy who suddenly developed intense thirst and excessive urination. After ruling out diabetes mellitus, subsequent tests led to a diagnosis of central diabetes insipidus. Further investigations to identify the underlying cause revealed cystic lung lesions indicative of Langerhans cell histiocytosis, for which the child was referred to paediatric haematology-oncology to begin chemotherapy.
Neuropsychiatric conditions frequently coexist with physical health problems in children and adolescents, yet they may remain unrecognised when presenting symptoms are interpreted in isolation. The paediatrician, particularly in primary care, is in a privileged position to identify early warning signs through longitudinal observation and knowledge of the child’s overall functioning. This article illustrates three common clinical presentations - a child who does not speak, a child who eats excessively and a child with recurrent physical symptoms - to highlight how apparently isolated complaints may represent early manifestations of autism spectrum disorder, attention-deficit/hyperactivity disorder, or anxiety disorders. Rather than focusing exclusively on the presenting symptom, an integrated assessment of communication, behaviour, emotional regulation, eating patterns, somatic complaints and functional impairment may facilitate early recognition and timely referral to Child and Adolescent Neuropsychiatry. The article also emphasises the importance of avoiding both diagnostic overshadowing and excessive medical investigation, while maintaining appropriate attention to underlying physical conditions. An integrated and multidisciplinary approach may improve early identification, treatment and long-term outcomes for children and their families.
Background - Ketamine is widely recognised as a safe and effective drug for procedural analgesia and sedation in paediatric patients; however, its use in Italian paediatric emergency units remains heterogeneous. This report amis to describe the use of ketamine in a tertiary-level paediatric emergency unit, by analysing its indications, modalities of use and safety. Materials and Methods - A single-centre retrospective study conducted at the IRCCS ‘Burlo Garofolo’, including all ketamine administrations between January 2016 and November 2025. Patients aged 0-17 years were included. Demographic data, clinical indications, routes of administration, concomitant use with other drugs and adverse events were analysed. Results - A total of 680 administrations in 622 patients were assessed. The intravenous route was predominant (95%). The main indication was sedation for painful procedures (77%), followed by status epilepticus (9%), psychomotor agitation (8%) and sedation for non-painful procedures (6%). In 67% of cases, ketamine was used as a single sedative. Its use increased progressively over the years, reaching a peak of 66.2 doses per 10,000 visits in 2025, with a broadening of clinical indications. Mostly mild adverse events occurred in 8% of cases. One severe adverse event of laryngospasm - 0.15% - was recorded. Conclusions - The above-reported data support ketamine use by paediatric emergency physicians and suggest the importance of shared protocols to ensure appropriateness and safety.
The article addresses the complex world of hydro-electrolytic homeostasis in children and highlights the practical difficulties paediatricians face in choosing infusion fluids and in daily clinical management. The fundamental concepts of osmolarity, body compartments (distinguishing between the intracellular and extracellular spaces) and the physiology of water and solute balance are reviewed. The different types of commercially available and ‘homemade’ solutions are analysed and their use (the ratio of sodium, chlorine, potassium and osmotic load) and the recommended electrolytic intake per kilogram of body weight across different age groups are critically discussed.
