Pediatric Primary Care Case Studies (72 page)

Litton, J., Rice, A., Friedman, N., Oden, J., Lee, M. M., & Freemark, M. (2002). Insulin pump therapy in toddlers and preschool children with type 1 diabetes mellitus.
Journal of Pediatrics, 141
(4), 490–495.

Ludwig, D. S., & Ebbeling, C. B. (2001). Type 2 diabetes mellitus in children: primary care and public health considerations.
Journal of the American Medical Association, 286
(12), 1427–1430.

Macaluso, C. J., Bauer, U. E., Deeb, L. C., Malone, J. I., Chaudhari, M., Silverstein, J., et al. (2002). Type 2 diabetes mellitus among Florida children and adolescents, 1994 through 1998.
Public Health Reports, 117
(4), 373–379.

Mack-Fogg, J. E., Orlowski, C. C., & Jospe, N. (2005). Continuous subcutaneous insulin infusion in toddlers and children with type 1 diabetes mellitus is safe and effective.
Pediatric Diabetes, 6
(1), 17–21.

Maillet, N. A., D’Eramo Melkus, G., & Spollett, G. (1996). Using focus groups to characterize the health beliefs and practices of black women with non-insulin-dependent diabetes.
Diabetes Education, 22
(1), 39–46.

Mallare, J. T., Cordice, C. C., Ryan, B. A., Carey, D. E., Kreitzer, P. M., & Frank, G. R. (2003). Identifying risk factors for the development of diabetic ketoacidosis in new onset type 1 diabetes mellitus.
Clinical Pediatrics (Philadelphia), 42
(7), 591–597.

Mulvaney, S. A., Schlundt, D. G., Mudasiru, E., Fleming, M., Vander Woude, A. M., Russell, W. E., et al. (2006). Parent perceptions of caring for adolescents with type 2 diabetes.
Diabetes Care, 29
(5), 993–997.

Must, A., & Strauss, R. S. (1999). Risks and consequences of childhood and adolescent obesity.
International Journal of Obesity and Related Metabolic Disorders, 23
(Suppl 2), S2–S11.

National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. (2004). The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents.
Pediatrics, 114
(Suppl 2), 555–576.

Ogden, C. L., Carroll, M. D., & Flegal, K. M. (2008). High body mass index for age among US children and adolescents, 2003–2006.
Journal of the American Medical Association, 299
(20), 2401–2405.

Peterson, K., Silverstein, J., Kaufman, F., & Warren-Boulton, E. (2007). Management of type 2 diabetes in youth: an update.
American Family Physician, 76
(5), 658–664.

Pinhas-Hamiel, O., Standiford, D., Hamiel, D., Dolan, L. M., Cohen, R., & Zeitler, P. S. (1999). The type 2 family: a setting for development and treatment of adolescent type 2 diabetes mellitus.
Archives of Pediatric and Adolescent Medicine, 153
(10), 1063–1067.

Quinn, M. T., Cook, S., Nash, K., & Chin, M. H. (2001). Addressing religion and spirituality in African Americans with diabetes.
Diabetes Education, 27
(5), 643–644, 647–648, 655.

Rennert, O. M., & Francis, G. L. (1999). Update on the genetics and pathophysiology of type I diabetes mellitus.
Pediatric Annals, 28
(9), 570–575.

Roche, E. F., Menon, A., Gill, D., & Hoey, H. (2005). Clinical presentation of type 1 diabetes.
Pediatric Diabetes, 6
(2), 75–78.

Rosenbloom, A., & Silverstein, J. (2003).
Type 2 diabetes in children and adolescents: a guide to diagnosis, epidemiology, pathogenesis, prevention and treatment
. Alexandria, VA: American Diabetes Association.

Rosenbloom, A. L. (2007). Diabetes in the child and adolescent: diagnosis and classification. In F. Lifshitz (Ed.),
Pediatric endocrinology
(Vol. 1, pp. 57–62). New York: Informa Healthcare.

Rothman, R. L., Mulvaney, S., Elasy, T. A., VanderWoude, A., Gebretsadik, T., Shintani, A., et al. (2008). Self-management behaviors, racial disparities, and glycemic control among adolescents with type 2 diabetes.
Pediatrics, 121
(4), e912–e919.

Samuel-Hodge, C. D., Headen, S. W., Skelly, A. H., Ingram, A. F., Keyserling, T. C., Jackson, E. J., et al. (2000). Influences on day-to-day self-management of type 2 diabetes among African-American women: spirituality, the multi-caregiver role, and other social context factors.
Diabetes Care, 23
(7), 928–933.

Sawyer, S. M., & Aroni, R. A. (2005). Self-management in adolescents with chronic illness. What does it mean and how can it be achieved?
Medical Journal of Australia, 183
(8), 405–409.

Schofield, L., Mummery, W. K., & Schofield, G. (2005). Effects of a controlled pedometer-intervention trial for low-active adolescent girls.
Medicine and Science in Sports and Exercise, 37
(8), 1414–1420.

Silverstein, J., Klingensmith, G., Copeland, K., Plotnick, L., Kaufman, F., Laffel, L., et al. (2005). Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association.
Diabetes Care, 28
(1), 186–212.

Skinner, A. C., Weinberger, M., Mulvaney, S., Schlundt, D., & Rothman, R. L. (2008). Accuracy of perceptions of overweight and relation to self-care behaviors among adolescents with type 2 diabetes and their parents.
Diabetes Care, 31
(2), 227–229.

Soltesz, G., Patterson, C. C., & Dahlquist, G. (2007). Worldwide childhood type 1 diabetes incidence—what can we learn from epidemiology?
Pediatric Diabetes, 8
(Suppl 6), 6–14.

Stewart, S. M., Rao, U., Emslie, G. J., Klein, D., & White, P. C. (2005). Depressive symptoms predict hospitalization for adolescents with type 1 diabetes mellitus.
Pediatrics, 115
(5), 1315–1319.

Svec, F., Nastasi, K., Hilton, C., Bao, W., Srinivasan, S. R., & Berenson, G. S. (1992). Black-white contrasts in insulin levels during pubertal development. The Bogalusa Heart Study.
Diabetes, 41
(3), 313–317.

Swift, P. G. (2007). Diabetes education. ISPAD clinical practice consensus guidelines 2006–2007.
Pediatric Diabetes, 8
(2), 103–109.

Tan, J. M. (2009). Nephrology. In J. W. Custer & R. E. Rau (Eds.),
The Harriet Lane handbook: a manual for pediatric house officers
(18th ed., pp. 507–536). Philadelphia: Elsevier Mosby.

TRIGR Study Group. (2007). Study design of the trial to reduce IDDM in the genetically at risk (TRIGR).
Pediatric Diabetes, 8
, 117–137.

U.S. Department of Health and Human Services. (2005).
Dietary guidelines for Americans
. Retrieved August 9, 2008, from
http://www.health.gov/dietaryguidelines/dga2005/document/pdf/DGA2005.
pdf

Weinger, K., O’Donnell, K. A., & Ritholz, M. D. (2001). Adolescent views of diabetes-related parent conflict and support: a focus group analysis.
Journal of Adolescent Health, 29
(5), 330–336.

White, N. H., Cleary, P. A., Dahms, W., Goldstein, D., Malone, J., & Tamborlane, W. V. (2001). Beneficial effects of intensive therapy of diabetes during adolescence: outcomes after the conclusion of the Diabetes Control and Complications Trial (DCCT).
Journal of Pediatrics, 139
(6), 804–812.

Wilson, D. M., Buckingham, B. A., Kunselman, E. L., Sullivan, M. M., Paguntalan, H. U., & Gitelman, S. E. (2005). A two-center randomized controlled feasibility trial of insulin pump therapy in young children with diabetes.
Diabetes Care, 28
(1), 15–19.

Winter, W. E. (2007). Diabetes autoimmunity. In F. Lifshitz (Ed.),
Pediatric endocrinology
(5th ed., Vol. 1, pp. 83–99). New York: Informa Healthcare.

Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. (2002). Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus.
Journal of the American Medical Association, 287
(19), 2563–2569.

Young-Hyman, D., Schlundt, D. G., Herman-Wenderoth, L., & Bozylinski, K. (2003). Obesity, appearance, and psychosocial adaptation in young African American children.
Journal of Pediatric Psychology, 28
(7), 463–472.

Zdravkovic, V., Daneman, D., & Hamilton, J. (2004). Presentation and course of type 2 diabetes in youth in a large multi-ethnic city.
Diabetic Medicine, 21
(10), 1144–1148.

Zeitler, P., Epstein, L., Grey, M., Hirst, K., Kaufman, F., Tamborlane, W., et al. (2007). Treatment options for type 2 diabetes in adolescents and youth: a study of the comparative efficacy of metformin alone or in combination with rosiglitazone or lifestyle intervention in adolescents with type 2 diabetes.
Pediatric Diabetes, 8
(2), 74–87.

Chapter 19

Migrant Farmworker’s Toddler with Anemia

Veronica Kane

Sometimes a single cause may be the culprit when a child presents with multiple symptoms. However, there are those times when multiple symptoms stem from multiple causes, creating a diagnostic dilemma. To derive the most probable diagnoses and appropriate treatment plans, methodical synthesis of data about each of the multiple possible causes is imperative. Developing a schema for analyzing complex situations is essential for practitioners.

Educational Objectives

1.   Develop a schema for approaching/evaluating the child who presents with multiple symptoms.

2.   Integrate environmental histories into the data gathering for pediatric clients and their families.

3.   Assess the child who presents with hematologic symptoms.

4.   Analyze basic hematologic laboratory studies.

5.   Differentiate among the causes and presentations of various anemias.

6.   Integrate cultural information that might affect any aspect of the child’s diagnosis, treatment, or compliance.

7.   Integrate age-relevant information into the decision-making process.

   Case Presentation and Discussion

Oswaldo Garcia, an 18-month-old, is here for his well-child visit. He is with his mother and the clinic’s interpreter. Mrs. Garcia tells you that her family and friends in the housing area have expressed concern lately because the child is so pale and skinny. He recently has had a few nosebleeds and seems fussier than usual without any identifiable cause. You now look at Oswaldo for the first time and note blatant pallor in a quiet toddler sitting complacently on his mother’s lap. He is wearing a diaper and tee shirt, with a holy medal around his neck and his thumb in his mouth.

Health History

What aspects of the history would be useful to help you refine the nature of Oswaldo’s problem?

The following information would be helpful:

•   History of present illness

•   Past medical history

•   Family medical history

•   Social history

•   Environmental history

•   Complete review of systems

Oswaldo was last seen in the clinic 3 months ago for an ear infection and fever, and at that time he was given amoxicillin. Although he did not come in for follow-up, Mrs. Garcia reports that he got better very fast and has been fine. She states that she had an uncomplicated pregnancy except for hyperemesis and poor weight gain in the first 4 months of pregnancy. Her labor and delivery were uneventful, and he was discharged home at 2 days with mom and had no problems as a neonate. He has had no hospitalizations, surgeries, major illnesses, or visits to the emergency department.