Of 370 children receiving ampicillin, 35 (9.46%) developed a skin rash. Nineteen of these children and 19 who received ampicillin but did not develop rash were observed. One patient from each group had serologic evidence of Epstein-Barr virus infection. No child with ampicillin rash had a positive skin test to ampicillin or penicillin major or minor determinants. Fourteen children with rash continued ampicillin therapy with no ill effects and with disappearance of the rash
Physicians become involved in child sexual abuse when they must report suspected abuse or when they are asked to medically evaluate a child who is an alleged victim of abuse. This article reviews recent progress in the medical profession's attention to child sexual abuse and discusses current issues surrounding reporting and medical evaluation. The reporting requirement raises several concerns for pediatricians. Their legal responsibilities as reporters may conflict with their traditional relationship with the family as a unit and with the confidentiality of the doctor-patient relationship. Knowledge about pediatric anogential anatomy is in a relatively early stage of development, and few pediatricians receive training adequate to enable them to determine whether medical observations are consistent with sexual abuse. Even fewer pediatricians receive training in the unique considerations and needs present when taking the medical history of a possible abuse victim or when preserving evidence for possible later use in court. The medical evidentiary evaluation of suspected sexual abuse also raises a number of concerns. There is great variability in referral patterns, which determine whether a medical examination will be requested and whether a general practice physician or a specialist will be asked to conduct the exam. Although professional medical associations have laid out broad outlines of recommended procedures for medical exams when sexual abuse is suspected, more detailed protocols are needed for addressing the many cases where findings are ambiguous or subtle. Often physicians need training in forensics and assistance in coordinating services with multiple agencies and professions. Finally, attention must be given to ensuring adequate cost reimbursement for medical evaluations.
The increasing availability and use of marijuana in children, adolescents, and adults have been well documented in recent years. Adverse reactions have been described in adults who absorb the drug via inhalation or by oral and intravenous routes.1-5 To our knowledge, no cases of oral intoxication in very young children have been reported in the pediatric literature. We describe the adverse effects experienced by three children after an accidental oral ingestion of marijuana. CASE REPORTS Case 1 J.H., a 3-year-old previously healthy, white girl, was noted by her baby-sitter to be behaving abnormally a short time after lunch. Approximately two hours later, her mother observed the child to have an ataxic gait and a voracious appetite.
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