Learning Pediatrics

Appearance of Epstein pearls in the mouth of newborn infants

Epstein's pearls are very common and benign small white or yellow cystic vesicles (1 to 3 mm in size) often seen in the median palatal raphe of the mouth of newborn infants (occur in 65-85% of newborns).

It represents epithelial tissue that becomes trapped during the palatal fusion. On palpation, these are firm papules that can be appreciated when the infant is sucking on the examiner's finger. They do not require treatment as they resolve spontaneously over the first few weeks of life.

Epstein Pearl in 5 week old infant

Appearance of Sunset sign in infant eyes

The sclera are visible between the upper eyelid and the iris,Sunsetting sign is seen usually in hydrocephalus due to loss of upward conjugate gaze caused by raised intracranial pressure (ICP)

The setting-sun phenomenon is an ophthalmologic sign in young children resulting from upward-gaze paresis.......................

Characteristic appearance of the rash of Henoch-Schonlein purpura (HSP)

Henoch–Schonlein purpura

Henoch–Schonlein purpura (HSP or anaphylactoid purpura) is the commonest childhood vasculitis, with an incidence between 13.5 and 24 per 100000 children under 14 years old, falling with
increasing age. "Vasculitis is a general term that refers to the inflammation of arteries, or blood vessels".
It is a multisystem disorder affecting the skin, joints (in 60–84 %) particularly ankles and knees, gastrointestinal tract with pain and gastrointestinal bleeding, and kidneys. The aetiology is unclear although preceding infection, particularly upper respiratory tract infection; there is a seasonal variation in incidence supporting an infectious aetiology. No single organism has been found to be associated with HSP.

For most children, Henoch–Schonlein purpura HSP is diagnosed by the appearance of the rash......purple, bruised rash on legs, buttocks or elsewhere. This is caused by red blood cells that leak out of the damaged blood vessels.

The palpable purpuric rash of Henoch–Schonlein purpura in the classic distribution around the lateral malleoli,the ventral aspects of the feet,the buttocks and the extensor aspects of the legs.The rash may start with urticaria.

Joints: painful, brief swelling. The joints most frequently affected with pain and swelling are the ankles and the knees. Usually this only lasts from 1-3 days in the individual joints. Sometimes whole limbs will swell. The inflammation does not cause crippling arthritis.

Intestines: mostly abdominal pain, but can also include loss of appetite, diarrhea, vomiting and occasional blood in stools. Rarely, patients develop an abnormal bowel folding called intussusception.

Kidney: a significant number develop nephritis with an estimated 1 per cent developing endstage renal failure. 5 to 15 % of children requiring dialysis have Henoch–Schonlein purpura.

How to Remember The Fallot's tetrology, triad and pentad - A different Medical mnemonic

Medical Video mnemonic, showing a different way to remember the components of fallot's tetrology, fallot's tetrad and pentad.

Diagram shows Assessment of the seriously ill child

Photos of Salmon Patches in neonates

Salmon patches are commonly seen in the newborn period ,Salmon patches are more common in Caucasian populations. Alternative terms are naevus simplex, "angel kisses" (when on the forehead or eyelids), and "stork bites" (over the nape of the neck). They are midline malformations consisting of ectatic capillaries in the upper dermis with normal overlying skin.

Most will resolve over the first couple of years of life, but some - especially the nuchal lesions - may persist into adulthood.

It is important to differentiate salmon patches from port-wine stains (PWS). PWS are more lateral, do not resolve, and may darken and thicken with age. Some haemangiomas over the eyelid may also start as a faint erythematous patch before developing into a more typical haemangioma.