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Welcome to the August 6 edition of The Differential. Created by physicians for physicians, this high-quality pediatrics briefing is designed to be quick (skim it in just a few minutes) and thorough (all the information you need is in this email). Today’s Differential is edited by Dr. Daniel Flanders, a pediatrician and adjunct lecturer at the University of Toronto.

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Single-Sentence Summaries

1. Adolescents are most risky and reckless when driving in the period immediately after obtaining their drivers license. Science Direct, July 2018

2. An exploratory study shows promise for using Google Glass technology to help children with autism learn to read facial expressions. npj Digital Medicine, August 2018

3. Incidence of trampoline-associated injuries is soaring with the increased popularity of trampoline parks. Today, July 2018

4. A high BMI in older teens may cause cardiac dysfunction in early adulthood. Circulation, July 2018

5. Adolescent cancer survivors are 73 percent more likely (compared to the normal population) to develop endocrine disease later in life. JAMA Network Open, June 2018

Clinical Quiz

An 11-year-old female presents with a pruritic rash, a fever, and fatigue after returning from a family vacation two days earlier. Her mother mentions she spent the last days of their holiday in the hotel hot tub. On examination, a papular, erythematous rash is seen on the skin that was covered by her bathing suit. How would you manage this patient?

A. Ciprofloxacin
B. Cephalexin
C. Symptomatic treatment
D. Doxycycline

Answer at the bottom of this email, or click here to see the full case and discussion on Figure 1.

Editor’s Pearl

This week’s pearl — Things to Bring to a No-Antibiotic Discussion — comes from

  1. The Right Attitude: Although there are many reasons to not prescribe antibiotics, the reason that should be driving us at this moment should be that the benefits do not outweigh the risks.
  2. The Right Words: Talk in terms of benefit and what is best. Avoid talking in terms of need. If antibiotics were needed there would be no discussion.
  3. The Right Emphasis: Spend as much time as possible emphasising the benefits of analgesia. Treating fever is not the aim but helping the child to feel well enough to drink is very important.
  4. The Right Information: It helps to have a leaflet to back up and reinforce what is discussed. Signposting trusted websites can also be very useful.
  5. The Right Plan: Antibiotics may not prevent complications of upper respiratory tract infection in children but they are needed when complications occur. Safety-netting is key.


C. Symptomatic treatment

This patient’s history and clinical findings suggest a diagnosis of Pseudomonas or “hot tub” folliculitis—a pruritic erythematous rash that develops after exposure to water contaminated with Pseudomonas aeruginosa. In immunocompetent individuals, the rash typically resolves within days with symptomatic treatment alone.

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