C

Café-au-lait Spots

• Definition: Flat, pigmented skin macules that are light to dark brown, resembling coffee with milk.

• Clinical Significance:

  • Common in otherwise healthy children, but multiple spots (>6) larger than 0.5 cm in prepubertal children or >1.5 cm in postpubertal children are diagnostic criteria for Neurofibromatosis Type 1 (NF1).

  • May also be associated with McCune-Albright syndrome, tuberous sclerosis, and Fanconi anemia.

• Investigations: Genetic testing for NF1 if criteria are met, skin examination, ophthalmologic exam for Lisch nodules.

• Management: Monitoring for NF1 complications (learning difficulties, scoliosis, tumors).

Calcaneovalgus Foot

• Definition: Benign foot deformity seen in neonates where the foot is dorsiflexed and everted against the tibia.

• Etiology: Intrauterine positioning.

• Clinical Features: Flexible deformity, foot can be passively corrected.

• Differential Diagnosis: Talipes equinovarus (clubfoot), vertical talus.

• Management: Usually resolves spontaneously; physiotherapy and stretching exercises may help. Rarely, casting is required.

Calcium Disorders (Pediatric Hypocalcemia & Hypercalcemia)

• Hypocalcemia:

  • Causes: Hypoparathyroidism, Vitamin D deficiency, DiGeorge syndrome, sepsis, renal failure.

  • Symptoms: Tetany, seizures, stridor, prolonged QT on ECG.

• Hypercalcemia:

  • Causes: Hyperparathyroidism, Williams syndrome, vitamin D intoxication, malignancy.

  • Symptoms: Lethargy, vomiting, constipation, polyuria, nephrocalcinosis.

• Investigations: Serum calcium, phosphate, PTH, vitamin D levels.

• Management:

  • Hypocalcemia: Calcium gluconate IV in emergencies, Vitamin D supplementation.

  • Hypercalcemia: IV fluids, diuretics, bisphosphonates if severe.

Campylobacter Infection

• Definition: Bacterial gastroenteritis commonly caused by Campylobacter jejuni.

• Epidemiology: Common cause of diarrhea in children, associated with undercooked poultry.

• Clinical Features: Fever, abdominal pain, bloody diarrhea. May mimic appendicitis.

• Complications: Guillain-Barré syndrome, reactive arthritis.

• Investigations: Stool culture, PCR.

• Management: Supportive hydration. Antibiotics (macrolides) reserved for severe/prolonged disease.

Caput Succedaneum

• Definition: Subcutaneous edema of the newborn’s scalp that crosses suture lines, present at birth.

• Cause: Pressure from the birth canal during vaginal delivery.

• Clinical Features: Soft, boggy swelling that resolves within 24–48 hours.

• Differential Diagnosis: Cephalohematoma (does not cross suture lines), subgaleal hemorrhage (serious).

• Management: Self-limiting, no treatment required.

Cardiac Murmurs in Children

• Innocent Murmurs: Soft, systolic, vary with position, no associated symptoms.

• Pathologic Murmurs:

  • VSD (Holosystolic at LLSB)

  • ASD (Fixed split S2)

  • PDA (Continuous machinery murmur)

  • TOF (Ejection systolic, single S2)

• Investigations: ECG, CXR, Echocardiography.

• Management: Depends on etiology—surgical repair for VSD/ASD, indomethacin for PDA.

Cardiomyopathy (Pediatric)

• Types:

  • Dilated: Viral myocarditis, Duchenne muscular dystrophy.

  • Hypertrophic: Genetic, Noonan syndrome, infants of diabetic mothers.

  • Restrictive: Rare, often infiltrative diseases.

• Symptoms: Heart failure, arrhythmias, sudden cardiac death (HCM).

• Investigations: Echo, ECG, genetic testing, CMR.

• Management:

  • Dilated: ACE inhibitors, diuretics, transplant.

  • Hypertrophic: Beta-blockers, avoid dehydration/exertion.

  • Restrictive: Symptomatic, transplant definitive.

Carpenter Syndrome

• Definition: Rare genetic craniosynostosis syndrome.

• Features: Craniosynostosis, syndactyly, obesity, congenital heart defects, developmental delay.

• Genetics: Autosomal recessive, mutations in RAB23 gene.

• Management: Multidisciplinary: neurosurgery, cardiology, orthopedic surgery, special education.

Celiac Disease (Pediatric)

• Definition: Autoimmune enteropathy triggered by gluten in genetically predisposed children.

• Symptoms: Diarrhea, failure to thrive, abdominal distension, anemia, irritability.

• Investigations:

  • Serology: Anti-tTG IgA, EMA.

  • Confirmed by duodenal biopsy showing villous atrophy.

• Management: Strict lifelong gluten-free diet, nutritional supplementation.

• Complications: Malnutrition, osteoporosis, increased lymphoma risk.

Central Cyanosis in Neonates

• Definition: Bluish discoloration of skin/mucous membranes due to arterial hypoxemia.

• Causes:

  • Cardiac: Tetralogy of Fallot, Transposition of Great Arteries.

  • Pulmonary: RDS, pneumonia, meconium aspiration.

  • Hematologic: Methemoglobinemia.

• Investigations: Pulse oximetry, hyperoxia test, CXR, Echo.

• Management: Oxygen therapy, treat underlying cause, prostaglandin E1 for duct-dependent lesions.

Cerebral Palsy (CP)

• Definition: Non-progressive motor impairment due to an insult to the developing brain.

• Types:

  • Spastic (most common) – Diplegia, hemiplegia, quadriplegia.

  • Dyskinetic – Athetosis, dystonia.

  • Ataxic – Poor balance, coordination.

• Risk Factors: Prematurity, hypoxic-ischemic encephalopathy, infections, trauma.

• Features: Motor delay, abnormal tone, reflex abnormalities, seizures, intellectual disability.

• Investigations: MRI brain, developmental assessment.

• Management:

  • Multidisciplinary (physio, OT, speech therapy).

  • Medications: Baclofen, botulinum toxin for spasticity.

  • Orthopedic surgery for contractures.

Chickenpox (Varicella)

• Definition: Primary infection with Varicella Zoster Virus (VZV).

• Clinical Features: Fever, malaise, pruritic vesicular rash in crops (“dew drops on a rose petal”).

• Complications: Secondary bacterial infection, pneumonia, encephalitis, cerebellitis, Reye’s syndrome.

• Management: Supportive; acyclovir for immunocompromised/severe cases.

• Prevention: Varicella vaccine.

Choanal Atresia

• Definition: Congenital obstruction of posterior nasal apertures.

• Presentation: Newborn with cyclic cyanosis, worse during feeding and relieved by crying.

• Diagnosis: Failure to pass nasogastric tube, CT scan.

• Management: Emergency airway stabilization, surgical repair.

Chronic Lung Disease of Prematurity (Bronchopulmonary Dysplasia)

• Definition: Long-term oxygen requirement beyond 28 days postnatal age in preterm infants with RDS.

• Pathogenesis: Lung injury from oxygen toxicity, barotrauma, inflammation.

• Features: Tachypnea, retractions, hypoxemia.

• Investigations: CXR shows hyperinflation, cystic changes.

• Management: Oxygen therapy, diuretics, nutrition, inhaled steroids. Prevention with antenatal steroids, gentle ventilation.

Clubfoot (Talipes Equinovarus)

• Definition: Congenital deformity with hindfoot equinus and varus, forefoot adductus, and cavus.

• Management: Ponseti method (serial casting, Achilles tenotomy), surgical correction if refractory.

Coarctation of the Aorta

• Definition: Congenital narrowing of aortic arch.

• Presentation:

  • Infant: CHF, shock after duct closure.

  • Older child: Hypertension in upper limbs, weak femoral pulses, radio-femoral delay.

• Investigations: Echo, CXR (“figure 3 sign”).

• Management: Prostaglandin E1 infusion in neonates, surgical repair, or balloon angioplasty.

Congenital Diaphragmatic Hernia

• Definition: Herniation of abdominal viscera into thorax due to diaphragmatic defect.

• Presentation: Respiratory distress at birth, scaphoid abdomen, decreased breath sounds.

• Investigations: CXR showing bowel loops in chest.

• Management: Intubation, gastric decompression, surgical repair once stabilized.

Congenital Hypothyroidism

• Causes: Thyroid dysgenesis, dyshormonogenesis, maternal antithyroid drugs.

• Clinical Features: Prolonged jaundice, macroglossia, umbilical hernia, hypotonia, constipation.

• Investigations: Newborn screening (T4, TSH).

• Management: Lifelong levothyroxine. Early treatment prevents intellectual disability.

Croup (Laryngotracheobronchitis)

• Definition: Acute viral infection (usually parainfluenza virus) causing upper airway obstruction.

• Symptoms: Barking cough, inspiratory stridor, hoarseness, worse at night.

• Investigations: Clinical diagnosis; X-ray shows “steeple sign.”

• Management:

  • Mild: Humidified air, steroids (dexamethasone).

  • Severe: Nebulized adrenaline, oxygen, intubation if impending obstruction.