The parent of a 14-month-old child reports the child appears pale, tired, fussy, and has a decreased appetite and hard stools. The onset of these symptoms began 1 month ago when the grandparents began watching the child in their home daily while the parents worked.  The child has been healthy and is up to date on vaccinations and well visits. What should be included in the plan for this child?

A 5-year-old girl has severe vesicoureteral reflux that has not responded to daily low-dose antibiotic therapy. What is the next step in the management of this child?

A 10-year-old presents to clinic with new-onset bedwetting. He denies dysuria, fever, vomiting, headache, change in behavior or new stressors in his life. He is on no medications and is doing well in school. His BMI is above the 97th percentile. He is afebrile. His BP is 120/80, pulse 95, and respiratory rate 18. The examination reveals his nuchal skin is hyperpigmented and velvety in texture. Other physical findings are unremarkable. What is the most probable underlying cause of his bedwetting?

A 9-year-old child presents to clinic with his second migraine headache in 3 months. The caregiver has been giving the child acetaminophen for pain without improvement. Which medication should be the next step in treating this child’s migraine headache?

Which of the following symptoms after a concussion would warrant further evaluation with neuroimaging in a high school athlete? 

A  30-month-old child presents to clinic with a “rash” which developed 3 weeks after the child had Influenza B. The parent states the rash looks like “little red dots”. Additionally, the parent noted the child’s gums bled this morning when brushing teeth. The child is afebrile and the rash is non-blanching upon exam. What is the most likely diagnosis for this child?

A mother brings her 6-year-old son in because he is having problems with nocturnal enuresis and reports he has never been totally dry at night. She is concerned that he is just not trying and wants to know what can be done. How should the nurse practitioner respond?

Which condition corresponds with the attached photograph?

 Which tests should be ordered to diagnose thalassemia? 

A 13-year-old girl presents for assessment of her short stature. On exam, the child has height and weight below the 5th percentile, webbed neck, lack of breast bud development, high-arched palate and low-set posterior hair line. What is the most likely diagnosis in this child?