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Anemia

Age	Hemoglobin (gm/dL)	Range
2 weeks	16.5	13-20
3 months	12.0	9.5-14.5

· Timing of "screening" is controversial.

· 9-12 months - peak age for Fe deficit

· 24 months

· Adolescence - especially in girls

· Peripheral hematocrit may be lower than central venous hematocrit

Lead Poisoning

Sources of Lead

· Lead-confining paint pre -1950's

· Leaded gasoline - industrial lead

· Fumes from burning batteries

· Glazed ceramic vessels and folk medicines

· Young children are at risk thru hand-mouth exposure and thru respiratory tract

· Testing

· blood level - finger vs. venipuncture

· Lead levels >10 deserve attention

Hypercholesterolemia

· Childhood symptoms of hyperlipidemia are very rare but may include xanthomas, corneal arcus, heart disease, and hypertension.

· Family history will identify 40-60% of children with hypercholesterolemia.

· Total cholesterol = LDL-cholesterol + HDL-cholesterol + Triglycerides/5

· Secondary causes of high total cholesterol include endocrine, renal and hepatic disorders, and drugs.

· Screening is recommended after age · "Physiologic anemia" occurs 2-3 months for patients with a family history of hypercholesterolemia. A fasting level is preferred.

NCEP Classification of Hyperlipidemia
Category	Total Cholesterol	LDL-cholesterol
Acceptable	<170	<110
Borderline	170-199	110-129
High	>200	>130

A two week old anemia, lead poisoning, hypercholesterolemia, developmental dysplasia of the Hip, hip dysplasia, hypertension, sports injury, injuries, preventive medicine presents with a unilateral "hip click".

Developmental Dysplasia of Hip

The presentation can vary from mild instability to true dislocation.

· Incidence: Dislocatable hip = 1:100

Frank dislocation = 1:1000

· Clinical Examination

· Barlow. Pressure dislocates the joint

· Ortolani. "Clunk" is felt when joint is reduced

· Galiazzi. Aymmetric skin folds are visualized

· Limited abduction (>3 months)

· Ultrasound best imaging test