NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL

Passing the torch: welcoming the new editor-in-chief of Birth and Growth Medical Journal

Sílvia Álvares — 2025-04-07

Ulcerative skin lesions – what is the diagnosis?

Ana Foles — 2025-04-07

Ecthyma is an ulcerative skin infection, usually caused by group A beta-hemolytic Streptococcus.

High temperatures and humidity facilitate the development of the disease, which is particularly common among travelers returning from tropical countries. Early diagnosis and adequate treatment, with systemic antibiotics and local intervention, is essential to minimize the risk of complications.

The authors present the case of an 11-year-old boy with exuberant ecthyma lesions conditioning severe pain, which prevented walking.

Purpuric rash in an adolescent

Joana Melo — 2025-04-07

A previously healthy 17-year-old girl presented to the emergency department with a 14-day history of fever, sore throat, and a generalized reddish-purple pruritic rash. The rash, initially erythematous and maculopapular, worsened and became coalescent and purpuric. She had been treated with azithromycin for three days starting on the third day of illness. Physical examination revealed a good general condition, pharyngeal erythema with exudate, and a purpuric rash covering the body, including the face, palms, and soles, without other systemic signs. Serological tests confirmed a diagnosis of acute infectious mononucleosis. The patient was managed conservatively and had fully recovery at re-evaluation, 50 days after symptom onset. Acute infectious mononucleosis typically presents with fever, cervical lymphadenopathy, and tonsillitis/pharyngitis, with spontaneous exanthema occurring in 3-15% of cases. This case highlights the importance of considering acute infectious mononucleosis in adolescents presenting with purpuric exanthema and the potential for antibiotic-associated rash including azithromycin, emphasizing the need for thorough clinical and serological evaluation.

Scurvy in a 5-Year-Old Girl - A Re-emerging Diagnosis

Aida Correia de Azevedo — 2025-04-07

Monotonous diets may lead to various nutritional deficits, which in turn can result in diseases such as scurvy.

A five-year-old girl presented with a one-month history of anorexia, inability to walk, and bleeding gums. Her daily dietary intake consisted almost exclusively of chocolate milk at every meal. Due to frequent missed appointments with her family doctor and her parents' limited parenting skills, the condition remained undiagnosed for nearly two years. Serum vitamin C levels were undetectable, while vitamin D and iron levels were low. Knee X-rays revealed Trümmerfeld zones, Frankel lines, and an enlarged metaphyseal margin. The diagnosis of scurvy was established, and a multidisciplinary approach was implemented, including iron, vitamin C, and vitamin D supplementation, alongside behavioral intervention. The patient achieved full recovery.

Although scurvy is generally a rare disease, its prevalence has been increasing due to unbalanced and monotonous diets. It can cause a wide spectrum of clinical manifestations, and its diagnosis is based on anamnesis, physical examination, and complementary tests. Treatment involves vitamin C supplementation, with an overall excellent prognosis.

Wait-and-see approach in a paediatric patient with Neuroblastoma with Metastatic Disease

Biana Moreira — 2025-04-07

Neuroblastoma is the most common extracranial solid tumour in the paediatric population, accounting for approximately 8-10% of all childhood cancers. It arises from the abnormal proliferation of embryonic neural crest cells which normally give rise to the sympathetic nervous system (SNS) and the adrenal gland medulla. Its prognosis is uniquely heterogeneous, with some children experiencing spontaneous regression, while others develop widespread metastatic disease with poor outcomes despite aggressive multimodal therapy. Treatment choice dependents on risk stratification based on the patient’s age at diagnosis and tumour characteristics, such as stage and biological features.

We describe the case of an infant who presents with hepatic metastasis secondary to a solid tumour in the left adrenal gland, classified as stage MS according to the INRGSS classification. A wait-and-see approach was adopted, with clinical, analytic and radiologic surveillance, verifying spontaneous regression of the tumour afterwards.

Phytophotodermatitis: a challenging diagnosis in children

Ana Isabel Ferreira da Costa — 2025-04-07

Phytophotodermatitis, a form of plant dermatitis, is a common phototoxic reaction resulting from the interaction between photosensitising botanical substances present in several common plant families and ultraviolet radiation. We report a case of phytophotodermatitis in an 8-month-old infant who presented a progressively well-demarcated erythematous rash with blisters and subsequent erosions covering both upper limbs and feet. Additionally, asymmetric hyperpigmented streaks with bizarre configurations, were observerd in photo-exposed areas. The diagnosis of phytophotodermatitis was established based on the history of outdoor activities with sun exposure and physical examination findings. Topical treatment with antibiotic and corticosteroid cream was started. The phytophotodermatitis is a self-limiting condition, which can be challenging to diagnosis in this age group due to heterogeneity of clinical manifestations, which can mimic a range of different diseases, such as non-accidental injury in the context of child abuse, potentially delaying timely diagnosis and treatment.

Feeding difficulties in the offspring of mothers with an eating disorder - a case report

Pedro Marques — 2025-04-07

Background: One of the main risk factors for eating disorders (ED) in early childhood is maternal ED. Mothers with a history of ED have difficulties in their approach to feeding their children, with mealtimes being perceived as stressful, with controlling behavior and intrusiveness.

Case presentation: An 11-month-old female infant was evaluated at a Child Psychiatry Consultation for feeding difficulties. Her mother had a history of Restrictive Anorexia Nervosa. Mother-child psychotherapy was performed due to a pattern of insecure attachment and an ongoing conflict over control and autonomy between the caregiver-child. After the intervention, mealtimes became more natural and less conflictual.

Discussion and conclusion: The authors aim to shed light on the transgenerational transmission of ED. Feeding interactions between mothers with ED and their offspring are less harmonious, with greater conflict, controlling behaviors, negative affect and decreased emotional availability to the child. Clinicians must be aware of a potential parental history of ED when dealing with children with feeding problems.

Cyberbullying in pre-adolescence - reality of a city in northern Portugal

Vanda Melo — 2025-04-07

Introduction: The rapid evolution of communication technologies has enabled easy and premature access for children and young people to social networks, the internet, and smartphones. The indiscriminate use of these technologies has led to the emergence of cyberbullying. The objective was to analyse the prevalence of cyberbullying and the most frequent forms involved in this age group.

Methods: A cross-sectional observational study was conducted through anonymous questionnaires distributed in primary schools (2nd and 3rd cycles) in the municipality.

Results: The study included 482 students, with a median age of 12 years (9-15 years), and a similar gender distribution (55% female, 45% male). Regarding the daily screen time, 20.5% reported spending less than 1 hour, 47.7% between 1 to 3 hours, while 31.1% spent more than 3 hours per day. The prevalence of cyberbullying in the studied sample was 30.9%, with 34.9% of them admitting to being victims in the last 3 months, with only 50% requesting help. The most reported type of cyberbullying was being excluded from a chat or social network. In the subsample of children who experienced cyberbullying, a statistically significant relationship was found between victimization and being female (p-value 0.046) and between victimization and being an aggressor (p-value <0.001).

Conclusion: According to this study, the exposure to digital technology in this age group is practically universal, with a cyberbullying prevalence of around 31%. This alarming victimization rate occurs during a crucial phase of the child's social and emotional development.

Breastfeeding for Better Health – A Community-Based Intervention

Sofia Padilha — 2025-04-07

Introduction: Breastfeeding provides multiple health benefits for both mother and child. Several studies suggest that community interventions enhance breastfeeding literacy, practice and duration. The authors developed an intervention to improve parents’ knowledge of the benefits of breastfeeding in the prenatal period as a means of promoting this practice.

Methods: An informative session on breastfeeding was organized for pregnant women registered at USF Rainha D. Amélia and their partners. Questionnaires were implemented before, immediately after, and one month post-session to assess knowledge at these intervals. Statistical analysis included descriptive analysis, comparison between questionnaires and analysis of the effect of several variables on knowledge progression.

Results: The study included 33 participants, 78.8% of whom were women. Initial questionnaire results showed 67.3% correct answers, which increased to 91.5% immediately post-session, representing a 36% improvement (p < 0.001). Level of education was the sole predictor of higher initial knowledge (p = 0.023). Age and level of education significantly impacted knowledge progression (p = 0.034), but after adjusting for confounders, only previous attendance of a breastfeeding course predicted greater knowledge progression (p = 0.023).

Discussion: The project effectively met its goals, confirming the efficacy of community interventions on breastfeeding conducted by healthcare professionals. Age, level of education, and prior breastfeeding knowledge positively influenced the decision to breastfeed. Father’s involvement and increased understanding of breastfeeding will likely enhance their ability to support the mothers.

Conclusion: This community intervention positively impacted breastfeeding literacy.