https://www.theskygallerypattaya.com/japch/ A Heighpubs Open Access Journal en-us 01/30/2021 https://www.theskygallerypattaya.com/japch/pdf/japch-aid1024.pdf <h2>Abstract</h2> <p>We explored if adolescents with Gilles de la Tourette syndrome (GTS) had functional postural control impairments and how these deficits are linked to a disturbance in the processing and integration of sensory information. We evaluated the displacements of the center of pressure (COP) during maximal leaning in four directions (forward, backward, rightward, leftward) and under three sensory conditions (eyes open, eyes closed, eyes closed standing on foam). GTS adolescents showed deficits in postural stability and in lateral postural adjustments but they had similar maximal COP excursion than the control group. The postural performance of the GTS group was poorer in the eyes open condition (time to phase 1 onset, max-mean COP). Moreover, they displayed a poorer ability to maintain the maximum leaning position under the eyes open condition during mediolateral leaning tasks. By contrast, during forward leaning, they showed larger min-max ranges than control subjects while standing on the foam with the eyes closed. Together, these findings support the idea that GTS produces subclinical postural control deficits. Importantly, our results suggest that postural control disorders in GTS are highly sensitive to voluntary postural leaning tasks which have high demand for multimodal sensory integration.</p> 01/15/2021 https://www.theskygallerypattaya.com/japch/japch-aid1023.php <h2>Abstract</h2> <p>Background: Interleukin-6 (IL-6) promotes antibody production. The objective of this study was to investigate whether IL-6 C-572G single nucleotide polymorphisms (SNP) and clinical factors are associated with positive platelet antibody test.</p> <p>Materials and methods: Thirty platelet recipients with platelet antibodies (responders) and 20 platelet recipients without platelet antibodies (non-responders) were randomly selected. The -572 C>G (rs 1800796) SNPs in the promoter region of IL-6 gene were genotyped by polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) method. Solid phase red cell adherence assay (SPRCA) was used for platelet antibody detection.</p> <p>Results: Age, sex, percentage patients with benign diseases, and percentage of patients with homozygotes for the C allele at position -572 of the IL-6 gene were similar between responders and non-responders. Although the amounts of platelets pheresis transfused to patients with hematologic diseases were higher than those of non-hematologic diseases (47.2 ± 54.2 vs. 17.4 ± 13.8 units, p = 0.019), detection rate of platelet antibodies was lower in patients with hematologic diseases than that in patients with non-hematologic diseases (42.3% vs. 79.2%, p = 0.01).</p> <p>Conclusion: There was no association between IL-6 C-572G gene polymorphism and positive reactivity in solid phase platelet antibody detection method in platelet recipients.</p> 01/11/2021 https://www.theskygallerypattaya.com/japch/japch-aid1022.php <h2>Abstract</h2> <p>Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe multiorgan hypersensitivity reaction mostly caused by several eliciting drugs in patients with a genetic predisposition. Incidence of DRESS in children is very variable, frome 1:1000 to 1:10.000, and the mortality rate seems to be lower than 10%. Anti-convulsants are the main drugs involved both in adults and in children. The treatment of choice is the prompt withdrawn of the offending drug and using intravenous immunoglobulins and corticosteroids used in synergy. In recent years, emerging studies have outlined the disease more clearly. We present a pediatric case in which the patient developed DRESS syndrome as a result of exposure to lamotrigine before and carbamazepine after and a relapse after exposure to omeprazole. Starting from this case report we provide an overview on DRESS Syndrome.</p> 12/21/2020 https://www.theskygallerypattaya.com/japch/japch-aid1021.php <p>Abstract</p> <p>Background: School nurses possess an essential role in treating and helping children maintain health. However, the full scope of their role has not been identified by parents. Therefore, the purpose of this study was to explore parents’ perceptions of the role of the school nurse.</p> <p>Methods: Descriptive statistics were used to analyze the data. One hundred eighty parents participated in the study. The perception of the roles of school nurses was assessed by a 16-item questionnaire, which was adapted from a study by Kirchofer, et al. 2007.</p> <p>Results: The four most important school nurses’ roles perceived by the parents were providing first aid and emergency care to children, communicating with parents and health care providers in the presence of a problem, providing medical treatment, and preventing and controlling diseases.</p> <p>Conclusion: School nurses have many important roles, and while parents identified some essential roles, they did not recognize other vital roles as being very important. Increasing awareness of school nurses’ multifaceted roles among parents is essential so that they can utilize nurses’ expertise in maintaining their student’s health as well as tap into a key resource in the coordination of care for their child.</p> 12/08/2020 https://www.theskygallerypattaya.com/japch/japch-aid1020.php <h2>Abstract</h2> <p>The diagnosis of acute necrotising pancreatitis is a rare event in the Paediatric Emergency Department (ED).</p> <p>We report a case of acute pancreatitis in a paediatric patient, diagnosed in our ED, a tertiary level paediatric hospital.</p> <p>This child presented with vague symptoms of constipation, abdominal pain and back pain, and on clinical examination had a distended abdomen with peritonism. She rapidly deteriorated and needed aggressive fluid resuscitation in the ED for treatment of septic shock. The diagnosis of acute pancreatitis (AP) was only considered once elevated amylase levels were apparent.</p> <p>Whilst AP is an important differential diagnosis in a patient who is presenting with acute abdominal symptoms, the diagnosis in children in particular is seldom and thus easily overlooked in the previously healthy child.</p> 12/08/2020 https://www.theskygallerypattaya.com/japch/japch-aid1019.php <h2>Abstract</h2> <p>Juvenile xanthogranuloma (JXG) is a rare form of non-Langherans cell histiocytosis (non-LCH) observed almost exclusively in infants and young children. It is rarely systemic, involving extracutaneous sites, such as the liver, lungs, spleen, kidney, pancreas, bone or central nervous system. Systemic JXG may be associated with significant complications requiring aggressive medical or surgery care; especially, central nervous system lesions are difficult to treat and reported to be possibly fatal. Clinical presentation of JXG of central nervous system is not specific and is related to the involved site while magnetic resonance imaging examination remains the first choice for localizing the lesions. If no other system is involved, surgical excision could be sufficient.</p> 11/23/2020 https://www.theskygallerypattaya.com/japch/japch-aid1018.php <p>Shellfish are extensively consumed worldwide because of their nutritional value. In general they are good sources of low-fat protein rich in several essential vitamins and minerals as well as in the essential nutrients omega-3 long-chain polyunsaturated fatty acids (n-3 LCPUFAs) [1].</p> 11/19/2020 https://www.theskygallerypattaya.com/japch/japch-aid1017.php <h2>Abstract</h2> <p>Premature ovarian insufficiency (POI) is a rare disease, especially in children and adolescents. It was previously called premature ovarian failure (POF). It can be manifested as delayed puberty, primary or secondary amenorrhea that occurred before the age of 40 years with no less than two abnormal serum sex hormones (low estrogen and high gonadotropin). It is reported that the incidence rate is 1% at the age of 40 years and 0.01% at the age of 20 years. Although the disease usually occurs in middle-aged and elderly women, clinical practice in recent years has shown that it has also been found in adolescents and even children. It is generally believed that the etiology of POI includes genetic factors, immune factors, and iatrogenic factors. So far, several genetic mutations that may cause POI have been found clinically, but the etiology of 90% of POI is still unknown. In recent years, the incidence of POI in children and adolescents has increased, and there are more urgent requirements for its early diagnosis, treatment, and clinical management. Based on this, this article will mainly review the research progress of the etiology, treatment, and clinical management of POI in children and adolescents.</p> 09/29/2020 https://www.theskygallerypattaya.com/japch/japch-aid1016.php <h2>Summary</h2> <p>Child neglect is a global problem that involves large costs for both the individual and for society. This article is based on published reviews and meta-analyses in the field of child neglect between 1980 and 2018. Of a total of 433 articles, 13 was included, main Data bases has been PubMed, Scopus, Web of Science, Psych Info, ERIC, CINAHL. The prevalence in the normal population was found to be between 16 and 26 percent, while the prevalence in clinical groups seem to be significantly higher. For example, was the prevalence of neglect 50% among patients with eating disorder. It is especially important to know who is reporting neglect. Research shows that neglect is strongly associated with among other things, depression, one of the most common illnesses among the general public. The theoretical models that are used are ecological. Risk factors can be found at all levels when using ecological models. Research shows that factors involving the relationship parent-child are among the most important. Neglect is more common in low-income countries than in high income countries.</p> <p>Most studies point to the importance of prevention. Existing preventive programs are most often of family and parental character.</p> <p>More research is needed, especially as concerns the development of preventive programs that can identify specific types of neglect and present suitable preventive measures, both at the societal and family level.</p> <p>Key points<br /> 1. Neglect is a global problem.<br /> 2. Prevalence depends on the measurement method and can vary between about 16% and 76%.<br /> 3. Prevalence is higher when negligence is self-reported than when reported by professionals.<br /> 4. The most common and most serious risk factors are present in the microsystem. Parenting and interactions between child and parent are considered important.<br /> 5. There is a link between neglect and, above all, depression, but also anxiety, self-harm and eating disorders.</p> 09/01/2020 https://www.theskygallerypattaya.com/japch/japch-aid1015.php <p>As per report of WHO  [1] (World Health Organization), air pollution (ambient/outdoor and household/indoor air pollution) kills an estimated seven million people worldwide every year largely as a result of increased mortality from stroke, heart disease, chronic obstructive pulmonary disease, lung cancer and acute respiratory infections.</p> 07/17/2020 https://www.theskygallerypattaya.com/japch/japch-aid1014.php <h2>Summary</h2> <p>Self-medication is a common practice in Democratic Republic of Congo (DRC). There are few studies on mothers’ practice of self-medication in children in DRC. Trying to draw an inventory of this practice, we carried out a survey of self-medication of children under 12 years of age by their mothers (n = 392) in Lubumbashi, DRC. The main objective was to assess frequency of self-medication and the secondary purposes were to describe habits, dangerous behaviors and common mistakes. The results speak for themselves: 96% of the mothers self-medicate their children; 95.7% do not know the exact dosage of the drug used; 97.17% do not check the expiry date; over 91% of the mothers use antimalarials, 41.3% antipyretics/analgesics and 26.3% antibiotics. Healthcare practitioners should involve household members in focused awareness on self-medication and its negative implications in order to encourage them to serve as change agents against the practice by mothers.</p> 04/02/2020 https://www.theskygallerypattaya.com/japch/japch-aid1013.php <h2>Abstract</h2> <p>This paper is an attempt to enrich the literature about the role that can play some economic approaches, such as cost-effectiveness analysis, in order to help medical stuffs to decide about the treatment to adopt in case of a chronic disease such as Haemophilia. Data from morocco were gathered in order to explain the importance of such approaches.</p> 03/10/2020 https://www.theskygallerypattaya.com/japch/japch-aid1012.php <h2>Abstract</h2> <p>In development of movement apparatus in small children, youth and – if not cured – in adults play the role two factors. First is connected with small disorders in brain – and in Pediatrics Orthopedic Departments we see very often children with the symptoms of Minimal Brain Dysfunctions [MBD]. The second is connected with asymmetries in anatomy and in function of movement apparatus in “Syndrome of Contracture and Deformities” described by Professor Hans Mau (Tübingen, Germany). These second problems are the subject of this paper.</p> 03/10/2020 https://www.theskygallerypattaya.com/japch/japch-aid1011.php <h2>Abstract</h2> <p>In the article presented the etiology of the so-called idiopathic scoliosis (Adolescent Idiopathic Scoliosis [AIS]), new classification, there are given rules of therapy and causal prophylaxis. This knowledge is based on observations from 1984, but essentially from the years 1995 – 2007. In 2001 it was given the first description in classification – “S” scoliosis in 1st group / type and “C” and “S” scoliosis in 2nd A / B group and types, in 2004 “I” scoliosis in 3rd group / type.</p> 02/05/2020 https://www.theskygallerypattaya.com/japch/japch-aid1010.php <h2>Abstract</h2> <p><strong>Introduction:</strong> Current pediatric residents spend less time in the neonatal intensive care unit (NICU) and as a result, resident exposure to neonatal pathophysiology has decreased. Engaging learners efficiently while balancing clinical demands is challenging. Practices to enhance adult education include integration of problem centered learning into the demands of daily life in an environment in which learners feel safe asking questions and expressing themselves.</p> <p><strong>Methods:</strong> With this principal in mind, we developed a curriculum to enhance resident and medical student education during busy NICU rotations. The curriculum was case-based, available on-line and facilitated by neonatology faculty and fellows. A template designed to be concise and interactive was used to create and present the cases. After the case vignette, the template prompted medical students and residents to generate a differential diagnosis, order a diagnostic workup and narrow the diagnosis. Discussion of the diagnoses occurred at the conclusion of the cases; however, the template discouraged didactic lectures.</p> <p><strong>Results:</strong> In two years, cases were viewed 2,362 times. Facilitators and learners rated the quality and utility of the cases favorably overall. Cases took approximately 20 minutes to complete. Approximately 57% of survey respondents reviewed 1-2 cases per week and 9.6% reviewed 3-5 cases per week.</p> <p><strong>Discussion:</strong> A template with a concise and consistent format to construct and present cases allows for the creation of a curriculum that can be incorporated into a clinically demanding service and may enhance clinical teaching and learner engagement.</p> 01/31/2020 https://www.theskygallerypattaya.com/japch/japch-aid1009.php <h2>Abstract</h2> <p><strong>Purpose:</strong> Children with autism spectrum disorder are at an increased risk for developing seizures, which can be triggered by classical antipsychotics. Aripiprazole is an atypical antipsychotic that has a safer drug profile. The objective is to present the experience with seizure control in autistic children who are placed on Aripiprazole.</p> <p><strong>Methods:</strong> Series of consecutive autistic children with comorbid epilepsy treated with Aripiprazole were identified prospectively over a 3-year period. Monthly follow up by one pediatric neurologist was performed to document seizure control.</p> <p><strong>Results:</strong> 56 autistic children with comorbid epilepsy were placed on Aripiprazole. Most children (59%) were seizure free for at least 6 months. The initial Aripiprazole dose was 5 mg in all patients. Follow up ranged between 5-8 months (mean 6.9). A total of 5 (9%) children developed seizure provocation (3/5) or worsening seizure control (2/5). There were 3 males and 2 females with ages ranging between 6-11.5 years (mean 8.5). Three of these children had a previous history of seizure worsening with other antipsychotic drugs (respiridone in 2 and haloperidol in 1). One child with seizure provocation developed status epilepticus 5 days after introducing Aripiprazole that required intensive care admission. The drug was stopped in all 5 children with no long-term effects.</p> <p><strong>Conclusion:</strong> Seizure provocation or worsening seizure control is not uncommon following the introduction of Aripiprazole in autistic children with controlled epilepsy. Although the risk is low, parents should be warned and advised on what to do, particularly in the first month of therapy.</p> 01/29/2020 https://www.theskygallerypattaya.com/japch/japch-aid1008.php <h2>Summary</h2> <p><strong>Background:</strong> The number of childhood cancer survivors (CCSs) is increasing due to improved survival. Most suffer at least one treatment-related late effect, even decades after treatment, thus lifelong long-term follow-up (LTFU) care is a necessity. Currently no standardized LTFU programme for CCSs exists in South Africa.</p> <p><strong>Study purpose:</strong> This study investigated current LTFU care of CCSs in South Africa.</p> <p><strong>Methods:</strong> A survey was conducted amongst 31 South African paediatric oncologists using the SurveyMonkeyTM online tool. Information obtained included: training/experience, LTFU practices, late effects knowledge and opinion regarding the importance of a standardized LTFU programme.</p> <p><strong>Results:</strong> The response rate was 74% (23/31). Respondents had an average of 9 years’ experience. All (22/23; 96%) regarded LTFU as important. Only half (12/23; 52%) discussed late effects at diagnosis. Infertility and second malignancy risks were discussed by a third. Less than half (48%) used LTFU guidelines; the majority (9/11; 82%) adjusted them to the local context. Most survivors were followed by a paediatric oncologist (17/23; 74%).</p> <p>About half of respondents (47.8%) shared LTFU with colleagues in private practice (50%), secondary (66.7%) or primary care facilities (25%). Almost half of respondents (10/23; 43.5%) regarded their late effects knowledge and LTFU experience as good, 8/23 (34.8%) as adequate and 3/23 (13%) as inadequate. All agreed that a national LTFU programme would be very important (87%) or important (13%). Almost half of the respondents (48%) understood what a Survivorship Passport was.</p> <p><strong>Conclusion:</strong> It is essential to develop a national standardized LTFU programme for CCSs in South Africa to ensure appropriate care for all survivors.</p> 11/29/2019 https://www.theskygallerypattaya.com/japch/japch-aid1007.php <h2>Clinical Image</h2> <p>A 3-month-old girl presented to the surgical consultation room with bilateral cleft lip incomplete. A girl weighing 4205 g, was born at term  after an uneventful pregnancy with a birth weight of 2500 g. There was no family history. On examination, a congenital, linear, erythematous cutaneous anomaly on the left side of her neck was highlighted with ocular anomalies (strabismus and the eyes are widely spaced) and a broad nose with a flattened tip. The examination of the other systems was unremarkable. In front of the association of these different anomalies BOFS was suspected but molecular diagnosis has not been made. The child benefited surgery to correct cleft lip with tennisson procedure with a good postoperative result.</p> 09/27/2019 https://www.theskygallerypattaya.com/japch/japch-aid1006.php <h2>Abstract</h2> <p><strong>Introduction:</strong> Sepsis is an important cause of morbidity and mortality among neonates. Neonatal sepsis can alter the glucose level and both hypoglycemia and hyperglycemia may occur. A high or low blood glucose level may have a significant effect on the outcomes in patients of neonatal sepsis.</p> <p><strong>Aims:</strong> The aim of the study to see the glycaemic status and its effect on outcome of neonatal sepsis.</p> <p><strong>Material and Methods:</strong> This hospital based prospective observational cross-sectional study was conducted in Neonatal Intensive Care Unit in Universal College of Medical Sciences, a tertiary care hospital over a period of 4 months, from May 2019 to August 2019. A total of 220 Neonates suspected sepsis under the age of 28 days admitted in NICU, were studied and included in our study. Clinically suspected neonatal sepsis cases were enrolled in the study. Venous blood was collected before giving any intravenous fluid, dextrose or antibiotics and blood sugar, complete blood counts, CRP levels and blood culture were send to laboratory within half hour of collection. All patients included in this study were treated accordingly and followed up strictly. Blood glucose level and mortality of neonates having hypoglycemia, hyperglycemia were analyzed among CRP and culture positive patients. Quantitative data were expressed as mean and standard deviation. Qualitative data were expressed as frequency and percentage and comparison carried by Chi-square (χ2) test.</p> <p><strong>Results:</strong> A total of 220 patients clinically diagnosed as neonatal sepsis were studied. 118 (53.6%) patients were found CRP positive and 56 (25.5%) patients were blood culture positive. Glycaemic status was analyzed among CRP and culture positive patients. Majority (55.9%) patients were found normoglycemic, 35.5% were found hypoglycemic and 8.6% were found hyperglycaemic in this study. 182 (82.73%) patients were cured and 38 (17.27%) died. Mortality was high in hypoglycaemic patients (34.4%) compared with normoglycaemic patients (9.82%), but the difference was not statistically significant (p > 0.05) between two groups, the mortality was high in hyperglycaemic patients (58.33%) compared with normoglycaemic patients (9.82%) and the difference was statistically significant (p < 0.05) between two groups.</p> <p><strong>Conclusion:</strong> Alteration of glycaemic status occurred in septic newborn. Mortality is higher among the septic newborn with hyperglycemia. The present study found that majority of neonate with sepsis had high mortality rate when blood glucose level were either more than 145 mg/dl or less than 45 mg/dl. This signifies the importance of meticulous blood glucose estimation in cases of neonatal sepsis to improve mortality outcome.</p> 09/03/2019 https://www.theskygallerypattaya.com/japch/japch-aid1005.php <h2>Abstract</h2> <p><strong>Background:</strong> Nutritional status of expectant women is an important indicator of healthy pregnancy and an ideal birth weight of the infant. The present study is an attempt to understand food eating practices and related taboos among the Paite women and whether or how these practices influence weight gain among infants during their first year of life.</p> <p><strong>Methods:</strong> The longitudinal study was conducted for a period of 16 months between November 2010 and February 2012) among 186 Paite mother-infant pairs. Women who had completed 37 to 42 weeks of pregnancy were included. Infant’s weights were measured using standard technique and information on mothers’ food related practices was recorded during the house visit using a structured schedule. Standard statistical methods were used for description and analysis.</p> <p><strong>Results:</strong> A peculiar practice, ‘pica’ was observed among a few women. A number of food taboos were found to be followed by the ‘Paite’ women during course of their pregnancy.</p> <p><strong>Conclusion:</strong> No significant difference was noticed in the mean weight of babies from birth through the age of 1 year between mothers practicing and not practicing food taboos. However, it was found that the mean weight of the babies throughout the study period was comparatively higher among non-taboo mothers. It could be suggested that women must be counseled during their antenatal and postnatal visits to the maternity clinics and hospitals about dietary practices and their anticipated impact on health of the newborns.</p> 08/08/2019 https://www.theskygallerypattaya.com/japch/japch-aid1004.php <h2>Background</h2> <p>Urinary tract infection (UTI) is one of the extremely popular causes of febrile illness in children, demanding antimicrobial therapy [1]. Overall, 8% of females and 2% of males, experience at least one incident of UTI by seven years of age, and recurrence takes place in up to 30% during a year [2].</p> <p>Escherichia Coli has been known as the commonest causative organism of the majority of urinary tract infections in children with prevalence ranging from 80-90% [3]. Extended-spectrum beta-lactamases (ESBL) are enzymes produced by Gram-Negative Bacilli (GNB), accountable for fighting against penicillin, cephalosporin and aztreonam [4].</p> 07/24/2019 https://www.theskygallerypattaya.com/japch/japch-aid1003.php <h2>Abstract</h2> <p>Transaldolase TALDO deficiency is a rare autosomal recessive disorder of the pentose phosphate pathway. It has variable presentations with poor outcome when present early in life. We present a young Saudi infant with a fatal early presentation of TALD deficiency.</p> 09/25/2018 https://www.theskygallerypattaya.com/japch/japch-aid1002.php <h2>Abstract</h2> <p><strong>Objective:</strong> To determine the impact of Adenotonsillectomy on Health-related quality of life (HRQoL) in children’s before and after surgery.</p> <p><strong>Study Design:</strong> Prospective, Observational, before and after the trial. 142 children who underwent Adenotonsillectomy were included in the study. Parents were made to fill pre and post-operative questionnaires which were customized from Tonsil and Adenoid health status instrument (TAHSI) and HR-QoL (Health-related quality of life) forms, one day prior to the surgery and 6 months after the surgery respectively, and the results were tabulated and analyzed.</p> <p><strong>Setting:</strong> Tertiary pediatric otolaryngology practices.</p> <p><strong>Result:</strong> Out of the 142 children in the study, 80 were male and 62 were female. Male to Female ratio is 1.3:1. Age group 1-4 years had the highest number of patients while the age group 9-12 had the least. Preoperatively the Mean score of the domain for Sleep disturbances, Physical Symptoms, Emotional distress, Daytime functions, and Caregiver concern was 14.1, 15.83, 6.89, 7.54, and 13.78 respectively. After 6 months of the surgery, the score decreased to 4.65, 4.22, 4.32, 3.1 and 4.2 respectively. This shows a significant improvement in the symptom complex and the quality of the life.</p> <p><strong>Conclusion:</strong> Adenotonsillectomy definitely leads to an improvement in the HRQoL in children as the majority of parents were extremely satisfied with the surgical outcome. Almost all of the parents reported a decrease in Sleep disturbances, Physical Symptoms, Emotional distress, Daytime functions, and Caregiver concern.</p> 08/30/2018 https://www.theskygallerypattaya.com/japch/japch-aid1001.php <p>This is the case of a full-term baby girl, born to a mother with a history of parenteral inorganic mercury administration. Thirteen years prior, this mother injected 1mL of inorganic mercury in her right forearm, was subsequently hospitalized, but never received chelation treatment. Her first trimester blood and urine mercury concentration were found to be elevated at 28μg/L (normal <10μg/L) and 162 μg/L (normal <20μg/L) respectively. Her chest x-ray also revealed multiple small punctate metallic densities within the lower lung fields. The remainder of the prenatal course was uneventful. The baby was born at 40 weeks of gestation via uncomplicated caesarian section, and on day of life 3, blood mercury concentrations were found to be 20μg/L (normal <20μg/L). The baby, however, remained asymptomatic throughout her hospital stay and on outpatient follow up. She is now two years old. Mercury poisoning in the pediatric population remains a concern, and knowledge of exposure and health effects continues to be relevant as newer uses and modes of exposure are discovered. This case report illustrates a rare perinatal exposure scenario, and, while the mother and child were essentially asymptomatic, the case serves to raise awareness of the many ways in which fetuses, infants, and children may still be exposed to the harmful effects of mercury. This case underscores the need for careful environmental history taking in pregnancy, after birth, and ideally in the pre-conception period as well.</p>