We use generally the criteria as set forth in the DSM-IV which is our ” Bible” for psychiatric diagnoses. In addition to this the American Academy of Pediatrics has also added in a few additional criteria for ADHD to consider when looking at medication therapy. The AAP’s additional criteria essentially asks that we use explicit criteria from DSM-IV, second that we obtain information about the child in more than one setting, and third that we give consideration to the possibility of comorbid disorders as OCD and Oppositional Defiant Disorder

Here are the DSM criteria…

IA. Six or more of the following signs of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

* Inattention:

1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (such as toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Often forgetful in daily activities.

IB. Six or more of the following signs of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

* Hyperactivity:

1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often “on the go” or often acts as if “driven by a motor”.
6. Often talks excessively.

* Impulsiveness:

1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one’s turn.
3. Often interrupts or intrudes on others (example: butts into conversations or games).

II. Some signs that cause impairment were present before age 7 years.

III. Some impairment from the signs is present in two or more settings (such as at school/work and at home).

IV. There must be clear evidence of significant impairment in social, school, or work functioning.

V. The signs do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The signs are not better accounted for by another mental disorder (such as Mood Disorder, Anxiety Disorder, Dissociative Identity Disorder, or a Personality Disorder).

I like to evaluate the child over the course of several visits. It is important to take a careful dietary history in the process of ADHD evaluation. Many processed cereals and convenience foods are loaded with corn syrup. A high sugar diet may play a role in inattentiveness and hyperactivity in many children. Another important factor is sleep. A child who is not getting enough sleep may present with hyperactivity. A careful physical exam and history are necessary to rule out sleep apnea, which may also present with hyperactivity and inattention. Some children will really improve with a trial of diet and sleep hygiene.

Molluscum contagiosum (MC) is a viral infection of the skin or occasionally of the mucous membranes. It is caused by a DNA poxvirus called the molluscum contagiosum virus (MCV). MCV has no animal reservoir, infecting only humans. There are four types of MCV, MCV-1 to -4; MCV-1 is the most prevalent and MCV-2 is seen usually in adults and often sexually transmitted. This common viral disease has a higher incidence in children, sexually active adults, and those who are immunodeficient,[1] and the infection is most common in children aged one to ten years old.[2] MC can affect any area of the skin but is most common on the trunk of the body, arms, and legs. It is spread through direct contact or shared items such as clothing or towels.

The virus commonly spreads through skin-to-skin contact. This includes sexual contact or touching or scratching the bumps and then touching the skin. Handling objects that have the virus on them (fomites), such as a towel, can also result in infection. The virus can spread from one part of the body to another or to other people. The virus can be spread among children at day care or at school. Molluscum contagiosum is contagious until the bumps are gone (which, if untreated, may last up to 6 months or longer).

The time from infection to the appearance of lesions can range up to 6 months, with an average incubation period between 2 and 7 weeks.

Individual molluscum lesions may go away on their own and are reported as lasting generally from 6 to 8 weeks,[4] to 2 or 3 months.[5] However via autoinoculation, the disease may propagate and so an outbreak generally lasts longer with mean durations variously reported as 8 months, to about 18 months,[6][7] and with a range of durations from 6 months to 5 years.

Treatment is unnecessary in kids depending on the location and number of lesions, and no single approach has been convincingly shown to be effective. It should also be noted that treatments causing the skin on or near the lesions to rupture may spread the infection further, much the same as scratching does

It is helpful for toddlers to treat irritated areas with neosporin, and also helps to put a long shirt over the area, so keep the child from scratching the warts. There are medical treatments for molluscum, but we generally don't recommend them as they are painful and can cause permanent scarring, whereas molluscum that run their natural course resolve with no scars.

It seems bizarre for a viral wart rash to last for so long but the best outcome with the least pain and suffereing ( for both the child and the parent) is watchful waiting!

Natalie Hodge MD FAAP

Dr. Natalie Hodge MD, Pediatrics

Yes: The first step is installing secure gates at the top and bottom of your stairs around 9 months of age once the baby starts crawling. Use gates that screw in to your woodwork, not the expandable gates that you often see, these are not secure! Teach all family members to close the gates as they go through them. Remember gates only work when you USE them properly.