Headache is a common complaint for which parents seek pediatrician's consult. Headaches are seen in increasing frequency from 3 y of age onwards with peaks in older children and adolescents. In children, secondary headaches due to underlying etiologies are far more common than primary headaches due to migraine. Recognition of temporal pattern of headache along with focused neurological examination will help in narrowing down the etiology. The key goal in urgent care assessment is to identify children with underlying serious illnesses that require stabilization and urgent referral. For benign causes, symptomatic treatment with analgesics like paracetamol or ibuprofen would suffice initially, while identification of the underlying condition would lead to further appropriate management, particularly in primary headaches.

Background: Dengue viral infection caused by arthropod borne flavivirus has become endemic worldwide. India contributes to a tune of 20% of global burden. The clinical manifestation ranging from benign dengue fever (DF) to life threatening dengue hemorrhagic fever (DHF)/ dengue shock syndrome (DSS), has varied nonspecific features in infants. study was undertaken during our peak dengue season to know the clinical profile and outcome of dengue viral infection in infants.Methods: This is a prospective observational study. All infants with features suggestive/ clinical suspicion of dengue were enrolled with parental consent. Their demographic detail, history, clinical features were collected, categorised and treated according to WHO 2012 dengue guidelines.Results: A total of 86 infants were enrolled. Male female ratio was 2.44:1. Majority of infants were in Category B (63.9%) Fever being the most common presentation, Gastrointestinal and Respiratory symptoms, CNS manifestation like convulsion/ altered sensorium was noticed in 3.4% cases. Majority of cases were in critical phase (80%), recovery phase with fluid overloaded (edema) features were present in 7% cases. Thrombocytopenia was seen in all infants. Infants in Category C needed ionotropes, ventilator support and blood products, whereas those in other two categories did not. Recovery was seen in 94.25% and mortality was 4.6%.Conclusions: This study highlights the varied presentation of dengue in infants and to have a high index of clinical suspicion for dengue in infants presenting with nonspecific symptoms, for effective care of this dynamic disease.

Intracranial infection due to Salmonella is uncommon in children. Subdural empyema (SDE) is described with Salmonella typhi as a complication of meningitis. We report a 6-month-old infant with SDE secondary to Salmonella paratyphi B who had presented with prolonged fever and enlarging head. A literature review of Salmonella SDE in infants with respect to clinical course and outcome is presented.

Acute necrotizing encephalitis of childhood (ANEC) is characterized by respiratory or gastrointestinal infection and high-grade fever accompanied by rapid alteration of consciousness and seizures. Diagnosis is based on clinical presentation and characteristic neuroimaging features. The aim of this study was to report the etiological, clinical, and radiological findings and therapeutic outcomes of ANEC. This is a retrospective chart review of children aged 1 month to 18 years diagnosed with ANEC, from January 2017 to May 2022 at a tertiary care center in Bangalore, India. Of 36 patients, 17 were males, with age ranging from 10 months to 15 years. Major presenting complaints were altered sensorium in 36 (100%), fever in 33 (91.6%), and seizures in 27 (75%). The etiologies included dengue and chikungunya in 2 (5.5%) cases, Japanese encephalitis, influenza, and RAN binding protein 2 (RANBP2) in 1 (2.7%) case each, and unknown in 29 (80.5%) cases. Common findings of the magnetic resonance imaging (MRI) of the brain were abnormal signals in thalami in 20/20 (100%) and in brainstem in 11/20 (55%). Computed tomography (CT) of the brain done in all 16 cases showed thalamic hypodensities. All patients received empiric antibiotics, antivirals, and intravenous methylprednisolone. The modified Rankin scale showed excellent outcomes in 19/25 (76%), 3 were bedridden (8.3%), and 3 died (8.3%). ANEC is common in children under 5 years of age (76.7%). Altered sensorium, fever, and seizures were the main presenting symptoms. Genetic testing must be done in case of family history and recurrence. CT brain is also very useful in an emergency setup; MRI brain can be useful to suspect and prognosticate.

Clonidine, a commonly used anti-hypertensive agent, is being increasingly used in the treatment of pediatric behavioral disorders, thus increasing the incidence of pediatric poisoning. Poisoning causes somnolence, respiratory depression, hypotension, sinus bradycardia, and miosis. Clonidine overdose of >0.01 mg/kg causes bradycardia and hypotension and >0.02 mg/kg causes apnea and respiratory depression. A 13-year-old boy presented to us with ingestion of 0.073 mg/kg clonidine. He had only sinus bradycardia and drowsiness, which had resolved without any active interventions. As the life-threatening side effects of clonidine poisoning seem to be very rare even at toxic doses, it can be used safely in the pediatric age group.