22. The pain in the stomach is a result of a patient developing pneumonia in the lower lobes of the lungs, Hirsh said. Kleinman K, http://www.acr.org/~/media/ACR/Documents/AppCriteria/Diagnostic/UrinaryTractInfectionChild.pdf. Moving from bag to catheter for urine collection in non-toilet-trained children suspected of having urinary tract infection: a paired comparison of urine cultures. 1986;152:55–58. Gaboury I. et al. 5. Babl FE. A clinical decision rule to identify children at low risk for appendicitis. 23. 2007;298(4):438–451. Absent bowel sounds can indicate ileus or peritonitis, whereas hyperactive bowel sounds may indicate obstruction. Search date: November 26, 2014. Prophylactic antibiotics are recommended for health care workers providing mouth to mouth resuscitation, endotracheal intubation and suctioning. Hayes R. Bhosale PR, Javitt MC, Atri M, et al. 150. et al. Want to use this article elsewhere? After about five days, he was extubated and was discharged in excellent condition after 10 days of hospitalization. 2007;49(6):778–784.e.1. Auscultation of bowel sounds can help a clinician understand where the abdomen is painful because the child may try to block the stethoscope from that area. J Pediatr. Mok E, There was no animal exposure or history of travel. Upon awakening the same morning, he appeared well and was without complaint. Sign up for the free AFP email table of contents. Pearl RH. The patient had no significant past medical history, without history of previous hospitalizations or surgeries. Rates of meningococcal disease are one to three out of 100,000 in developed countries and 10 to 25 out of 100,000 in developing countries. Neurological sequelae occur less commonly in meningococcal meningitis than H. influenzae and S. pneumoniae. 31. Shaikh N, The effect of abdominal pain duration on the accuracy of diagnostic imaging for pediatric appendicitis. The risk of a radiation-induced solid cancer is estimated to be one per 300 to 390 CT scans of the abdomen and pelvis for girls, and one per 670 to 760 scans for boys.22 The American College of Radiology Appropriateness Criteria offer recommendations for imaging children with abdominal pain (http://www.acr.org/Quality-Safety/Appropriateness-Criteria). Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Pearl RH. Toorenvliet BR, ACR appropriateness criteria. Bachur RG, Michalowski W, Montgomery DF, 25. et al. Shinholser J. Ebell MH, Nasopharyngeal colonization is common and contributes to the development of host immunity. Flu HC, Visceral pain receptors in the stomach, lower esophagus, or duodenum cause epigastric pain; receptors in the small intestine cause periumbilical pain; and in the colon, lower abdominal pain. Family history was noncontributory. A1. Lopez J, In a minority of cases, colonization results in invasive disease. Rectal examination may be necessary to identify a pelvic abscess or occult blood in the stool. It occurs frequently in children over three years of age. The symptoms and signs include a sore throat, fever, and abdominal pain… CARIN E. REUST, MD, MSPH, is an associate professor in clinical family and community medicine at the University of Missouri–Columbia.... AMY WILLIAMS, MD, MSPH is an assistant professor in clinical family and community medicine at the University of Missouri–Columbia. Hancock BJ, *—Score < 4 = low risk of appendicitis, no imaging required; 4 to 8 = intermediate risk of appendicitis; ≥ 9 = high risk of appendicitis. ACR appropriateness criteria. (β-hCG = beta human chorionic gonadotropin; CBC = complete blood count; CRP = C-reactive protein; ESR = erythrocyte sedimentation rate; STI = sexually transmitted infection.). The pain may stay in the same place or move around. Enlarge A child with fever, rebound tenderness, a history of mid-abdominal pain migrating to the right lower quadrant, and an elevated white blood cell count, erythrocyte sedimentation rate, or C-reactive protein level should be evaluated for appendicitis16,40 (eTable A). Do opiates affect the clinical evaluation of patients with acute abdominal pain? et al. Mendez D, A five-day course of therapy is adequate. 2012;92(3):505–526, vii. Causes can include overeating, intestinal infections, stress and anxiety, and chronic gastrointestinal disorders. An abdominal examination in a sick, crying child can be difficult to perform. Toorenvliet B, He lived at home with his parents and six siblings, all of whom were healthy. Choose a single article, issue, or full-access subscription. Latex agglutination testing with antibodies to meningococcal capsular antigens may be used as rapid diagnostic tests on cerebrospinal fluid specimens, although the sensitivity and specificity is considerably lower for serogroup B than for A and C. PCR assays for N. meningitidis in blood and cerebrospinal fluid may be used for rapid detection but are not currently available in most clinical laboratories. Babl FE. Webster AC, American College of Radiology. No organisms were seen on Gram’s stain of the cerebrospinal fluid. Farrell MH. The prevalence and geographic distribution of Crohn's disease and ulcerative colitis in the United States. Pickering LK, Baker CJ, Long SS, McMillan JA, eds. Gram’s stain of the blood revealed gram-negative diplococci, and culture of both the blood and cerebrospinal fluid grew Neisseria meningitidis serogroup B within 24 hours. Abdominal computed tomography was obtained to rule out appendicitis, which was negative. Toorenvliet B, Appelbaum H, Coronavirus symptoms: Abdominal pain named as weird new symptom Coughs, fever and headaches are textbook COVID-19 symptoms. He took no medication and has no history of allergies. But an unusual symptom led a nurse to fear he was … Swidsinski A. Breslau PJ. Other terms for this condition are stomach flu or a stomach bug. Merkus JW, Ann Emerg Med. 11. Kleijnen J. et al. Initial laboratory tests include complete blood count, erythrocyte sedimentation rate or C-reactive protein, urinalysis, and a pregnancy test. A clinical decision rule to identify children at low risk for appendicitis, A4. Symptoms and signs that increase the likelihood of a surgical cause for pain include fever, bilious vomiting, bloody diarrhea, absent bowel sounds, voluntary guarding, rigidity, and rebound tenderness. Katznelson J, Tsalkidis A, Reynolds SL, Smith MP, Katz DS, Rosen MP, et al. Rice HE. Andrews T, Radiation dose is dependent on the child's size. Print, Algorithm for the evaluation and diagnosis of acute abdominal pain in children. Committee on Practice Bulletins—Gynecology. Ackerman M. Asking the child to point to the part of the abdomen that hurts the most, and then initially avoiding that area, can also facilitate the examination. Nager AL. Your child may not want to do his daily activities because of the pain. Shinholser J. 36. Abdominal migraine: an under-diagnosed cause of recurrent abdominal pain in children. Intussusception usually occurs before two years of age.41 Infants and toddlers may present with right lower quadrant tenderness, a sausage-shaped mass in the abdomen, and red currant jelly stool caused by venous congestion of intussuscepted bowel.41 However, the classic triad of colicky abdominal pain, vomiting, and bloody stool is found in less than 50% of cases.29,41 In children, 90% of cases of intussusception are idiopathic, with 10% of cases resulting from a lead point or sticky spot in the colon.41 Air or contrast enema can be diagnostic and therapeutic for intussusception. Despite improved intervention for these patients, the mortality remains in the range of 8% to 10%. Webster AC, Diagnosing abdominal pain in a pediatric emergency department. Abdominal migraine is severe abdominal pain with nausea, vomiting, or loss of appetite. Their bellies hurt because the pain from the lung infection is “referred” or felt in the nerve endings in the abdomen. Strohmeier Y, ACR appropriateness criteria. Parents or caregivers face the difficult decision of whether a complaint needs emergency care or not. 34. Abraham C, Mesenteric lymphadenitis is an inflammation of abdominal lymph nodes causing pain, diarrhea, fever… CARIN E. REUST, MD, MSPH, and AMY WILLIAMS, MD, MSPH, University of Missouri–Columbia, Columbia, Missouri. 2014;64(4):365–372.e2. A3. et al. Radiography may identify a renal or ureteric calculus, abdominal mass, ingested foreign body (including bezoars), bowel perforation with free air, and constipation.12,27,33, CT of the abdomen may be required to diagnose complications such as necrosis from pancreatitis or abscess formation in appendicitis27,33 and may be used for the diagnosis of omental torsion or mesenteric lymphadenitis.33. Correll R, 6. Watt I, Incarcerated inguinal hernias present with a tender groin mass. Shaikh N, ; et al. Carty HM. Ann Emerg Med. Clear symptoms are abdominal pain, vomiting, nausea, fever and loss of appetite. A systematic review. / Journals Approved treatment includes rifampin or ceftriaxone in children and ciprofloxacin in adults. 2013;31(3):775–793. He may have nausea, … Farion KJ, Acute pelvic pain in the reproductive age group. Emerg Med Clin North Am. A person with appendicitis will … 2010;34(3):480–486. Kleijnen J. A clinical decision rule to identify children at low risk for appendicitis. Morone NE, Right lower quadrant pain—suspected appendicitis. A systematic review. Hamming JF, Hamming JF, 2011;21(2):120–123. Shaikh N, Diagnosis and management of pediatric appendicitis, intussusception, and Meckel diverticulum. et al. Rifas-Shiman SL, Singh SJ, Dayan PS, Standard outpatient re-evaluation for patients not admitted to the hospital after emergency department evaluation for acute abdominal pain. Bundy DG, Other risk factors include exposure to an infected person (up to 500 times increased risk), terminal complement (C5-C9) or properdin deficiency and asplenia. Am J Emerg Med. Previous: Flibanserin (Addyi) for Hypoactive Sexual Desire Disorder in Premenopausal Women, Next: Diagnosis and Management of Sarcoidosis, Home Gentle palpation can elicit guarding, and percussion without deep palpation can elicit rebound pain. 2012;24(3):357–364. Javid MH. Clinical differentiation between acute appendicitis and acute mesenteric lymphadenitis in children. Does this child have appendicitis? Get the latest news and education delivered to your inbox, Receive an email when new articles are posted on, Please provide your email address to receive an email when new articles are posted on. 32. Brouet D, Beginning palpation just above the iliac crest in the lower quadrants of the abdomen will help identify an enlarged liver, spleen, or other abdominal mass. Trials using activated protein C, or drotrecogin alfa (Xigris, Eli Lilly) in patients with severe sepsis have been promising. Urinary tract infection—child. Dayan PS, Mulrooney E, Key clinical predictors in the early diagnosis of adnexal torsion in children. et al. N. meningitidis colonizes the nasopharyngeal respiratory epithelium of approximately 3% of humans. Rheumatic fever. The child's age can help in narrowing potential causes of abdominal pain (Table 16,7). Pain that is sharp, localized, and worsens with movement has most likely originated from somatoparietal receptors found in the parietal peritoneum, muscle, and skin. Etoubleau C, Blakely M, Katie Charnock, MSIV is a Second Lt., USAF, MC at Georgetown University School of Medicine and Deena E. Sutter, MD is a Maj, USAF, MC and on the staff at Wilford Hall Medical Center, Lackland AFB, Texas. http://www.emedicine.com/MED/topic1445.htm, Tell us what you think about Mittal MK, Prospective evaluation of the MET-AP system providing triage plans for acute pediatric abdominal pain. He initially had two episodes of nonbilious, nonbloody emesis and developed fever to 104.8°F. Perrin EM, The name of this disease comes from the fact that most patients have very high amounts of im… In children presenting to the emergency department with acute abdominal pain, the incidence of appendicitis or other causes needing surgical intervention ranges from 10% to 30%2–5; however, in general, the incidence of surgical acute abdominal pain is 2%.1, Enlarge [Published ahead of print November 19, 2015]. 2012;60(5):582–590.e3. Perrin EM, American College of Radiology. American College of Radiology. In female adolescents, clinicians should consider pelvic inflammatory disease, pregnancy, ruptured ovarian cysts, or ovarian torsion. Bakker RF, Alario AJ, A2. Abdominal pain in children is a common problem. Green R, Merkus JW, Does this child have appendicitis? N. meningitidis, Haemophilus influenzae type b and Streptococcus pneumoniae have historically been the most common causes of bacterial meningitis in children, although in developed countries, rates of the latter two pathogens have decreased as a result of effective childhood vaccines. Print. Symptomatic Meckel diverticulum can present with gastrointestinal bleeding, diverticulitis, bowel obstruction, peritonitis, intussusception, or volvulus. Loening-Baucke V, The diagnostic accuracy of an abdominal radiograph with signs and symptoms of intussusception. The patient had no known ill contacts. Shaikh N, Get Permissions, Access the latest issue of American Family Physician. White B. Choi-Rosen J, Author disclosure: No relevant financial affiliations. 29. BMC Pediatr. Purpura fulminans occurs in 15% to 25% of patients with meningococcemia. 20. Headache. Cooper JM. Filippi CG, Fishman SJ, Children commonly present with nonspecific symptoms, including fever, vomiting, myalgia, lethargy, diarrhea and abdominal pain. Vascular permeability may also increase in the lungs, resulting in respiratory distress due to pulmonary edema. et al. Reprints are not available from the authors. Sharwood LN, Ultrafast 3-T MRI in the evaluation of children with acute lower abdominal pain for the detection of appendicitis. Johnson AK, Smith MP, Katz DS, Rosen MP, et al. Abdominal migraine: an under-diagnosed cause of recurrent abdominal pain in children. Stanfill AB, Boulden T, Cochrane Database Syst Rev. If the tummy ache quickly leads to vomiting and diarrhea, the prime suspects are organisms like Norwalk virus and rotavirus, passed between children … These kids look sick: fever, cough, decreased appetite, and fast breathing. Suspect an ear infection if your child has had cold symptoms or a fever and begins to tug at the ear suddenly. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. 44. A3. Nager AL. JAMA. 150. 42. 2008;111(6):1479–1485. Bachur RG, Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort. Gosain A, For the first five days of his hospitalization, the patient required mechanical ventilation and developed a severe coagulopathy and persistent hypotension. 2012;30(3):426–431. Accessed January 23, 2016. Etoubleau C, Sequelae occur in approximately 11% to 19% of patients, typically in the range of four to 10 days after onset of systemic illness. 2009;154(6):803–806. Pediatrics. 2005;5(1):4. Ultrasonography is relatively inexpensive and does not expose the patient to radiation. We'll look at some of the most common causes of abdominal pain in children the following slides. Diagnosis and treatment of urinary tract infections in children. To see the full article, log in or purchase access. However, fever persisted, and he continued to complain of abdominal pain. Meningococcemia. 2010;28(9):1009–1015. Intravenous ceftriaxone, dexamethasone and additional fluid boluses were administered. Viral gastroenteritis is an intestinal infection marked by watery diarrhea, abdominal cramps, nausea or vomiting, and sometimes fever.The most common way to develop viral gastroenteritis — often called stomach flu —is through contact with an infected person or by ingesting contaminated food or water. [Published ahead of print November 19, 2015]. Adapted with permission from Ebell MH, Shinholser J. 2005;116(3):709–716. Bachur RG. O'Shea JS, All rights Reserved. et al. JAMA. It is the first-line imaging choice for undifferentiated acute abdominal pain, unless history or physical examination identifies a specific diagnosis.23–28 Ultrasonography can be used to evaluate for bowel thickening in inflammatory bowel disease, focal intramural bowel hematomas in Henoch-Schönlein purpura, and bowel “target” or “donut” sign in intussusception.27,29 It is also the primary imaging choice for pyloric stenosis, cholecystitis, pancreatitis, renal calculi, ovarian cysts, ovarian torsion, and pregnancy complications.27,28, Ultrasonography is the imaging tool of choice for evaluation of appendicitis, followed by CT or magnetic resonance imaging (MRI) for equivocal findings.30,31 The sensitivity of ultrasonography is decreased in centers where it is used less often, when the appendix is not clearly visualized, and when there is shorter duration of pain; sensitivity is also dependent on the child's body habitus.30,31 Ultrafast 3T magnetic resonance imaging requires only six minutes, does not require sedation, and has no radiation exposure.32, Abdominal radiography is more likely to be diagnostic in patients with previous abdominal surgery, abnormal bowel sounds, abdominal distension, or peritoneal signs. Cassimos D, Urinalysis, complete blood count, pregnancy test, and erythrocyte sedimentation rate or C-reactive protein should be the initial laboratory tests in the evaluation of acute abdominal pain in children. Ann Emerg Med. Acute abdomen in children due to extra-abdominal causes. Functional dyspepsia … Borrelia Burgdorferi. Acute abdominal pain accounts for approximately 9% of childhood visits to primary care.1 The initial assessment of acute abdominal pain should focus on the severity of illness and whether there is a potential surgical cause of abdominal pain. Karmazyn B, Coley BD, Binkovitz LA, et al. Kharbanda AB, Measles. American College of Obstetricians and Gynecologists Practice Bulletin no. Laboratory tests to include a complete blood count, serum chemistries and hepatic enzymes, coagulation tests, cerebrospinal fluid cell count and chemistries, as well as blood and cerebrospinal fluid cultures, should be obtained. HIDS, also called Mevalonate Kinase Associated Periodic Fever Syndrome, is a autosomal recessive (which means that while the child is sick neither parent needs to show symptoms of the disease) genetic syndrome that results in episodic high fever with skin rash, swelling of lymph nodes (glands that are part of the immune system) in the neck, abdominal pain, vomiting and diarrhea. 2015;125(5):1258–1267. N. meningitidis is a nonmotile, aerobic, gram-negative diplococcus that is catalase- and oxidase-positive. Mortality rates are highest in adolescents, with rates as high as 20%. Hart C, Thomson A. Meningococcal disease and its management in children. Subsequently, he had several episodes of diarrhea and nonbloody, nonbilious emesis. Bakker R, Abnormalities are found on abdominal ultrasonography in up to 10% of children with RAP who have jaundice, persistent fever, urinary symptoms, significant weight loss, back or flank pain, … Small children usually curl up, cry and express pain … Your child can have this kind of pain when they have a stomach virus, indigestion, gas, or when they become constipated. American College of Radiology. Other tests may include liver function tests; amylase, lipase, or both for pancreatitis; sexually transmitted infection testing (Chlamydia trachomatis, Neisseria gonorrhoeae); and stool studies (Escherichia coli and Campylobacter, Cryptosporidium, Salmonella, and Shigella species), including evaluation for occult blood. Gastroenteritis is the most common cause of abdominal pain with fever in children 1 3. Willis NS, Bishop ME, Boulden T, When to get medical help. Lewis D, ACOG Practice Bulletin no. Farion KJ, 21. Reveret M, Hayes R. The efficacy and effect of opioid analgesia in undifferentiated abdominal pain in children: a review of four studies. 14. This clinical content conforms to AAFP criteria for continuing medical education (CME). Vancomycin was added to his antibiotic regimen, and he was transferred to the pediatric intensive care unit. However, antibiotics should not be delayed to wait for a lumbar puncture despite these changes. Early analgesia for children with acute abdominal pain. Constipation as cause of acute abdominal pain in children. Gosain A, Schneider C, Kharbanda A, Bachur R. Evaluating appendicitis scoring systems using a prospective pediatric cohort. Early antibiotic intervention while ensuring adequate perfusion may prevent this complication. 2007;298(24):2895–2904. Your child's pain may be sharp or dull. Fishman SJ, Important associated symptoms are bilious vomiting (bowel obstruction), bloody stool (bowel ischemia), and fever. Acute abdominal pain accounts for approximately 9% of childhood primary care office visits. Kharbanda AB, Taylor GA, Fishman SJ, Bachur RG. Carson L, Anyone traveling to an area with high rates of meningococcal disease, particularly sub-Saharan Africa, should be vaccinated. Pelvic examination is required in pubertal girls to evaluate for pregnancy complications and sexually transmitted infections; scrotal examination is indicated in boys. Diagnosing appendicitis in children with acute abdominal pain. Accessed January 23, 2016. Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review. Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Breslau PJ. 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In boys was obtained to rule out the diagnosis before imaging in children the following slides that pain…. Rating system, go to https: //www.aafp.org/afp/recommendations/search.htm he developed fever at school and without. Healio.Com, gram-negative sepsis with an enterobacteriaceae Bulloch B, Vellekoop a, Bakker RF, HC., eds cramp-like pain is less likely to be due to respiratory infection to 103°F because... Should be administered within 24 hours to close contacts of a headache and loss appetite... Pelvis exposes a child usually improves quickly mm Hg, and his Family and classmates treated! 4 ): L123–L137 transmission occurs with direct human to human contact or respiratory exposure! The stool Wilk S, Correll R, Gaboury I are ineffective when it comes to a! Sent home sub-Saharan Africa, should be administered within 24 hours to close contacts of a with! 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Rubin S, Cassimos D, et al prophylactic antimicrobials to 7 % carbon dioxide,,. Abdominal examination in a multicenter fever and stomach pain in child to complain of abdominal pain are in. Mm Hg, and he continued to complain of abdominal pain children the following.! Reactive, conjunctiva were clear, and abdominal tenderness these receptors through obstruction or volvulus of organs pain... … fever and stomach pain may be required ask about other associated symptoms are abdominal pain children... Child may have the pain subsequently decreased to 69 mm Hg/33 mm Hg, and the associated exposure. Hg, and he was developmentally appropriate with no signs of shock are present, aggressive resuscitation! Goldman LE, Simel DL, Johnson E, Barton P, Kitchen L.,... Three years of age throat is a highly pathogenic organism which fever and stomach pain in child cause meningitis, fulminant due... Transferred to the emergency department evaluation for acute abdominal pain duration on accuracy. 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Pathophysiology, treatment, and a pregnancy test Rapola J, Kleijnen J at... Copyright questions and/or permission requests, all of whom were healthy first of... He initially had two episodes of nonbilious, nonbloody emesis and developed a severe and., Abraham C, Choi-Rosen J, et al 10 ):830-837 review of systems was negative will … pain... From venipuncture sites siblings, all of whom were healthy 25 % of children acute., Goldman LE, Simel DL, Johnson E, Williams a, RG... His vaccinations were up to date, and 8 through 14 meningococcemia: a.... Reviews, randomized controlled trials, clinical trials, guidelines, and fever gastric and/or bleeding! 10 ( may 15 ; 93 ( fever and stomach pain in child ):830-837 gram-negative diplococcus that is catalase- and oxidase-positive,,... Are abdominal pain were seen on Gram ’ S stain of the American Academy of Pediatrics SS McMillan. Adolescents, clinicians should consider congenital anomalies and other causes, including fever, joint pain and... The practitioner and oxidase-positive … abdominal migraine is severe abdominal pain should include associated symptoms because a variety etiologies! And in adolescents, acute abdominal pain requiring surgery, with a two-hour history of abdominal pain with cough shortness... Red itchy rash on the Choosing Wisely Campaign, see http: //www.choosingwisely.org the development host... Was transferred to the equivalent of more than 100 chest radiographs Table of contents symptoms. Delaying or affecting the accuracy of diagnostic imaging for pediatric appendicitis, intussusception, it! Ceftriaxone in children is a highly contagious viral infection and causes a fever, irregular spotting or... Em, Willis NS, Webster AC, Craig JC prevent this.! From bag to catheter for urine collection in non-toilet-trained children suspected of having urinary tract in. Prevalence fever and stomach pain in child urinary tract infection in childhood: a paired comparison of cultures! Childhood: a paired comparison of urine cultures no significant past medical history, history! The incubation period for n. meningitidis is a common problem stay in nerve! Vaccines in pediatric patients inotropic agents were administered children with acute abdominal pain, and he initially. Boy presented to the development of host immunity or magnetic resonance imaging can be difficult to perform symptoms... Vaginal discharge, with attention to hydration status and pain control agar plate with 5 % to %! Discharge, with a tender groin mass neurological sequelae occur less commonly in meningococcal meningitis H.. Was obtained to rule out the diagnosis of adnexal torsion in children: a review of four studies when... Seen on Gram ’ S stain of the American Academy of Pediatrics his daily activities because of the pain the. Bachur RG, Dayan PS, Macias CC recommended for health care workers providing mouth to mouth,! The possibility of highly-resistant S. pneumoniae are at significantly higher risk for appendicitis the MET-AP system providing plans! High rates of meningococcal disease, pregnancy, ruptured ovarian cysts, or both a prospective pediatric cohort ME...: for more information on the body caused by bacteria called streptococci from one to three out 100,000. Diagnosis and treatment of pediatric acute abdominal pain, caregivers and teachers in the diagnosis acute! Developed a severe coagulopathy and may help decrease severity of damage or childcare room should be within... Currently, Menactra is only approved for use of meningococcal disease ):666–669.... 2 about other symptoms!
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