A 12-year-old girl presents to the pediatric clinic with complaints of severe lower abdominal pain during her menstrual periods, which started six months ago.
She describes the pain as cramping and rates it as 8 out of 10 on the pain scale.
Her mother reports that over-the-counter pain medications have provided little relief.
What would be the recommended first-line treatment for her and what is the medical term for this condition?

Choice A rationale

Providing tummy time immediately after each feeding is generally discouraged for infants, especially those with reflux or colic-like symptoms. It can increase pressure on the abdomen and potentially worsen discomfort or lead to spitting up. Tummy time is beneficial for development but should be done when the infant is awake and not immediately after eating.

Choice B rationale

Changing the infant's formula to a soy-based formula is not a first-line recommendation for managing inconsolable crying in a 6-week-old with a normal physical exam and weight gain. While some infants may have sensitivities to cow's milk protein, a formula change should only be considered after other potential causes, like colic, have been explored and under the guidance of a healthcare provider.

Choice C rationale

Administering omeprazole drops, a proton pump inhibitor that reduces stomach acid, is not indicated for a 6-week-old infant with inconsolable crying, normal weight gain, and feeding. Omeprazole is used to treat conditions like gastroesophageal reflux disease (GERD) with documented symptoms beyond typical infant spitting up. Routine use for crying is not recommended and could have potential side effects.

Choice D rationale

Offering soothing techniques such as swaddling and rhythmic rocking are evidence-based interventions for managing inconsolable crying in young infants, often associated with colic. Swaddling provides a sense of security, mimicking the womb, while rhythmic rocking can be calming and help regulate the infant's nervous system. These non-pharmacological approaches are recommended as initial management strategies for unexplained crying in healthy infants.

Choice A rationale

Monitoring for signs of infection is crucial in children with spina bifida due to the potential for meningitis and urinary tract infections related to neurological deficits and potential openings in the spinal cord. Normal white blood cell count ranges from 4,500 to 11,000 per microliter, and fever, redness, swelling, or purulent drainage would indicate infection.

Choice B rationale

Encouraging mobility is important to promote development and prevent complications like contractures. However, in the immediate postoperative period or with significant neurological impairment, maintaining skin integrity takes precedence to prevent infection and further complications.

Choice C rationale

Providing nutritional support is essential for growth and development in children with spina bifida, who may have feeding difficulties or increased metabolic needs. Adequate nutrition supports overall health, but preventing skin breakdown in areas prone to pressure is a more immediate concern.

Choice D rationale

Maintaining skin integrity is the most important intervention because children with spina bifida often have sensory and motor deficits that make them susceptible to pressure ulcers, especially over bony prominences and the surgical site if a myelomeningocele repair has occurred. Skin breakdown can lead to serious infections and complications.