A 9-month-old infant with a diagnosis of gastroesophageal reflux (GER) is being discharged from the hospital.
The nurse is educating the parents about signs of possible complications related to GER.
Which of the following signs should the parents report immediately to the pediatrician?

Choice A rationale

Eczema, also known as atopic dermatitis, is a chronic inflammatory skin condition characterized by pruritus (itching), erythema (redness), and scaling. Topical corticosteroids are the first-line treatment due to their potent anti-inflammatory and immunosuppressive properties, which help to reduce the inflammatory response in the skin and alleviate itching.

Choice B rationale

Psoriasis is a chronic autoimmune skin disorder characterized by thickened, scaly plaques. Topical calcineurin inhibitors are used to treat psoriasis by suppressing the activity of T-cells, which are involved in the inflammatory process. The presentation of an itchy rash as the primary finding is less consistent with typical psoriasis.

Choice C rationale

Contact dermatitis is an inflammatory skin reaction resulting from direct contact with an irritant or allergen, often presenting with redness, swelling, and vesicles in addition to itching. While topical antihistamines can help with itching associated with allergic reactions, topical corticosteroids are generally more effective for managing the inflammation in contact dermatitis.

Choice D rationale

Tinea corporis, or ringworm, is a fungal infection of the skin characterized by circular, raised, scaly patches with central clearing. Topical antifungals are the appropriate treatment for tinea infections as they inhibit the growth and reproduction of the dermatophyte fungi causing the infection.

Choice A rationale

Nephroblastoma, also known as Wilms tumor, is the most common malignant renal tumor in young children, typically presenting between the ages of 3 and 4 years. A firm, non-tender abdominal mass, often in the right flank, is a classic finding. The association with aniridia, a congenital absence of the iris, is a known risk factor for Wilms tumor, occurring in WAGR syndrome (Wilms tumor, aniridia, genitourinary anomalies, and intellectual disability).

Choice B rationale

Neuroblastoma is a cancer that arises from immature nerve cells and can occur in various locations, most commonly the adrenal glands. While it can present with an abdominal mass, it is often associated with other symptoms such as fever, weight loss, and irritability due to catecholamine secretion. It is less specifically linked to aniridia than nephroblastoma.

Choice C rationale

Hepatoblastoma is a rare malignant tumor of the liver that typically presents in children younger than 3 years old. While it causes abdominal swelling due to a liver mass, it is not typically associated with aniridia. Palpation might reveal a mass in the upper right quadrant rather than the flank.

Choice D rationale

Hydronephrosis refers to the swelling of a kidney due to a buildup of urine. While it can cause an abdominal mass, it is often associated with urinary symptoms or pain, which are not reported in this case. Furthermore, it is not a malignancy and has no known association with aniridia.