🩸 Chapter 587 · Vaginal Bleeding in the Prepubertal Child

Nelson Textbook of Pediatrics 22nd Edition — Comprehensive approach to vaginal bleeding in prepubertal females. Common causes: vulvovaginitis, urethral prolapse, foreign body, lichen sclerosus. Less common but worrisome: precocious puberty, neoplasms (rhabdomyosarcoma, yolk sac tumor), trauma/abuse.

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📋 30 Clinical Scenarios — Prepubertal Vaginal Bleeding

📇 High‑Yield Review Cards

🩺 Clinical Presentations: Vaginal Bleeding in Prepubertal Girls

Select a presentation for diagnostic clues and management.

📋 Stepwise Approach: Evaluation of Prepubertal Vaginal Bleeding

🔑 Key Principles (Nelson Ch.587)
• Neonatal (day 3-7): Physiologic withdrawal bleeding (resolves 3-4 days). Persistent >1 month → investigate.
• Most common causes: Vulvovaginitis, urethral prolapse, foreign body, lichen sclerosus.
• Precocious puberty: Breast development before 8 years + bleeding → evaluate with bone age, LH, estradiol, pelvic US.
• Neoplasms: Rhabdomyosarcoma (sarcoma botryoides) → grapelike mass protruding from vagina, usually <3 years.
• Trauma: Straddle injuries → labial hematoma; hymen sparing. Suspect abuse if hymenal laceration.

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Chapter Summary: Vaginal Bleeding in Prepubertal Child