Objectives: There is limited literature on pediatric liver abscesses (LA) in the Indian subcontinent. Thus, we aimed to study the epidemiological spectrum, clinical features, management approach, and outcomes of pediatric LA. Materials and methods: This was a retrospective, single-center analysis covering the period 2011–2021. It included all consecutive children under 18 years of age who were diagnosed with LA, and their profiles were examined. Results: A total of 92 children, with a median age of 10 (5–14) years, were included in the study. They were categorized as amebic liver abscess (ALA)—72.8%, indeterminate—15.2%, pyogenic liver abscess (PLA)—8.7%, and other causes—3.3%. The most common presenting complaint among all subjects was fever (100%), followed by abdominal pain in 76 cases (82.6%). The majority of cases had a single abscess (74, 80.4%), with a predilection for the right lobe (70%). Additionally, 75 children (81.5%) had a history of admission to an outside hospital prior to the presentation. Twenty children had complicated LA (21.7%), including 14% experiencing capsule rupture. The median duration of hospital stay was 9 (7–14) days. All children showed improvement with conservative management, which included broad-spectrum antibiotics, with or without percutaneous drainage. The median time to resolution was 34 (21–52) days, and none of the patients required surgical intervention. Conclusion: Diagnosing the exact cause of pediatric LA in the Indian subcontinent can be challenging; however, excellent outcomes can be achieved through a nonsurgical management approach. Clinical significance: In endemic regions, diagnosing pediatric LA is challenging due to limited diagnostics and overuse of antibiotics, yet simple parameters upon admission can predict complications, and nonsurgical management achieves excellent outcomes.

Prolonged cholestasis is a rare distinct complication of hepatitis A infection, and its association with intense refractory cough is even rarer. We present a case of acute viral hepatitis, whose liver function test showed a very high level of direct bilirubinemia with disabling pruritus and dry cough, refractory to standard conventional treatment. Treatment with naltrexone led to complete recovery in the patient. This observation in our patient strongly supports the hypothesis that increased central opioidergic tone may be a component behind the pathophysiology of prolonged and intense cholestasis, which may cause refractory dry cough by modulating the central cough reflex.

Infantile-onset inflammatory bowel disease (IOIBD) is an IBD that presents in children <2 years of age. It is very rare, and sometimes, the condition is challenging to diagnose as the characteristic diagnostic features may not be present at the time of the initial assessment. Often, they present with an aggressive phenotype requiring escalating treatment regimens and intense nutritional rehabilitation. Here, we discuss a case where the infant presented with symptoms, signs, and endoscopic features suggestive of IBD; however, the histology was not supportive. In this case, allergic colitis was the closest differentials considered. The child required steroids for induction therapy and was also started on mesalazine. The child had a flare of symptoms after the initial course of steroids was stopped and required reinduction with steroids and immunomodulator azathioprine as maintenance therapy. The genetic evaluation has been inconclusive so far. We discuss the possible differential diagnosis considered and the relevant literature.

India is a very rich country in terms of ancient cultural practices. Modifying dietary practices and using some plant-based products for the treatment of various diseases are described in ancient Indian books. Also, there is huge diversity in dietary and nutritional practices across the nation from north to south and east to west. Various dietary products are being used orally or locally at the sites in affected areas. Various dietary remedies are being used in childhood illness by parents and grandparents of children for symptomatic relief and for curing the illness. Many of these dietary practices are also being practiced by pediatricians and general physicians. Many of these dietary practices are scientifically proven; however, some of the unscientific dietary practices are still practiced by some pediatricians and general physicians. In this mini-review article, we will discuss myths and facts about milk and milk products used for gastrointestinal and liver illness in children.