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nipple discharge is present, Gram stain, culture, and rarely cytology can be of
value. Fine-needle aspiration is used in a limited fashion in children and adults,
since the majority of lesions are typically benign. Serum endocrinology testing
may be indicated for some breast lesions, although these generally take place
outside the ED.

FIGURE 16.1 Approach to breast complaints in the prepubertal child.

APPROACH
The approach to the patient with complaints related to the breast primarily
depends first on whether the patient is prepubertal or pubertal/postpubertal.
Among patients who are pubertal/postpubertal, the considerations vary greatly
between boys and girls. Finally, unique considerations pertain to the pregnant or
lactating girl, as discussed earlier in this chapter.

Prepubertal Child
Among prepubertal children ( Fig. 16.1 ), the most common breast disorders are
physiologic hypertrophy in the newborn period and premature thelarche in young
girls. When physiologic hypertrophy is noted in newborns, erythema or
tenderness should be assessed, and mastitis and potential serious bacterial