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