Peds


Breath-holding spells are a form of autonomic syncope freq misdiagnosed as sz. REF

Genetic disorders (e.g., Waardenburg syndrome, Usher’s syndrome, Alport syndrome, and Turner’s syndrome) are responsible for more than 50% of hearing impairments in children. Look these up. REF

Normal HR:
< 2 80 - 180
> 2 60 - 160

Treatment goals for children with hypertension ? (REF)

A 4-wk old w/ dyspnea, cough, poor feeding, conjunctivitis. Likely pathogen ? (REF)

Primitive reflexes normally end as follows:
- root - 4 months
- Moro (startle) - 6 months 
- Babinski - 24 months (thankfully the Babinski = 4X6 (rootXMoro) = 24 months !
- Parachute - lasts for life


3yo diabetic has a BGL of 20. What to do ? 2cc/kg D10W IV. Q. 488 MedStudy 

Peds reference material for rotation: PEDsAndAllOtherFiles

How long should it take an infant to regain birth weight ? REF

A child with fever and hip pain.  What to do ? REF

A neonate at 48 hrs becomes hypoxic.  Likely cause ? REF

Hypothyroidism results in bone age delayed relative to height and chronologic age. REF

Bilious vomitus in a 3 week old. REF

Gut pain in a 3yo followed by vomiting then bloody stool. REF

Give Rota at 2, 4 and 6 months. REF
 
Breastfeeding is permitted in Hep C mothers. REF
Exanthems - the findings below are associated with which diseases ? REF
1. Shallow uclerations confined to the posterior pharynx ?
2 .Gingivostomatitis of the anterior mouth ?
3. Petechiae of the soft palate, but does not usually cause pharyngeal lesions ?
4.
This exanthem usually coincides with defervescence ?
5.
Pinpoint petechiae involving the soft palate (Forschheimer spots), but not the pharynx ?

Measles with 'Koplik spots' - pinpoint spots.
Kawasaki disease - Conjunctival injection and edema of the hands and feet, acute gallbladder extension.
Aphthous ulcers - Grayish white erosions.
Scarlet fever - intensification of sandpaper-like rash in inguinal and axillary region, strawberry tongue.
Varicella - contagious 1-2 days prior to rash and then until all are crusted over.
Kasabach-Merritt syndrome - thrombocytopenia 2/2 an enlarging hemangioma.
McCune-Albright, Neurofibromatosis, Adrenal tumor, Hamartoma of tuber cinereum - DDX 4 prec. puberty.
DMII marker in children - plasma 1,5 anhydroglucitol > 17 ug/ml.

Acute Rheumatic Fever (ARF) - Develops 2-4 weeks after GAS pharyngitis.
Jones Criteria - 2 Major or 1 Major + 2 Minor
Major - Carditis, Erythema Marginatum, SubQ nodules, Polyarthritis, Chorea
Minor - Arthralgia, incr ESR & CRP, increased PR, fever.
Absolute requirement - evidence of a recent GAS infection (ASO Ab titers, anti-DNase B, antihyaluronidase Abs).

Dehydration assessment in a child:

The most useful findings for identifying dehydration are:
1. prolonged capillary refill time
2. abnormal skin turgor,
3. abnormal respiratory pattern (SOR C).

Capillary refill time is not affected by fever and should be less than 2 seconds. Skin recoil is normally instantaneous, but recoil time increases linearly with the degree of dehydration. The respiratory pattern should be compared with age-specific normal values, but will be increased and sometimes labored, depending on the degree of dehydration. Unlike in adults, calculation of the BUN/creatinine ratio is not useful in children. Although the normal BUN level is the same for children and adults, the normal serum creatinine level changes with age in children. In combination with other clinical indicators, a low serum bicarbonate level (<17 mmol/L) is helpful in identifying children who are dehydrated, and a level <13 mmol/L is associated with an increased risk of failure of outpatient rehydration efforts. REF

A low serum bicarbonate level (<17 mmol/L) is helpful in identifying children who are dehydrated, and a level <13 mmol/L is associated with an increased risk of failure of outpatient rehydration efforts.  REF

Pediatric seizures - Ativan 0.1 mg per kg is the treatment of choice for acute tonicclonic pediatric seizures. Buccal midazolam is superior to rectal diazepam (Diastat) when IV administration is not possible. REF

 
Development (by months)
birth - crossed extension (fades by 2-3 mo) persistance = spastic cerebral palsy.
1
2 raise head on same plane as body, head lag, social smile, coo
3 social laugh
4
5 regard and reach for a rasin
6 parachute reflex
7 sit w/0 support, lift head, roll over, creap/crawl, sit briefly
9 sits -no support, walks holding furniture, thumb & forefinger grasp, mama
0
1
2 release an object into a hand, 6-8 deciduous teeth, RR = 30-40
3
4 walks unassisted
5 walk alone & crawl upstairs, stack 3 cubes, draw line, put pellet in bottle
6
7
8
9
0
1
2
3
4 2-3 word sentences, walk up steps
30 - knows full name.



 
Anticipatory Guidance 0-2 Months of Age:

CARE

Breast buds are normal in both boys and girls

Circumcision care – avoid adhesions

Vaginal discharge is normal

Umbilical Cord Care

NUTRITION

Vitamin D supplementation if taking less than 32 ounces of formula per day

Formula or breast milk until 1 year

No solids or juice or water

Hold baby while feeding

SAFETY

Rear-facing car seat until 1 yr and 20 lbs

Sleep position – back or side – no pillows or blankets – slat spacing <2 3/8”

Smoke/Carbon Monoxide detector

Never leave a baby alone in the bathtub

Hot water <120 degrees – test before bathing

Risks of passive smoking

Never leave baby alone or with young siblings

Signs/Symptoms of illness: T>100.4

Rolling/falls

Pets – never leave child alone with pet

BEHAVIOR/SOCIAL

Normal stool patterns

Nurture with holding, rocking, talking

Social support/WIC/Insurance/CHIP

Learn baby’s temperament – crying is ok!

Sibling reactions

ORAL HEALTH

Don’t prop bottle – hurts teeth later

MATERNAL HEALTH

Assess risk of postpartum depression

--END 0-2 month anticipatory guidance.

DDX for neonatal hypoglycemia ?
1. Maternal diabetes.
2. Beckwith-Wiedemann syndrome.
3. Insulin-secreting tumor (look it up).
4. Glycogen Storage Disease
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Marc Curvin,
Nov 21, 2012, 10:53 AM
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