54. Pediatric Conditions Flashcards
Age classifications: neonate
0-28 days
Age classifications: infant
1 month-12 months
Age classifications: toddler
1-2 years
Age classifications: Child
2-12 years
Age classifications: adolescent
13-18 years
When to seek urgent care for a child age <3 months with temp of ___
100.4ºF/38ºC (rectal)
When to seek urgent care for a child age 3-6 months with temp of ___
101ºF/38.3ºC (rectal)
When to seek urgent care for a child age > 6 months with temp of ___
103ºF/39.4ºC (rectal)
What measurement tool is preferred for pediatric liquid medications?
Oral syringe (can also use dosing cup)
What is Apgar scoring?
A newborn’s general condition is assessed with an Apgar score, which is taken at 1 min and again at 5 min after birth
Lower score = more medical care
Standard meds/treatments given at birth: ____ to prevent bleeding, ___ for jaundice
IM vitamin K to prevent bleeding
Light therapy for jaundice
Others to note:
ophthalmic erythromycin to prevent conjunctivitis
Hep B vaccine
Analgesia if being circumcised
A baby is considered pre-term if it is born prior to ___ weeks of pregnancy
37 weeks of pregnancy
Low Apgar scores in pre-term infants are usually d/t ____
immature lung and heart develpment
What is patent ductus arteriosus (PDA)?
Ductus arteriosus is normal opening b/t aorta and pulmonary artery in an unborn fetus that remains opened after delivery (should close naturally after delivery)
Requires med attn with surgery/drugs
What medication can be used for patent ductus arteriosus (PDA)?
NSAIDs (such as IV indomethacin or ibuprofen) can help PDA to close by blocking prostaglandins that keep the PDA open
Must be administered within 14 days of birth to be effective
NSAIDs should NOT be used in third trimester of pregnancy bc it can cause PDA to close prematurely
When an infant is born, blood vessels in the lungs normally relax, which allows blood flow into the lungs. When this process fails, it can lead to ____
Persistent pulmonary hypertension (PPHN)
Persistent pulmonary hypertension (PPHN) may be linked to utero __ exposure
SSRI
___ is caused by deficiency of surfactant production in lungs that are not fully developed (alveoli collapse, followed by respiratory failure and death)
Respiratory distress syndrome (RDS)
Most babies born <____ gestation will receive surfactant immediately after birth or within first few days of life
35 weeks
What are some examples of surfactant products?
Poractant alfa (Curosurf)
Calfactant (Infasurf)
“surf” or “actant” in the name
What meds are a/w Reye’s children when used in children recovering from viral infections?
Aspirin and salicylate-containing products (e.g. bismuth subsalicylate)
Do NOT recommend aspirin or salicylates for pts < ___ yo, as it may not be apparent that they are recovering from a viral illness
16yo
T/F: Ibuprofen infant drops and children’s suspension are the same conc to help reduce dosing errors
False - APAP infant drops and children’s suspension are the same conc but ibuprofen is not (counseling point)
Avoid ibuprofen in infants age <___ for pain/fever d/t risk of nephrotoxicity
<6 months
FDA does not recommend OTC cough and cold meds in children <____
< 2yo
Note: most manufacturers include product labeling to avoid in children < 4yo
What are some non-med ways to help with nasal congestion in pediatric pts?
Cool-mist humidifier near bedside to reduce congestion
Gentle suction with saline drops or spray to loosen mucus can provide relief
What are some options for constipation treatment in pediatric pts?
Oral PEG3350 (MiraLax) for intermittent constipation
Prunes or pears as fruit or juice
OTC pediatric glycerin suppositories are commonly used for quick relief (FDA indication is for ages 2 and up)
What are some options for diarrhea treatment in pediatric pts?
Fluid and electrolyte replacement - oral rehydration solutions (Pedialyte, Enfamil Enfalyte)
Antidiarrheal meds like peptobismol should NOT be used d/t risk of Reye’s syndrome
Loperamide is not recommended OTC use in children < 6yo
Acetaminophen pediatric dosing
10-15mg/kg/dose every 4-6 hrs (max 75mg/kg/day)
What concentration does APAP oral liquid (infant and children) come in?
160mg/5mL
Ibuprofen pediatric dosing
5-10mg/kg/dose every 6-8 hours (max 40mg/kg/day)
Note: Indicated for infants ≥6 months old
T/F: Common pathogens for bacterial meningitis is the same in all patient groups
False
Classic signs of meningitis are uncommon in neonates. Bulging fontanelles (swelling b/t bones of skull) and ___ will be present in <25% of cases; otherwise, s/sx are non-specific
nuchal rigidity (inability to bend the neck)
Why is ceftriaxone typically avoided in neonates?
Displaces bilirubin from albumin which can cause bilirubin-induced brain damage (kernicterus)
Ceftriaxone and ____-containing solutions can precipitate causing an embolus and death. Concurrent use in neonates is contraindicated
calcium
Age <1 mo empiric treatment for bacterial meningitis
Ampicillin + cefotaxime
Ampicillin + aminoglycoside (getnamicin)
Age >1 mo empiric treatment for bacterial meningitis
Vancomycin + 3rd gen cephalosporin (CTX or cefotaxime)
Respiratory syncytial virus (RSV) symptoms mimic the common cold in older, healthy children. In ____ and ____, RSV can be deadly
Premature babies and neonates
RSV is a common cause of ___
Bronchiolitis (swelling and mucus build up in the bronchioles)
RSV treatment
Primarily supportive (supplemental oxygen, IV fluids, suction of secretions)
Severe lower respiratory tract RSV infections with underlying compromising condition - inhaled ribavirin (Virazole) can be considered (not used routinely!)
Is there a vaccine/prevention for RSV?
No vaccine and no lasting immunity develops after infection
Palivizumab (Synagis) indicated for prevention of serious lower respiratory tract disease caused by RSV at high risk children
Who should receive palivizumab (Synagis)
Premature infants born <29 weeks gestation
Premature infants born < 32 weeks gestation with chronic lung disease (CLD) who are < 12 months of age
Infants <12 months of age with certain heart conditions
When is it RSV season?
Late fall, winter, early spring
How is palivizumab administered?
Monthly IM injection in the anterolateral thigh muscle for neonates and infants
Typically not given more than 5 monthly doses during RSV season (unless season extended)
If the baby becomes infected, no further doses should be given
What causes croup (laryngotracheobronchitis)
Viral infection which causes inflammation of the upper airway, larynx, trachea, and bronchi
What are hallmark signs of croup
Inspiratory stridor (high pitched breathing sound), barking cough, and hoarseness
Croup is most common in children ___ and is often worse at night
<6 yo
Croup treatment
Systemic steroids (usually dexamethasone) + nebulized racemic epinephrine if needed
What is nebulized racemic epinephrine made of?
1:1 mixture of dextro (D) and levo (L) isomers (L-isomer is the active component)
If racemic epinephrine is not available, L-epinephrine is used
Epinephrine is an adrenergic (agonist/antagonist) that relaxes the bronchial smooth muscle and causes bronchodilation
Agonist
Nocturnal enuresis (bed-wetting) is a normal part of a child’s development and is not generally treated before age ___
5 yo
How to approach nocturnal enuresis (bed-wetting)
Behavioral approaches first
Positive reinforcement, establishing normal daytime voiding pattern and hydration pattern
Limit fluid intake prior to bedtime
Should try for up to 3 months and if not, try alarm therapy ± meds (desmopressin)
___ is the only preferred medication for enuresis in children
Desmopressin (PO)
Desmopressin (DDAVP) dosing for nocturnal enuresis
0.2mg PO QHS (can titrate to 0.6mg max)
Contraindications of desmopressin
Hyponatremia, hx of hyponatremia
CrCl <50
Side effects of desmopressin
HA, fatigue, possible decrease Na d/t water retention
Desmopressin tablets are used for enuresis while tablets, nasal spray or injection is used for ____
diabetes insipidus and hemophilia A (to control bleeding)
Codeine use is contraindicated in all patients age ____ and in those <18 yo after _____
<12yo
after tonsillectomy/adenoidectomy
In Jan 2018, FDA changed labeling for all prescription cough and cold meds that contain codeine or hydrocodone; they are no longer indicated in pts < ___ yo
18 yo
Codeine is metabolized to morphine by CYP___; certain children over-express this enzyme = higher than expected amount of morphine
CYP2D6
___ is contraindicated in children <2yo d/t potential for severe and potentially fatal respiratory depression
Promethazine
Which abx are not recommended in pediatric pts d/t possibility of ADEs on cartilage, bone, and muscle?
Quinolones
___ are not recommended in children <8yo because they stain teeth and deposit into growing bone and cartilage, which weakens it
Tetracycliens
Tetracyclines are generally not recommended in children <8yo d/t tooth discoloration but the exception is ____
tick-borne Rickettsial diseases (Rock Mountain spotted fever, ehrlichiosis and anaplasmosis)
Doxycycline is most effective and benefit > risks
Topical teething products containing ___ increase risk of methemoglobinemia. FDA now recommends against use in children <___ yo
benzocaine
<2yo
Codeine and tramadol are contraindicated in pediatric pts age < ___
12 yo
Promethazine is contraindicated in pediatric pts age < ___
2yo
CTX is contraindicated in pediatric pts age ___
0-28 days (neonates)
What are some meds that are generally not recommended in children?
Aspirin in children and teens
Quinolones
Tetracyclines in ages <8yo
OTC teething meds containing benzocaine in ages <2yo
OTC cough and preparations in ages <2yo (per FDA, manufacturers may say <4yo)
What are 2 common culprits of accidental overdose in children?
Iron and APAP
S/sx of measles
Koplik spots (small white spots inside cheeks)
Maculopapular rash
How does measles spread?
Airborne, highly contagious
S/sx of mumps
Swollen and tender salivary glands under eats (parotitis)
S/sx of rubella
Fine pink rash that begins on face and quickly spreads to rest of body
S/sx of polio
Majority have no symptoms
Some get severe nerve damage (paralytic polio) and later in life, post-polio syndrome, which causes progressive weakness and cognitive issues
Which vaccine prevents polio?
IPV vaccine
Which vaccine prevents pertussis (whooping cough)
DTaP vaccine
Which vaccine prevents rotavirus?
RV vaccine
S/sx chickenpox (Varicella)
itchy rash, fever, malaise
Which vaccine prevents chickenpox?
Varicella vaccine
