54. Pediatric Conditions

Question 1

Age classifications: neonate

Answer 1

0-28 days

Question 2

Age classifications: infant

Answer 2

1 month-12 months

Question 3

Age classifications: toddler

Answer 3

1-2 years

Question 4

Age classifications: Child

Answer 4

2-12 years

Question 5

Age classifications: adolescent

Answer 5

13-18 years

Question 6

When to seek urgent care for a child age <3 months with temp of ___

Answer 6

100.4ºF/38ºC (rectal)

Question 7

When to seek urgent care for a child age 3-6 months with temp of ___

Answer 7

101ºF/38.3ºC (rectal)

Question 8

When to seek urgent care for a child age > 6 months with temp of ___

Answer 8

103ºF/39.4ºC (rectal)

Question 9

What measurement tool is preferred for pediatric liquid medications?

Answer 9

Oral syringe (can also use dosing cup)

Question 10

What is Apgar scoring?

Answer 10

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

Question 11

Standard meds/treatments given at birth: ____ to prevent bleeding, ___ for jaundice

Answer 11

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

Question 12

A baby is considered pre-term if it is born prior to ___ weeks of pregnancy

Answer 12

37 weeks of pregnancy

Question 13

Low Apgar scores in pre-term infants are usually d/t ____

Answer 13

immature lung and heart develpment

Question 14

What is patent ductus arteriosus (PDA)?

Answer 14

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

Question 15

What medication can be used for patent ductus arteriosus (PDA)?

Answer 15

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

Question 16

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 ____

Answer 16

Persistent pulmonary hypertension (PPHN)

Question 17

Persistent pulmonary hypertension (PPHN) may be linked to utero __ exposure

Answer 17

SSRI

Question 18

___ is caused by deficiency of surfactant production in lungs that are not fully developed (alveoli collapse, followed by respiratory failure and death)

Answer 18

Respiratory distress syndrome (RDS)

Question 19

Most babies born <____ gestation will receive surfactant immediately after birth or within first few days of life

Answer 19

35 weeks

Question 20

What are some examples of surfactant products?

Answer 20

Poractant alfa (Curosurf)
Calfactant (Infasurf)

“surf” or “actant” in the name

Question 21

What meds are a/w Reye’s children when used in children recovering from viral infections?

Answer 21

Aspirin and salicylate-containing products (e.g. bismuth subsalicylate)

Question 22

Do NOT recommend aspirin or salicylates for pts < ___ yo, as it may not be apparent that they are recovering from a viral illness

Answer 22

16yo

Question 23

T/F: Ibuprofen infant drops and children’s suspension are the same conc to help reduce dosing errors

Answer 23

False - APAP infant drops and children’s suspension are the same conc but ibuprofen is not (counseling point)

Question 24

Avoid ibuprofen in infants age <___ for pain/fever d/t risk of nephrotoxicity

Answer 24

<6 months

Question 25

FDA does not recommend OTC cough and cold meds in children <____

Answer 25

< 2yo Note: most manufacturers include product labeling to avoid in children < 4yo

Question 26

What are some non-med ways to help with nasal congestion in pediatric pts?

Answer 26

Cool-mist humidifier near bedside to reduce congestion Gentle suction with saline drops or spray to loosen mucus can provide relief

Question 27

What are some options for constipation treatment in pediatric pts?

Answer 27

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)

Question 28

What are some options for diarrhea treatment in pediatric pts?

Answer 28

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

Question 29

Acetaminophen pediatric dosing

Answer 29

10-15mg/kg/dose every 4-6 hrs (max 75mg/kg/day)

Question 30

What concentration does APAP oral liquid (infant and children) come in?

Answer 30

160mg/5mL

Question 31

Ibuprofen pediatric dosing

Answer 31

5-10mg/kg/dose every 6-8 hours (max 40mg/kg/day) Note: Indicated for infants ≥6 months old

Question 32

T/F: Common pathogens for bacterial meningitis is the same in all patient groups

Answer 32

False

Question 33

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

Answer 33

nuchal rigidity (inability to bend the neck)

Question 34

Why is ceftriaxone typically avoided in neonates?

Answer 34

Displaces bilirubin from albumin which can cause bilirubin-induced brain damage (kernicterus)

Question 35

Ceftriaxone and ____-containing solutions can precipitate causing an embolus and death. Concurrent use in neonates is contraindicated

Answer 35

calcium

Question 36

Age <1 mo empiric treatment for bacterial meningitis

Answer 36

Ampicillin + cefotaxime Ampicillin + aminoglycoside (getnamicin)

Question 37

Age >1 mo empiric treatment for bacterial meningitis

Answer 37

Vancomycin + 3rd gen cephalosporin (CTX or cefotaxime)

Question 38

Respiratory syncytial virus (RSV) symptoms mimic the common cold in older, healthy children. In ____ and ____, RSV can be deadly

Answer 38

Premature babies and neonates

Question 39

RSV is a common cause of ___

Answer 39

Bronchiolitis (swelling and mucus build up in the bronchioles)

Question 40

RSV treatment

Answer 40

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!)

Question 41

Is there a vaccine/prevention for RSV?

Answer 41

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

Question 42

Who should receive palivizumab (Synagis)

Answer 42

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

Question 43

When is it RSV season?

Answer 43

Late fall, winter, early spring

Question 44

How is palivizumab administered?

Answer 44

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

Question 45

What causes croup (laryngotracheobronchitis)

Answer 45

Viral infection which causes inflammation of the upper airway, larynx, trachea, and bronchi

Question 46

What are hallmark signs of croup

Answer 46

Inspiratory stridor (high pitched breathing sound), barking cough, and hoarseness

Question 47

Croup is most common in children ___ and is often worse at night

Answer 47

<6 yo

Question 48

Croup treatment

Answer 48

Systemic steroids (usually dexamethasone) + nebulized racemic epinephrine if needed

Question 49

What is nebulized racemic epinephrine made of?

Answer 49

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

Question 50

Epinephrine is an adrenergic (agonist/antagonist) that relaxes the bronchial smooth muscle and causes bronchodilation

Answer 50

Agonist

Question 51

Nocturnal enuresis (bed-wetting) is a normal part of a child's development and is not generally treated before age ___

Answer 51

5 yo

Question 52

How to approach nocturnal enuresis (bed-wetting)

Answer 52

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)

Question 53

___ is the only preferred medication for enuresis in children

Answer 53

Desmopressin (PO)

Question 54

Desmopressin (DDAVP) dosing for nocturnal enuresis

Answer 54

0.2mg PO QHS (can titrate to 0.6mg max)

Question 55

Contraindications of desmopressin

Answer 55

Hyponatremia, hx of hyponatremia CrCl <50

Question 56

Side effects of desmopressin

Answer 56

HA, fatigue, possible decrease Na d/t water retention

Question 57

Desmopressin tablets are used for enuresis while tablets, nasal spray or injection is used for ____

Answer 57

diabetes insipidus and hemophilia A (to control bleeding)

Question 58

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

Answer 58

18 yo

Question 59

Codeine is metabolized to morphine by CYP___; certain children over-express this enzyme = higher than expected amount of morphine

Answer 59

CYP2D6

Question 60

___ is contraindicated in children <2yo d/t potential for severe and potentially fatal respiratory depression

Answer 60

Promethazine

Question 61

Which abx are not recommended in pediatric pts d/t possibility of ADEs on cartilage, bone, and muscle?

Answer 61

Quinolones

Question 62

___ are not recommended in children <8yo because they stain teeth and deposit into growing bone and cartilage, which weakens it

Answer 62

Tetracycliens

Question 63

Tetracyclines are generally not recommended in children <8yo d/t tooth discoloration but the exception is ____

Answer 63

tick-borne Rickettsial diseases (Rock Mountain spotted fever, ehrlichiosis and anaplasmosis) Doxycycline is most effective and benefit > risks

Question 64

Topical teething products containing ___ increase risk of methemoglobinemia. FDA now recommends against use in children <___ yo

Answer 64

benzocaine <2yo

Question 65

Codeine and tramadol are contraindicated in pediatric pts age < ___

Answer 65

12 yo

Question 66

Promethazine is contraindicated in pediatric pts age < ___

Answer 66

2yo

Question 67

CTX is contraindicated in pediatric pts age ___

Answer 67

0-28 days (neonates)

Question 68

What are some meds that are generally not recommended in children?

Answer 68

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)

Question 69

What are 2 common culprits of accidental overdose in children?

Answer 69

Iron and APAP

Question 70

S/sx of measles

Answer 70

Koplik spots (small white spots inside cheeks) Maculopapular rash

Question 71

How does measles spread?

Answer 71

Airborne, highly contagious

Question 72

S/sx of mumps

Answer 72

Swollen and tender salivary glands under eats (parotitis)

Question 73

S/sx of rubella

Answer 73

Fine pink rash that begins on face and quickly spreads to rest of body

Question 74

S/sx of polio

Answer 74

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

Question 75

Which vaccine prevents polio?

Answer 75

IPV vaccine

Question 76

Which vaccine prevents pertussis (whooping cough)

Answer 76

DTaP vaccine

Question 77

Which vaccine prevents rotavirus?

Answer 77

RV vaccine

Question 78

S/sx chickenpox (Varicella)

Answer 78

itchy rash, fever, malaise

Question 79

Which vaccine prevents chickenpox?

Answer 79

Varicella vaccine

Question 81

Codeine use is contraindicated in all patients age ____ and in those <18 yo after _____

Answer 81

<12yo after tonsillectomy/adenoidectomy