Ch 23: Pediatric Conditions Flashcards
neonate
0-28 d
infant
1 mo - 12 mo
child
1-12 yrs
adolescent
13-18 yrs
codeine in children
contraindicated in <12 YO and <18 YO after 2 common childhood surgeries (tonsillectomy, adenoidectomy). tramadol also.
promethazine
contraindicated <2 YO d/t resp depression risk
quinolones
not generally rec d/t ADRs regarding muscle. used case by case for anthrax, CF, or MDR organisms
tetracyclines
not generically rec d/t teeth discoloration and retardation of skeletal development and bone growth. exception if rocky mountain spotted fever (benefit outweighs risk of doxycycline)
OTC cough and cold preparations
do not use <6 YO per AAP
refer for urgent care for any of following temp
<3 mo with temp of 100.4 F, 3-6 mo with 101 F rectal, >6 with 103 F rectal
refer for urgent care for any of following s/s
cough/cold that worsens or does not improve within several days, unusual/severe/persistent pain that does not go away after several hours, blood in urine/stool, inability to sleep/drink, rash that looks severe or any rash with fever, abrasions that are dirty or deep (requiring sutures), limping or unable to move an extremity, seizure
respiratory syncytial virus (RSV) ppx
no vax. if child at high risk then Palivizumab (Synagis) is indicated during RSV season (late fall/early winter)
child high risk for RSV
premature infants born <29 wks gestation, premature infants born <32 wks gestation with chronic lung disease and are <12 mo, infants <12 mo with certain heart conditions
Palivizumab
Synagis. dosing: 15 mg/kg IM monthly in anterolateral thigh muscle. max doses: 5. do not continue if pt get infected with RSV
croup
viral infection with inspiratory stridor (high pitched breathing sound), barking cough, hoarseness.
croup tx
if mild: cool mist or steam and hydration. otherwise: dexamethasone 0.6 mg/kg x1 (max 16 mg/dose) is mainstay. if difficulty breathing: nebulized racemic epi or L-epi (half dose of racemic mix) for bronchodilation.
nocturnal enuresis nondrug tx
positive reinforcement, normal daytime voiding pattern normal hydration pattern. try up to 3 mo. bladder training not rec. if not helpful (does not result in dryness), alarm tx + desmopressin is next line.
desmopressive
synthetic analog of ADH to dec nocturnal urine production. DDAVP. hyponatremia contraindication.
intestinal gas OTC <12 mo
simethicone drops for mild benefit. as pt ages, sx usually resolve around 6-8 mo.
nasal congestion OTC <12 mo
sit pt upright like carseat indoors. cool mist humidifier. steamy bathroom. suction with saline drops or spray (bulbs sold in pharmacy). do not use OTC cough/cold products <2 YO.
mild pain/fever OTC <12 mo
apap drops and susp are same conc - use 5-10 mg/kg q4-6h, max 70 mg/kg/d. avoid ibu <6 mo d/t nephrotox. ibu supplied in diff dosages for children/infants (unlike apap) - use 10-15 mg/kg q6-8h (more potent), max 40 mg/kg/d.
constipation OTC <12 mo
miralax (peg 3350) dosed 0.2-0.8 g/kg/d. prune or pear juice helps. OTC ped size glycerin suppositories are for children 2+ YO. if ongoing issue, seak pediatrician.
