Ch 23: Pediatric Conditions

Question 1

neonate

Answer 1

0-28 d

Question 2

infant

Answer 2

1 mo - 12 mo

Question 3

child

Answer 3

1-12 yrs

Question 4

adolescent

Answer 4

13-18 yrs

Question 5

codeine in children

Answer 5

contraindicated in <12 YO and <18 YO after 2 common childhood surgeries (tonsillectomy, adenoidectomy). tramadol also.

Question 6

promethazine

Answer 6

contraindicated <2 YO d/t resp depression risk

Question 7

quinolones

Answer 7

not generally rec d/t ADRs regarding muscle. used case by case for anthrax, CF, or MDR organisms

Question 8

tetracyclines

Answer 8

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)

Question 9

OTC cough and cold preparations

Answer 9

do not use <6 YO per AAP

Question 10

refer for urgent care for any of following temp

Answer 10

<3 mo with temp of 100.4 F, 3-6 mo with 101 F rectal, >6 with 103 F rectal

Question 11

refer for urgent care for any of following s/s

Answer 11

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

Question 12

respiratory syncytial virus (RSV) ppx

Answer 12

no vax. if child at high risk then Palivizumab (Synagis) is indicated during RSV season (late fall/early winter)

Question 13

child high risk for RSV

Answer 13

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

Question 14

Palivizumab

Answer 14

Synagis. dosing: 15 mg/kg IM monthly in anterolateral thigh muscle. max doses: 5. do not continue if pt get infected with RSV

Question 15

croup

Answer 15

viral infection with inspiratory stridor (high pitched breathing sound), barking cough, hoarseness.

Question 16

croup tx

Answer 16

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.

Question 17

nocturnal enuresis nondrug tx

Answer 17

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.

Question 18

desmopressive

Answer 18

synthetic analog of ADH to dec nocturnal urine production. DDAVP. hyponatremia contraindication.

Question 19

intestinal gas OTC <12 mo

Answer 19

simethicone drops for mild benefit. as pt ages, sx usually resolve around 6-8 mo.

Question 20

nasal congestion OTC <12 mo

Answer 20

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.

Question 21

mild pain/fever OTC <12 mo

Answer 21

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.

Question 22

constipation OTC <12 mo

Answer 22

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.