Common Pediatric Problems Flashcards
What is infantile colic?
- Excessive crying with no clear aetiology
- Paroxysms of crying
- No clear trigger
- Louder, higher pitched cry
- Increased body tone
- Difficult to console
- Completely mirrors the normal crying pattern of infants (peaks at 6 weeks of age, gone by 4 months)
How is infantile colic diagnosed?
- Rule of Three/Wessel criteria
- Crying for >3 hours/day, >3 days/week, for >3 weeks
- Onset >3 months of age
- Usually parents seek help at the peak, when resolution naturally follows (around ~ 3-4 months)
What is the etiology of infantile colic?
- GI disturbance
- Early form of migraine
- Overstimulation
- Tense/stressful environment
- Neurodevelopmental issue
What is defined as normal crying?
Less than 2 hours a day in the first 3 months of life
How is infantile colic managed?
- Family support and education
- Changes in feeding technique
- Soothing strategies
- Nutrition via hypoallergenic maternal diet or extensively hydrolyzed formula
- Probiotics
- Simethicone, lactase, sucrose
- All strategies have no/conflicting/insufficient evidence
How common is GER?
- Very common
- 50-60% of infants in first 4 months of life
- Occurs frequently between feeds
- Typically improves and resolves by the end of the first year
How is GERD differentiated from GER?
- Reflux disease is defined as episodes associated with complications
- Deviates from normal reflux
- Complications might include esophagitis, poor weight gain, respiratory complications
- Complications vary with age
- In GER, there will be good weight gain and no impacts on health
What are other considerations when diagnosing GERD in infants?
- Feeding adequacy
- SDOH
- Formula preparations
- Maternal mental health concerns
- Sleep patterns
- Pyloric stenosis
How is GERD managed?
- Tobacco smoke avoidance
- Positioning therapy
- Avoiding overfeeding
- If suspected allergy to dietary proteins, trial of hypoallergenic formula
- Trial of thickened feeds
- If all above fail with associated complications: 2 week trial of PPI medication
Diagnosed of GERD is based on…
Clinical history with assessment of total caloric intake and nutrition first
What are temper tantrums?
- Begin 12-18 months
- Worsen at 2-3 years and improve thereafter
- Can persist for longer in language delay
How should temper tantrums be prevented?
- Provide choice when possible
- Positive reinforcement of good behaviour
- Regular meals, snacks, and naps
How should temper tantrums be managed?
- Remaining calm
- Ignore tantrum and distract with another activity
- Provide food/sleep if needed
What are breath holding spells?
- Occur in 6 months to 6 years
- Can be cyanotic (more common) or pallid
- Typically apnea occurs during expiration following pain/trauma leading to crying
- May be accompanied with LOC, decreased/increased tone
What is the aetiology of breath holding spells?
- Autonomic dysfunction
- Genetic component
- Iron deficiency +/- anemia
What is involved in the work-up of breath-holding spells?
Labs: ferritin, CBC
Neuro or cardiac work up
R/O seizures and cardiac syncope
How should breath holding spells be managed?
- Iron supplementation if indicated
- Reassurance
- Maintain boundaries with child
- Usually there is spontaneous remission
Has any harms been demonstrated through sleep training?
No
What are etiologies of diaper-associated rash?
- Irritant diaper dermatitis
- Secondarily infected dermatitis (candida, impetigo)
- Allergic contact dermatitis
What is Jacquet’s erosive dermatitis?
Severe chronic form of diaper rash with nodules and ulcerations
How can candidal diaper rash be identified?
- Beefy red plaques
- Satellite lesions
- Commonly involves the skin folds
How is diaper-associated diaper rash managed?
- Frequent diaper changes
- Diaper free time
- Zinc ointment
- Low potency sterioid cream
