Ex. 6 - Intro to Pediatrics (69) Flashcards
Pediatric patient populations
Approx. 22% of people living in the US are <18 years
Community: around 14% of children take at least one chronic medication (3 months+)
Hospital: 5.2 mill pediatric hospitalizations in 2019
-Includes new births (3.6 million)
-Outside newborns, about half of patients go through emergency department
-Children under 10 -> respiratory diagnoses
-Children 10 and older -> mental health diagnoses
Children are/are not small adults
ARE NOT
Fontanelle + open sutures
Short narrow trachea
Rate dependent cardiac output
Reduced ability to concentrate urine
Larger BSA: weight ratio
-Head size
-Higher metabolic rate and caloric needs
-Smaller lung volume
Higher percentage of body water
Soft bones
Pediatric Terminology
Pediatric: birth to 18 years
Neonate: 0-28 days of life
-Pre term: <37 completed weeks gestational age
-Term: 37 weeks gestational age or greater (usually 40 weeks)
Infant: 28 days/1 month up to 12 months
Child: 1-11 years
Adolescent: 12-18 years “late adolescent” sometimes used for 18-21)
Neonatal Terminology
First day of last menstrual period
-Gestational age
Postmenstrual age
-Postnatal age (chronological age)
Corrected age = Postnatal (actual) age - weeks (or months) born early
Ex: a now 16 week old baby born at 28 weeks gestational age
-40 expected gestation - 28 weeks actual gestation = 12 weeks premature
Corrected age
-16 weeks (actual) - 12 weeks (#early) = 4 weeks corrected age
Q: A woman approaches your pharm with her baby. She tells you the baby is 8 weeks old and was born early at 31 weeks. What is the patient’s post menstrual age?
postmenstrual: 39 weeks
Pediatric growth
Pediatric patients should grow
Infant weight doubles by 4-6 months
Infant weight triples by 12 months
Length increases 50% by 12 months
Check and document wright/height at every well-child visit
-Track weight gain to ensure appropriate medication doses (patients may “grow out” of doses)
Growth charts
Tools for monitoring weight, length, and head circumference
-Helpful in assessing nutritional status
-Different versions for girls, boys, and some special populations
-WHO charts for birth-24 months and CDC charts for 2-20 years
Based on averages; may not be appropriate for all patients
To use:
-Plot weight and or length with corresponding age
-Line closest to plotted point = percentile
Q: Use your growth chart to plot the following child: A 5-year old boy weighing 44 pounds who is 110 cm tall
What percentile is his weight for age? His length for age?
Pediatric Vital Signs
Look at chart
Temperature
“Normal” temp 36.5-37.5C
> 100.4F generally considered a fever (38C) but definition varies
Reference range differs by method of measurement and age
Rectal and oral more accurate
Neonates have difficulty regulating temp; more susceptible to environmental factors
When to refer for fever?
Everyone <3 months of age
Fever > 24 hrs if less than 2 years of age
Fever >72 hours if > 2 years of age
Fever > 104F (40C) any age
Everyone if no improvement despite treatment
Clinical picture
-Neck stiffness
-(Sign of menningitis)
-Irritability
-Lethargy
-Vomiting/diarrhea
-Unexplained rash
-Immunocompromised
-Severe pain - HA, earache, sore throat
-Seizure
-“looks sick”
OTC options for fever and pain
Acetaminophen
-10-15mg/kg/dose Q4-6H
-Max dose: 75mg/kg/day OR 4g/day, whichever is lower
-Standard concentration: 160mg/5mL (32mg/mL)
Ibuprofen
-5-10mg/kg/dose Q6-8H
-Give only to children >6 months of age
Max dose: 40mg/kg/day
-Standard concentration: 100mg/5mL (20mg/mL)
-Can causse nephrotoxicity, bleeding
Check concentration before providing doses in mL
Lab values
Some reference ranges similar to adults, others vary
Ex: SCr will be lower (even down to <0.2) in infants
-Byproduct of muscle and infants don’t have much!
-Consult resources for guidance on specific labs
PK
ADME
Absorption
Examples of differences include:
-Thinner skin layers in neonates
-Maturing intestinal motility and generally slower rate of enteral absorption
-Increased gastric pH
oral admin of acid-labile compounds (ex. penicillin G)
-Greater bioavailability
Oral admin of weak acids (Ex. phenobarbital)
-Require relatively larger oral doses
