Exam 3 Flashcards
Risk factors for Cancer (8)
- Genetic alterations (germline
- Certain meds (chemo, immunosuppressive therapies)
- Radiation exposure (incl. sunlight and tanning)
- Heredity (Wilms and retinoblastoma)
- Exposure to carcinogens (esp prenatally- smoking)
- Epstein Barr virus (EBV) (HL, NHL,
- advanced parental age
- birth weight > 4000 g (ALL)
General Symptoms of Cancer (9)
- Unusual mass or swelling
- Anemia (Pallor and fatigue)
- thrombocytopenia (Petechiae, Sudden easy tendency to bruise)
- Persistent, localized pain or limping
- Prolonged, unexplained fever or illness
- Frequent headaches, often with vomiting
- Sudden eye or vision changes (leukocoria in retinoblastoma; squinting, strabismus, swelling if solid eye tumor)
- Excessive, rapid weight loss
- enlarged firm lymph nodes
Leukemia
Patho
Most affected extramedullary areas (2)
Patho: unrestricted proliferation of immature white blood cells (blasts) in the blood-forming tissues of the body
Most affected extramedullary areas: spleen and liver b-c highly vascular
Leukemia
Symptoms (5)
- Bone marrow (anemia, thrombocytopenia, leukopenia; bone and joint pain)
- Physiologic fractures r/t increased pressure in bone
- Enlarged spleen, liver, lymph nodes r/t infiltration -> can become fibrotic
- Leukemic meningitis r/t CNS infiltration
- Cellular Starvation r/t hypermetabolism
Leukemia: Diagnostics
- CBC (2)
- Biopsy (3)
- Lumbar puncture
CBC
- immature leukocytes (blasts) present
- Low blood counts (WBC, RBC, platelets)
Bone marrow biopsy and/or aspiration
- Definitive diagnosis to differentiate b/w ALL and ALM
- Shows infiltration of blast cells
- Often sedation for pediatrics b-c must remain still
Lumbar Puncture (LP)
- Determination of CNS involvement (metastasis, brain tumors)
Leukemia
Treatment (5)
- Surgery (palliative or curative)
- Chemotherapy (primary)
- Targeted therapy (tyrosine kinase inhibitors (TKIs), monoclonal antibodies, proteasome inhibitors)
- Radiotherapy
- Hematopoietic Stem Cell Transplant (HSCT) or Bone Marrow Transplant (BMT)
Chemotherapy drugs
Nursing Care (6)
- Requires a double check from a second RN
- PPE (gloves, gowns, masks/face shield if splashes possible)- including gauze when in contact w/ drug
- Often need central line or infusion port
- DO NOT crush or alter chemotherapy drugs
- Stop infusion immediately if s/s of infiltration (pain, stinging, swelling, redness)
- Observe child for 1 hr after infusion for signs of anaphylaxis (rash, urticaria, hypotension, wheezing, NV)
Chemotherapy Drugs
Notes (2)
- combo drug regimen used b-c optimal cell destruction with minimum toxic effects
- Not selectively cytotoxic for malignant cells (kills fast growing healthy cells i.e. bone marrow, hair, skin, and GI tract)
Monoclonal Antibody drugs
Pros (2)
Cons
Pros
- fewer reactions vs chemo (no hair loss or mucositis)
- alters immune system to recognize cancer cells by attaching to proteins
Cons
- anaphylaxis common so premedicate w/ steroids or benadryl
Granulocyte Colony stimulating factor (G-CSF)- filgrastim, pegfilgrastim)
Purpose (2)
Care (2)
Purpose
- Regulate reproduction, maturation and function of blood cells.
- Decreases duration of neutropenia
Care
- Discontinued when ANC > 10,000
- watch for bone pain, fever, rash, malaise, headache
Biologic Response modifiers
- Action
- Examples (5)
Action: Alters relationship b/w tumor and host by changing the host’s biologic response to tumor cells.
Examples
- Monoclonal antibodies
- Chimeric Antigen Receptor T-cell Inhibitors (CAR-T)
- Angiogenesis inhibitors
- Colony-stimulating factors (CSFs)- G-CSF (filgrastim, pegfilgrastim)
- checkpoint inhibitors (block pathways that allow cancer cells to escape immune system)
Radiation
Side effects (9)
Side effects (based on area)
- neck (hypothyroidism )
- chest (reduced lung function, heart damage)
- obesity and metabolic syndrome ( hormone-producing organs)
- ovaries and testes (infertility)
- GI (anorexia, mucosal ulceration, NVD)
- Skin (alopecia, dry or moist desquamation, hyperpigmentation)
- Head (NV(stimulation of vomiting center), alopecia, mucositis, parotitis, sore throat, loss of taste, xerostomia, GH deficiency, cognitive deficits, hearing loss)
- bladder (cystitis)
- Bone marrow (myelosuppression)
Radiation
Nursing Care (3)
Patient education (5)
Nursing Care
- Encourage fluids & nutritional intake (Light, small, frequent meals)
- get I&O and Daily weights
- Do not refer to skin changes as burns b-c implies too much radiation use
Patient Education
- Use mild soap
- Do not remove skin markings
- Avoid creams or lotions
- Loose-fitting clothing over irradiated area to minimize skin irritation
- Protect area from sunlight and sudden temp changes (ice or heating packs)
Hematopoietic Stem Cell Transplant (HSCT)
Indication (2)
Risks (3)
Pre-op
Indication
- malignancies unable to be cured by other means
- replacement of dysfunctional bone marrow
Risks: infection, relapse, Graft vs Host disease(due to HLA mismatch)
Pre-op: High dose chemo and radiation – to reduce ANC to nadir (0) (irreversible)
Hematopoietic Stem Cell Transplant (HSCT)
Procedure (2)
Post-op (4)
Procedure
- Transfuse PRBCs, and platelets as indicated
- Autologous (self-donation) vs Allogeneic (family or volunteer, umbilical cord blood) stem cells
Post transplant
- Give G-CSF if ANC still low
- give calcineurin inhbitor w/ chemo to prevent graft versus host disease
- Minimize pressure in dependent areas (frequent movement, pressure-relieving)
- Promote healing (frequent sitz baths to perianal area and protective skin barriers i.e hydrocolloid dressing or occlusive ointments)
Effects of Cancer Treatment: Infection
Related to? (2)
Patient education (4)
Related to: neutropenia (ANC < 500), altered nutrition (prolongs neutropenia)
Education:
- Avoid crowds and sick individuals
- wear a mask in public
- Low bacterial diet ( no fresh fruits, no soft serve; fully cooked foods, no deli meats)
- Avoid fresh flowers, live plants
Effects of Cancer Treatment: Infection
Nursing Care (6)
- Handwashing
- Monitor s/s of infection or sepsis (fever)
- G-CSF Injections if ANC < 500
- Cultures and antibiotics as soon as possible for 7-10 days
- Protective isolation
- Prophylaxis against Pneumocystis pneumonia (trimethoprim-sulfamethoxazole)
Effects of Cancer Treatment: Anaphylaxis( tachycardia, tachypnea, flushing, urticaria, hypotension)
Related to?
Nursing Care (6)
Related to: chemo, BRMs
Nursing Care
- pre-medicate if ordered
- Monitor patient closely (vital signs, and assessment)
- Assess for hx of anaphylaxis with certain meds
- discontinue drug if happens and maintain patency of IV line w/ NS
- Obtain crash cart give emergency drugs (epinephrine, dopamine)
- administer supplemental O2 (call RRT)
Effects of Cancer Treatment: Hemorrhage
(epistaxis, gingival bleeding)
Related to?
Nursing Care (7)
Related to: thrombocytopenia (<20K)
Nursing Care
- Administer platelets as ordered (no need for cross matching; peak: 1 hr, Duration:1-3 days)
- Avoid invasive procedures and skin punctures
- Gentle mouth and perineal care (wipes front to back)
- AVOID rectal temperatures and suppositories
- Educate patient to avoid contact sports, bike or skateboard riding if < 100,000
- avoid aspirin products
- Frequent turns and pressure-reducing mattress under bony prominences to prevent pressure sores and decubital ulcers
Effects of Cancer Treatment: Anemia
Nursing Care (4)
- Monitor for s/sx of anemia (pallor, fatigue, tachycardia, increased cap refill)
- Allow for frequent periods of rest (regulated by child
- Transfuse PRBCs if ordered (to increase Hgb > 10 g/dL)
- Administer G-CSF (filgrastim, pegfilgrastim)
Effects of Cancer Treatment: Pain
Related to?
Nursing Care (3)
Related to: bone marrow involvement (acute, chronic, neuropathic)
Nursing Care
- Assess pain frequently w/ age-appropriate pain scale
- Administer pain meds PRN (IV (morphine or hydromorphone PCA), PO, transdermal patches (Fentanyl, lidocaine), nerve blocks/epidurals_
- Involve interdisciplinary teams (quality of life team; pain team)
Effects of Cancer Treatment: Altered Nutrition
(Anorexia, NV)
Nursing Care (5)
Nursing Care (prevention is key)
- administer meds (ondansetron, lorazepam, diphenhydramine, dronabinol, granisetron, hydrocortisone) 30-60 min prior to admin of chemo and for 24 hrs after
- give metoclopramide w/ diphenhydramine if severe b-c metoclopramid has extrapyramidal effects
- Monitor I&O, daily weight, albumin/prealbumin (increased risk of dehydration and electrolyte disturbances)
- Fortify foods with nutritious supplements (High protein, high calorie)
- use NGT and TPN as needed
Effects of Cancer Treatment: Altered Nutrition
(Anorexia, NV)
Related to? (3)
Patient Education (4)
Related to: chemo, radiation, steroids (increased appetite)
Parental education
- avoid strong smells
- relax pressure placed on eating.
- Allow child to be involved in preparation and selection to make food appealing
- give chemo at night
Effects of Cancer Treatment: Mucositis/ Stomatitis (eroded, red, painful areas in mouth, pharynx, rectum)
Nursing Care
- mouth lesions (5)
- rectal lesions (3)
Nursing Care for mouth lesions
- Encourage frequent oral care (q2-4 hrs w/ soft sponge toothbrush) and Lubricate lips PRN
- Alkaline saline mouth rinses, viscous lidocaine, chlorhexidine mouth rinse (No lidocaine for under 2 yrs b-c diminishes gag reflex)
- Avoid alcohol rinse, lemon glycerin swabs and hydrogen peroxide b-c drying effects and acidity of lemon is irritating
- Administer nystatin for thrush as indicated
- Encourage a bland, moist, soft diet
Nursing Care for rectal lesions
- AVOID suppositories and rectal temps
- Daily CHG wipes/baths, Sitz bath as needed
- Occlusive ointments
Effects of Cancer Treatment: Neurologic problems
Examples w/ nursing care (6)
- Foot drop (Encourage use of foot board or high-top tennis shoes when in bed)
- severe constipation (use stool softeners, activity, laxatives)
- Peripheral neuropathy (Give antidepressants (TCAs), AEDs
- Jaw pain (use repetitive gum chewing or suck hard candy)
- Developmental delays
- Post irradiation syndrome (somnolence, anorexia, N/V, fever; 5-8 wks after CNS radiation lasting 4-15 days) (indicator of neurologic sequelae)
Effects of Cancer Treatment: Hemorrhagic cystitis (irritation of bladder lining)
Related to?
Nursing Care (5)
Related to: urinary stasis r/t radiation and chemo
Nursing Care
- Monitor for hematuria and blood clots in urine
- Ensure adequate oral or parenteral fluid intake (1.5x daily fluid requirement (2L/m2/day))
- Monitor strict I&O and ensure frequent voiding around the clock every 2 hrs until 24 hrs after last dose
- Administer bladder protectant (mesna) after certain chemo
- give chemo early in day to allow adequate flushing and fluids throughout day
Effects of Cancer Treatment: Body Image Concerns
Related to? (4)
Nursing Care (2)
Patient education (2)
Related to:
- alopecia (all body hair)
- weight changes, steroids (cushingoid)
- body additions (CVAD, IV lines)
- body changes (scars, amputations)
Nursing Care
- Encourage shorter haircuts prior to hair falling out b-c falls out in clumps
- Provide emotional support
Patient education
- Educate on options such as wigs, scarves, and bandanas
- Educate that hair grows back in 3-6 months
Effects of Cancer Treatment: Tumor Lysis Syndrome
What is it?
S/s (4)
Related to: rapid release of intracellular contents seen in lysis of cells in ALL or burkitt lymphoma
S/s
- hyperkalemia (NV)
- hyperuricemia (flank pain, lethargy, renal failure)
- hyperphosphatemia (muscle cramps, pruritus)
- hypocalcemia (tetany, seizures)
Effects of Cancer Treatment: Tumor Lysis Syndrome
Nursing Care (5)
Nursing Care
- monitor frequent serum chemistries and urine pH
- strict I&O
- aggressive IV fluids
- For hyperkalemia, furosemide
- For hyperuricemia, allopurinol (decrease formation) or rasburicase (convert to soluble allantoin)
Cancer: Immunizations (4)
- Avoid admin of live, attenuated vaccines (polio, MMR) due to immunosuppression
- Avoid exposure to childhood diseases such as chickenpox then give antivirals (acyclovir, valgancyclovir) if child develops varicella or is exposed
- If vaccinated 2 weeks prior to starting chemotherapy or during treatment, consider child unimmunized b-c immune system not strong enough for developing active immunity.
- Revaccinate or administer live virus vaccines 6 months after treatment is stopped.
Non-Hodgkin Lymphoma (NHL)
What is it?
Key s/s
Classifications (3)
Treatment (3)
Tumors of the peripheral lymph nodes, thymus, or abdominal organs such as the bowel.
Key s/s: tumors compressing organs (intestinal or airway obstruction, CN palsies, spinal paralysis)
Classifications: Lymphoblastic, Burkitt/Non-Burkitt (mature B-cell), Large Cell/anaplastic
Treatment: chemo, radiation (emergencies), surgery (Burkitt or anaplastic)
Hodgkin Lymphoma (HL)
What is it?
Key s/s (5)
Diagnostic
Treatment
progressive enlargement of affected lymph nodes and sometimes spread to the spleen, liver, bone marrow, bones, mediastinum, or lungs
Key s/s
- Enlarged, firm, nontender, movable lymph nodes in supraclavicular or cervical areas
- Mediastinal lymphadenopathy – persistent nonproductive cough
- Enlarged retroperitoneal nodes – unexplained abdominal pain
- splenomegaly/hepatomegaly
- Systemic symptoms: low or intermittent fever, anorexia, nausea, weight loss, night sweats, pruritus
Diagnostic: Lymph node biopsy shows Reed Sternberg cells (seen in mono as well)
Treatment: radiation and chemo
Neuroblastoma
What is it?
Diagnosis (3)
Treatment (3)
originate from embryonic neural crest cells (neuroblasts) which form adrenal medulla and SNS and cause abdomen (arising from adrenal gland) OR head, neck, chest, or pelvis tumor
Diagnosis
- usually after metastasis (silent tumor)- lymph node, bone, liver (lymphadenopathy, bone pain, hepatomegaly)
- Metaiodobenzylguanidine (MIBG) scan – biopsy and aspirate of bone marrow to evaluate metastasis
- CT or MRI to locate primary tumor
Treatment: chemo, radiation, surgery (primary)
Wilm’s Tumor
What is it?
Key s/s (3)
Diagnosis (2)
Treatment (4)
Solid tumor of the kidneys from immature kidney cells
Key s/s
- UNILATERAL firm, nontender swelling or abdominal mass (does not move w/ respiration)
- hematuria
- HTN (due to excess renin secretion by tumor)
Diagnosis
- Metastasis is rare (Pulmonary metastasis (dyspnea, cough, SOB, pain in chest)
- CBC may show polycythemia if tumor secretes excess erythropoietin
Treatment
- DO NOT PALPATE (appropriate signage in room)
- surgical resection of tumor, adrenal gland, kidney (transplant if stage 5)
- radiation (maybe post-op depending on stage)
- chemo
Osteosarcoma
What is it?
Key s/s (4)
Arises from bone-forming mesenchyme in osseous tissue of metaphyseal region of long bones
Key S/s
- Pain, swelling, and sometimes decreased joint motion and limp (relieved pain w/ flexion)
- inability to hold heavy items
- occasional fracture at the tumor site if tumor presses on bone
- palpable mass
Osteosarcoma
Diagnosis (4)
Treatment (3)
Diagnostic Testing
- MRI of affected bone
- Plain radiograph - Radial ossification in soft tissue gives sunburst appearance of tumor
- chest CT b-c metastasis to lung usually
- increased alkaline phosphatase.
Treatment:
- Surgery – limb salvage or amputation then Post-op care: continuous passive motion; TCA (amitriptyline) for phantom pain
- Chemotherapy
- Thoracotomy if pulmonary metastasis
Ewing Sarcoma
What is it?
Key s/s (3)
Diagnosis (3)
Treatment (3)
- small, round cell tumors that arise in marrow spaces of bone or in soft tissues (extraosseous-pelvis, femur, tibia, fibula, humerus, ulna, vertebra, scapula, ribs, and skull
Key s/s
- Localized pain w/ limp
- spinal cord compression (back pain, sensation change, extremity weakness, loss of bowel or bladder function, respiratory insufficiency)
- respiratory distress (metastasis to lungs)
Diagnostic Testing
- X-ray (involvement of diaphysis w/ detachment of periosteum from bone (Codman triangle))
- CT/MRI of primary site and CT chest
- bone marrow aspiration and biopsy
Treatment: Chemotherapy, high dose radiation, surgery (limb salvage more likely)
Retinoblastoma
What is it?
Key s/s (4)
Intraocular malignancy usually unilateral and nonhereditary
Key s/s
- Leukocoria (whitish pupil glow) esp in flash photo
- Strabismus (due to poor fixation of visually impaired eye esp if tumor in macular (area of sharpest visual acuity)
- Late: blindness, pain, orbital cellulitis, glaucoma
- High risk for secondary malignancy (osteosarcoma)
Retinoblastoma
Diagnosis (2)
Treatment (5)
Diagnostic Testing
- ophthalmoscopy
- Blood and tumor samples – test for RB1 gene mutations
Treatment
- eye enucleation (if unilateral)
- chemotherapy
- brachytherapy, radiation
- photocoagulation (laser beam to destroy retinal BVs i.e. nutrition of tumor)
- cryotherapy (freeze tumor and destroys microcirculation of tumor and cells through microcrystal formation
End-of-life care: Nursing Care (5)
- Provide palliative care and support at the time of diagnosis of life-threatening illness or injury
- Advocate for parental empowerment (let them make decisions)
- include input of child after 14 yrs of age
- If parent does not want child to know truth, do not lie but do not disobey parents
- attend funeral services if helpful
Discomfort specific care at end of life
- Dyspnea (3)
- oral secretions
- fatigue
For dyspnea
- Allow position of comfort
- encourage use of fan
- use Morphine to calm patient and decrease work of breathing
For oral secretions
- Scopolamine patch
For fatigue
- minimize activities
Developmental Views of Death
- infant
- toddler/preschooler
- school age (2)
- adolescent
Infant
- Fear of separation so let parents hold
Toddler/Preschooler
- Death = sleep and reversible (so stay close)
School age
- most understanding and accepting of diagnoses
- think more factual vs emotional so may not understand completely what they are missing
Adolescent
- Understands what they are missing (heartbreaking grief)
How to emotionally support dying child? (4)
- Do not compare
- Do not tell how they should feel but interpret what they say
- Listen
- Be there (presence)
Kubler’s general stages of Grief(5)
- Denial
- Anger
- Bargain
- Depression
- Acceptance
Fluid Requirements
Daily fluid requirements
Measuring Output (4)
- Based on child weight i.e. 100 (first 10 kg)+ 50 (2nd 10kg) + 20 (remaining kg)
Output
- q2h
- subtract weight of dry diaper from wet diaper (unable to distinguish stool from urine)
- minimum 1 mL/kg/hr (30 mL/hr if > 30 kg)
- Bladder capacity (oz) = Age (years) + 2
Conditions that increase fluid needs (6)
- Sweating losses (fever (12% per 1 C), radiant warmer, phototherapy)
- Tachypnea
- High output (Diarrhea, vomiting, blood loss)
- Low intake (malabsorption)
- Conditions (burns, shock, DI, DKA, high output kidney failure)
- Post-op bowel surgery (gastroschisis, omphalocele r/t GI suctioning)
Conditions that decrease fluid needs (6)
- Congestive heart failure
- SIADH
- Mechanical ventilation
- After surgery
- Oliguric renal failure
- Increased ICP
Dehydration: Isotonic
What is it?
Treatment
- balanced loss of electrolytes and water from ECF
Treatment: isotonic fluids (NS, LRs)
Dehydration: hypotonic
What is it?
Treatment
- electrolyte deficit (low Na) > water deficit so water goes into ICF
Treatment: hypertonic fluids (D5NS, 3NS)
Dehydration: hypertonic
What is it?
Treatment
- water deficit > electrolyte deficit (Na> 150) due to water loss or increased electrolytes; fluid goes from ICF to ECF
Treatment: D5W, 1/2 NS (DO NOT GIVE RAPID b-c risk for water intoxication
Dehydration: Mild (3-5% infant, 3-4% child)
Manifestations (4)
- Normal pulse, respiration, blood pressure, behavior, mucus membranes, fontanel
- Slight thirst
- Cap refill 2 sec
- Urine SG ›1.020
Dehydration: Moderate (6-9% infant, 6-8% child)
Manifestations (8)
- Slight increased HR, RR, normal to orthostatic BP
- Irritable
- Dry mucous membranes
- Moderate thirst
- Decreased tears
- Normal or sunken fontanel
- Cap refill 2-4 seconds, decreased turgor
- Oliguria
Dehydration: Severe (≥ 9-10%)
Manifestations (8)
- Very tachycardia and hyperpnea
- decreased BP/shock
- Lethargic to hyperirritable
- Parched mucus membranes and intense thirst
- Absent tears w/ sunken eyes
- Sunken fontanel
- Cap refill › 4 seconds, cool skin, mottled, acrocyanotic, tenting
- Oliguria, anuria
Oral Rehydration Therapy (ORT)
Purpose
Choices (6)
- Enhance the reabsorption of Na and water via reducing vomiting, diarrhea, and duration of illness (stomatitis, emesis)
Choices
- Use Centralyte, Pedialyte, Rehydrate w/ 50 mEq/L
- Add unsweetened Kool-Aid to ORS
- Low sugar popsicles
- do not give fruit juice, soft drinks, gelatin (high carb, low electrolyte, high osmolarity)
- do not give chicken or beef broth or gatorade (excess sodium, low carb)
- Avoid BRAT diet (contraindicated b-c little value (low protein, low energy, high carb, low electrolytes)
Degrees of Dehydration: Treatment w/ ORT or IV
Mild
Moderate
Severe
Amount Variations (2)
Mild dehydration- 50 mL/kg within 4 hours
Moderate dehydration- 100 mL/kg within 4 hours
Severe dehydration- IV fluids 40 mL/kg/hr until HR and LOC normal, then IV or oral rehydration solution
Amount Variations
- Add 10 ml/kg of ORT fluid for every loose stool or episode of vomiting
- If vomiting, ORT frequently in small amounts (5- 10 ml syringe q1-5 min)
TPN
Risk
Nursing Care (5)
Risk: infection due to hyperglycemia risk or hypoglycemia
Nursing Care
- Administer in central venous catheter
- Filtered tubing to remove particulate matter
- “Ramp up” and “Ramp down” rate of infusion slowly to prevent dysregulation of glucose
- Monitor glucose, electrolytes, liver function tests, triglycerides, albumin, renal function
- Daily weights
Diarrhea: Stool characteristics and potential problem
- Watery explosive stools
- Foul-smelling greasy bulky stools
- Diarrhea after cow’s milk, fruits, cereal intro (2)
- Neutrophils or RBCs in stool (2)
- Eosinophils (2)
- Gross blood or occult blood (3)
- Watery explosive stools = glucose intolerance
- Foul-smelling greasy bulky stools = fat malabsorption
- Diarrhea after cow’s milk, fruits, cereal intro = enzyme deficiency or protein intolerance
- Neutrophils or RBCs in stool = bacterial gastroenteritis or IBD
- Eosinophils = protein intolerance or parasitic infection
- Gross blood or occult blood = shigella, campylobacter, E-coli
Chronic nonspecific diarrhea (CNSD)
What is it?
Effects (3)
irritable colon of childhood and toddlers’ diarrhea which may be r/t sorbitol (artificial sweeteners) or excessive juice for > 14 days
Effects: no blood in stools, no enteric infection, no malnutrition
Diarrhea: Acute vs Chronic
Timing
Cause
Acute
- Timing: self-limited under 14 days usually in under 5 yrs old
- Cause: infectious agent (C.diff (antibiotic use), rotavirus (immunization), Giardia lamblia (day cares)) esp. URI, UTI, antibiotics, or laxatives
Chronic
- Timing: over 14 days
- Cause: malabsorption syndromes, IBD, immunodeficiency, food allergy, lactose intolerance, CNSD
Spitting up/Regurgitation
Cause
Treatment (5)
Cause: due to weakened Sphincter at entry of stomach until 6-12 months of age esp in bottle-fed
Treatment
- Frequent burping before/after feedings
- Minimum handling during/after feedings
- Position child on right side with head slightly elevated after feeding (stomach drains better)
- NEVER overfeed ~ more frequent smaller feedings
- meds (rare but Ondansetron (few side effects) is okay; Avoid promethazine and metoclopramide b-c somnolence, nervousness, irritability, and dystonic reactions)
