Final lecture 9 Flashcards
When can children swallow tablets and capsules
7-8 yo
Compare GER and GERD
GER (gastroesophageal reflux)- is the passage of gastric contents into the esophagus
GERD(gastroesophageal reflux disease) gastric reflux causes troublesome symptoms or complications
What is GER caused by
Relaxation of lower esophageal sphincter
symptom difference between infants and Children older than 4
Infants with reflux may be happy spitters or may be fussy.
Children older than 4 yo have classic heartburn symptoms similar to adults
GERD symptom in infants
1)Gastrointestinal
Regurgitation
feeding difficulties
2)Extra-intestinal
Irritability
back arching
persistent cough
Symotims of GERD in children
Heartburn
vomiting
regurgitation
dysphagia
chest pain
alarm symptoms for when to refer
Bilious or projectile emesis
GI bleeding/hematemesis
vomiting beginning after 6 months of age
difficulty swallowing
fever
diarrhea/constipation
non-pcol therapy for infant patients
feeding changes- thickening of food, increasing caloric density of feeds while decreasing volume
Positioning therapy- Keep upright after feeds.
Elevate head of bed
Lifestyle changes
Frequent burping, weight reduction, smaller or more frequent feeding
Treatment of GERD in older children
Diet/ positional modifications (same as infant)
Consider antacids for short term relief
Consider PPI for classic reflux symptoms
When do we consider using pharmacologic therapy in infants
Lifestyle mods not improving symotoms
What do we consider failure of lifestyle mods
no gain weight after 2-4 weeks
What are some available agents for pcol therapy of infants
Acid suppressants (H2RAs) (PPIs)
prokinetics
Antacids
consider weining after 4-8 weeks. No stopping suddenly
H2RA MOA
competitive inhibition of histamine at receptors on gastric parietal cells, results in decreased acid secretion
available agents for H2RA
famotidine
MOA of PPI
Irreversibly block gastric H/K/ATPase pumps
selectively inhibit H+ secretions
PPI dosing
1 mg/kg/day QD
4 main pathways that an trigger vomiting
Bloodborne toxins (medications)
Motion (vestibular pathway)
Mechanical (vagal))
Emotion (fear, anxiety)
Fecal impaction
Large fecal mass that is unlikely to be passed on command
Encopresis definition
Fecal incontinence
Normal stooling patters in infants, toddlers and 4 yo
Infants- 3-4 stools per day
toddler- 2-3 stools per day
4 yo adult patterns
treatment of constipation in infants
1st line- glycerin suppositories (do not use for more than 3 days and has an onset of 30 mins)
Treatment of constipation in children
1 (dispemaction).
Oral PEG (miralax)
1-1.5 g/kg/day x 3-6 days
- Maintainence
PEG (miralax)
If no stool on mainatinence therapy, use Stimulants (senna, bisacodyl)
Chronic diarrhea v diarrhea
Chronic is when lasting for more than 14 days
Diarrhea is 3 or more loose stools per day
4 major categories of diarrhea in children
Secretory
osmotic
excretory
altered motility
