Pediatric Conditions

Question 1

Age Classifications

Answer 1

• Neonate: 0-28 days
• Infant: 1 month - 12 months
• Toddler: 1-2 years
• Child: 2-12 years
• Adolescent: 13-18 years

Question 2

Critical Fever Temperatures by Age

Answer 2

• <3 months => temperature 100.4 F or 38 C (rectal)
• 3-6 months => 101 F or 38.3 C (rectal)
• > 6 mo => 103 F or 39.4 C (rectal)

Question 3

Apgar Scoring

Answer 3

• Assesses newborn condition
• Lower scores require more medical attention: healthy is 7-10
• Often immature lungs or heart are causing the low scores

Question 4

PDA

Answer 4

• Patent ductus arteriosus
• Opening between aorta and pulmonary artery doesn’t close naturally postpartum
• NSAIDS, like IV indomethacin, can help PDA close

Question 5

PPHN

Answer 5

• Persistent pulmonary HTN of newborn

- May be linked to SSRI in utero exposure

Question 6

RDS

Answer 6

• Respiratory distress syndrome
• Deficiency of surfactant since lungs aren’t fully developed
• Most babies born <35 weeks will receive surfactant
• Names of these drugs tend to have “surf” or “actant” in the name (EX: Curosurf or Infasurf)

Question 7

Pain/Fever in < 12 Mo

Answer 7

• No ASA or salicylate due to Reye’s syndrome risk (occurs when recovering from viral infection); not recommended for any <16 yo
• APAP infant drops and suspension have same, standardized concentration (160 mg/5 mL)
• Avoid ibuprofen when <6 mo due to nephrotoxicity
• Ibuprofen also has overdose risk due to different products having different dosage strengths

Question 8

Nasal Decongestion in <12 Mo

Answer 8

• Cool-mist humidifier near bed can help reduce congestion
• Gentle suction with saline drops or spray can also help loosen mucus
• No OTC cough/cold medications in kids < 2 yo per FDA (<4 on most package labeling)

Question 9

Constipation in <12 Mo

Answer 9

• Miralax (PEG 3350) is recommended for intermittent constipation
• Prunes or pears can also be helpful
• OTC glycerin suppositories can also provide quick relief

Question 10

Children’s Tylenol

Answer 10

• APAP
• Dosed at 10-15 mg/kg/dose Q4-6h (max of 75 mg/kg/d)
• Same concentrations: 160 mg/5 mL

Question 11

Infants’ Advil Drops and Others

Answer 11

• Ibuprofen
• Dosed at 5-10 mg/kg/dose Q6-8h (max of 40 mg/kg/d)
• Different concentrations for drops vs suspensions

Question 12

Bacterial Meningitis

Answer 12

• Treatment based on age range due to likely pathogens
• Classic sxs tend to be absent, look for nuchal rigidity (inability to bend neck)
• Definitive diagnosis made with lumbar puncture

Question 13

Ceftriaxone in Neonates

Answer 13

• AVOID!
• Displaces bilirubin and can induce brain damage (kernicterus)
• Ceftriaxone and calcium-containing solutions can also precipitate and cause embolism/death

Question 14

Bacterial Meningitis Tx in <1 Mo

Answer 14

• GBS is most common

- Empiric treatment is usually ampicillin PLUS cefotaxime OR gentamicin (aminoglycoside)

Question 15

RSV

Answer 15

• Respiratory Synctial Virus
• Has infected nearly all kids by the age of 2
• Can be deadly in premature babies and neonates
• Sxs: bronchiolitis (swelling and mucus build up in bronchioles)
• Main treatment is supportive
• IF patient has severe infection with underlying compromising condition, can potentially use inhaled ribavirin (Virazole)

Question 16

Synagis

Answer 16

• Palivizumab
• Humanized monoclonal antibody used to prevent serious RSV infections in high-risk kids
• Used for premature infants with select medical conditions during RSV season (later fall => early spring)
• Dosed monthly, IM, in anterolateral thigh muscle
• Max of 5 doses/season

Question 17

Conditions to Receive Palivizumab

Answer 17

• Premature infants born < 29 weeks
• Premature infants born with chronic lung disease
• Infants < 12 mo with certain heart conditions

Question 18

Croup

Answer 18

• Viral infection that causes inflammation in upper airway
• Hallmark signs: inspiratory stridor (high-pitched breathing sound), barking cough, and hoarseness
• Most common in <6 yo

Question 19

Croup Tx

Answer 19

• Systemic steroids (dexamethasone 0.6 mg/kg) is a mainstay in all levels of severity
• For mod-severe, inpatient cases, nebulized, racemic Epi is also administered PRN
• Epi is an adrenergic agonist that causes bronchodilation

Question 20

Nocturnal Enuresis/Tx

Answer 20

• Bed wetting
• 1st line of treatment = positive reinforcement, daytime voiding patterns, and normal hydration patterns
• If behavioral methods don’t result in dryness, then alarm therapy +/- drugs used
• Drug of choice = desmopressin, synthetic analog of ADH

Question 21

DDAVP

Answer 21

• Desmopressin
• Only preferred agent for enuresis
• Formulations: tablets (used for bed wetting), nasal spray, and injection
• Dose: 0.2 mg PO QHS
• CI: Hyponatremia
• SE: HA

Question 22

CI Meds in Pediatrics

Answer 22

• Codeine < 12 yo
• Tramadol < 12 yo
• Promethazine < 2 yo
• Ceftriaxone in neonates

Question 23

Non-recommended Meds in Pediatrics

Answer 23

• ASA in kids/teens
• Quinolones
• Tetracyclines < 8 yo
• OTC teething meds with benzocaine < 2 yo
• OTC cough/cold products < 2 yo (FDA)

Question 24

Measles

Answer 24

• Classic sxs: white sports on inside of cheeks (koplik)
• Maculopapular rash
• Airborne disease

Question 25

Mumps

Answer 25

• Swollen salivary glands

- AKA Parotitis