Pediatric Conditions Flashcards
Neonate age range
0-28 days
Infant age range
1 month - 12 months
Child age range
1 year to 12 years
Adolescent age range
13-18 years
At what temperature should a child
temperature of 100.4 F (rectal)
At what temperature should a child 3-6 months old be referred for urgent care
101 F (rectal)
At what temperature should a child >6 months old be referred for urgent care
103 F (rectal)
After how long of a cough/cold that worsens or does not improve should a child be referred for urgent care
several days
after how long of unusual, severe, or persistent pain should a child be referred for urgent care
several hours
Signs of bacterial meningitis in neonates
bulging fontanelles, nuchal rigidity, nonspecific symptoms
Common bacterial pathogens in bacterial meningitis for
Streptococcus agalactiae (Group B strep), E. coli, Listeria, Klebsiella
Empiric antibiotic treatment of bacterial meningitis in those
Ampicillin + Cefotaxime or Ampicillin + Aminoglycoside (Gentamicin)
Why is ceftriaxone avoided in neonates
ceftriaxone displaces bilirubin from albumin and can cause bilirubin induced brain damage (kernicterus)
Common bacterial pathogens in bacterial meningitis for 1-23 months of age
Streptococcus pneumoniae, Neisseria meningitidis, S. agalactiae, Haemophilus influenza, E. coli
Empiric antibiotic treatment of bacterial meningitis for patients 1-23 months of age
Vancomycin + 3rd generation cephalosporin (ceftriaxone or cefotaxime)
Common bacterial pathogens in bacterial meningitis for 2+ years of age
N. meningitidis, S. pneumoniae
Empiric treatment of bacterial meningitis for 2+ years of age
Vancomycin + 3rd generation cephalosporin (Ceftriaxone or cefotaxime)
Symptoms of RSV
low grade fever, cough, dyspnea, and cyanosis
Palivizumab brand name
Synagis
Palivizumab indication
prevention of high risk lower respiratory tract disease caused by RSV in high risk children
Palivizumab mechanism/class
humanized monoclonal antibody
When is Synagis (palivizumab) recommended
RSV season (late fall - early spring) for infants born before 29 weeks gestation and younger than 12 months or infants with chronic illness (congential heart disease or chronic lung disease)
Synagis dosing
15 mg/kg IM (anterolateral thigh muscle) per dose - monthly - max 5 doses per season
CROUP symptoms
inspiratory stridor, barking cough, hoarseness
treatment for mild, moderate, and severe croup
steroid (dexamethasone) and nebulized racemic ephinephrine via neb (use L-epinephrine if racemic not available)
dexamethasone dosing for croup
0.6 mg/kg x 1 PO/IM/IV - max 16 mg/dose
dosing of racemic epinephrine for croup
0.05-0.1 ml/kg (max 0.5 ml) diluted in 2 ml NS Q 20 minutes PRN
dosing of L-epinephrine for croup
0.5 ml/kg of 1:1000 solution (max 5 ml) diluted in NS, can repeat Q 20 minutes PRN
Warnings for epinephrine
caution with cardiovascular disease, cerebrovascular disease, thyroid disease, diabetes (increase BG), extravasation (IV)
Side effects of epinephrine
increased BP, HR, anxiety, arrhythmia
Behavioral approaches to nocturnal enuresis
positive reinforcement, normal daytime voiding pattern, normal bowel pattern, normal hydration pattern
First line treatment for nocturnal enuresis
behavioral methods
Length of an adequate trial of behavioral approaches for nocturnal enuresis
up to 3 months
Drug treatment for nocturnal enuresis
Desmopressin
Desmopressin MOA
synthetic analog of antidiuretic hormone leading to decreased nocturnal urine production
DDAVP dosing
0.2 mg PO HS up to 0.6 mg max
DDAVP contraindications
hyponatremia or history of hyponatremia, CrCl
DDAVP side effects
HA, fatigue, possible hyponatremia due to water retention
DDAVP counseling notes
limit fluid intake 1 hour before dose until the next morning
OTC treatment for intestinal gas in children
simethicone drops - mild if any benefit, safe to use. symptoms will dissipate at 6-8 months of age
OTC treatment for nasal congestion in children
car seat - sitting upright, cool mist humidifier, steamy bathroom, suctioning with saline drops or spray
At what age does FDA say not to use OTC cough and cold meds in children
At what age does the AAP say not to use OTC cough and cold meds in children
Ibuprofen should be avoided at what age and why
OTC treatment of constipation in children
pediatric glycerin suppositories or PEG (miralax)
Simethicone dosing for infants
20 mg, 1-4 times/day PRN
Simethicone counseling notes
Take after meals. shake before using. Can be mixed with water, formula or other liquids.
Dosing of acetaminophen in infants
10-15 mg/kg/dose Q4-6H (max 75 mg/kg/day)
Dosing of ibuprofen in infants
5-10 mg/kg/dose Q6-8H (max 40 mg/kg/day)
Ibuprofen counseling notes for infants
caution about nausea, drop strength 50 mg/1.25mL
Glycerin suppository dosing for infants
1 pediatric suppository. insert high into the rectum. retain for ~15 minutes
Miralax dosing for infants
> or = 6 monhts: 0.2-1 gram/kg (max 17 grams). Dissolve in a least 4 oz of water or beverage.
Why are quinolones not used in pediatrics and exceptions
possibility of adverse musculoskeletal effects - exceptions: anthrax, cystic fibrosis, or MDR organisms
Why are tetracyclines not used in pediatrics and exceptions
not used
Why is promethazine not used in children?
Contraindicated
Why is codeine not used in pediatrics?
Some children are rapid metabolizers of CYP2D6 - leading to excess conversion to morphine and respiratory depression. Boxed warning for tonsillectomy and adenoidectomy.
What are Koplick spots
small white spots in the inside of the cheeks appearing 2-5 days prior to measles rash
Symptoms of measles
koplick spots, maculopapular rash, fever, malaise, cough, rhinitis, conjunctivitis
Symptoms of mumps
swollen salivary glands, fever, headache, myalgia, fatgue, loss of appetite - 50% have mild/no symptoms
Symptoms of rubella
Fever, rash, swollen glands, cold-like symptoms, aching joints, birth defects if contracted in pregnancy, up to 50% have mild/no symptoms
Symptoms of polio
Fever, fatigue, sore throat, nausea, headache, abdominal pain, nerve damage, post-polio syndrome - progressive weakness and cognitive issues
Symptoms of pertusiss
sudden cough outbursts, whoooping cough, fever, rhinitis, bluish skin, vomiting, fatigue, respiratory failure, death
Symptoms of chicken pox
itchy rash(starting on head, trunk, then arms and legs; starts as sores, blisters, bursting to crusts) fever malaise
