Pediatric Pearls

Question 1

baby weight at 6 months / 12 months of age

Answer 1

double / triple the birth weight

Question 2

contraindications to breast feeding

Answer 2

HIV, 
CMV and HSV if lesions on the breast
acute maternal disease if infant does not have the disease (TB, sepsis)
breast cancer
substance abuse
some drugs
NOT MASTITIS (helps mastitis)

Question 3

supplements for baby

Answer 3

iron at 4-6 months
no water
fluoride
vitamin k given at birth (usually produced by gut bugs) - IM
**if on goats milk, baby needs Folate
** don’t use cows milk (renal problems, iron not as available) under 1 year

Question 4

feeding

Answer 4

4 months - iron fortified cereal
don’t give honey under 1 year
avoid egg whites, citrus, nuts

Question 5

suddenly stops growing - cuts across chart

Answer 5

acquired hypothyroidism

Question 6

vitamin deficiencies for 
A
B1
Niacin
C
D

Answer 6

A - night blindness, skin problem
Thiamine (b1) beriberi (neuritis, heart failure , encephalophy)
Niacin - pellegra (diarrhea, dermatitis worse on sun exposed skin, dementia, death)
C - skurvy (limies, pseudoparalysis, scorbutic rosary, mucous membrane hemorrhage
D - type of rickets (tetany, bowing of legs)

Question 7

Development Milestones

Answer 7

newborn - turn head when on stomach, rubs nose on surface, prefers face 9 to 13 inch, floppy on ventral suspension

one month - clears nose when turning head when on stomach, ventral suspension for a little bit

two month - clears head and check when turning head, smiles, coos, attends to voice

three months - extends arms when on stomach, head lifted above plain of back, reaching towards objects, less head lag

four months - cries if you stop playing them, hands to midline, holds head up, sits with truncal support, roll over from stomach to back

six months - rolls over both ways, may creep and craw, sits with pelvic support (rounded back), prefers the mom

nine months - sits by itself, no support, may walk with hand held, pincer grasp, peek a boo, “daa daa”

one year - cruising, may stand, walks with one hand held, releasing things to you, may start using words, adjust position on dressing

15 months - three cube tower, walking on own, indicates wants by pointing

18 months - four cube tower, running, walks down stairs with held hand, feeds self, 10 words, “No”, body parts

24 months - seven cube tower, jumps in place, listens to stories, handles spoon, helps to address, 2 word sentences

30 months - walking up stairs alternating feet, 9 cube tower, “I”, put things away

36 months - downstairs alternating feet, knows sex, knows age “free years old”

four years - four sides (square) four objects

over five years old - potty trained

Question 8

immunizations

Answer 8

Live, attenuated:
MMR (measles, mumps, rubella)
Varicella
Nasal influenza

Inactivated:
DTaP
Hepatitis B
Hepatitis A
Hib conjugate
Parenteral influeza
meningococcal
pneumococcal
rabies

live virus vaccines given on different days should be a month apart (if missed dates)

if unknown or unreliable history, assume no immunizations

** if person has received a gamma globulin for any reason, you must wait 3 months before giving live virus vaccine

• no contraindications for minor illness, delay for moderate to severe for illness (high fever, pneumonia)

no egg in MMR, but influenza and yellow fever DO have egg, don’t use in egg allergy

• no live vaccines in pregnancy or immunocompromised (even parent) except MMR if not severely immunocompromised
• DTap fever may go to 105, above this don’t give again
• five doses, except 4 doses if 4th dose after 4th birthday
• DTap once, then booster, then tetanus every 10 years, and if > 5 years in dirty wound
• pertussis
• inactivated polio only one used , four doses by 4 - 6 years
• heamophilus influenza type b vaccine , disease does not confer immunity, don’t give after 5 years
• pneumococcal vaccine -
• MMR must be repeated if born after 1957, side effects appear 1 - 2 weeks later
• hepatitis A for everyone
• meningococcal conjugated give at 11 years of age, college freshmen in dormitories, barracks, a splenic
• influeza, every year for everyone over 6 months old
• papiloma vaccine nine years old

Question 9

Asthma treatment

Answer 9

Mild Intermittent - 2/week day >2 mo night - inhaled steroids, b-agonist for breakthrough

Moderate Persistant - Daily symptoms - inhaled steroids, long acting b-agnonist, short acting b-agonist for breakthrough

Severe Persistant - Continual frequent, high-dose inhaled steroid, long-acting b agonist, short-acting B agonist, systemic steroids

Question 10

Wiskott-Aldrich syndrome

Answer 10

X-linked 
Low but not absent T cell function
Eczema 
Thrombocytopenia with deceive platelets
Petechia 
Draining ears 
Palpable lymph tissue 
Low igm

Question 11

Brutons

Answer 11

X linked
No lymph nodes
No immunoglobulins

Question 12

Chronic granulomatous disease

Answer 12

Umbilical chord takes long to detach after birth
Nitrous blue dye
Best is dihydrorhodamine dye 
Rx is bone marrow transplant 
Make sure cover staph aureus