Pediatrics Flashcards
Treatment for tinea capitus
- 1st Line: Oral griseofulvin
- topical therapy of 2.5% selenium sulfide or ketoconazole shampoo twice weekly suppresses viable spores
Tinea pedis
- mc org
Trichophyton rubrum
Tinea pedis
- treatment
Topical antifungals
Tinea corporis
- mc org
Trichophyton rubrum
Tinea corporis
- treatment
- Topical azole antifungals (1% clotrimazole, 2% ketoconazole)
- 1% terbinafine cream applied twice daily for 2–4 weeks
Tinea versicolor
- org
Malassezia furfur
Tinea versicolor
- treatment
selenium sulfide 2.5% applied to affected skin for 10 minutes.
Do hives blanch?
Yes
Darier’s Sign
localized urticaria appearing where the skin is rubbed
Darier’s Sign
localized urticaria appearing where the skin is rubbed
Epinephrine treatment of anaphylaxis
- Dose adults
- Dose peds
- IM dilution
- IV dilution
- Adults 0.3–0.5 mg
- Peds 0.01 mg/kg SC/IV
- IM is 1:1,000 dilution
- IV is 1:10,000
Name for genital warts
Condyloma acuminatum
Name for genital warts
Condyloma acuminatum
Acute vs. chronic otitis media
- acute < 3 weeks
- chronic > 3 months
Definition of recurrent otitis media
3 episodes in 6 months
or
4 episodes in 12 months
with clearing between episodes
Chronic OM
- Clear serous fluid in the middle ear without signs or symptoms of ear infection.
- May have hearing loss, may be asymptomatic, does not require antibiotics.
- pseudomonas, s. aureus
Acute otitis media
- treatment
- First line: Amoxicillin x 10-14 days
- Cefixime in children
- Augmentin is 2nd line
- If PCN allergic give Azithromycin, Erythromycin or Bactrim
MCC epiglottitis
H. influenzae type B (Hib)
MCC epiglottitis
H. influenzae type B (Hib)
Epiglottitis
- xray sign
thumbprint sign
Epiglottitis
- treatment
- Secure airway: anesthesiology and prepare to establish airway, transfer to OR to perform exam, tracheostomy if necessary to maintain airway
- Admit for observation, humidified O2, IV antibiotics (ceftriaxone + clindamycin), and IV corticosteroids
Epistaxis: anterior bleed
- MC location
Kiesselbach’s Plexus
Epistaxis: posterior bleed
- MC location
- Woodruff’s Plexus: sphenopalatine artery
Epistaxis: anterior bleed
- treatment
- Direct pressure at least 10-15 minutes, seated leaning forward
- Short-acting topical decongestants: oxymetazoline/Afrin, phenylephrine, cocaine
- Anterior nasal packing + antibiotics
Epistaxis: posterior bleed
- treatment
- Posterior balloon
- Must be admitted to the hospital and prompt consultation with an otolaryngologist is indicated
Recurrent epistaxis
- workup
Must rule out hypertension or hypercoagulable disorder
Antiviral for influenza
zanamivir and oseltamivir
Treatment for pinworms
mebendazole, albendazole, pyrantel
- single dose, repeat 2-4 weeks
- hand washing
- wash bedsheets
Erythema infectiosum
- causative org
parvovirus B19
hand foot and mouth
- causative org
coxsackie virus
Roseola
- causative org
HHV 6 or 7
Roseola
- clinical presentation
- fever, resolves before rash appears
- pink, macular rash, blanchable
Pneumonia MCC
<1
<2
young adults/college
- RSV
- parainfluenza virus
- mycoplasma pneumoniae, chlamydia pneumoniae
What respiratory condition should bulbous myringitis make you think of?
mycoplasma pneumoniae pnuemonia
outpatient CAP treatment
- macrolide (clarithromycin or azithromycin)
- doxycycline
bronchiolitis
- management
- supportive: ensure oxygenation and hydration
- RSV: consider hospitalization and admin of ribavirin, esp if high risk pt (premie, underlying conditions, severely ill)
- nebulizer albuterol, IV fluids, antipyretics, chest physiotherapy, humidified O2
croup
- aka
laryngotracheobronchitis
croup
- MCC causative orgs
- parainfluenza types 1 and 2
- RSV
- adenovirus
- influenza
- rhinovirus
croup
- clinical findings
- harsh, barking, seal-like cough
- inspiratory stridor
- hoarseness
- aphonia
- low-grade fever
- rhinorrhea
croup
- treatment
Mild: hydration, cool humidified air, dexamethasone
Moderate: IM/PO dexamethasone, supportive, +/- nebulized epinephrine
Severe: dexamethasone, nebulized epinephrine, hospitalize (O2 < 92%)
how should asthma spirometry respond to albulterol
FEV1 or FVC increase > 12%
Asthma
- CXR
- ABG
- hyperinflation
- hypocarbia: have increased respiratory rate. If normal or high, may be sign of impending respiratory failure
Intermittent Asthma
- daytime sx / SABA use
- nighttime sx
- interference with activities
- FEV1
- ≤ 2 days/week
- ≤ 2 times a month
- no interference
- FEV1 >80% predicted
Mild persistent asthma
- daytime sx / SABA use
- nighttime sx
- interference with activities
- FEV1
- > 2 days/week, not daily
- 3-4 times a month
- minor
- FEV1 >80% predicted
moderate persistent asthma
- daytime sx / SABA use
- nighttime sx
- interference with activities
- FEV1
- Daily
- > once a week, not nightly
- Some interference
- FEV1 60-80% predicted
severe persistent asthma
- daytime sx / SABA use
- nighttime sx
- interference with activities
- FEV1
- multiple times daily
- daily
- extremely limited
- FEV1 < 60% predicted
Asthma therapy steps
Step 1: SABA
*steps 2-6 SABA plus…
Step 2: Low dose ICS
Step 3: medium dose ICS OR low dose ICS + LABA/montelukast/theophylline
Step 4: medium dose ICS + LABA/montelukast/theophylline
Step 5: high dose ICS + LABA +/- omelizumab
Step 6: high dose ICS + LABA + oral steroid =/- omelizumab
Cystic fibrosis
- genetics
- overview
- autosomal recessive
- abnl production of mucus by almost all exocrine glands = obstruction
Cystic fibrosis
- clinical
- chronic lung dz, bronchiectasis, pancreatitis, infertility
- sx: cough, sputum, dec exercise tolerance, sinus pain, purulent nasal dc, steatorrhea, diarrhea, abd pain
- signs: clubbing of fingers, anteroposterior chest diameter inc, apical crackles
Cystic fibrosis
- dx studies
- ABG: hypoxemia and possible compensated respiratory acidosis
- PFT: mixed obstructive and restrictive
- CXR: hyperinflation, peribronchial cuffing, mucous plugging, bronchiectasis, inc insterstitial markings, etc.
- GS: sweat chloride test (>60 mEq/L) on two diff days, then DNA testing for definitive evidence
Hyaline membrane disease
- aka
respiratory distress syndrome, RDS
hyaline membrane disease/RDS
- general
- MC cause resp distress in preterm infant
- deficiency of surfactant
hyaline membrane disease/RDS
- dx
- CXR: air bronchograms, diffuse bilateral atelectasis causing a ground-glass appearance, doming of the diaphragm
hyaline membrane disease/RDS
- management
- synchronized intermittent ventilation
- exogenous surfactants
Cyanotic heart defect
right-to-left shunt (skipping the lungs)
Four cyanotic heart defects
- Tetralogy of Fallot
- Pulmonary atresia
- Hypoplastic left heart
- Transposition of the great arteries
Tetralogy of fallot
- define anomoly
- ventricular septal defect
- aortic origination over defect (aortic override)
- right ventricular outflow obstruction
- right ventricular hypertrophy
Tetralogy of fallot
- murmur
crescendo-decrescendo
holosytolic
LSB
radiates to back
Tetralogy of fallot
- physical findings
cyanosis
clubbing
increased RV impulse at LLSB
Loud S2
Tetralogy of fallot
- clinical information
- polycythemia usually present
- tet spells: extreme cyanosis, hyperpnea, agitation (medical emergency)
noncyanotic congenital heart anomalies (5)
- atrial septal defect
- ventricular septal defect
- atrioventricular septal defect
- patient ductus arteriosus
- coarctation of the aorta
Atrial septal defect
- MC subtype
osmium secundum
Atrial septal defect
- murmur
- systolic ejection murmur at 2nd LICS
- early to middle systolic rumble
Atrial septal defect
- physical findings
- failure to thrive
- fatigue
- RV heave
- wide fixed split S2
Ventricular septal defect
- three types
- perimembranous (MC)
- muscular
- outlet openings btwn ventricles
Ventricular septal defect
- murmur
systolic murmur at LLSB
Ventricular septal defect
- physical findings
asx to signs of CHF
Patent Ductus Arteriosus
- describe
- failed or delayed closure of ductus arteriosus between pulmonary artery and aorta - allows placental gas exchange during fetal state, bypasses the lungs
- sx treatment generally not indicated
Patent Ductus Arteriosus
- treatment
IV indomethacin (reduction of prostaglandins)
Patent Ductus Arteriosus
- murmur
continuous (machine like) murmur
Patent Ductus Arteriosus
- physical findings
- wide pulse pressure
- hyper dynamic apical pulse
Coarctation of the aorta
- describe
narrowed proximal thoracic aorta
Coarctation of the aorta
- murmur
- systolic, LUSB/left intrascapular area
- may be continuous
Coarctation of the aorta
- physical findings
- infants: CHF
- older: systolic hypertension or underdeveloped lower extremities
- difference between UE and LE blood pressure is pathognomonic
Treatment for cyanotic defects prior to surgical correction
- if PDA: prostaglandins to maintain
Hypertrophic cardiomyopathy
- presentation
- dyspnea and angina
- syncope and arrhythmias common
- asx to sudden death
Hypertrophic cardiomyopathy
- dx
- EKG: nonspecific ST- T-wave changes, exaggerated septal Q wave, LVH
- Echo: key to dx. LVH, asymmetric septal hypertrophy, small LV, diastolic dysfunction
Hypertrophic cardiomyopathy
- management
- BB or CCB, disopyramide
- sx or nonsx ablation of hypertrophic septum
- dual-chamber pacing, implantable defibrillators, mitral valve replacement
Rheumatic fever
- describe
2-3 weeks following beta-hemolytic strep pharyngitis
- ages 5-15 MC
- self-limited to progressive valve deformity
Rheumatic fever
- valves affected
- MC: mitral valve
- also aortic valve
Rheumatic fever
- Jones criteria
2 major
or
1 major + 2 minor
Rheumatic fever
- Major jones criteria
- carditis
- erythema marginatum
- subcutaneous nodules
- chorea
- polyarthritis
Rheumatic fever
- minor jones criteria
- fever
- polyarthralgias
- reversible prolonged PR interval
- rapid ESR
- CRP
Rheumatic fever
- management
- bed rest
- IM penicillin (erythromycin if PCN allergic)
- antipyretics and steroids to reduce joint sx
Rheumatic fever
- prevention
early tx of strep pharyngitis
Kawasaki dz
- aka
- etiology
- aka mucocutaneous lymph node syndrome
- etiology unknown, suspect virus
Kawasaki dz
- presentation
- fever > 5 D
AND 1+: - conjunctivitis
- lip crack/fissure, strawberry tongue, inflammation oral mucosa
- cervical lymphadenopathy
- polymorphous exanthem
- red/swelling of hands and feet, subsequent desquamation
Kawasaki dz
- cardiac involvment
- worrisome
- myocarditis, pericarditis, valvular heart disease, coronary arteritis, aneurysms all possible
Kawasaki dz
- Testing for all pts
- 2D echo or angiography to r/o heart involvement
Kawasaki dz
- treatment
- IV immunoglobulin, high dose ASA
- early treatment -> lower chance cardiac involvement
- cardiac involvement: long term ASA and annual f/u
Cause of intussusception
- child
- adult
- follows URI
- neoplasm
(proximal goes into distal portion)
Intussusception
- dx
barium or air enema
- diagnostic and therapeutic
- if not, then surgery
Vitamin A deficiency
- function
- s/sx
- vision, epithelial cell maturity, infection resistance, antioxidant
- night blindness, dry skin, squamous metaplasia, bitot’s spots
Vitamin C deficiency
- function
- s/sx
- collagen synthesis, hormone function, nt synthesis
- scurvy: hyperkeratosis, hemorrhage, hematologic (3 Hs)
Vitamin D deficiency
- function
- s/sx
- calcium regulation, cell differentiation
- rickets, osteomalacia
Niacin deficiency
- function
- s/sx
- energy, fat metabolism
- Pellagra: diarrhea, dementia, dermatitis (3 Ds)
eosinophilic esophagitis
- associated with what
- clinical
- atopic disease
- dysphagia, +- reflux or feeding difficulties in children
eosinophilic esophagitis
- dx
- management
- endoscopy: normal +- multiple corrugated rings +- white exudate
- remove foods that incite allergic response, inhaled topical corticosteroids
Crigler-Najjar syndrome
- Type 1
no UGT activity = no conversion of indirect to direct bilirubin
- neonatal jaundice with severe progression in the 2nd week, leads to kernicterus
- normal LFTs, indirect bilirubin 20-50 mg/dL
- Tx: phototherapy, plasmapheresis, liver transplant
Duodenal atresia
- clinical
- XR findings
- polyhydramnios in pregnancy, inc risk in Downs
- intestinal obstruction shortly after birth, abd distention, bilious vomiting
- double-bubble sign
Duodenal atresia
- management
- decompression fo GI tract
- electrolyte and fluid replacement
- duodenoduodenostomy: repair or anastomosis
what is the only childhood exanthem that starts on the trunk?
roseola
when do annual blood pressure readings start (age)
3 yo
when should intermittent alternating strabismus stop (age)?
6 months
when does the rooting reflex stop?
2-3 months
by what age should posterior fontanelle close?
2 months (usually closed at birth)
What drug is used to treat Lyme disease in kid <8 yo
amoxicillin
What level of bilirubin is suspicious for kernicterus?
20-25 mg/dL
** encephalopathy
Hyperbilirubinemia
< 24 hours old
>24 hours old
< 24 is more worriesome for non-physiologic causes (ABO, Rh isoimmunization, etc.)
What maternal blood types can lead to hyperbilirubinemia in the infant?
- O
- Rh neg
Down syndrome
- dx sx
- hypotonia
- poor Moro reflex
- hypermobility of joints
- flattened facies and occiput
- excess posterior neck skin
- anomalous auricles
- upward-slanting palpebral fissures
- pelvic dysplasia
- dysplasia of middle phalanx of 5th finger
- Simian crease
Down syndrome
- common congenital defect
ASD
what should always be considered in neonate presenting with fever
herpes simplex infection
herpes simplex meningitis neuro signs
seizures
lethargy
poor feedings
Test of choice to confirm CNS herpes simplex
PCR of cerebrospinal fluid
Four signs of neonatal herpes simplex infection
- keratoconjunctivitis
- vesicular skin rash
- seizure meningitis
- sepsis
Duodenal atresia
- s/sx
- xray findings
- management
- associated with what
- bilious vomiting w/o abd distention within first days of life
- double bubble sign on XR
- NG or OG decompression, IVF until surgery
- Down’s syndrome
What RA finding is rarely found in juvenile idiopathic arthritis
rheumatoid factors
What are the three types of juvenile idiopathic arthritis?
- systemic juvenile idiopathic arthritis
- Oligoarticular juvenile arthritis
- Polyarticular juvenile arthritis
Major clinical manifestation of juvenile idiopathic arthritis
persistent joint swelling that may lead to deformity
What is the age range for febrile seizures
6 months to 5 years
Definition of simple febrile seizure
- tonic clonic
- less <15 min
- only once w/in a febrile episode
Simple febrile seizure RF
- elevated fever
- viral infection
- fam hx
- recent immunization
Treatment for recurrent febrile seizures
- if >5 min, diazepam gel or suppository (one dose)
Presentation of CF
- chronic sinopulmonary disease: persistent infection with CF pathogens, chronic cough/sputum, chest xr abnl, airway obstruction, nasal polyps, digital clubbing
- GI and nutritional abnl: meconium ileum, distal GI obstruction, rectal prolapse, pancreatic insufficiency, DM, chronic hepatic dz, FTT, etc.
- salt loss syndromes
- male urogenital abnl
CF
- management
- meds to clear resp secretions (DNase and inhaled hypertonic saline)
- chest physiotherapy
- anti-inflammatories
- nutritional optimization
- exercise as tolerated
- *anti-pseudomonal abx when indicated
what two sugars form lactose
glucose
galactose
Prolonged QT syndrome
- common presentation
syncope
presyncope, torsades de pointes, sudden cardiac death
Prolonged QT syndrome
- QT interval
> 440 milliseconds
Prolonged QT syndrome
- 1st line treatment
beta blockers - blunt paradoxical effects of catecholamine on QT interval
concerning sign for pathologic murmur
widely split and fixed S2
mastoiditis
- s/sx
- anteverted ear
- pain with palp of post auricular area
Mastoiditis
- dx
CT - coalescence of air cells, subperiosteal abscess
Mastoiditis
- management
- sx
- prolonged abx (initial vanc and ceftriaxone)
- possible tympanostomy tubes
Effects of fetal coarctation of the aorta in utero
blood flow through PDA bypasses the coarctation, resulting in hemodynamic stability
what electrolyte disorder is commonly seen in hyperparathyroidism
hypercalcemia
What two meds are known to exacerbate hypercalcemia
- thiazide diuretics
- lithium
Lead testing
- screening
- definitive test
- capillary blood for screening: easier to get but easily contaminated yielding false positives
- venous blood: confirms dx and guides management based on levels
common lead poisoning sx
- HA
- joint pain
- constipation
Lead poisoning
- management
- education
- remove lead
- oral succimer
- IV EDTA
- > 45 mcg/dL = chelation
CF dx
- test of choice
- another test
- Sweat chloride test
- Fecal elastase - elevated: indicates malfunction of exocrine pancreas
Perforated TM
- management
- min hearing loss, no vestibular sx
- ofloxacin drops
- keep ear dr
- f/u primary care in 4 weeks: audiometry to assess hearing loss and healing of TM
what type of ear drops are ototoxic
gentamicin - only use if positive TM is not perforated
f/u for breech baby with unremarkable exam and no family hx of developmental hip dysplasia
- US of hips at 4-6 weeks
developmental hip dysplasia
- RF
- female
- breech> 34 weeks
- fam history
- tight lower extremity swaddling
developmental hip dysplasia
- testing
- Barlow and Ortolani: subluxation = hip laxity or mild instability
- Galeazzi: unequal height of legs or asymmetrical skin folds
developmental hip dysplasia
- tx for <6 mo
Pavlik harness
Hereditary spherocytosis
- RBCs
biconcave shape
Howell-jolly bodies
Hereditary spherocytosis
- heredity
autosomal dominant
Hereditary spherocytosis
- PE findings
- splenomegaly
- jaundice
- scleral icterus
- microcytic/normocytic anemia
- reticulocytosis
- ** increased MCHC
- Coombs negative
What is cryptorchidism associated with?
low birth weight
prematurity
When do undescended testes usually descend
- by three or four months
- ## after 6 months, rare to descend further
Management of undescended testes after four months
surgical orchiopex
Complications associated with cryptorchidism
testicular torsion
infertility
malignancy
Croup
- Clinical
- URI sx
- barking, seal cough
- stridor
- sx worse at night
- hypoxia UNCOMMON
Croup
- management
- cool, humidified air
- racemic epinephrine
- corticosteroids (dexamethasone)
Acute otitis media
- abx algorithm
1st line: amoxicillin
2nd line: amox-clavulanate (Augmentin)
3rd line: Cefixime, Cefaclor
4th line: Ceftriaxone
Acute otitis media + conjunctivitis
- mc org
H. influenza
Acute otitis media + conjunctivitis
- abx
Augmentin
Non-accidental Trauma
- suspicious fracture (6)
- metaphysical fracture (pathognomonic)
- Rib fx
- skull fx
- scapular fx
- sternal fx
- transverse long bone fx
Injuries suggestive of non-accidental trauma
- bruises and fractures in various stages of healing
- retinal hemorrhage
- cigarette burns
- glove-and-stocking pattern burns
Comedonal acne
- treatment
- topical retinoid
- azelaic acid/salicylic acid
Mild papulopustular and mixed acne
- treatment
- topical antimicrobial (benzoyl peroxide/abx) and topical retinoid
OR - benzoyl peroxide and topical abx
moderate papulopustular and mixed acne
- topical retinoid
- oral abx
- topical benzoyl peroxide
(all)
Severe acne
- topical retinoid AND oral abx AND topical benzoyl peroxide
- isotretinoin monotherapy
Best acne option for pregnant woman
oral erythromycin
what test is recommended for children who present with hearing loss
ophthalmology exam - often seen together
Medication given as pretreatment for chemo (dt non-hodgkin lymphoma)
benzodiazepines help with n/v
Management for child with mild strabismus but no other vision deficits
- observation
- f/u with ophthalmologist q 6 months
Four types of strabismsu
- Esotropia (looks medial)
- Exotropia (looks lateral)
- hypertropia (up)
- hypotropia (down)
Tropia vs. phoria
Tropia: manifest strabismus, evident with both eyes uncovered
Phoria: latent strabismus, evident when one eye is covered
Physiologic anemia
- MC anemia in young infants 6-9 weeks
- decrease in erythropoiesis dt increased tissue oxygenation
- hgb drops from 14 g/dL newborn to 11 g/dL
At what age are hemoglobinopathies generally discovered?
3 and 6 months
- sickle cell and thalassemia
What age is iron deficient anemia usually first seen
not before 6 months
Pertussis
- org
bordetella pertussis
Pertussis
- stages
- catarrhal: coryza, cough, low energy, lacrimation (1-2 weeks). Most contagious
- paroxysmal: paroxysms of cough, inspiratory stridor, associated with cyanosis, apnea, emesis. up to 2 months
- Convalescent phase: sx gradually subside
Pertussis
- infants <4 mo
higher risk of severe illness, mortality
Pertussis
- management
- Azithromycin first line (macrolide)
- Bactrim second line
How to remove insect from ear
- Kill insect: mineral oil, lidocaine, ethanol
2. remove via syringe or alligator forceps
Fanconi anemia
- inheritance
- presentation
- autosomal recessive
- pancytopenia and congenital anomalies (hyper or hypo pigmented skin, cafe-au-lait spots, short stature, upper limb abnl, hypogonadism, skeletal abnl, renal malformations, etc.)
Fanconi anemia
- management
- supportive care
- transfusions and abx for infection
- stem cell transplantation
Nutritional vitamin D deficiency
- phosphate
- calcium
- PTH
- hyperphosphatemia
- hypocalcemia
- elevated PTH
(due to low calcium levels)
Rickets
- MC cause
Vit D deficiency
- inadequate mineralization = widened epiphyseal regions, softening bones = bend
Rickets
- clincial
- softened cranial bones
- widened costochondral junctions
- growth plate widening in wrists and ankles
- FTT
- Weakness
- Seizure
Meckel’s Diverticulum
- describe
- persistence of omphalomesenteric duct beyond fetal development
- contains all layers of small bowel
Meckel’s Diverticulum
- rules of two
- M:F 2:1
- 2% of population
- within 2 feet of ileocecal valve
- 2” in length
- complications usu before age 2
Meckel’s Diverticulum
- Complications
painless GI bleeding or obstruction
Meckel’s Diverticulum
- dx
nuclear medicine scan: 99m technetium pertechnetate
Fetal lung surfactant
- starts production 20 weeks
- gradual increase to 33-36 weeks
- 36+ lrg increase in production
Respiratory Distress Syndrome
- RF
- DM mother
- C-section
- birth asphyxia
Respiratory Distress Syndrome
- decreased risk
- prolonged rupture of membranes
- prenatally admin steroids
Respiratory Distress Syndrome
- clinical features
- tachypnea
- nasal flaring
- exp grunting
- retractions
Respiratory Distress Syndrome
- management
- mechanical ventilation
- exogenous surfactant
Respiratory Distress Syndrome
- prolonged ventilator support at risk for?
bronchopulmonary dysplasia
Acute cystitis peds
- MC pathogen
- Abx
- e. coli
- cephalosporins, augmentin
- bactrim if PCN allergic
Perioral dermatitis
- management
- 1st line: topical metronidazole and erythromycin
- oral tetracycline
- avoid steroids!!
Treatment for neonatal conjunctivitis
- gonorrhea
IV aqueous PCN G
Treatment for neonatal conjunctivitis
- chlamydia
PO erythromycin
Oral candidiasis
- tx
- nystatin
- clovtrimazole troches
- po fluconazole
RSV is what family of virus
paramyxoviridae
Pneumonia
- MCC org neonates (<28 d)
- tx
S. aureus
- ampicillin + gentamicin or ampicillin + cefotaxime
Pneumonia
- MCC org 2wk - 4 mo
- tx
C. trachomatis
- erythromycin, azithromycin, cefotaxime
Pneumonia
- MCC org >6 weeks lobar
- tx
S. pneumoniae
- 1st: amox, clindamycin
- 2nd: ceftriaxone, cefotaxime
Pneumonia
- MCC org atypical 6W to 4Y
- tx
- B. pertussis
- macrolide or clarithromycin
Pneumonia
- MCC org atypical >4Y
- tx
- mycoplasma or chlamydia, influenza
- macrolide, doxy
Pneumonia prevention
vaccination with hib and pneumococcal
What sx is most sensitive and specific to pneumonia in kids? Rate by age group
tachypnea
- <2 months >60
- 2-12 months >50
- 12 mo - 5 Y >40
- > 5 Y >20
Pertussis
- dx
mostly clinical
- Culture and PCR assays
Pertussis
- tx
- supportive care: bronchodilators, steroids, antihistamines, anti-tussive agents
- Macrolide, bactrim 2nd line
SSRIs
- list
Paroxetine Sertraline Fluoxetine citalopram escitalopram
SNRI
- list
duloxetine
venlofaxine
Two SSRI recommended <18 yo
Fluoxetine
Paroxetine
First line med for ADHD
- stimulant: ritalin
Psych treatment for <6 yo
behavioral therapy
Best medication for bulimia purging
fluoxetine (but watch for cardio ADR)
what med has ADR of gingival hyperplasia
phenytoin
US findings in torsion of testicular appendage
blue dot sign
Marfan findings
- pectus excavatum
- wrist and thumb signs (stretchy)
- aortic root dilation and dissection
Ehlers Danlos
- findings that differentiate from Marfan
- skin laxity
- contractures
- skin nodules
- Easy bruising
Other name for mongolian spot
Dermal melanosis
Henoch-Schonlein purpura
- overview
generalized vasculitis of skin, GI, joints, kidney
Henoch-Schonlein purpura
- findings
- palpable purpura: LE and buttocks
- normal platelet count
- colicky abd pain
- intussusception
- heme + stool
- microscopic hematuria, proteinuria, elevated BUN/Cr
- peri-articular disease of knee and ankle
- Most cases resolve within 6 to 8 weeks, with a recurrence rate of up to 33%.
how to confirm dx of appendicitis in pediatrics?
ultrasound: noncompressible, dilated appendix, aperistalsis, target appearance, etc.
Erythroblastosis fetalis
transplacental passage of maternal antibody active against paternal RBC antigens of the infant and is characterized by an increased rate of RBC destruction that leads to anemia and jaundice in newborn infants
First line treatment for urticaria
Second generation antihistamines: cetirizine, loratadine, fexofenadine
necrotizing enterocolitis
- MC neonatal GI emergency
- abdominal XR to dx
- RF: premature
- abd distention, bloody stool, vomiting
- tx: IVF, abx, sx
Shigella
- common complication kids
seizures and high fever
Still’s murmur
- heard with bell at apex or LLSB
- systolic, ejection, soft/vibratory
- grade 1-2/6
- louder supine
- decreased sitting, standing, inspiration
chlamydia trachomatis infant
- two MCC presentation
- conjunctivitis
- pneumonia
chlamydia trachomatis infant
- presentation
- 3-16 weeks of age
- nontoxic and is afebrile, but is tachypneic with a prominent staccato cough
- diffuse rales with few wheezes
- CXR: hyperinflation and diffuse interstitial or patchy infiltrates
- Labs: eosinophilia
- Tx: Azithromycin
Tx for mod to severe croup
steroids
Lyme disease
- two abx used in children
- amoxicillin
- doxy
Acute epiglottis
- MC orgs
- h. flu (non immunized)
- Group A Strep - more common now due to immunization for h. flu
Sickle cell with osteomyelitis
- MCC org
Salmonella spp
** overall increased risk of osteomyelitis
Burn % of body
- head/neck 9%
- upper limbs 9% ea
- trunk 36%
- lower limbs 18% ea
- genitalia 1%
Burn management
- wash with mild soap and water
- cool compress
- water over chemical burn X 20 min
- Acetaminophen, NSAIDs, opioids
- Silver sulfadiazine (silvadine) but not on face
When is silvadine CI
sulfa allergy
pregnant
Parkland formula for burn IVF
(% burn)(4 mL)(kg)
1/2 first 8 hours, 1/2 next 16 hours
Type I allergic reaction
- IgE
- urticaria and angioedema
- immediate
Type II allergic reaction
- cytotoxic
- Ab-mediated
- drug+cytotocix antibody = cell lysis
Type III allergic reaction
- Ab-Ag complex
- vasculitis, serum sickness
- IgG and IgM
Type IV allergic reaction
- delayed, cell mediated
- morbiliform
- erythema multiform
Drug eruption
- management
- Dc drug
- antihistamine oral
- systemic steroids
- IM epinephrine if warranted
Erythema Multiforme
- overview
- Type IV reaction
- MC 20-40 yo
- HSV MC cause, also mycoplasma in children
Erythema Multiforme
- clincal
- target, dull red, vesicle/bullae in middle with pale rim, red halo
- often febrile
Impetigo
- MC org
- 2nd MC org
- staph aureus
- GABHS
Mumps
- org
- clinical
- paramyxovirus
- low grade fever, myalgia, HA –> parotiditis
Mumps
- complications
- orchitis (unilateral)
- oophoritis
- encephalitis
- meningitis
- MCC pancreatitis in children
MMR vaccine
12-15 months and 4-6 years
measles
- org
paramyxovirus
- rubeola
Measles
- complications
- diarrhea
- otitis media
- pneumonia
- encephalitis
Rubella
- org
Togavirus
Rubella
- clinical
“three day rash”
- low grade fever, cough, anorexia, lymphedema
- pink/light-red spotted maculopapular rash on face -> extremities. More rapid spread vs. measles
- transient photosensitivity and joint pain
Rubella
- congenital defects
- sensorineural deafness
- cataracts
- TTP (blueberry rash)
- Mitral regorge
(part of TORCH)
What exanthema is associated with ___ complication in sickle cell / G6PD?
- erythema infectious (Parvovirus B19)
- aplastic crisis risk
Lice
- treatment
- permethrin topical
- head for 10 min
- pubis and corporis 8-10 hours
- only >2 yo
Lichen Planes
- RF
- describe
- Hep C
- purple, polygonal, planar, pruritic papules
- fine scale and irregular borders
Lichen Planes
- management
- topical steroids
- antihistamines
- 2nd line: oral steroids, UVB light, retinoids
Scabies
- management
- permethrin topical neck to feet 8-14 hours, repeat in 1 week
Conjunctivitis: Viral
- MCC
- presentation
- tx
- adenovirus (pool MC source)
- red, itchy
- preauricular lymphadenopathy
- watery discharge
- scanty mucoid discharge
- usu bilateral
- slit lamp: punctate staining
- Tx: supportive, antihistamine
Conjunctivitis: allergic
- presentation
- tx
- cobblestone mucosa
- itching, red, tearing
- stringy dc
+/- chemises - topical antihistamines (H1 blockers), olopatadine, pheniramine/naphazoline
Conjunctivitis: bacterial
- MC org
- presentation
- MC staph aureus, strep pneumo, h. flu
- purulent dc, lid crusting
- no visual change or ciliary injection
Conjunctivitis: bacterial
- tx
- erythromycin, fluoroquinolone, aminoglycoside topical abx
- contacts: FQ/aminoglycoside to cover pseudomonas
MCC org for neonatal conjunctivitis by time
- day 1: chemical from silver nitrate
- day 2-5: gonococcal
- day 5-7: chlamydia
- Day 7-11 HSV
orbital cellulitis
- dx
- tx
- CT (MRI)
- IV abx (vancomycin, clindamycin, cefotaxime)
otitis externa
- tx
- cipro +/- dexamethasone (ok with TM perf)
- neomycin/polytrim +/- steroid (not ok with TM perf)
AOM
- MC org
- S. pneumonia (MC)
- m. cat
- h. flu
AOM with bullae = ?
mycoplasma pneumonia
Weber
- sensorineural
- conductive
- lateralizes to normal ear
- lateralizes to affected ear
Rinne
- sensorineural
- conductive
- AC > BC
- BC > AC
Way to memorize sensorineural
sensoriNeural lateralizes to Normal ear and Normal Rinne
peritonsillar abscess
- progression
tonsillitis > cellulitis > abscess
peritonsillar abscess
- mc org
GABHS, s. aureus, polymicrobial
peritonsillar abscess
- dx
- CT to differentiation from cellulitis
peritonsillar abscess
- management
- abx (ampicillin, clindamycin, PCN, metro)
- aspiration / I&D
Herpes Simplex
- dx
- PCR most sensitive and specific
- Tzanck smear
Pinworms
- tx
- albendazole
- mebendazole
Varicella zoster
- org
HHV-3
Varicella
- presentation
- fever, malaise
- vesicles on an erythematous base (dew drops on a rose petal) in crops
- face and trunk -> extremities
Pertussis
- dx
- PCR nasopharyngeal swab within first 3 weeks of sx (gold standard)
Bronchiolitis
- presentation
- fever
- URI
- progresses to respiratory distress (wheezing, tachypnea, nasal flaring, cyanosis, retractions, +/- rales)
Bronchiolitis
- CXR findings
hyperinflation
peribronchial cuffing
Reye syndrome
- ASA + viral illness
- rash, vomiting, liver damage, encephalopathy
Acute hepatitis AST and ALT
both >500, if viral ALT > AST
Hirschsprung dz congenital RF
Down Syndrome
Hirschsprung
- presentation
- meconium ileus ( no meconium in >48 hrs)
- bilious vomiting
- abd distention
- FTT
- toxic megacolon
Duodenal atresia
- congenital condition RF
- associated with what
- Down syndrome
- polyhydramnios
Jaundice
- physiologic timing
- rises day 3-5
- falls during first week
Jaundice
- indications of pathologic cause
- present within first 24 hours
- persistent 10-14 days
- direct >2
- total >12
Jaundice
- what level is worrisome for kernicterus
> 20
Jaundice
- causes of increased indirect
- premature baby
- breast feeding jaundice
- diseases
Jaundice
- causes of increased direct
- infection
- Dubin-Johnson
- Rotor syndrome
hypertrophic cardiomyopathy
- overview
- hypertrophied septum
2. systolic anterior motion of mitral valve and papillary muscle displacement
hypertrophic cardiomyopathy
- murmur
- harsh, systolic crescendo-decrescendo LLSB
- decreases with increased venous return (preserves outflow)
- increase with decreased venous return (valsalva, sit to stand)
hypertrophic cardiomyopathy
- mgmt
- ICD
- avoid dehydration and exertion
- BB (caution with digoxin, nitrates, diuretics)
VSD
- location
- MC perimembranous
- muscular (swiss cheese)
L to R shunt
VSD
- clinical
- small: asx or mild sx
- moderate: sweating/fatigue, esp during feeding (inc SNS dt reduced CO)
- large: severe sx
- restrictive: retained pressure between ventricles (small)
- non-restrictive: pressure equal between ventricles
VSD
- murmur
- loud, harsh holosystolic LLSB
- signs of CHF
- ## +/- thrill and diastolic rumble at mitral valve due to increased flow
ASD
- mc location
- osmium secundum MC
ASD
- clinical
- usu asx until > 30
- recurrent infections
- dyspnea
- FTT
- fatigue
ASD
- murmur
- systolic ejection crescendo-decrescendo at pulmonic
- wide, split, fixed S2
PDA
- location
descending aorta and pulmonary artery
PDA
- murmur
- continuous machinery murmur at pulmonic
- wide pulse pressure
- bounding peripheral pulse
PDA
- to keep open
- to close
- open: prostaglandin (E2)
- close: indomethacin
Coarctation of the aorta
- location
descending aorta
** associated with bicuspid aortic valve
Coarctation of the aorta
- clinical
- 2 HTN
- bilateral claudication
- FTT
- poor feeding
- incr BP UE
- delayed or weak femoral pulse
Coarctation of the aorta
- murmur
- systolic
- radiates to back/scapula/chest
Coarctation of the aorta
- CXR
- GS dx
- rib notching dt increased collateral circulation
- 3 sign
- GS: angiogram
Coarctation of the aorta
- mgmt
- sx
- balloon angio and stent
- prostaglandins pre-op
Tetralogy of Fallot
- shunt type
MC R to L shunt
Tetralogy of Fallot
- four components
- RV outflow obstruction
- RVH
- VSD (lrg, unrestrictive)
- overriding aorta
Tetralogy of Fallot
- murmur
- harsh, systolic LUSB
- RV heave
Tetralogy of Fallot
- CXR
boot shaped heart
Turner Syndrome
- clinical
- 1 amenorrhea
- early ovulation failure
- delayed 2nd sex characteristics
- short, webbed neck, edema, low hairline, low-set ears, widely spaced nipples
Turner Syndrome
- assoc with what congenital defect
coarctation of the aorta
Simple partial seizure
focal sensory, autonomic, motor sx
- no LOC
complex partial seizure
- aura (sensory, autonomic, motor)
- lip smacking, picking, patting, etc
- yes LOC
Absense seizure
MC childhood seizure
- ethosuximide
Febrile seizure
- simple
- <15 min, tonic-clonic, once in 24 hours
- fever >38
- antipyretics will not prevent
- no anti convulsive tx
- may reoccur
Febrile seizure
- complex
> 38 degrees
15 min or focal or recurs within 24 hours
- phenobarbital, valproic acid
Hep B vaccine schedule
0, 2, 4 months
what vaccines are given at 2, 4, 6 months
- rotavirus
- DTap
- PCV
- Hib
- Polio
when is DTap given
2, 4, 6, 15-18 months
4-6 years
12 years
what vaccines are given 12-15 months and 4-6 years
MMR and varicella
Hep A vaccine schedule
between 12-23 months
6-18 months apart
HPV vaccine schedule
11-26 years for F
11-21 years for M
Meningococcal vaccine schedule
11-12 years
MC org meningitis
- neonate
- older
- listeria
- strep pneumonia, h flu, N. meningitis
LP findings in bacterial meningitis
neutrophils
cell # >1000
dec glucose
inc protein
bacterial meningitis
- tx
IV abx
- ampicillin
+/- cefotaxime
+/- vanc
LP findings ascetic meningitis
- lymphocytes
- cell # <1000
- nl glucose
- inc protein
Panic disorder
- 3 components
- concern for future panic attack
- concern about implication of panic attacks
- change in behavior to avoid panic attacks
+/- agoraphobia
Panic disorder
- mgmt
- SSRI
- CBT
- benzo for acute management
GAD
- define
- anxiety/worry majority of days about various aspects of life
- > 6 months
- not episodic or focal
GAD
- mgmg
- SSRI
- buspirone
- benzo (ST only)
- CBT
MC offender in sexual abuse
- male who knows the victim
MC offender in physical abuse
primary female caregiver
** hyphema and retinal hemorrhage shaken baby
Neglect
- failure to provide the basic needs
- malnutrition, withdrawal, poor hygiene, FTT
Obesity
- BMI
> 30 or body weight >= 20% ideal weight
Obesity management
- behavioral mod: exercise, diet, therapy
- SSRI if depression
- Orlistat (dec fat digestion), Lorcaserin (5HT agonist)
- bariatric surgery
Anorexia nervosa
- types
- Restrictive: reduce kcal intake, diet pills
- purging: vomit, diuretic, laxative, enema
Anorexia nervosa
- BMI
<17.5
weight <85% ideal weight
when to hospitalize anorexia nervosa
- <75% ideal weight
- medical complications
Bulimia nervosa
- weight
- normal or overweight
management for AN and bulimia
- CBT
- SSRI (fluoxetine)
- +/- atypical antipsychotics for AN
autism
- describe
- social interaction difficulties (emotional discomfort, detachment)
- impaired communication
- restricted, repetitive, stereotyped behavior
Autism
- screening
M-CHAT
Oppositional defiant disorder
- overview
- pattern of negative, hostile, defiant behavior to adults
- 6 months or more
1. angry/irritable
2. argumentative/defiant behavior
3. vindictiveness
Oppositional defiant disorder
- mgmt
- may progress to what
- CBT
- conduct disorder
Conduct disorder
- overview
- persistent behavior that deviates from age-appropriate norms and violate the rights of others
- social and academic difficulty
- 40% become antisocial personality
Conduct disorder
- 4 components
- serious violates of law
- aggressive, cruel to animals
- deceitful
- destruction of property
ADHD
- 3 components
- inattentiveness
- hyperactivity
- impulse control
ADHD
- required for dx
- screening test
- must have sx < 12 yo
- must be in 2+ settings (home, school, etc.)
- must occur >6 months
- Vanderbilt to screen
ADHD
- mgmt
- behavioral modification
- sympathomimetic meds (stimulants)
- non stimulants
ADHD
- stimulants
- methylphenidate (Ritalin)
- amphetamine/dextroamphetamine (Adderall)
- MoA: blocks NE and dopamine reuptake
- S/E: anxiety, HTN, tachycardia, weight loss, growth delay, addiction
ADHD
- nonstimulant
- atomoxetine
1 predictive factor for suicide
previous attempt or threat
ask directly if they have a plan
Major depressive disorder
- define
- decreased mood and/or anhedonia for 2+ weeks and >5 of: - fatigue - insomnia - guilt, etc. SIGECAPS
Major depressive disorder
- mgmt
- CBT
- SSRI min 3-6 weeks
- Add on burporpion or mirtazapine
- 3rd line: TCA, MAO
- Electroconvulsive therapy
Legg-Calve-Perthes
- avascular necrosis of femoral head
- MC 4-10 male
- painless limping, worse with activity, end of day
- lose abduction and internal rotation
- XR: Crescent sign
- observation, activity restriction, pelvic ostomy
Slipped Capital femoral Epiphysis
- femoral head is posterior and inferior
- hip, knee pain with limp
- external rotation of leg
- Mgmg: ORIF and non weight bearing
Osgood Schalter disease
- osteochondritis of patellar tendon at tibial tuberosity
- dt overuse
- MC 10-15 yo active male with growth spurt
- RICE, NSAIDs, quad stretching
Scoliosis
- lateral curve >10
- MC F 8-10 onset
- 20-40: brace
- > 40 surgery
Osteosarcoma
- 90% on metaphysis of long bone (femur, tibia, humerus)
- MC mets to lung
- bone pain, joint swelling
- XR: hair on end/sunburst
- mgmt: sx and chemo
Ewing Sarcoma
- giant cell tumor
- MC 5-25
- femur MC, then pelvis
- bone pain, mass, joint swelling
- MC mets to other bone
- XR: layered periosteal layers “onion skin”
- mgmt: sx, chemo, radiation
Osteochondroma
- mc benign tumor
- 10-20 male
- pedunculate, grows away from physics
- observation, resection if painful or in pelvis
congenital hip dysplasia
- RF
- fam hx
- breech
- female
- first born
congenital hip dysplasia
- clinical
- unequal thigh folds
- short leg
- painless limp
- ortolani and barlow
- Galeazzi - unequal knee length
- Trendelenburg
congenital hip dysplasia
- dx
- mgmt
- PE at birth and WCC until walking
- limited hip adduction when knees at 90 flexion
- Ultrasound
- observation for spontaneous resolution, Pavlik harness, closed reduction
Juvenile RA
- 3 kinds
- Paci-articular
- systemic/acute febrile
- polyarticular
Juvenile RA
- paci-articular
- 50%
- <5 joints
- MC large joints like knee and ankle
- type I assoc with iridocyclitis / anterior uveitis
- Type II assoc with ankylosing spondylitis
Juvenile RA
- systemic/acute febrile
- 20%
- daily arthritis
- diurnal fever
- large and small joints
- salmon/pink rash
Juvenile RA
- polyarticular
30%
- > = 5 small joints
- most similar to adult RA
- risk iridocyclitis
Juvenile RA
- dx
- mgmg
- ESR, CRP, ANA (RF only 15%)
- NSAIDs, steroids, methotrexate, leflunomide
- eye exams
Insulin
- rapid acting
- short acting
- intermediate acting
- long acting
- Humalog and Novolog
- Regular
- NPH
- Levemir and lantus
hypercalcemia
- lab findings
- increased ca
- increased PTH
- decreased phosphate
hypercalcemia
- clinical
- stones, bones, groans, psych overtones
- decreased DTR
Hyperthyroid
- MCC graves
- TSH receptor antibodies increase thyroid hormone synthesis
- sign: pretibial myxedema
- dx: thyroid-stimulating ab, red TSH, inc T4
- RAIU increased uptake
hyperthyroid
- mgmt
- radioactive iodine
- methimazole/PTU
- BB for sx
- thyroidectomy
Cretinism
- cause
- congenital hypothyroid
- dt maternal hypothyroid or infant hypopituitarism
Cretinism
- clinical
- macroglossia
- hoarse cry
- coarse facial features
- umbilical hernia
- weight gain
- mental development issues
- levothyroxine to treat
Anemia
- lab
- dec ferritin
- inc TIBC
- dec serum iron
- dec transferrin saturation
Anemia
- lead poisoning
- sideroblastic anemia
- basophilic stippling
- increased serum lead and iron
- XR: lead lines at metaphyseal plates
- screen 9-12 mo and 24 months
Thalassemia
- overview
- reduced production of globin chains
- normal or increased iron
- suspect if anemia doesn’t respond to iron treatment
Thalassemia
- alpha overview
- decreased alpha globin production
- Asian
Alleles affected:
1: asx
2: mild microcytic anemia
3: similar to beta-thalassemia
4: hydrops fettles, still birth
Thalassemia
- alpha dx
folate, avoid oxidative stress, no Fe supplements
Thalassemia
- beta overview
- reduced beta chains, increased alpha chains
- B-thal. trait (minor): usu asx, mild ot mod anemia
- B-thal major (Cooleys): asx at birth, sx start about 6 months
Thalassemia
- beta major clinical
- frontal bossing and maxillary overgrowth dt extra medullary hematopoeisis
- hepatosplenomegaly
- severe hemolytic anemia
Beta Thalassemia
- dx
- electrophoresis
Minor: increased HgbF, decreased HgbA
Major: major inc HgbF, little to no HgbA
Thalassemia
- mgmt
- blood transfusions
- vitamin C and folate supplementation
- iron chelation
Sickle Cell
- signs
- dactylitis (digital swelling)
- osteomyelitis (salmonella**)
- functional asplenia
Sickle cell
- dx
- sickled RBC
- Howell-jolly bodies
Sickle cell
- mgmg
- pain: O2 and IVF
- folic acid
- immunizations: SHiN (s. pneumo, Hib, influenza, N. meningitis)
Hemophilia A
- Factor 8
- MC, almost only males
- Intrinsic pathway (PTT)- normal platelets but increased PTT
- hemarthrosis, hemorrhage
- Factor 8 infusion, DDAVP
Hemophilia B
- Factor 9
- clinically similar to A
- Factor 9 infusion, DDAVP not used
Hodgkin lymphoma
Bimodal: peak at 20 and >50
- Epstein-barr virus association
- upper body lymph nodes
- painless lymphadenopathy
- Reed-Sternberg cells
- mediastinal lymphadenopathy
Non-hodgkin lymphoma
- peripheral lymph nodes
- usually older people
Acute lymphocytic leukemia
- malignancy of lymphoid stem cells in bone marrow
- peak age 3-7
- RF down syndrome
- Clinical: pancytopenia (fever MC)
- CNS sx: HA, vision change, etc.
- Dx: bone marrow hyper cellular with >20% blasts
- chemo
Brain tumor
60% infratentorial
- pilocytic astrocytoma MC overall: benign
- medulloblastoma MC malignant
Cystitis
- mgmt
- nitrofurantoin
- bactrim
- <2 : cefixime
Cystitis
- RF
- vesicourethral reflux
- DM
- catheter
- UA: pyuria, leukocyte esterase, nitrites
Enuresis
- def
- mgmt
- bedwetting > 5 w/o infection
- behavioral (motivation, bladder training, fluid restriction), enuresis alarm, desmopressin, TCA last resort
Hypospadias
- mgmt
- do not circumsize
- bilateral US to eval for ascending pathology
- pediatric urologist referral
Vesicourethral reflux
- mislocated or incompetent uterovesical valves
- RF: recurrent UTI, weakness of trigone
- F>M
- bedwetting, renal insufficiency, HTN, proteinuria
- Dx: VCUG, renal US
- magma: spont resolution common, ACE/Arb HTN, abx prophylaxis for UTI
Post streptococcal glomerulonephritis
- 3 sx
- hypertension
- hematuria
- peri-orbital edema
Bacterial tracheitis
- mcc org
staph aureus
how long can an ingested blunt object be observed before must be removed?
24 hours
Breast milk jaundice vs. breastfeeding jaundice
- Breastmilk: factor in milk increases enterohepatic recirculation of bilirubin. Onset later half first week of life, peak bilirubin about 2 weeks. Baby feeds, voids, grows, normal development
- Breastfeeding jaundice: Suboptimal milk intake by baby. Decreased urine output, excessive weight loss, sleepiness, and decreased skin turgor, prolonged duration of meconium,
When should infant regain birth weight
2 weeks
