Pediatrics

Question 1

Bottlefeeding infant formula guidelines

Answer 1

• Boil or wash in dishwasher bottlets etc
• Wash tops of formula can before opening
• Refrigerate unused prepared formula milk and use within 48 hours
• Warm bottled in pan of hot water or watm tap water
• Test on wrist before serving
• Never overdillute (less nutrients) or overconcentrate (bad for kidneys and can cause constipation)
• Dont microwave - causes hotspots
• Do not refrigerate and reuse leftover prepared formula

Question 2

Infant botulism

Symptoms and treatment

Answer 2

• food poisoning after eating clostridium botulinium, bacteria in soil and animal products like raw honey, milk.
• In infants bacteria stays in GI tract, release toxin that cause life threwtening paralysis. Infants kess than 1 year old do not have developed bowel flora so suscdltible to this infection. So dont feed them honey
• Symtpoms
• • constipation, decreased head control, difficulty feeding, diminished deep tendon reflexes. Progresses rapidly to respiratory failure and arrest

Question 3

Signs of hypoglycemia

Treatment

Answer 3

Signs of hypoglycemia
S - sweating and pallor
W- weak, drowsy
I - irritable, confusion, hungry
T - tachycardia, tremors

What to do when there are signs of hypoglycemia
• check Bg immediately <3.9 mmol/L needs treatment but if not Bg testing available treat based on symtoms
• - in concious client admin 15g of quick acting carbs then recheck bg every 15min giving the carbs as needed (soft drink, juice, low fat milk, honey, 6 hard candies, commercial dextrose products)
• If unconcious, seizing or unable to swallow - emergency glucagon injection
• If Bg improvex give more complex carbs plus protein and fat like peanut butter cheese to maintain glucose levels

Question 4

Retinoblastoma

Signs and treatment

Answer 4

• Tumor in the retina
• Most common intraocular malignancy in childhood typically occurs under age 2

Signs
• often recognized by parents as white glow of pupil or strabismus
• No red reflex instead white
• Loss of vision - late sign
Treatment
• radiation therapy or enucleation (removal of eye) and prosthesis

Question 5

Wilm’s tumor/neohroblastoma

Answer 5

• kidney tumor usually occuring in children <5
• Usually onely in 1 kidney, prognosis good if not metased yet
• Noticed as bulge or swelling.
• Can also cause htn due to excess prod of renin
• Abdomen should not be palpated as this could disrupt the tumor and cause spread of tumor cells

Question 6

Epistaxis

Causes and home management

When to seek emerg

Answer 6

• dry mucous memrbanes, nose picking, foreign body, rhinitis
• Home management
• Direct continuous pressure below nasal bone for 5-15 minutes to promote clotting
• Cold cloth or ice pack over bridge of nose to promote vasoconstriction and slow bleeding
• Encourage to keep calm and quite as otherwise upinterventions are hard to implement
• Sit upright and tilt head forward so blood will not go to throat and cause aspiration
• Go to emerg if bleeding can’t be controlled, breathing is impaired, or bleeding came after traumatic injury

Question 7

Toddler expected weight gain

Answer 7

• 4-6 lb yearly

* By 30 mos - should be 4x greater than birth weight