Pediatrics Flashcards
FTT criteria
-weight for age <3rd to 5th percentile
Most common chromosomal disorder in US
DS
DS presentation
- flat face
- upward slanting eyes: palpebral fissures
- low-set ears
- macroglossia
- short neck
- broad hands with transverse palmar crease (simian crease)
- newborns with hypotonia
- poor reflexes
What should children with DS avoid using before age 6
trampoline
FAS presentation
- microcephaly
- shortened palpebral fissures
- epicanthal folds
- flat nasal bridge
- thin upper lip with smooth philtrum
- ears underdeveloped
When is surgical correction needed for cryptochoridism
within first year of life it not spontaneously descending
Neonate presenting with acute conjunctivitis within 30 days or less from birth, concerned about what
- chlamydia
- gonorrhea
- herpes simplex
- bacterial infection
Treatment for neonate with gonococcal ophthalmia neonatorum
ED for IV abx
Trachoma
chlamydial ophthalmia neonatorum
What else to rule out if neonate presents with trachoma
-chlamydial pneumonia
Risks for SIDS
- prematurity
- LBW
- maternal smoking and/or drug use
- poverty
Expected newborn weight loss
- formula fed: up to 5%
- breast fed: 7-10 %
- loss within 5-7 days
When should neonatal weight loss be regained
-within 10-14 days
Signs of severe dehydration in neonates
> 10% weight loss
- tachycardic
- tachypneic
- parched mucous membranes
- anterior fontanelle sunken
- tenting
- cool skin
- acrocyanosis
- anuria
- change in LOC
Mongolian spot
- present in almost all Asians
- blue to black colored patches or stains
- most commonly on lumbosacral area
what age do Mongolian spots typically fade
-by 2-3 years
MIlia, Milaria, or Prickly Heat
- papules on forehead, cheeks, nose
- retention of sebaceous material and keratin
- resolves spontaneously
Erythema toxicum neonatorum
- small pustules surround by red base
- erupts during 2nd-3rd day of life
- lasts 1-2 weeks
- resolves spontaneously
Seborrheic dermatitis
- cradle cap
- thick scaling on scalp
- treat with soaking with vegetable oil or mineral oil
- shampoo and gently scrub
- prevention with frequent shampooing with mild baby shampoo
- resolves in a few months
Faun Tail Nevus
-tufts of hair overlying spinal column usually at lumbosacral area
What can faun tail nevus indicate
-possible NTD
Plan for faun tail nevus
- neuro exam
- US of lesion to r/o occult spina bifida
Cafe au lait spots
- flat spots
- > 6 or larger than 5 mm –> r/o neurofibromatosis or von Recklinghausen’s disease
- refer to pediatric neuro if it fits this criteria
Port wine stain
- Nevus Flammeus
- pink to red, flat, stain like lesions on upper and lower eyelids of branches of CN V
- blanches
- Large lesions on half of face may be sign of trigeminal nerve involvement
Port wine stain treatment
- does not regress
- grows with child
- treat with pulse-dye laser therapy
Hemangioma
- strawberry hemangioma
- rapid vascular lesions 0.5-4 cm
- bright red in color
- soft to palpation
- majority spontaneously resolve
- PDL therapy
Newborn vision: far or near sighted
- Myopia (near sighted)
- 20/200
T/F: newborns may appear with crossed eyes and is a normal finding
- True
- unless one eye is consistently turned in or out —> ophto
T/F: newborns shed tears
-False: lacrimal ducts not fully mature at birth
Horizontal strabismus may be
Estropia
inward turning of eyes
Extropia
outward turning of eyes
Vertical strabismus may be
Hypertropia
one eye higher than the other
Hypotropia
one eye lower than the other
What can uncorrected strabismus lead to
permanent visual loss
abnormal vision
What is strabismus
misalignment of one eye
Amblyopia
lazy eye
Esotropia
misalignment of both eyes (cross eyed)
Indications for optho referral
- abnormal red reflex
- (+) white reflex
- strabismus
- greater than two line difference between each eye
- esodeviation present after 3-4 months
- corneal light reflex with abnormal
- shape/appearance of pupils not equal
- new onset strabismus
Hirschberg test
corneal light reflex test
High risk factors for hearing loss
-HEARS Hyperbilirubinemia Ear infections that are frequent Apgar score low Rubella, CMV, toxoplasmosis Seizures
Phenylketonuria
- severe mental retardation if not treated
- inability to metabolize phenylalanine to tyrosine
- test only performed after being fed for at least 48 hours
Which hemoglobin do normal newborns have
F and A
When is screening for anemia done for in infants
9-12 months
Lead screening
- high risk screened at 1 to 2 years
- early as 6 months
Dose of vitamin D drops
400 IU
Why is cow’s milk avoided
- avoid for 1st year of life
- causes GI bleeding
- common cause of IDA in <12 month olds
Failure to pass meconium within 24 hours of birth is concerning for what
- intestinal obstruction
- cystic fibrosis
When can solid foods start
4-6 months
- start with rice cereal
- introduce one food at a time
First time teeth erupt
-6-10 months
First teeth to erupt
-lower central incisors
When are all the primary teeth erupted by
2.5 years
When do first permanent teeth erupt
6 years
Hypospadias
-urethral meatus on ventral aspect of penis
Positive Babinski reflex is normal up until
2 years old
T/F a strong Moro reflex in a 6 month old is normal
False
indicative of brain damage
MMRV vaccine schedule
1 at 12 months
2 at 4-6 years
Trivalent flu vaccine given to minimum what age
6 months
Quadrivalent flu vaccine given to minimum what age
18 years
Is FluMist recommended?
No
DTaP schedule
2 months 4 months 6 months 16-18 months 4-6 years
Tdap age requirement
at least 7 years
Vaccine Adverse Event Reporting System (VAERS)
Report adverse reactions to vaccines
Which vaccines should be completed by age 15-18 months
- Hepatitis B
- Hib
- PCV 13
- Rotavirus
What is the only vaccine given at birth
hepatitis B
When is Tdap given as a booster
11-12 years
Physiological jaundice spreads how
starts on head
progresses downward to chest, abdomen, legs, and soles of feet
When does physiological jaundice start
24 hours after birth
clear up in 2-3 weeks
Breast milk jaundice begins when
after 7 days
peaks in 2-3 weeks
can take a month to clear
Possible cause of breast milk jaundice
- insufficient breast milk intake
- some women may have a substance that slows down hepatic conjugation of bilirubin
Why does jaundice happen in neonates
- increased breakdown of fetal RBC
- bilirubin exceeding the infants liver capacity to conjugate bilirubin
Treatment plan for pathologic jaundice
- serum fractionated bilirubin level
- Coombs test
- CBC
- retic count
- peripheral smear
- treatment usually not needed, keep well hydrated
First line therapy for jaundice
- phototherapy
- light in blue-spectrum most effective
- bilirubin excreted in urine
Kernicterus
- complication of high levels of unbound bilirubin
- severe mental retardation, seizures
When does Hgb drop to the lowest level in neonates
6-8 weeks
Why does physiological anemia of infancy occur
-stimulates kidneys to produce more erythropoietin to prompt BM to make more RBC
Dacryostenosis
- congenital lacrimal duct obstruction
- spontaneously resolves within 6 months
Dacryostenosis presentation
persistent tearing and crusting in am
- reflux of mucoid discharge when lacrimal duct palpated
- yellow to green is abnormal
Acute dacrocystitis
- redness, warmth, tenderness, and swelling on one or both lacrimal ducts
- usually due to staph or strep
- systemic abx for 7-10 days
Acute dacrocystitis lacrimal sac massage
-palpate sac and massage down toward mouth
Infant colic rule of 3s
- crying and irritability >3 hours a day in <3 month old. crying occurs at the same time each day
- crying occurs more than 3 days a week
- colic resolves by 3-4 months
Up to 30% of neonates with coarctation of the aorta also have what syndrome
Turner syndrome
Normal finding for screening coarctation of the aorta
-systolic BP higher in legs than arms
Higher risk for developmental dysplasia of hip
- breech births
- female
- family history
- oligohydramnios
Ortolani test
- hold each knee and place middle finger over greater trochanter
- rotate hips in the frog leg position (abduction, then adduction)
- (+) click or clunk, or trochanter displacement palpated
Barlow test
- place index and middle finger over greater trochanter
- push both knees together at midline and downward, then pull upward
- (+) clunk heard when trochanter slips back into acetabulum
Galeazzi sign
-one femur appears shorter when infant is supine
When can a child play patacake and peek a boo
9 months
Neuroblastoma most common presentation
painful abdomen crossing midline
Neuroblastoma Horner’s syndrome
- miosis
- ptosis
- anhidrosis
Initial imaging for Wilm’s tumor
abdominal US
Epiglottis organism
Haemophilus influenzae
Prophylaxis of close contacts for epiglottitis
Rifampin
Is epiglottis a reportable disease
yes
Ophthalmoplegia
limited movement of eyeball
Preseptal cellulitis
-infection of anterior portion of eyelid that does not involve orbit
Greenstick fractures may indicate what
child abuse
Top 3 cancers in children
- leukemia
- bran and CNS tumors
- neuroblastoma
Clues a child is ready for toilet training
- walking
- can reach potty chair
- indicates when diaper is dirty
- can pull down pants
- can stay dry for 2 hours
- interested about toilet
- can understand basic instruction
When are most children typically ready for toilet training
18-24 months
-some not ready until 36 monhs
When will a child usually have complete nighttime bowel control
4-5 years
When should a child not dry at night be evaluated
if >5 years old
How long should all infants and toddlers ride in a rear-facing car seat
2 years
Car safety for toddlers and preschoolers
back seat with car seat facing forward
Until what age do children need to be restrained in the back seat
12
When do early signs of autism begin to show
18 months
Autism screening times
18 months to 24 months
Autism signs to watch for
- no pointing, waving, grasping by 12 months
- no babbling or cooing by 12 months
- no single words by 16 months
- no two words by 24 months
- loss of language or social skills by 24 months
- no gesturing at 24 months
What population are Wilm’s tumors more common in
AA females
At what age is speech understood by strangers
3 years
What age is speech understood mostly by family members
2 years
Kawasaki disease presentation
- high fever
- enlarged lymph nodes in neck
- bright red rash
- conjunctivitis
- dry cracked lips
- strawberry tongue
Kawasaki disease treatment
- aspirin
- IVIG
Kawasaki disease sequelae
- aortic dissection
- aneurysms of coronary arteries
- blood clots
- need f/u with pediatric cardiologist for several years
Reye’s syndrome
- history of febrile viral illness and took ASA or salicylate (Pepto Bismol)
- stage 1: severe vomiting, lethargy, stupor, elevated LFTs
- stage 2: change in LOC, hyperactive reflexes
- stage 3-5: confusion, delirious, cerebral edema, coma, seizures, death
DS without atlantoaxial stability and sports
-low-impact sports and sports not requiring extreme balance
Still’s murmur
- benign systolic murmur
- vibratory or musical quality
- louder in supine
- grade 1-2
- usually resolved by adolescence
Can patients with MVP be cleared for sports
NO
possible sudden cardiac death
-cardio referral for clearance
If a child had documented history of chickenpox, do they still need the chicken pox vaccine
no
If child did not complete hepatitis B series, do they need to repeat series
no
Menactra lowest age to adminsiter
9 months
Menveo lowest age to adminster
2 months
When is Menactra or Menveo first dose given
11-12 years
When is Menactra/Menveo booster typically given
16 years
Autism treatment plan
- refer to psychiatrist for testing and eval
- OT, PT, speech therapy
- some prescribed Risperdal
Hand-foot-mouth disease organism
coxsackievirus A16
When is a patient with hand foot mouth the most contagious
-during first week
Hand foot mouth treatment
- supportive care
- complete recovery usually in 5-7 days
Measles aka
rubeola
Functional constipation aka
encoporesis
Rome IV criteria for diagnosis functional constipation
- must meet 2 or more at least once per week for at least 1 month
1: history of withholding stool
2: history of painful or hard BM
3: history of large-diameter stools that may obstruct toilet
4: presence of large fecal mass in rectum
5: two or fewer defecations in toilet per week
6: at least one episode of fecal incontinence per week (thin fluid with feces that passes large stool), ask about soiling of underwear
Treatment for functional constipation
- laxatives (PEG, Miralax)
- behavior modifications
- dietary changes
- reward system
- goal for one soft stool a day
- plain film xray for retained stools
All 11-12 year old children should be vaccinated with what single dose
quadrivalent meningococcal vaccine (MenACWY)
Menactra or Menveo
Which immunizations are needed at age 11-12
Tdap
HPV
MCV4
What organism is molluscum caused by
poxvirus
Youngest age for HPV vaccination
9
acetaminophen is also known as
paracetamol
Antidote for acetaminophen poisoning
-N-acetylcysteine IV
Testicular torsion initial diagnostic test
doppler US
Precocious puberty in females
<8 years
Delayed puberty in females
no breast development (Tanner 2) by 12 years
Skeletal growth is considered complete within __ years after menarche
2
Mittelschmerz
-unilateral midcycle pelvic pain caused by enlarged ovarian follicle
Average age of menarche
12
After which tanner stage do girls typically start menses within 1-2 years
2
Dysmenorrhea is caused by
elevated prostaglandins
Precocious puberty in boys
<9
Delayed puberty in boys
no testicular/scrotal growth by age 14
Spermarche average age
13.3
Which situations are parental consent not necessary
- contraception
- treatment of STD
- diagnosis and management of pregnancy
Criteria for emancipated minor
- legally married
- active duty in armed forces
Which situations can confidentiality be broken
- gunshot wounds and stab wounds –> must be reported to police
- child abuse–> authorities
- SI or SA
- HI or intent
What is a mature minor rule
- unemancipated minor (15-17) with the mental capacity to understand the consequences of a decision
- Has the right to refuse or to request treatment (even if parents disagree)
- Each state has its own laws about this
What Tanner stage does puberty start
Stage 2
Primary amenorrhea
no menarche by age 15
with or without development of secondary sexual characteristics
-50% caused by chromosomal disorders
Secondary amenorrhea
- no menses for 3 cycles or 6 months if previously had menses
- most common cause is pregnancy
- others: ovarian disorders, stress, anorexia, PCOS
Secondary amenorrhea associated with exercise and underweight
-higher incidence due to caloric deficiency
Female athlete triad
- anorexia nervosa/restrictive eating
- amenorrhea
- osteoprosis
Secondary amenorrhea labs
- pregnancy test
- serum prolactin
- serum TSH, FSH, LH
- if amenorrhea for >6 months, measure bone density
Secondary amenorrhea d/t exercise treatment
- educate about caloric intake
- decrease exercise
- Calcium and vitamin D 1200-1500 mg and vitamin E 400 IU daily
Physiological gynecomastia
benign
more common during infancy and adolescence
normal in up to 40% of prepubertal boys
resolve by 6 months to 2 years
Gynecomastia findings
- round, rubbery, mobile mound under areola
- no skin changes
- if mass if hard or fixed, suspect a secondary cause and refer.
Pseudogynecomastia
- bilateral enlarged breasts due to fatty tissue
- common in obesity
- no breast bud or disk
Scoliosis testing
Adam’s Forward Bend Test
Cobb angle
-degree of spinal curvature
Scoliosis curve <20 degrees treatment
-observe and monitor for changes
Scoliosis curve 20-40 degrees treatment
- bracing
- Milwaukee brace
Scoliosis curve >40 degrees
-surgical correction with Harington rode
What is needed to measure Cobb angle of spine
spinal xray PA view
Scoliosis treatment
refer all patients with scoliosis to a pediatric orthopedic specialist
Osgood-Schlatter disease
- common knee pain in young athletes
- overuse of knee
- pain, tenderness, and swelling at tibial tuberosity
- pain improves with rest
- rule out avulsion fracture or posttrauma with xray
Osgood-Schlatter disease treatment
- RICE
- stretching
Klinefelter syndrome genetics
extra X chromosome
Klinefelter presentation
- testicles small and firm with small penis
- tall with wide hips
- reduced facial and body hair
- higher risk of osteoporosis
Klinefelter treatment
-testosterone replacement and fertility treatment
Klinefelter syndrome is due to a ____ leading to a deficiency of ___
primary hypogonadism
testosterone
Turner’s syndrome genetics
partial absence of second X chromosome
Turner’s syndrome presentation
- webbed neck
- congenital lymphedema of hands and feet
- high-arched palate
- short fourth metacarpal
- short stature
- ovarian failure
- CVD and renal issues
- ear malformations
- amenorrhea
Primary amenorrhea labs
- serum pregnancy
- prolactin (if elevated –> CT of sella turcica; location of pituitary gland)
- r/o hypogonadism: estrogen, progesterone, DHEA, FSH, TSH
Hepatitis A dosing schedule
12 months
18 months
If mother HBsAg positive, what to do with newborn
- HBIG within 12 hours of birth
- give hep B vaccine
Hib vaccination lead to the almost eradication of what disease
epiglottitis
MMR and MMRV is contraindicated with which allergy
neomycin or gelatin
For children <8 receiving flu shot for first time, 2nd dose needs to be given by
4 weeks
HPV vaccine for 9-14 year old
0, 6-12 months later
HPV vaccine for >15 year old
0, 1-2 months, 6 months
CDC recommends monitoring a child for at least ___ after receiving a vaccine
15 minutes
T1DM labs will show what
- pancreatic antibodies
- insulin levels
- C-peptide levels
DSM-V criteria for ADHD
- Symptoms present prior to 12 years old
- Symptoms last >6 months
- symptoms evident in 2 different settings
ADHD treatment first line
meds considered first line for patients >6 years old
-methyphenidate, amephetamines
What schedule are medications for ADHD
2
Screening tool for autism
MCHAT-R/F
18-30 months
What age can montelukast be given
starting 2 years
When can asthma treatment be stepped down
-if well controlled at least 3 months
Step 2 of child 0-4 with asthma
- low dose ICS
- alt: Singulair, Cromolyn
Step 3 of child 0-4 with asthma
-medium dose ICS
Step 4 of child 0-4 with asthma
- medium dose ICS
- AND either Singulair or LABA
Step 5 of child 0-4 with asthma
- high dose ICS
- AND either Singulair or LABA
Step 6 of child 0-4 with asthma
- high dose ICS
- AND either sinulair or LABA
- AND oral corticosteroid
Montelukast (Singular) class
Leukotriene Receptor Antagonist
Nedocromil class
Mast cell stabilizer
Alternative medications that can be used for 5-11 year olds with asthma
- LTRA
- Nedocromil
- Theophylline
- Cromolyn
Cromolyn class
Mast cell stabilizer
Which 2 alternative medications can be used with Step 3-6 for 5-11 year olds with asthma
- LTRA
- Theophylline
Step 3 of 5-11 year old with asthma
- preferred low dose ICS + LABA, LTRA, or
- theophylline
- or med dose ICS
Step 4 of 5-11 year old with asthma
-medium dose ICS + LABA
Step 5 of 5-11 year old with asthma
-high dose ICS +LABA
Step 6 of 5-11 year old with asthma
-High dose ICS + LABA + oral steroid
PCV13 plus PCV23 should be given to who
high risk children >2 years old
PNA management in children
- Amoxicillin 90 mg/kg/day first line (Augmentin, or 3rd gen ceph if recent abx exposure)
- PCN allergy: macrolide, clindamycin
Bronchiolitis treatment
-supportive
Best steroids to give to children if needed
-single dose oral dexamethasone 0.6 mg/kg
Fastest onset medication for GFR
-nebulized epinephrine
Cystic fibrosis patho
-abnormal transport of Na and Cl across epithelial membranes
Cystic fibrosis testing
- sweat test
- if positive once, repeat again
- it positive twice, send to CF clinic
Symptom to suspect CF
persistent productive cough
weight loss
greasy stools
Patients with sickle cell anemia may take daily what
-daily PCN for Strep pneumo prophylaxis
Lead toxicity presentation
- fatigue
- GI complaints
- irritability
Leukemia presenting signs
- anorexia
- hepatosplenomegaly
- fever
- bleeding
- plts <100,000 (thrombocytopenia)
- lymphadenoapthy
- bone pain
- pancytopenia
What presentation of nodes should be considered malignant
-nontender
-firm
-rubbery
immoble
Headache red flags
- <3 years old
- HA awakens child
- thunderclap HA
- N/V
- altered mental state
- absent family history of migraine
Headache in children management
- avoid caffeine
- avoid daily analgesics
- possibly refer
What age are pyloric stenosis symptoms most likely to present
-3-6 weeks
Imaging study for pyloric stenosis
US
Normal amount of reflux in healthy infant
> 30
Red flags of possible pathologic reason for reflux
- choking
- coughing with eating
- forceful vomiting
- bilious vomiting
- blood in stool
- poor weight gain
- refusing to eat
- constipation, diarrhea
- abdominal tenderness
- fever
GERD management
- usually no intervention
- avoid cigarette smoke
- consider non-cows milk protein formula
Acid suppressants and infants
- assess feeding, sleep habits
- assess soy and cow milk exposure
- thickened feeds
- avoid smoke
- Trial: PPI for 2 weeks, if improving, extend to 2-3 months
- refer to pedi GI if no improvement
Reflux usually resolves by what age due to what
- 1 year
- due to immature LES, matures by 9-12 months
Most common cause of intestinal obstruction in children
intussusception
Classic triad of intussusception
- intermittent colicky abdominal pain (pulls up legs to chest)
- vomiting
- bloody mucosy stools (currant jelly)
Preferred means of rehydration for child with viral gastroenteritis
commercially prepared electrolyte solution (Pedialyte)
Retractile testes
- movement of testes between scrotum and inguinal ring by cremasteric reflex
- not associated with same risks as cryptochordism
- send to urology
How much time is given for a testicle to descend
6 months
When should a hydrocele in a child resolve
by 1 year
What is the most important to rule out when a child presents with hydrocele
-inguinal hernia
Treatment for first ever pediatric UTI
-aggressive treatment to prevent PN and renal scarring
First pediatric UTI medication treatment
- consider 2nd, 3rd gen ceph if no GU abnormalities
- Ceftin, Suprax
When is imaging for a UTI needed
- 2-24 month patient with first febrile UTI treatment–> renal and bladder US
- voiding cystourethrogram test of choice for VUR
- Child of any age with recurrent febrile UTI
- UTi with fam hx of renal or urologic disease
When should BP screening begin for children
3
Innocent murmur clues
- grade <2
- softer intensity when sitting compared to supine
- not holosystolic
- minimal radiation
- musical or vibratory quality
Pathologic murmur cluse
- Grade >3
- holosystolic
- max at LUSB
- harsh or blowing
- systolic clicks
- diastolic murmur
- increased in upright position
- gallop or friction rub
Metatarsus adducts
Forefoot turned inward, may be an incomplete club foot
treat with stretching and extending
-if not stretchable, refer to ortho
Club foot aka
- talipes equinovarus
- urgent ortho referral
Nursemaid elbow cause
-annular ligament slips over head of radius and becomes trapped
Nursemaid elbow maneuver
-Supination-flexion technique
Osgood Schlatter disease occurs in conjunction with
rapid growth spurt
Characteristics of Osgood Schlatter disease
- pain reproduced with extension of knee against resistance
- straight leg raise test negative
Legg-Calve-Perthe’s disease
-osteonecrosis of capital femoral epiphysis due to interrupted vascular supply
Trendelnburg’s test
- (+) stand on affected side causes pelvic tilt (unaffected side lower)
- positive with Legge-Calve-Perthes, SCFE, developmental dysplasia
Slipped capital femoral epiphysis presentation
- chronic hip/knee pain with intermittent limp
- adolescent
- refer
Most common cause of hip pain in children
- transient synovitis of hip “irritable hip”
- benign
- absent systemic symptoms
- history of URI within 7-14 days
- resolves in 7-14 days
Exanthem
rash on skin
Enanthem
rash on mucous membranes (Koplik)
Roseola agent
Human herpesvirus 6
Fifth disease agent
Parvovirus B19
Herpangina agent
-Coxsackie A virus
Fifth disease aka
erythema infectiosum
Fifth disease presentation
- 3 stages
- prodrome: symptoms of URI with low-grade fever, HA, chills, malaise
- second: slapped cheek rash, resolves in 2-3 days
- third: rash moves to arms and legs, lacy-appearing rash, flat and appears purple, may last for a few weeks
Roseola aka
Exanthem subiitum
Roseola infantum
Roseola presentation
- high fever for 2-4 days, abrupt cessation
- appearance of maculopapular rash not on face
Herpangina presentation
-painful vesicles on soft palate and mouth
Measles 3 “C’s”
- conjunctivitis
- coryza
- cough
AOM treatment for <6 month old
antibiotics
AOM treatment for 6 month to 2 year old
- certain OM: abx if severe or bilateral, observe if unilateral
- uncertain: abx if severe, observe if mild
AOM treatment for >2 year old
- certain: abx if severe, observe if not
- uncertain: observation
First choice medication for AOM
- amoxicillin 80-90 mg/kg/day
- recent abx: Augmentin
Referral for OM
- 3 or more distinct and well-documented episodes in 6 months
- 4 episodes in 12 months
First permanent teeth to appear
-first molars
around 6 years old
What to do with child with nits and no itchyness
- if more than 1/4 inch from scalp and no itching –> most likely not viable
- remove nits by soaking head with distilled vinegar which will break down the protein of the nit casings, making it easy to comb them out of the hair
non-amphetimine ADHD medication
- Straterra (Atomoxetine)
- SNRI