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Peds Ex. 1 Study Material > Problems Infant, Early Childhood > Flashcards

Problems Infant, Early Childhood Flashcards

1
Q

What is Positional Plagiocephaly?

A

–Acquired condition occurring as a result of cranial molding during infancy attributed to supine sleeping position

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1
Q

How are head lice transmitted, what are the clinical manifestations, and how is it treated?

A

Transmission:

Prolonged close contact when a female louse is able to obtain blood meal at scalp and deposit eggs on hair shaft at night.

Clinical manifestations:

– Intense pruritus of scalp (behind ears or nape of neck)

– Nits attached to hair shaft

Treatment:

  • Pediculicide and removal of nits:
  • Permethrin1% cream (OTC), repeat in a week, treat affected family
  • Family may attempt other treatment regimens
  • Education and support to families
  • Advocacy and support for school attendance
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2
Q

How is failure to thrive classified?

A

Persistent weight < 5th percentile for age; height WNL

Different Classes:

  • Inadequate caloric intake: incorrect formula prep, neglect, poverty, behavioral problems
  • Inadequate absorption—CF/ Celiac disease, other
  • Increased metabolism: hyperthyroidism, CHD (congenital heart defects)
  • Defective utilization—genetic anomaly/ metabolic storage disease
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3
Q

What are common sources of allergies (food related) in children?

A

Eggs, cow’s milk, and peanuts

–80% of children with hypersensitivity to milk may outgrow it by 4 years of age

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3
Q

What is colic?

A
  • Colic: excessive crying in an otherwise healthy infants
  • Crying begins ~ 2 weeks, peaks ~ 6 weeks and improves by 3-4 months; usually self-limiting
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4
Q

What are some treatment options for FTT children?

A
  • ↑ formula to 24cal/oz for infants
  • ↑ formula to 30cal/oz for older children (1-6yrs)
  • High calorie milk (Pediasure): toddlers
  • Vitamin supplementation
  • Parent teaching: formula prep, feeding time schedule, avoid juice
  • Treating family
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4
Q

How is Erythema Infectiosum (fifth disease) transmitted, what are the clinical manifestations of it, how do you treat it?

A
  • Transmission: probably droplet or direct contact
  • Clinical manfiestations:
    • Rash that followed stages:
    • I – erythema on face (slapped face appearance)
    • II – maculopapular rash on upper and lower extremities (proximal to distal)
    • III – rash disappears but reappears if skin irritated (example – sun, cold, friction).
  • Treatment:
    • antipyretics, analgesics, anti-inflammatory drugs (blood transfusion for aplastic anemia)
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5
Q

How would you manage an infant with atopic dermatitis?

A

Skin Hydration

  • Avoid hot water and skin or hair products containing perfumes, dyes or fragrance
  • Bathe child in warm (not hot) water using mild soap
  • Pat child dry; do not rub skin
  • Topical ointments/creams to affected area
  • Fragrance-free moisturizer all over body
  • Avoid bubble baths

Relieve pruritus

  • If moderate or severe: oral antihistamine
  • Non-sedating during day
  • Mild sedating at night

Reduce flare-ups or inflammation

  • Topical steroids
  • May need prescription strength

Prevent/control infection

  • Treat secondary skin infection systemically
  • Minimize scratching, keep fingernails short and clean

Live as near as normal as possible

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5
Q

What is apnea of infancy?

A

–Definition—Unexplained respiratory pause lasting 20 seconds or more OR
–Less than 20 seconds accompanied by pallor, cyanosis, bradycardia, or hypotension (term infant)
–Can be symptom of other disorders:
•sepsis, sz, neurologic, upper/lower airway infection/abnormalities, GER, metabolic disorders, impaired regulation of breathing during sleep, result of intentional harm by caretaker

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6
Q

What are standard precautions?

A
  • Wash hands: properly and thoughly between patient contact and other contact with bodily fluids or soiled equipment
  • Wear gloves: when handling blood, body fluids, nonintact skin or soiled items, and change gloves between patients
  • Wear mask: and eye protection or face sheild to protect mucous membranes of the eyes, nose, and mouth when likely to be splashed
  • Wear gown: to prevent soiling of clothing and to protect skin, wash hands after removing gown
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7
Q

How would you manage diaper dermatitis?

A
  • Prevention: ointments (Vitamin A, D or E; zinc oxide) or petroleum to provide barrier to the skin (make sure skin is clean or you are sealing in the bad stuff)
  • Frequent diaper changes
  • Use super-absorbent disposable diapers
  • Gentle washing of diaper area
  • Avoid baby wipes that contain fragrance or preservatives
  • Expose skin to air
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8
Q

How would you treat Protein and Energy Malnutrition
caused by diarrhea?

A

–Oral rehydration
–Medications (antibiotics, anti-diarrheals)
–Provision of adequate nutrition with BF or proper weaning diet

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8
Q

How would you diagnose an infant with a cow’s milk allergy?

A

–Definitive diagnosis: elimination of milk then 2 or more challenge tests after symptoms improve
–Change infant formula to casein hydrolysate milk formula (Pregestimil, Nutramigen, Alimentum) or
–Soy formula: caution: ~ 50% sensitive to cow’s milk protein and sensitive to soy

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8
Q

What causes a secondary lactase deficiency?

A
  • Secondary lactase deficiency: secondary to damage of intestinal lumen -> destroys or decreases lactase
  • Ex: CF, celiac disease, kwashiorkor, infections, HIV, rotovirus
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8
Q

What is spitting up?

A

Dribbling of unswallowed formula from mouth immediately after feeding (it hasn’t gone into the stomach yet)

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9
Q

What are the clinical manifestations of scarlet fever and what are the treatment options?

A
  • Clinical manifestations:
    • Sandpaper rash
    • Strawberry tounge
    • Headache, sore throat, cervical
    • lymphadenopathy, fever
  • Treatment:
    • Throat swab
    • Oral penicillin or cephalosporin
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11
Q

How are scabies transmitted, what are the clinical manifestations, and how is it treated?

A
  • Transmission:
    • Prolonged close personal

contact where the mite burrows into the epidermis and deposits eggs.

  • Clinical Manifestations:
    • Intense pruritus
    • Excoriation and burrows
    • Discrete inflammation between finger webs, neck folds, groin
  • Treatment:
    • Scabicide: Older than 2 mo à Permethrin 5% cream x 8-14 hours
    • Hygiene of linensand clothing with high heat
    • Supportive care for pruritus 2-3 weeks.
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12
Q

How is the Enterobiasis Pinworm transmitted and what are the symptoms of having this, and treatment?

A
  • Transmission: fecal-oral
  • Symptoms
    • Nocturnal anal pruritus is the primary
    • Worms may be seen around the anus
    • Bed wetting
    • Poor sleep
    • Perinial itching
  • Treatment:
    • Mebendazole, pyrantel pamoate, and albendazole
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13
Q

When does Developmental lactase deficiency occur and what are some symptoms of it?

A
  • Lactase deficiency in preterm infants < 34 weeks gestation
  • Symptoms: abdominal pain, bloating, diarrhea 30 min to hours after ingestion
15
Q

What causes vitamin D deficiency in infants and how would you correct it?

A

Is caused by:

  • Exclusively BF infants without vitamin D supplement
  • Minimal sunlight exposure
  • Diets low in vitamin D and calcium
  • Milk products not supplemented with vitamin D

Is corrected with:

  • Vitamin D 400 IU/day for:
    • Exclusively BF infants until taking 1 L/day vitamin D fortified formula
    • Non-BF infants until taking 1 L/day vitamin D fortified formula
16
Q

What are some practices that may reduce the risk of SIDS?

A

–Avoid smoking during pregnancy and near the infant
–Breast-feeding
–Supine sleeping position
–Avoid soft, moldable mattresses, blankets, and pillows
–Avoid bed sharing
–Avoid overheating during sleep
–Vary infant head position to prevent plagiocephaly (flat head)

17
Q

How is mumps transmitted, what are the clinical manifestations of it, how do you treat it, and what type of precautions are taken for it?

A
  • Transmission: Airborne or droplet, also direct contact with saliva
  • Clinical manifestations:
    • Incubation 14-18 days, infectious period over 9 days after onset of swelling
    • Prodrome: non-specific myalgia, anorexia, headache and fever. Swelling usually 24 hours after fever.
    • History of parotid gland tenderness (max 1-3 days)
    • Earache that is worse with chewing
  • Treatment:
    • Analgesics and antipyretics as needed/ordered
    • IV fluid if dehydration or emesis is a factor
    • droplet and contact precautions
    • rest
    • fluids, soft diet, hot and/or cold compress to the neck
    • warmth and local support (fitted underwear)
  • Precautions: Droplet and contact
    • most communicable immediately before and after swelling begins
19
Q

What is diaper dermatitis and what causes it?

A
  • Acute inflammatory skin disorder caused by wearing diapers
  • May be secondary to bacterial or yeast infection
  • Bottle fed > BF infants
  • Prolonged and repeated contact with irritant (urine, feces, soaps, detergent, friction)
21
Q

How is chicken pox (varicella) transmitted, what are the clinical manifestations of it, how do you treat it, and what type of precautions are taken for it?

A
  • Transmission: Direct contact and respiratory secretions
  • Clinical manifestations:
    • “dew drop on a rose petal” appearance (frequently first lesion)
    • start on the trunk (greatest concentration)

less on limbs, various stages (papule, vesicle and crust at the same time)

  • Treatment:
    • Keep child cool
    • Anything to decrease itching (pruritus)
    • alternatives to scratching
    • trim nails (mittens or socks)
  • Precautions: Standard
    • Child is contagious a day before rash appears and until vesicles are crusted (then they are not infectious)
22
Q

What is Atopic Dermatitis and what are some characteristics of it?

A
  • It is a chronic inflammatory skin condition or eczema
  • Is a category of dermatologic diseases and not a specific etiology
  • Pruritic: “rash that itches”
  • Usually associated with allergy
  • Hereditary tendency (atopy)
  • Rash: generalized, especially cheeks, scalp, trunk, extensor surfaces of extremities
24
Q

Describe the pathophysiology behind diaper dermatitis

A

Prolonged skin contact with diaper wetness->

  • Maceration, friction damage, increases microbial counts, inflammation, ↑ skin pH -> ↑ fecal enzymes
  • Skin eruptions in the areas of where the skin has come in contact with the urine
  • It is not in the folds
25
Q

What are some characteristics of Kwashiorkor?

A

–Deficient protein but adequate calorie intake
–Cultural, physiologic, infective etiologies
–Edema and muscle wasting
–Large abdomen due to ascites
–Skin scaly and dry
–Blindness from vita A deficiency
–Other deficiencies: Fe, Ca, Zn
–Diarrhea (persistent diarrhea malnutrition syndrome)
–↑susceptibility to infection

26
Q

What are some symptoms of vitamin A toxicity?

A

nausea, jaundice, anorexia, vomiting, weakness; osteoporosis, fractures

28
Q

What are some treatment options for lactase deficiences?

A
  • Elimination of dairy
  • ↓ amount of dairy ingested: prevent reduced bone mass density and subsequent osteoporosis
  • Take small amounts if able to tolerate; drink milk with other foods; pre-treated milk with microbial-derived lactase; yogurt, hard cheeses, lactase tablets taken with dairy
29
Q

How would you manage positional plaglocephaly?

A

–Alternating head position nightly (left to right, right to left)
–Avoid prolonged placement in car seat/swing
–Practice “tummy time”: lie prone while awake
–Hold infant more often
–If torticollis, may need PT and home stretching exercises
–Helmet: ↓ pressure on affected side of the skull and redirect growth; worn ~23hr/day for ~ 3 months

31
Q

How is diptheria transmitted, what are the clinical manifestations of it, how do you treat it, and what type of precautions are taken for it?

A
  • Transmission: Direct contact
  • Clinical manifestations: URI-like symptoms which progress.
    • “Bull’s neck”
    • Gray membranous pharyngeal lesions (smells awful - “wet mouse oder”) , fever, cough
    • The swelling may cause an airway obstruction
  • Treatment: Antibiotics (Erythromycin or penicillin), bed rest, and support
  • Precautions: STRICT isolation (droplet until 2 negative cultures) & Monitor for signs of respiratory obstruction
32
Q

How would you treat a child with seborrheic dermatitis?

A
  • Soak area with mineral/vegetable oil to remove scales
  • mild baby shampoo and thoroughly rinse
  • Use fine-tooth comb or soft brush after shampooing to loosen crusts
33
Q

What is Seborrheic Dermatitis?

A

–Chronic, recurrent, inflammatory reaction of the skin
•Scalp—cradle cap
•Eyelids—blepharitis
•External ear—otitis externa
•Cause unknown: usually occurs with sebum production

34
Q

What are some deficiences that occur with vegitarian diets?

A
  • Inadequate protein for growth
  • Inadequate calories for energy and growth
  • Poor digestibility of many of the bulky natural, unprocessed foods, especially for infants
  • Vitamin B6, B₁₂, niacin, riboflavin, vitamin D, iron, calcium, and zinc
  • May require supplements
35
Q

What are some characteristics of Marasmus?

A

–General malnutrition of both calories and protein; insufficient quality and quantity of food
–Often seen with drought conditions in underdeveloped countries
–Physical and emotional deprivation
–Gradual wasting and atrophy of body tissues
–No edema, but loose wrinkled skin + small head size

36
Q

What are some symptoms of vitamin D toxicity?

A

hypercalcemia (nausea, vomiting, lethargy), HTN, kidney stones

37
Q

What is apnea of prematurity?

A

–Cessation of breathing longer than 20 seconds, or any period with bradycardia and cyanosis not associated with any predisposing conditions

38
Q

How is Measles (Rubeola) transmitted, what are the clinical manifestations of it?

A
  • Transmission: Direct contact from droplets
  • Clinical Manifestations:
    • Prodromal state: fever, malaiseà coryza (runny nose, coughing), cough conjunctivitis
    • “Koplick Spots” on mucosa
    • Rash appears on day 3-4 of illness
  • Treatment: Supportive care
  • Precautions: Droplet
39
Q

What is Regurgitation?

A

burping up undigested food from stomach

40
Q

How are lyne disease transmitted, what are the clinical manifestations, and how is it treated?

A

Transmitted: Infected deer tick bite

Clinical manifestations:

  • Stage 1: “Bull’s Eye”
    • Days to weeks after bite
    • Fever, HA, malaise
  • Stage 2: rash on hands and feet
    • 3-10 weeks after inoculation
    • Fever, fatigue,
    • lymphadenopathy, cough
  • Stage 3: Systemic involvement 2-12 mo

Treatment:

Early Lyme disease (21 days):

  • Doxycycline >8 yrs or Amox < 8 yrs
  • Alternative 3rd generation

cephalosporin (Cefuroxime) (also 21

days) or Azithromycin (7 day total)

41
Q

What causes a primary lactase deficiency?

A
  • Caused by a deficiency in lactase
  • Primary lactase deficiency is the most common
  • Occurs in children 4-5 years old; Asians, AA
  • Lactose malabsorption: Imbalance between ability of lactase to hydrolyze the lactose and the amount of lactose ingested
42
Q

What infants are at risk for SIDS?

A
  • Low birth weight
  • Low Apgar scores
  • Recent viral illness
  • Siblings of two or more SIDS
  • Male
  • Native American or AA
43
Q

How would you treat Kwashiorkor or Marasmus?

A

provide diet in high quality protein, CHO carbohydrates, vitamins and minerals

44
Q

How is Pertussis (whooping cough) transmitted, what are the clinical manifestations of it, how do you treat it, and what type of precautions are taken for it?

A
  • Transmission: Direct contact from droplets
  • Clinical manifestations:
    • disease starts with URI symptoms (catarrhal phase) –> to paroxysmal coughing (paroxysmal phase) over 3 to 6 weeks –> convalescent phase
    • URI symptoms.
    • Paroxysms of coughing, often with “whoops” on inspiration.
    • Coughing to the point of vomiting.
    • Dyspnea.
    • Seizures.
  • Treatment:
    • Supportive treatment
    • Hydration, pulmonary suctioning
    • O2
  • Precautions:
    • infants
45
Q

How is Roseola Infantum transmitted, what are the clinical manifestations of it, how do you treat it, and what type of precautions are taken for it?

A
  • Clinical manifestations:
    • history of high fever (3-4 days in child that otherwise appears healthy)
    • Biggest concern is febrile seizures
  • Treatment: Antipyretics, fever management, bed rest, and support
  • Precautions: Airborne if in hospital until day 5 of rash
46
Q

How is chornic malnutrtion classified?

A

If both height and weight low = chronic malnutrition
If weight low & height WNL = FTT

47
Q

What are the 3 basic combinations of foods that provides the complete proteins an infant needs?

A
    1. Grains (cereal, rice, pasta) + legumes (beans, peas, lentils, peanuts)
    1. Grains + dairy (milk, cheese, yogurt)
    1. Seeds (sesame, sunflower) + legumes

Peds Ex. 1 Study Material (5 decks)

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