Download - Addendum: Pediatrics Review
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Addendum: Pediatrics Review
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WHO 2009 Classification
• Dengue without warning signs: Live in/travel to endemic areas Fever and 2 of the ff criteria:1.Nausea, vomiting2.Rash3.Aches & pains4.Tourniquet test positive5.Leukopenia
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WHO 2009 Classification
• Dengue with warning signs:1.Abdominal pain or tenderness2.Persistent vomiting3.Clinical fluid accumulation4.Mucosal bleed5.Lethargy, restlessness6.Liver enlargement > 2 cms7. Increase in hct with decrease in platelet
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WHO 2009 Classification
• Severe dengue:1.Severe plasma leakage Shock (DSS) Fluid accumulation with respiratory distress
2. Severe bleeding As evaluated by clinician
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WHO 2009 Classification
3. Severe organ involvementliver: AST or ALT >1,000CNS: impaired consciousnessHeart and other organs
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Dengue Fever
• Dengue NS-1 Ag – Day 1 and Day 4 of the illness
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Rickets
• Disease of growing bone which occurs in children only before fusion of the epiphyses
• Due to unmineralized matrix at the growth plates
• Increase in the circumference of the growth plate and the metaphyses --> widening of the wrists & ankles
• General softening of the bones
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Rickets
• Craniotabes or softening of the cranial bones
• Widening of the costochondral junctions leads to “rachitic rosary”
• “Harrison groove” is a horizontal depression along the lower anterior chest due to pulling of the softened ribs by the diaphragm during inspiration
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La Leche League International
• All milk should be dated before storing. • Preferably, human milk should be refrigerated
or chilled right after it is expressed. • Guidelines for storing human milk:1.At room temperature (19-26 C) for 4 hours
(ideal), up to 6 hours (acceptable)2. In a ref < 4 C for 72 hrs (ideal), up to 8 days
(acceptable)
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LLLI
3. In a freezer (-18- -20 C) for 6 months (ideal), up to 12 months (acceptable)
. What type of container should be used?1. Glass or hard-sided plastic containers with
well-fitting tops2. Containers not made with the controversial
chemical bisphenol A (BPA)3. Containers which have been washed in hot,
soapy water, rinsed well, and air-dried
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LLLI
4. Containers should not be filled to the top - leave one inch of space to allow for expansion
5. Put only 2-4 ozs of milk in the container to reduce waste.
6. Disposable plastic bags are not recommended as it leads to greater risk of contamination.
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How to warm the milk:
1. Do not refreeze thawed milk.2. Previously frozen milk that has been thawed
can be kept in the refrigerator for up to 24 hrs.
3. Frozen milk: thaw in the ref overnight or under cool running water
4. Refrigerated milk: under warm running water for several minutes. Do not heat the milk directly on the stove. Do not use microwave.
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Guidelines on Infant & Young Child Feeding
• UNICEF & WHO recommend that infants be exclusively breastfed on demand for the 1st 6 months of life
• Early introduction of food & other liquids?
1.Reduces breast milk intake
2.Decreases full absorption of nutrients from breast milk
3. Increases the risk of diarrhea and URI
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Febrile Seizures
Most common seizure disorder in childhoodRare before 9 months and after 5 yrs oldPeak age of onset: 14-18 months oldNormal neurologic examNormal EEG(+) family history
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Comparison:
• Simple: Lasts a few secs &
rarely >15 mins. Initially generalized and
tonic-clonic Followed by a brief
period of post-ictal drowsiness
Occurs only once in 24 hrs
• Complex: Duration is >15 mins. Repeated convulsions
occur within 24 hrs Focal seizure activity
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Status Epilepticus
• One seizure lasting 30 mins or multiple seizures during 30 mins without regaining consciousness
• Usual cause: breakthrough seizures - missed doses of anti-epileptic drug/s
• May be due to CNS infection
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Persistent PulmonaryHypertension of the Newborn
• Failure of the normal circulatory transition that occurs after birth
• Syndrome: marked pulmonary hypertension that causes hypoxemia and right-to-left
extrapulmonary shunting of blood • With inadequate pulmonary perfusion,
neonates are at risk for developing refractory hypoxemia, respiratory distress, and acidosis.
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PPHN
• Most common cause is meconium aspiration syndrome
• about 13% of all live births are complicated by meconium-stained fluid but only 5% who had this complication subsequently develop MAS• Coarse streaking granular pattern in both
lung fields• Irregularly aerated lungs
• Flattened diaphragm, increased AP diameter
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PPHN
• 2nd most common cause is idiopathic• “black-lung”
• Significant remodeling of pulmonary vasculature with vascular wall thickening and
smooth muscle hyperplasia • Contributory factor: use of NSAIDs during 3rd
trimester leading to constriction of the fetal ductus arteriosus in utero
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SMR in BoysSMRStage PUBIC HAIR PENIS TESTES1 None Preadolescent Preadolescent2 Scanty, long, slightly pigmented Slight enlargement Enlarged
scrotum, pink, texture altered
3 Darker, starts to curl, small amount Longer Larger4 Resembles adult type but less in quantity;coarse, curly Larger; glans and breadth increase in size Larger, scrotum
dark5 Adult distribution,spread to medial surface of thighs Adult size Adult size
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SMR in GirlsSMR
STAGEPUBIC HAIR BREASTS
1 Preadolescent Preadolescent
2 Sparse, lightly pigmented, straight, medial border of labia
Breast and papilla elevated as small mound; areolar diameter increased
3 Darker, beginning to curl, increased amount
Breast and areola enlarged, no contour separation
4 Coarse, curly, abundant but amount less than in adult
Areola and papilla form secondary mound
5 Adult feminine triangle, spread to medial surface of thighs
Mature, nipple projects, areola part of general breast contour
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Gross motor skills
• 6 years old – skip
• 8 years old – hop on one foot twice, then the
other
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Fine motor skills
• 6 years old- tie shoe laces
• 7 years old- print letters, letter reversal
• 8-10 years old– rapid alternating movement
of the hand, cursive writing
• 10-12 years old – manipulative abilities
similar to adult
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Social development
• Expanding social world
• Identification and reliance on peer groups
7 years – attachment to parents decrease
and to peers increase
9 years – tightly knit groups are formed;
group loyalty and commitment to
best friends
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Social development 4-5 y/o
• Toilet-trained• Plays imaginary games• Helps in tasks in house• Cooperative group play: takes turns and
shares • Tender and protective• Cooperative most of the time• Chooses own friends
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Emotional development4-5 yrs old
Make-believe gamesToy guns are simply an innocent and entertaining way to be competitive and to boost their self-esteem (Shelov, 1994).Interest in basic sexuality May play with their genitals ---- signs of normal curiosity! Do not scold or punish! Be straightforward
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Emotional development:4-5 yrs old
• Parents should answer in simple and correct terms.
• Parents should tell their child not to let other person touch the “private parts”.
• Teach your child not to talk to strangers.• Teach child’s name, address, phone if lost.• Normal for a 4 year old to make up stories.• Encourage child to sleep in own bed.