Pediatrics Rotation

How to calculate corrected gestational age?

Corrected age = chronological age (actual age) - weeks premature

What is the Tanner staging in boys?

• Stage 1

  • Prepuberty

• Stage 2

  • Genitals: testicular volume and scrotal size increase

  • Pubic hair: sparse, lightly pigmented hair on the base of the penis

• Stage 3

  • Genitals: continued enlargement of testicles and scrotum, penis begins to grow

  • Pubic hair: dark, coarse, curly hair spreading over the pubic symphysis

• Stage 4

  • Genitals: continued enlargement of testicles and scrotum, increase in penile growth and diameter, development of glans penis

  • Pubic hair: adult pubic hair that does not extend to the inner thighs

• Stage 5

  • Mature

What are the breastfeeding recommendations?

• Exclusively for the first 4-6 months

  • Need to supplement with vitamin D

• Breast fed → 10 feedings/24 hours

• Formula fed → 8-10 feedings/24 hours

When are solids introduced?

• 4-6 months (need to have no extrusion reflex)

  • 6-8 months: 2-3 solids and 5-6 milk feedings

  • 8 months: 3 solids and 5 milk feedings

• Can begin finger foods at 9 months

What is the nutrition at 1 y/o?

• Change to whole milk or cows milk

• Do not use reduced fat milk before 2 y/o: need enough fat for brain development

• Should not need any night time feedings

What are the newborn-1 month milestones?

• Gross motor → turns and lifts head in prone

• Fine motor → grasps reflexively

• Language → cries

• Social → brief eye contact

What are the 2 month milestones?

• Gross motor → lifts head and chest in prone

• Fine motor → opens and shuts hands

• Language → coos

• Social → social smile

What are the 4 month milestones?

• Gross motor → rolls front to back

• Fine motor → plays at midline

• Language → extended cries

• Social → laughs aloud

What are the 6 month milestones?

• Gross motor → rolls back to front

• Fine motor → transfers hand to hand

• Language → babbles

• Social → starts to respond to name

What are the 9 month milestones?

• Gross motor → sits well, crawls, pulls to stand

• Fine motor → picks up with 3 fingers

• Language → mama and dada

• Social → stranger anxiety

What are the 12 month milestones?

• Gross motor → first independent steps

• Fine motor → 2 finger pincer grasp

• Language → mama, dada, 1 other word

• Social → object permanence

What are the 15 month milestones?

• Gross motor → squats, climbs, starts to run

• Fine motor → scribbles

• Language → 3 words

• Social → points to ask for things

What are the 18 month milestones?

• Gross motor → walks up stairs with hand held

• Fine motor → scribbles on own

• Language → 6-10 words

• Social → points to show interest

What are the 2 y/o milestones?

• Gross motor → runs, kicks ball, jumps with both feet

• Fine motor → stacks objects and turns pages

• Language → 50 words, 2-word phrases

• Social → parallel play

What are red flags of development?

• If Moro and palmar grasp do not fade by 4-6 months or are asymmetric

• Hand preference before 12-18 months

How to calculate antibiotic dosage?

• Childs weight: 20 kg

• Prescription: amoxicillin 30 mg/kg/day every 8 hours

• Available suspension: 400 mg/5 mL

Total daily dose: 30 mg/kg/day x 20 kg = 600 mg/day

Dose per administration: 600 mg/3 doses = 200 mg per dose

Volume per dose (mL): 200 mg × 5 mL = 2.5 mL per dose

400 mg

What is fluid management in children?

• Immediate fluid resuscitation: 20 ml/kg over 15-30 minutes

• Maintenance fluid

  • 4 ml/kg/hr for first 10 kg

  • 2 ml/kg/hr for next 10 kg

  • 1 ml/kg/hr for every kg over 20 kg

• Calculate fluid deficit

  • Pre-illness weight - illness weight: add to maintenance fluid

• Electrolytes

  • Children > 10 kg: D5 ½ NS + 20 KCl

  • Children < 10 kg: D5 1/3 NS + 10 KCl

How does weight typically fluctuate in newborns?

• In the first 4 days → lose around 5-7% of birth weight

  • Loss beyond 10% is the threshold for further workup

• Should gain around 1 ounce per day

What are the steps for treatment for DKA?

• Fluid resuscitation (0.9% NaCl)

• Potassium repletion (if baseline level <= 5 mEq/L)

• Short acting insulin once potassium level > 3.5

• IV sodium bicarbonate if severe refractory metabolic acidosis

What are symptoms of vitamin A deficiency?

• Night blindness

• Retinopathy

• Xerophthalmia

• Keratomalacia

• Bitot spots → gray, triangular, dry patches on the bulbar conjunctiva, covered by a layer with a foamy appearance

• Xerosis cutis

• Squamous metaplasia and keratinization

  • Skin → follicular hyperkeratosis

What is gold standard for suspected lymphoma or metastatic disease?

• Excisional lymph node biopsy

What is anemia of prematurity?

• Pathophysiology

  • Shortened RBC lifespan

  • Rapid body growth causing hemodilution

  • Frequent phlebotomy

• Have low EPO response to anemia due to the developmental switch of EPO production from the liver to the kidneys → hypo-proliferative anemia

• Normocytic normochromic anemia and low reticulocyte count

What is meconium ileus?

• Distal SBO caused by abnormally thick, inspissated meconium

  • Ground glass appearance of RLQ

• Pathognomonic for CF

What is first line treatment for lice?

• Permethrin

  • Lindane no longer first line: risk for neurotoxicity

What is a feared sequelae of measles?

• Subacute sclerosing pan-encephalitis → neurodegenerative disease that leads to a vegetative state and death