AIM Module 3 Peds

what are the 4 developmental milestone domains

personal-social (self-help), fine motor-adaptive, language, gross motor

2 month old milestone anchors

social = smiles; language = cooing (“ooaa”)

4 year old language milestone anchor

defines ~4 words

4 year old self-help milestone anchor

brushes own teeth

how to interpret developmental milestone charts (Denver II)

screening tool—if child is older than the age most kids achieve a milestone and cannot do it, this is concerning for delay

nasal congestion is associated with what diagnoses

URI, allergies, foreign body, nasal polyps

stertor is associated with pathology at what level and diagnoses

nasopharynx; OSA, enlarged tonsils/adenoids

stridor is associated with pathology at what level and diagnoses

upper airway/larynx; croup, epiglottitis, obstruction, vocal cord paralysis

rhonchi are associated with pathology at what level and diagnoses

large airways; bronchitis, viral infections

crackles are associated with pathology at what level and diagnoses

alveoli; pneumonia (bacterial/viral), pulmonary edema

wheezing is associated with pathology at what level and diagnoses

bronchioles; asthma/reactive airway disease, bronchiolitis, foreign body, anaphylaxis

nasal passages pathologic lung sound

congestion

nasopharyngeal/back of throat pathologic lung sound

stertor

upper airway/larynx pathologic lung sound

stridor

large airway/bronchus pathologic lung sound

rhonchi

alveoli pathologic lung sound

crackles

distal airway/bronchioles pathologic lung sound

wheezes

why nasal obstruction causes congestion sounds

turbulent airflow through narrowed nasal passages from mucus, swelling, or blockage

why nasopharyngeal obstruction causes stertor

vibration of soft tissues (tonsils/adenoids/soft palate) due to partial upper airway obstruction

why upper airway obstruction causes stridor

high-pitched sound from turbulent airflow through a narrowed larynx or trachea, usually during inspiration

why bronchiolar disease causes wheezing

narrowed small airways increase expiratory resistance, causing oscillation of airway walls

why alveolar disease causes crackles

sudden opening of fluid-filled or collapsed alveoli during inspiration

what are key signs of respiratory distress in a pediatric patient

tachypnea, nasal flaring, retractions, grunting, seesaw breathing, head bobbing, limited speech

why does grunting occur in respiratory distress

partial glottic closure during expiration increases airway pressure to prevent alveolar collapse

what is seesaw (paradoxical) breathing and why is it concerning

chest and abdomen move opposite directions, indicating severe respiratory muscle fatigue

what SpO₂ finding is concerning beyond the immediate newborn period

SpO₂ <90–92% suggests respiratory disease or cyanotic heart disease

when should supplemental oxygen be started in a pediatric patient

when SpO₂ <90% on room air

why is SpO₂ of ~90% used as the oxygen cutoff

below 90% the oxygen–hemoglobin dissociation curve becomes steep, so small drops in PaO₂ cause large drops in saturation

what does an SpO₂ of 87% indicate physiologically

patient is on the steep portion of the curve with inadequate oxygen reserve

what does SpO₂ measure

arterial oxygen saturation (percent of hemoglobin bound to oxygen)

why does giving oxygen help more once SpO₂ is <90%

increasing PaO₂ rapidly improves hemoglobin saturation on the steep part of the curve

what does TORCH stand for

Toxoplasma gondii, Other (syphilis, HIV), Rubella, Cytomegalovirus, Herpes simplex virus

how is toxoplasma gondii acquired during pregnancy

cat feces exposure or ingestion of undercooked meat

how does toxoplasma gondii typically present in the pregnant person

usually asymptomatic; rarely lymphadenopathy

what are classic neonatal manifestations of congenital toxoplasmosis

chorioretinitis, hydrocephalus, intracranial calcifications ± blueberry muffin rash

how is rubella acquired during pregnancy

respiratory droplets

how does rubella typically present in the pregnant person

rash, lymphadenopathy, polyarthritis, polyarthralgia

what are classic neonatal manifestations of congenital rubella

cataracts, sensorineural deafness, congenital heart disease (PDA) ± blueberry muffin rash

how is CMV acquired during pregnancy

sexual contact or organ transplant

how does CMV typically present in the pregnant person

usually asymptomatic or mononucleosis-like illness

what are classic neonatal manifestations of congenital CMV

hearing loss, seizures, petechiae, blueberry muffin rash, chorioretinitis, periventricular calcifications, microcephaly

how is HIV acquired during pregnancy or delivery

vertical transmission during pregnancy, delivery, or breastfeeding

how does HIV typically present in the pregnant person

may be asymptomatic or have chronic HIV symptoms

what are typical neonatal manifestations of congenital HIV

failure to thrive, recurrent or opportunistic infections, developmental delay

how is HSV-2 acquired during pregnancy or delivery

sexual contact with transmission most commonly during vaginal delivery

how does HSV-2 typically present in the pregnant person

genital vesicular lesions or asymptomatic shedding

what are neonatal manifestations of congenital HSV infection

vesicular skin lesions, encephalitis, or disseminated multiorgan disease

how is syphilis acquired during pregnancy

sexual contact

which maternal stages of syphilis are most likely to cause fetal infection

primary (chancre) and secondary (disseminated rash) syphilis

what are classic neonatal manifestations of congenital syphilis

stillbirth or hydrops fetalis; if surviving—saddle nose, notched teeth, short maxilla, saber shins, CN VIII deafness

which TORCH infections can cause a blueberry muffin rash

toxoplasmosis, rubella, CMV

which TORCH infection is associated with periventricular calcifications

cytomegalovirus

which TORCH infection causes diffuse intracranial calcifications with hydrocephalus

toxoplasma gondii

periventricular calcifications + hearing loss + petechiae (“blueberry muffin”) suggests

congenital CMV

why are calcifications periventricular in CMV

CMV infects germinal matrix and periventricular regions of the developing brain

notched teeth + saddle nose + saber shins in a neonate suggests

congenital syphilis

congenital cataracts + deafness + PDA suggests

congenital rubella syndrome

congenital infection with chorioretinitis + hydrocephalus + intracranial calcifications suggests

Toxoplasma gondii

pediatric vomiting gastrointestinal causes are divided how

upper GI, hepatobiliary, and lower GI causes

acute upper GI causes of pediatric vomiting

infectious gastroenteritis, gastric/duodenal obstruction, pyloric stenosis, intussusception, gastric volvulus, necrotizing enterocolitis

chronic upper GI causes of pediatric vomiting

gastroesophageal reflux disease, peptic ulcer disease, gastroparesis, gastritis

which upper GI cause presents with nonbilious projectile vomiting in infants

pyloric stenosis

which upper GI condition causes colicky pain and vomiting with possible currant jelly stools

intussusception

which neonatal upper GI condition is associated with prematurity and abdominal distension

necrotizing enterocolitis

hepatobiliary causes of pediatric vomiting

acute hepatitis, acute pancreatitis

which hepatobiliary condition causes vomiting with jaundice and elevated transaminases

acute hepatitis

which hepatobiliary condition causes vomiting with epigastric pain and elevated lipase

acute pancreatitis

acute lower GI causes of pediatric vomiting

infectious gastroenteritis, small or large bowel obstruction, intussusception, acute appendicitis, incarcerated hernia

chronic lower GI causes of pediatric vomiting

intestinal atresia, midgut malrotation

which lower GI cause of vomiting is a surgical emergency due to risk of volvulus

midgut malrotation

which lower GI cause presents with bilious vomiting in a neonate

intestinal atresia or malrotation

which lower GI condition presents with vomiting and localized RLQ abdominal pain

acute appendicitis

bilious vomiting in a child suggests pathology at what level

obstruction distal to the ampulla of Vater (lower GI or malrotation)

nonbilious vomiting suggests pathology at what level

upper gastrointestinal tract

vomiting with abdominal distension and no stool passage suggests

bowel obstruction

pediatric vomiting system causes are divided into what major categories

endocrine/metabolic, other systemic disease, drugs/toxins, and central nervous system causes

endocrine or metabolic causes of pediatric vomiting

pregnancy, diabetes/DKA, uremia, hypercalcemia, Addison’s disease, thyroid disease

why diabetic ketoacidosis causes vomiting

metabolic acidosis stimulates the chemoreceptor trigger zone and causes gastroparesis

why hypercalcemia causes vomiting

decreased GI motility and direct stimulation of the vomiting center

why Addison’s disease can cause vomiting

cortisol deficiency leads to hypotension, electrolyte imbalance, and GI symptoms

why thyroid disease can cause vomiting

altered metabolic rate and GI motility from excess or deficient thyroid hormone

systemic infectious or inflammatory causes of pediatric vomiting

sepsis (e.g., pyelonephritis, pneumonia), radiation sickness, poisoning, food allergy, urinary tract infection

why sepsis causes vomiting in children

systemic inflammation and hypoperfusion activate the vomiting center

why urinary tract infection can present with vomiting in pediatrics

immature autonomic response leads to GI symptoms rather than localized urinary complaints

why food allergy can cause vomiting

IgE-mediated or non–IgE-mediated GI hypersensitivity reaction

drug or toxin causes of pediatric vomiting

chemotherapy, antibiotics, carbon monoxide exposure

why chemotherapy commonly causes vomiting

stimulation of the chemoreceptor trigger zone and GI mucosal injury

why antibiotics can cause vomiting

direct gastric irritation or alteration of gut flora

why carbon monoxide poisoning causes vomiting

tissue hypoxia and central nervous system toxicity

central nervous system causes of pediatric vomiting include what major mechanisms

increased intracranial pressure, vestibular dysfunction, and psychiatric causes

causes of vomiting due to increased intracranial pressure

intracranial hemorrhage, meningitis, head trauma, brain tumor, hydrocephalus

why increased intracranial pressure causes vomiting

pressure on the medulla and vomiting center

what vomiting pattern suggests increased intracranial pressure

early morning vomiting with headache and no nausea

vestibular causes of pediatric vomiting

otitis media, motion sickness, vestibular migraine, Ménière’s disease, labyrinthitis

why vestibular dysfunction causes vomiting

mismatch between visual and vestibular input stimulates the vomiting center

psychiatric causes of pediatric vomiting

self-induced vomiting (bulimia), cyclic vomiting syndrome, psychogenic vomiting

what characterizes cyclic vomiting syndrome

recurrent stereotyped episodes of severe vomiting with symptom-free intervals

how psychogenic vomiting differs from organic causes

associated with stress and lacks objective physical findings

vomiting without abdominal findings should prompt evaluation of what categories

endocrine/metabolic, CNS, toxins, or systemic infection

early morning vomiting with headache suggests what category

increased intracranial pressure