Pediatrics: Tips of the Week

Acetaminophen Toxic Concentration

> 200 mcg/mL

Carbon Dioxide

Cord: 14-22 mEq/L

Premature 1 week: 14-27 mEq/L

Newborn: 13-22 mEq/L

Infant, child: 20-28 mEq/L

Chloride

Cord: 96-104 mEq/L

Newborn: 97-110 mEq/L

Child: 98-106 mEq/L

Conjugated direct Bilirubin

0.0-0.2 mg/dL

Creatinine

Cord: 0.6-1.2 mg/dL

Newborn: 0.3-1.0 mg/dL

Infant: 0.2-0.4 mg/dL

Child: 0.3-0.7 mg/dL

Adolescent: 0.5-1.0 mg/dL

Digoxin Toxin concentration

> 2.5 ng/mL

Serum Glucose

Newborn, 1 day: 40-60 mg/dL

Newborn, > 1 day: 50-90 mg/dL

Child: 60-100 mg/dL

Hematocrit

1 day: 48-69%

2 day: 48-75%

3 day: 44-72%

2 month: 28-42%

6-12 year: 37-49%

12-18 year male: 37-49%

12-18 year female: 36-46%

Hemoglobin

1-3 day: 14.5-22.5 g/dL

2 month: 9.0-14.0 g/dL

6-12 years male: 13.0-16.0 g/dL

6-12 years female: 12.0-16.0

Iron Serum

Newborn: 100-250 mcg/dL

Infant: 40-100 mcg/dL

Child: 50-120 mcg/dL

Fatally poisoned child: > 1,800 mcg/dL

Platelets Newborn (after 1 wk, same as adults)

84-478 × 103/mm3 (ul)

Potassium

Newborn: 3.0-6.0 mEq/L

Child: 3.5-5.0 mEq/L

Salicylates: Therapeutic

15-30 mg/dL

Sodium

Newborn: 134-146 mEq/L

Infant: 139-146 mEq/L

Child: 136-145 mEq/L

Leukocyte count (WBC count)

Birth: 9.0-30.0

24 hour: 9.4-34.0

1 month: 5.0-19.5

1-3 years: 6.0-17.5

4-7 years: 5.5-15.5

8-13 years: 4.5-13.5

Expected BP Range: 1 year

Girls: 83-114/38-67

Boys: 80-114/34-66

Expected BP Range: 3 years

Girls: 86-117/47/76

Boys: 86-120/44-75

Expected BP Range: 6 years

Girls: 91-122/54-83

Boys: 91-125/53-84

Expected BP Range: 10 years

Girls: 98-129/59-88

Boys: 97-130/58-90

Expected BP Range: 16 years

Girls: 108-138/64-93

Boys: 111-145/63-94

Average Resting HR

Birth to 1 week: 100-160/min

1 week to 3 months: 100-220/min

3 months to 2 years: 80-150/min

2 to 12 years: 70 to 110/min

12 years & older: 70-110/min

Average Resting Respiratory Rates

Newborn: 30-60/min w/ <15 sec of apnea periods

Newborn to 1 year: 30/min

1-2 years: 25-30/min

2-6 years: 21-24/min

6-12 years: 19-21/min

12+: 16-18/min

Pain Assessment by Age

2 months to 7 years: FLACC

3 years+: Faces

3-13 y/o: ouccher

5+: Numeric scale

3-18 y/o: non-communicating children’s pain checklist

Stressors in Hospitalized Infant

• interrupted routines

• parental separation

• lack of stimulation

• causes:

  • poor feedings

  • irritability

  • crying

  • altered sleep patterns

Stressors in Hospitalized Toddler

• interrupted routines

• separation from parents

• loss of control

• fear of being hurt

• causes:

  • protest stage (crying, fighting, tantrums)

  • despair stage

  • developmental regression

  • refusal to eat

  • sleep pattern disturbance

Stressors in Hospitalized Pre-Schoolers

• pain/bodily injury

• separation from parents

• loss of control

• causes

  • passiveness

  • withdrawal

  • poor appetite

  • sleep disturbances

  • magical thinking

  • bed wetting

Stressors in Hospitalized School Age Children

• guilty feelings

• fear of pain

• loss of control

• body image changes

• falling behind in school

• missing school friends

• causes:

  • decreased self esteem

  • anxiety, fearfulness, stalling, bargaining, stoicism, boredom, withdrawal

  • sleep disturbances

  • acting out, anger, cry

Stressors in Hospitalized Adolescents

• body image changes

• self-concept disturbances

• social isolation

• personal identity issues

• causes

  • anger

  • aggression

  • demanding

  • frustration

  • withdrawal

Erikson Psychosocial Development

Infant: trust vs. mistrust

Toddler (12 mos - 3 years): Autonomy vs. shame

Pre-schooler (3-5 y/o): Initiative vs. guilt

School-aged (5-12 y/o): Industry vs. inferiority

Adolescent (12-18 y/o): Identity vs. role confusion