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Passive immunity in infants

Temporary protection from maternal antibodies crossing the placenta and from breastmilk, before the infant's own active immunity develops

Vaccination — hand hygiene is important but is NOT the top prevention method

Definition of fever in pediatrics

A temperature of 100.4 F or higher — 99.8 F does not count as a fever

Fever in an infant under 3 months old

Always an ER evaluation to rule out sepsis, every time, no exceptions

Live vaccines

MMR, varicella, rotavirus, and intranasal influenza (LAIV/FluMist)

Minimum age for live vaccines

12 months or older — never given to a child younger than 12 months

Requirement before every vaccination

Consent

Vaccine given at birth

Hepatitis B dose 1, given 24-48 hr after delivery or at the newborn follow-up visit

Earliest age for the influenza vaccine

About 6 months

Vaccines at 11-12 years

The kindergarten-entry-style booster set plus the Tdap booster

Vaccines at 16 years

Tdap and meningococcal (MenACWY) booster

HPV vaccine timing

Recommended at 11-12 years, can start as early as 9 — NOT required for school entry

DTaP vs Tdap

DTaP is for children under 7, Tdap is for age 7 and up

Adult tetanus booster interval

Td/Tdap every 10 years, and with every pregnancy

Mild illness and vaccination

Still vaccinate — a low-grade temp or runny nose is not a reason to hold, and families often won't return for a makeup visit

Moderate or severe illness and vaccination

Hold LIVE vaccines only

Contraindications to ANY vaccine

Severe allergic reaction or anaphylaxis to a previous dose, and severe febrile illness

Contraindications to LIVE vaccines specifically

Immunocompromised, pregnant, or received blood products (acquired passive immunity) within the past 3 months

Premature infants and the vaccine schedule

Vaccinate by chronological age from birth once stable, NOT adjusted or gestational age — prematurity itself is not a reason to delay

Expected post-vaccine reactions

Localized swelling, redness, and pain at the site, low-grade fever, mild rash, irritability

Vaccine documentation requirements

Lot number, expiration date, and route — keep the vial to scan or read

Atraumatic care during immunization

Distraction and the caregiver's lap, sucrose solution on a pacifier for infants, VIS given every time, the 5 rights

Route knowledge expected for vaccines

The IM injection site/location — not a vaccine-by-vaccine route list

Sunken anterior fontanelle

Classic sign of dehydration in an infant

Treatment principle for any viral infection

Supportive care only — no antibiotics pushed

Main cause of conjunctivitis

Staph spread by direct contact — touching something and then touching the eyes

Bacterial conjunctivitis

Purulent thick colored discharge — antibiotics clear it in about 24 hr, discard old contacts, no school until 24 hr after antibiotics are started

Allergic conjunctivitis

Watery, itchy eyes that are NOT red or purulent — treated with allergy medication

Viral conjunctivitis

Watery discharge secondary to a viral infection — self-limited over 7-14 days, contact precautions

Chickenpox virus

Varicella zoster

Chickenpox hallmark

Itchy rash with crusting lesions that take 1-3 weeks to fully crust

Chickenpox return to school

Once all lesions have crusted over

Chickenpox treatment

Oatmeal baths, anti-itch measures, and acyclovir if severe or immunocompromised

Chickenpox latency

The virus stays latent for life, which is why adults need the Shingrix (shingles) vaccine at age 50+

Varicella precautions

Airborne plus contact

Fifth disease virus

Parvovirus B19

Fifth disease technical name

Erythema infectiosum

Fifth disease hallmark in children

Slap-cheek flushed red face plus a lacy rash on the trunk

Fifth disease presentation in adults

Joint pain and arthralgias only, usually with no rash — easily mistaken for rheumatoid arthritis

Fifth disease return to school

Once fever resolves — not contagious once the rash appears

Fifth disease pregnancy risk

Can cause fetal harm or pregnancy loss if a pregnant woman is exposed

Fifth disease treatment

Supportive only — antipyretics, antipruritics, oatmeal baths, stay out of sunlight

Mumps virus

Paramyxovirus

Mumps hallmark

Parotid gland swelling, unilateral or bilateral, with earaches, painful chewing, and fatigue

Mumps isolation

Droplet isolation until 9 days after onset

Mumps treatment

Fever and pain control, oral intake, ice

Mumps complications named in lecture

Orchitis, oophoritis, meningitis, and thrombocytopenia that can lead to hearing impairment

Rubella other name

German measles

Rubella hallmark

Pink maculopapular rash starting on the face and neck and spreading DOWN, with lymphadenopathy

Rubella precautions

Droplet precautions until several days after the rash

Rubella and pregnancy

Pregnant women should not care for these patients — congenital rubella causes deafness and miscarriage

Rubeola other names

Measles, American measles

Rubeola hallmark

Koplik spots — white spots on a red background INSIDE THE MOUTH

Rubeola precautions

Airborne — highly contagious

Rubeola treatment

Supportive — cool mist humidifier and antitussives

Rubeola complications

Otitis media, laryngitis, pneumonia, encephalitis

Mono virus

Epstein-Barr virus, the kissing virus

Mono hallmark

Splenomegaly, plus large red tonsils, fever, sore throat, excessive fatigue, and sometimes hepatomegaly

Mono activity restriction

No contact sports for at least 4 weeks, up to 2 months, until the spleen is confirmed no longer enlarged

Mono treatment

Supportive, with steroids if the airway is compromised by tonsillar swelling

Hand foot and mouth disease virus

Coxsackievirus

Hand foot and mouth hallmark

Rash on the hands, feet, AND mouth with sometimes severe mouth sores, appearing about 2 days after the fever starts

Hand foot and mouth contagious period

As long as the FEVER is present, even after the rash resolves

Hand foot and mouth transmission

Direct contact with fecal and oral secretions

Hand foot and mouth treatment

Fluids, antipyretics and analgesics such as ibuprofen, mouthwash, hand hygiene — resolves in about a week and can be worse in adults

Pertussis common name

Whooping cough

Pertussis hallmark

A barky, paroxysmal cough that won't go away after a cold has resolved, which can progress to stridor

Pertussis duration

Six weeks or longer — croup also causes stridor but resolves faster

Pertussis treatment

Antibiotics (Z-pack) plus supportive care

Pertussis inpatient care

Oxygen, IV fluids, cardiac monitor, emergency equipment nearby in case of stridor, and cluster care/cluster feeds to reduce the stress of coughing episodes

Pertussis prevention

Tdap vaccination

Strep throat manifestations

Fever, painful swallowing, and white exudate on the tonsils

Strep throat treatment

Penicillin or amoxicillin

Strep throat contagious period

Not contagious 24 hr after starting antibiotics

Toothbrush teaching after strep

Discard the toothbrush after 24 hr of antibiotics and clean the whole bathroom

Scarlet fever hallmark

Strawberry tongue plus a sandpaper rash and a very sore red throat, from untreated strep

Complications of untreated strep

Scarlet fever, rheumatic fever, glomerulonephritis, sepsis

Rash assessment in more pigmented skin

The rash may be hard to see — rely on Koplik spots in the mouth, texture change, and reported itching rather than visible redness

Communicable diseases needing airborne precautions

Rubeola (measles) and varicella, which also needs contact

Communicable diseases needing droplet precautions

Rubella, fifth disease, pertussis, mumps

Communicable disease needing contact precautions

Viral conjunctivitis

Peak age for otitis media

The first 24 months of life

Why young children get otitis media

Eustachian tubes are shorter and more horizontal than adults', so they drain poorly

AOM tympanic membrane findings

Bulging and inflamed with purulent material behind it

OME tympanic membrane findings

Opaque with decreased movement and no infection

AOM symptoms

Ear tugging, fussiness, fever, pain, and decreased or absent TM movement on pneumatic otoscopy

OME symptoms

Fullness in the ear and transient hearing loss

Otitis media risk factors

Short horizontal eustachian tubes, bottle-feeding while supine, daycare exposure, secondhand smoke, cleft palate, Down syndrome

Protective factor against otitis media

Breastfeeding, because of IgA

AAP management of uncomplicated AOM

Watch and wait 2-3 days before antibiotics in children 2-12 years old

AOM antibiotic and dose

High-dose amoxicillin 80-90 mg/kg/day divided, used if severe or if under age 2 with bilateral AOM

Treatment for recurrent AOM

Myringotomy tubes, which fall out on their own in 8-18 months

Priority nursing action for a toddler with AOM

Administer analgesics — treat the pain before teaching or comfort measures

Complication of repeated ear infections

Hearing loss and speech delay — refer for audiology and speech therapy

Acyclovir in pediatrics

Antiviral used for severe or immunocompromised varicella and high-risk mono complications

Antihistamine caution in children

Diphenhydramine and hydroxyzine can cause paradoxical hyperalertness — monitor drowsiness and safety

Aspirin in children

Contraindicated in febrile or viral illness because of Reye syndrome risk — use acetaminophen or ibuprofen instead

Early signs of increased ICP in infants

Bulging or tense fontanel, increased head circumference, irritability, poor feeding, distended scalp veins

Late signs of increased ICP in infants

Setting-sun eyes, high-pitched cry, posturing, Cushing's triad

Early signs of increased ICP in children

Headache, vomiting, blurred vision, decreasing pulse, irritability

Late signs of increased ICP in children