Pediatric Ambulatory Care

When is Allergic Rhinitis rarely seen in children?

Before 2 years of age

What is a factor that increases the risk of Allergic Rhinitis in the first year of life?

Maternal smoking exposure

What are the causes of Allergic Rhinitis in children?

Outdoor allergens (pollen/grass) and Indoor allergens (dust mites)

What are some non-pharmacologic treatments for Allergic Rhinitis?

Wash bedding weekly

Filters/Dehumidifiers

Avoid triggers

Shower at night

Children under which age are an exclusion for self care of Allergic Rhinitis?

12 years

What are symptoms that make Allergic Rhinitis an exclusion for self care?

Otitis media, sinusitis, bronchitis, other infections, asthma

What is the first line pharmacologic therapy for pediatric Allergic Rhinitis?

Nasal corticosteroids

What is the second line pharmacologic therapy for pediatric Allergic Rhinitis?

Antihistamines and decongestants

What is the third line pharmacologic therapy for pediatric Allergic Rhinitis?

Mast cell stabilizer

Which nasal corticosteroid is approved for children older than 4 years old?

Flonase

Which nasal corticosteroid is approved for children older than 2 years old?

Nasacort

What are the side effects for Flonase?

Nasal burning/irritation, headache, and throat irritation

What are the side effects for Nasacort?

Throat irritation, cough, and headache

Which oral antihistamine is not recommended in children?

1st generation (Diphenhydramine/Chlorpheniramine)

What is the preferred oral antihistamine in children?

2nd generation (Loratadine, Desloratadine, Cetirizine, Levocetirizine, Fexofenadine)

Which oral antihistamine is approved OTC for children older than 2 years old?

Claritin, Desloratadine, Cetirizine, Levocetirizine, Fexofenadine

Which oral antihistamine is approved as a prescription for children older than 6 months old?

Desloratadine, Cetirizine, Levocetirizine, Fexofenadine

Which intranasal antihistamine is approved OTC for patients older than 6 years old?

Azelastine

Which nasal decongestant is approved for patients older than 6 years old?

Oxymetazoline (Afrin)

Which nasal decongestant is approved for patients older than 2 years old?

Phenylephrine

Which oral decongestant is approved for patients older than 4 years old?

Pseudoephedrine (Sudafed) and Phenylephrine (Sudafed PE)

What age is a mast cell stabilizer approved for children?

2 years

When does the initial effect of a mast cell stabilizer begin to show?

3-7 days

When does the full effect of a mast cell stabilizer begin to show?

2-4 weeks

Which dosage form of a decongestant is recommended to be given first: nasal or oral?

Nasal

What is the common cause of cold in children?

Rhinovirus

What are the 2 ways that colds are transmitted?

Self-inoculation of nasal mucosa

Inhalation of aerosolized particles

How long do cold symptoms last?

7-14 days

A fever is a temperature above:

100.4 ̊F

What are symptoms of a cold that make it an exclusion for self care?

Chest pain, shortness of breath, new/worsening symptoms, history of asthma

What age makes treating a cold an exclusion for self care?

< 3 months

What are symptoms of a cough that make it an exclusion for self care?

Shortness of breath, barking/whooping cough

A cough that worsens after _____ days makes it an exclusion for self care in children:

3-5

A cough that does not improve after _____ weeks makes it an exclusion for self care in children:

2-3

Children under the age of _____ are an exclusion to self care for a cough:

4

What is the first line of therapy for cough and cold?

Non-pharmacologic

What is the non-pharmacologic therapy for cough/cold in children?

Increase fluid intake

Increased humidification

Saline nasal sprays/drops

Vicks VapoRub

Bulb suction

Honey

Salt gargle

What is the age restriction for honey in children for a cough/cold?

> 1 year

What is the pharmacologic therapy for children with a cold?

Decongestants and antipyretics

What is the pharmacologic therapy for children with a cough?

Expectorant or Antitussive

Which antitussive should not be used in children?

Codeine

What is the age restriction for Guaifenesin in children?

> 4 years old

What is the age restriction for Dextromethorphan in children?

> 4 years old

What drug is Codeine metabolized into?

Morphine

What are some non-pharmacologic treatments for pain in children?

RICE

Massage

Distraction

Repositioning

Pain lasting for longer than _____ days is an exclusion for self care

10

What are some symptoms associated with pain that make it an exclusion for self care in children?

Nausea, vomiting, fever, signs of infection, abdominal pain, bone pain

Children under what age are an exclusion for self care for pain?

< 2 years

What is the dosing for Acetaminophen (Tylenol) in children?

10-15 mg/kg/dose every 4-6 hours

What is the maximum daily dose for Acetaminophen (Tylenol) in children?

75 mg/kg/day or 4 g/day

What is the dosing for Ibuprofen (Advil) in children?

5-10 mg/kg/dose every 6-8 hours

What is the minimum age for Ibuprofen in children?

> 6 months

What is the maximum daily dose for Ibuprofen (Advil) in children?

40 mg/kg/day or 2400 mg/day

What can cause a fever in children?

Malignancy, Infection, Medication, Vaccination

What is the gold standard to measure temperatures in children < 4 years old?

Rectal

What is the age for children to measure temperatures orally?

> 4 years

What is the least accurate method for measuring temperatures?

Axillary

Which method for measuring temperature is the most ideal for core temperatures?

Tympanic

What temperature is considered a fever in children < 3 months of age?

≥ 100.4 ◦F

What temperature is considered a fever in children ≥ 3 months of age?

≥ 101.2 ◦F

Children older than 2 years old with fevers lasting for more than ___ days with/without treatment are an exclusion for self care:

3

Children younger than 2 years old with fevers lasting for more than ___ hours are an exclusion for self care:

24

What are symptoms in children with a fever that makes it an exclusion for self care?

Very sleepy, irritable or hard to wake up

Refuses to drink fluids/cannot stay hydrated

History of febrile seizures or seizures

Develop rash/spots

What are some nonpharmacologic treatment for fevers?

Cool compresses, warm bath, remove extra clothes, push fluids

What are the pharmacologic treatments for fever?

Acetaminophen or Ibuprofen

True or False: alternating acetaminophen and ibuprofen is not recommended

True

What is the age restriction for aspirin in children?

> 15 years old

What are the exceptions for using Aspirin in children younger than 15 years old?

Congenital heart patients with shunt or Kawasaki's disease

What are nonpharmacologic treatments for children who are teething?

Cold/frozen teething rings, frozen foods, massage baby's gums

What are the pharmacologic treatments for children who are teething?

Acetaminophen or Ibuprofen

Which pharmacologic treatment is not recommended in children for teething?

Benzocaine (Orajel)

What can Benzocaine (Orajel) induce in children who are teething?

Methemoglobinemia (decreased oxygen in the blood)

What are some causes of Infant Colic?

Immaturity of GI system

Inability of CNS to handle stimulus of environment

Allergies and hypersensitivity

Which diagnosis makes infant colic an exclusion for self care?

GERD, cow milk allergy, food allergy, colitis, pyloric stenosis

What are some non-pharmacologic treatments for infant colic?

Hypoallergenic formulas, maternal diet avoidance, feeding techniques, stimulation, probiotics, herbal remedies, time

What are pharmacologic treatments for infant colic?

Simethicone

What are herbal remedies for infant colic?

Chamomile or gripe water

Simethicone drops are not recommended in neonates younger than _____

1 month

What does simethicone contain that makes it not recommended in neonates?

Benzyl alcohol

By what age does GERD improve in most infants?

12-15 months

What is a nonpharmacologic treatment for GERD?

Thickened feeds or positioning upright

What are pharmacologic treatments for GERD in infants?

Famotidine, Omeprazole, or Metoclopramide

What are symptoms of GERD in older children?

Regurgitation into mouth, heartburn, dysphagia

What are some risk factors for GERD in older children?

Asthma, cystic fibrosis, developmental handicaps

Children younger than __ years are an exclusion to antacids:

2

Children younger than __ years are an exclusion to H2RAs:

12

Children younger than __ years are an exclusion to PPIs:

18