Infants (1month-1yr) & Communicable Diseases

Infants (1month-1yr) & Communicable Diseases

What are the growth charts used for biological development?

Birth → <2 years = WHO

2 → 20 years = CDC

Weight gain:

• 6 months → 2x birth weight

• 12 months → 3x birth weight

Daily weight gain:

• 0-3 months = 30 g/day

• 3-6 months = 20 g/day

• 6-12 months = 10 g/day

Length growth

• Birth → 6 months = 1 in/month

• 6-12 months = ½ in/month

Important physical changes during infancy time

Posterior fontanel closes by 2 months

Breathing:

• Slowly start breathing via nose + mouth

Reflexes:

• Moro, Stepping, Rooting fade by 4-6 months

Teeth:

• Deciduous (primary) teeth begin to erupt

• Begins growing chewing/biting skills

Gross motor skills: Utilizes large muscle groups

• Rolling

• Sitting

• Crawling

• Standing

• Walking

Infant develops from head to toes

• Cephacaudal/Proximodistal

  • Arm → Hand → Fingers

Gross Motor Milestones:

1 month → Turn head while supine

• Head lag: poor head control when turning infant from lying to other position

2 month → Hold head up while on tummy; moves arms & legs

4 months → Holds head w/out support; pushes onto elbows/forearms

• Commando crawling: use of arms/upper body to move along floor

6 months → Rolls tummy → back; pushes up w/straight arms; supports self w/hands while sitting

9 months → Goes sitting position by self; sits w/out support

12 months → pulls to stand; cruises along furniture

Grasp progression:

1 month → tight fist

2 month → briefly opens hands

4 months → crude palmar grasp

• Using palm w/out thumb to grasp objects

• Hold toys placed in hand

• Brings hand to mouth

7 months → radial palmar grasp

• fingers + opposing thumb

8 months → scissors grasp

• Side of index fingers + thumb

9 months → transfer from hand to hand

• Uses fingers to rake food

11 months → shake + throw objects

12 months → pincer grasp

• Thumbs + index fingers

• drinks from uncovered cup

When does stranger anxiety ususally occur and what they do?

9 months

Shy, clingy, cry, fearful

Object permannce?

Understanding that a person/object keeps existing despite it not being seen

• Peek-a boo

• 6-12 months

Psychosocial milestones:

2 months → relaxes when picked up or spoken too

• smiles socially

• looks at faces

4 months → Smiles for attention, chuckles

• Makes sounds/things to keep attention

6 months → recognizes people

• enjoys mirror

• laughts

9 months → Stranger anxiety

• Facial expressions

• Responds to name

• Separation reaction

• Understands & enjoys peek-a-boo

12 months → Plays interactive games (pat-a-cake)

• proto-imperative pointing

  • Aka “I want THAT”

Starts also developing memory, language, reasoning, thinking, attention

• If i do X → Y happens “cause and effect”

Screen time:

AAP: no screen time up to 18 months

WHO: none till 2 years or more

Cognitive Development Milestones:

1-2 months:

• Optical focal length of ~10 inches

• Responds to stimuli changes; fixates on objects (tracks them horizontally and slightly beyond midline”

• Uses sucking and grasping reflex to interact

2-6 months:

• Begins exploring via touch

• Stares at hands, touches body, explores senses = all contribute to cause/effect learning

6-12 months:

• Reaches for, inspects, holds, drops, manipulates, uses for purpose, mouth places objects

Language development + milestones

Hearing → interaction → association → communication

• More infant hears, more it develops

• Parent interaction:

  • Talking/Reading/Responding to them

  • Labeling objects

MIlestones:

• 2 months: makes sounds other than crying

  • Reacts to LOUD sounds

• 4 months: Cooing; makes sounds back; turns toward voices

• 6 months: Takes turns making sounds

  • Blows raspberries

  • Squeals

• 9 months: mamamama/babababba

  • Raises arms to be picked up

• 12 months:

  • waves bye

  • “Mama/dada”

  • Understands “no”

Play in Infants

Social smile: first sign of play

• Develops at 4-6 weeks

• After 4 months → regular smiling +cooing

• 3-6 months → seeks interaction and play

Avoid teasing and throwing things during this age

PPD:

Sadness, Guilt, Imcompetence, Anhedonia, Anxiety, Self-harm

May lead to:

• Developmental, Emotional, Language, Cognitive Delays

• Poor bonding

Interventions:

• Provide support

• Sleep routines

• Self-help

Separation Anxiety:

Normal dev stage

• 6 months → 3 years

  • 9 months = strongest anxiety

• Appears suddenly → intensifies → gradually resolves

• Crying, Screaming, Clinging, Refusal to separate

Prolonged can lead to:

• Constant fear, loss of securiy

• poor bonding and social interactions

• Poor feeding

Interventions: Gradual separation

1. Leave for a short period

2. Use a trusted caregiver

3. Keep infant in familiar place

4. Gradually increase time away

5. Return

Bowlby’s Attachment Theory:

Attachment-related stress → physical response

• Tachycardia

Foundation of Infant Health Promotion:

Safety:

• Risks:

  • Suffocation, Falls, Burns, Chocking, Drowning

• Interventions:

  • Cover outlets, pad sharp edges, locks, supervise

  • CPR and hemlicks

    • Alternating back blows + chest thrusts

Nutrition:

• Birth → 4-6 months

  • Formula feeding: 18-20 kcal/oz

    • use w/in 2 hrs of mixing OR keep in fridge for up to 1 day

  • Breast feeding: 18-20 kcal/oz

• Always discard left overs as it can grow bacteria

• ~6 months: slowly transition to solid food

  • Tongue-thrust reflex slowly decreases

  • One new fee q3-5 days

• Sippy cup: water is good when infant can use palmar graps

• Honey → ^ r/x for botulism

Food sensitivity

Cow’s milk, Eggs, Peanuts, Soy, Wheat → GI upset, ezcema, asthma

• When introducing new foods, wait 3-5 days

• AVOID HONEY when <1 year

Nutrition needs Infants:

100kcal/kg/day

• 40-60kcal/kg/day for metabolic processes

• Premature, illness, genetic disorders → ^ energy needs

Start 20-30 mL/kg → increase w/in 7-10 days

• colostrum → breast milk

Food Aversion:

Pain + Trauma + Fear

• GERD: feeding → pain → aversion

• NICU: mouth swabbing, pacifiers, oral procedures

• Fear

Intervention:

• Non-nutritive sucking → Pacifier

• Breast for non-nutritive sucking

• Cue-based feeding

• Sweet taste to milk

• Improve positive oral experiences at home

Vitamins + Minerals for Infants:

Iron:

• Helps for hemo and myoglobin formation

• v = cognitive and psychomotor issues

• Iron deficiency common in:

  • Premature infants

  • Exclusively breastfed

  • Non-iron fortified formula

• START GIVING AT 4 months

  • Until iron-fortified cereal or meats are added to diet

Ferrous sulfate:

• Prevents/treats iron deficiency anemia

• A/E:

  • Constipation, Diarrhea

  • Nausea & Vomiting

  • Abd pain, Green/Dark stools

  • Anorexia, Gas

• Toom much iron = fatal

Vitamin D:

• Deficiency most common in exclusively breastfed infants

• Uses:

  • Calcium, phosphate absorption and uptake

  • Increases Calcium availability in blood

• Start supplementing right after birth

  • Use a dropper to avoid dosing errors

• Toxicity A/E: “hypervitaminosis D”

  • Nausea, Vomiting

  • Irritable, Fatigue

  • Poor feeding, weak, weight loss, dehydration

Vitamin B12:

• May require ife parents are vegan/vegitarian diet

Sleep for infants and alterations in them:

Normal amount for sleep:

• < 3 months = 16-17 hours

• 6 months - 1 year = 13-14 hours

Sleep amount factors:

• Temperament

  • Poor self-soothing

  • Cries often

• Environment:

  • Loud, crowded, activity, no routines

Allow opportunities for infant to self sooth

• Don’t necessarly rush to soothe for every cry

Faliure to Thrive:

When infant does not effectively or receive enery for growth

• Low intake

• High energy expenditure

• Low Absorption

Causes:

• Malabsorption syndrome

• CF, Congenital heart defects

• Respiratory or Metabolic Disorders

• Neglect, poor parent educatiion

  • Possible Post partum depression occuring

D/x:

• Anthropometric Z-scores:

  • Compares weight for length AND BMI for age

  • The more negative z score it is = greater malnutrition degree

Sudden Unexpected Infant Death (SUID):

Umbrella term for unexpected intant death (<1 years old)

• SIDS:

• Accidental suffocation and strangulation in Bed

Risk:

• Maternal:

  • Age <20

  • Smokes, Lack of prenatal care

• Infant:

  • Premature, Low birth weight, Overheating

  • 2ndhand smoke, eating too much

  • Prone sleeping, soft mattress, loose bedding

  • Sleeping on cushined surface (couch)

Pacifiers may help despite not being fully understood why

PN Scope of Practice regarding Immunizations:

• Collect screening data & help find missed/upcomming ones

• Assist w/immunizations

• Reinforce education

• Monitor A/E

• Maintain records

Nationally Notifiable Diseases:

Resp/Neuro:

• Diphteria

• Pertussis

• Meningoccall disease

• H. Influenza

• Poliovirus

Hepatitis:

• A,B,C

Vaccine Preventable ones:

• Rubella

• Tetanus

• Varicella

• Diphtheria

• Pertussis

• Poliovirus

Precaution’s Examples:

Contact:

• Scabies, excessive wound drainage

• C.diff

• VRE, MRSA

Droplet:

• Pertussis, INfluenza

• Menignitis, Adenovirus

• Rhinovirus

• Group A Strep

Airborne:

• TB,SARS-CoV

• Rubeola

• Varicella

Donning + Doffing PPE

1⃣ Hand hygiene → 2⃣ Gown → 3⃣ Mask/respirator → 4⃣ Goggles/face shield → 5⃣ Gloves

Gloves → Goggles/Face shield → Gown →Mask → Hand Hygiene

Varicella/Chicken Pox

Spread via airborn droplets

• Fluid from vesicles

• AIRBORNE + CONTACT

  • Pregnant nurses should avoid caring for these childs

• Usually remains latent in sensory nerves and later reactivated as shingles

S/s:

• Itchy fluid-filled vessicles → scabs

  • Chest, back face

  • Later → mouth, eyelids, g3nitals, scalp

• Fever, fatigue, sore throat, headache

T/x:

• Acetaminophen → fever/pain

• Calamine lotion, Oatmeal baths

• Antihistamine → itching

  • Benadryl A/E:

    • Drowsy, Dry mouth, v BP

    • Avoid combination of oral w/topical dyphenhydramine

• Fluid intake

Edu:

• Avoid scratching via:

  • Keep nails short, cotton clothing, avoid overheating

  • Fluid intake, cool baths

• Varicella is no longer contagious when → all lesions are crusted and dried

• Take vaccine in 2 doses

Diphetheria:

Produces a strong exotoxin →

• Local inflammation, Sore throat, fever, cervical lymphadenopathy

• Gray pseudomebrane: takes around 2-5 days for incubation

  • Throat, Tonsils, Pharynx → thickens → Airway obstruction

• Myocarditis, Neuritis

D/x:

• Throat culture, PCR, toxin testing

T/x:

• Isolation → Antibiotics → Diphtheria antitoxin (DAT)

  • Ezythromycin & Penicillin G

  • Before giving DAT, a/x hypersensitivity → ^ r/x for anaphylaxis

    • Urticaria risk too

Edu:

• Soft diet due to odynophagia

• Fluids, quiet/restful place

• Keep airway open

Mumps:

From paramyxovirus via respiratory droplets, contact w/saliva, or fomites

• 7-21 days for incubation

• MMR vaccine to prevent

• Contagious when:

  • 1-2 days before s/s

  • 5 days after s/s

S/s:

• Parotitis: swelling of parotid glands; uni/bilateral

• Fever, Headaches, Fatigue, Myalgia, Anorexia

• May lead to:

  • Orchitis, Meningitis, Encephalitis

D/x:

• Buccal swab

• IgM serology

T/x: none

• Rest, Hydration, Analgesics

• Warm/Cold compress → parotitis

• Cold compress + elevation → orchitis

• Soft foods

Measles (Rubeola)

Transmitted via: (highly contagious)

• Respiratory, Direct Contact, or AIrbone (2 hours)

• MMR vaccine

• 3 Cs (Cough, Coryza, Conjuctivitis) →Koplik spots (red spots w/white centers on buccal mucosa) → Rash (hairline; moves DOWN) → LOW Vitamin A

D/x:

• IgM

• PCR

• Plaque reduction neutralization assay: Gold standard

T/x: supportive

• Hydration, nutrition, rest

• fever and infection control

• Vitamin A for 2 days

Poliomyelitis

Fecal → oral transmition → replicates in oropharynx & GI → remains in stool for weaks

• Contact precautions & IPV and OPV vaccines

• Polio = Paralysis

  • Muscle weakness, paralysis

    • Often in legs

  • May lead to → respiratory failure

D/x:

• Throat swab, stool, and CSF

• MRI, EMG

T/x: supportive

• PT, OT, resp support

• Nutrition, Hydration

COVID 19:

Leads to inflammatory immune response → severe → cytokine storm → widespread inflammation

S/s:

• Fever, Cough, Resp problems

• Possibly Asymptomatic

• Multisystem Inflammatory Syndrome:

  • Happens weeks after infection → heart, lyngs, kidneys, gi system issues

• Possibly lingering s/s:

  • Fatigue, Neuro and Resp issues

D/x:

• PCR, rapid antigen testing

• Swab thing

T/x:

• Remdesivir: blocks its RNA polymerase

  • A/E:

    • Rash, Nauses, Anaphylaxis, v BP

• Vaccines

• Airpurification

Meningitis:

Viral:

• Enteror, Herpes, Adenovirus

• Droplet, Hydration

• S/s:

  • Young:

    • Hypothermia

    • Fever, Irritable, vomiting, difficult to arous

    • Bulging anterior fontanel

  • Old:

    • Fever, Headahche, N/V, Photophobia

    • Nuchal rigidity

    • Diplopia, Irritable, Lethargic

  • Risk for SIADH → hyponateria, seizures, etc.

D/x:

• Lumbar puncture → CSF

  • WBC, protein, glucose, culture

  • PCR if viral suspected

T/x:

• Collect specimens → start empiric antibiotics → stop if u find out if it is viral→ IV acyclovir

Bacteria:

• N. meningitis, Strep. Pneumoniae

• MORE SEVERE → sepsis, heariling loss, hydrocephalus, death

• S/s:

  • Fever, hypothermia, Irritable, Vomiting

  • Bulging Fontanel, Kernig & Brudzinski

T/x:

• Empiric antibiotics, antipyretics, analgesis, hydration

• Dark, quiet, HOB >30

• Neutral body alignment

Meningitis CSF:

Finding	Viral	Bacterial
WBC	>100/mm³	>1,000/mm³
Protein	Normal → mildly elevated	Elevated
Glucose	Normal → mildly low	<40 mg/dL

Meningitis Precautions:

Droplet precautions

Continue until:

24 hours after IV antibiotics have been administered.

Close Contacts

Certain close contacts may require prophylactic antibiotics.

Hepatitis:

A:

• N/V, Diarrhea, Fever, Fatigue

• Jaundice

• T/x:

  • Hydration, supportive liver care

  • HAV, sanitation

B:

• Prodormal phase:

  • Malaise, v appetite, RUQ pain

• Icteric phase:

  • Jaundice, Yellow sclera, Hepatomegaly, Dark urine

  • Pale stools

• D/x:

  • HBsAG, IgB testing

• T/x:

  • Supportive care if Acute

  • Antivital Therapy if Chronic

  • HBV

C:

• Asymptomatic or malaise + v appetite

• May lead to chronic infection

Infectious Mononucleosis:

Epstein Bar virus

• Saliva Transmission “Kissing disease”

• 3-6 wks incubation

• Often occurs in 15-24 yr olds

S/s:

• Fatigue

• Pharyngitis

• Lymphadenopathy

• Headache, Maialse, Fever

• Splenegomegaly → Splenic rupture

Edu:

• Avoid strenuous activities or contact sports

D/x:

• Monospot antibody testing

• ^ WBC

T/x: supportive

• Rest, Hydration, NSAIDs

• Cool/soft food

• Salt water gargles

• Throat lozenges

Roseola Infantum

from HHV-6 → reproduces in leukocytes and salivary glands → disrupts blood-brain barrier → febrile seizures

• No current vaccine for it

• Respiratory droplets + saliva contact

• Mostly around 6-12 months females

• Children w/older siblings at higher risk aound spring to fall

S/s:

• Phase 1: High fever >104/40 for 3-5 days

  • irritable, periorbital edema

  • Otalgia, Anorexia, COugh

  • Cervical Lymphadenopathy

  • DEHYDRATION

• Phase 2: Rash

  • Rose pink, maculopapular, nonpruritic → neck, face, extremities

  • Fever disappears

T/x: supportive:

• Hydration, v fever meds, rest, lightweight clothing

• Avoid overheating, breast milk + E+ solutions

• May return to normal life after 24 hr fever subsides

Fifth Disease:

Parvovirus B19; around 5-15 years in spring → early summer

• Via resp droplets, blood exposure, & direct contact

S/s:

• Early:

  • Fever, Malaise, Headache, Myalgia, N/V, Diarrhea

  • Most contagious phase

• Then → slapped cheeck rash → lacy/net like rash]

  • Nonpruritic around trunk and extremities

  • No longer contagious, asymptomatic

• Arthropathy: common in females

High risk population:

• Pregnancy, Hemolytic (sickle cell), Immuno compromised

D/x:

• Parvovirus B19 IgM antibodies

T/x: supportive

• Rest, Hydration, Fever + Pain management

• Join pain control

Hand, Foot & Mouth disease:

Due to human enterovirus + Coxsackie Virus

• <5 yrs; MOST contagious in first 7 days

• Fecal oral (diaper changes); resp/oral secretions; direct contact from vesicle fluid; indirect fcontact (fomites)

  • Can remain in poop for 6 weeks → oropharyngeal shedding around 4 weeks (CONTACT PRECAUTIONS)

    • Always maintaine hygiene even after child improves

S/s:

• Early → low grade fever, sore throat, malaise

• Painful shallow ulcers

  • Red borders w//white bases → odynophagia and paonful water drinking

• Hands + Feeet → rashes

  • Also in buttocks, perineum, extremities

• May lead to: Vital meningitis & encephalitis

D/x: clinical

T/x: supportive care for 7-10 days

• Fluids, NSAIDS, soft foods, cold nutrition

• No current vaccine

Impetigo:

Highly contagious bacterial infection w/honey colored crusts; fibronectin receptors exposes → colonization

• Staph aureus, Group A strep

• Around 2-5 years; summer → fall

• Infants are more likely for bullous impetigo

Nonbullous:

• Vesicles rupture → honey colored crust

• Face & mouth; lymphadenopathy

BUllous:

• Small vesicles merge → large bullae → clear/yellow → purulent & dark

• Fever + Lymphadenopathy

T/x:

• Nonbullous → Mupirocin topical; use oral if more systemic s/s or more lesions present

  • Apply 3x/day small amount

  • Before, use soap + water to soften/remove crusts

• Bullous → oral antibiotics (Cephalexin)

  • Give w/w/out food and shake oral suspension; use accurate measuring device

• Nonadherence to meds leads to →

  • Rheumatic fever

  • Acute post-strep glomerulonephritis

Conjuctivitis:

Bacterial:

• Moraxela, strep. pneumonia, H. Influenza

• Contact → touches eye

• S/s:

  • Red sclera, thick purulent drainage, itchy

  • Eyelashes → crust, mat, cant open

• T/x: supportive for 7-10 days

  • Topical antibiotics (Ciprofloxacin opthalmic)

    • May be temporary burning or stinging or blurry vision = OK!

  • Compresses, sterile saline, avoid rubbing eyes

Viral:

• Most common; adenovirus/HSV/Enterovirus

• S/s:

  • REd + watery sclera w/discharge

  • Itching + Tearing

  • Sore throat + Rhinorrhea

  • UPPER RESP INFECTIONS

  • HSV may lead to blindness

• T/x: supportive

  • Compresses, artificial tears, avoid eye rubbing

  • Acyclovir

Allergic:

• Pollen, pet dander, air pollution

• S/s:

  • Intense itching, edness, tearing, eyelid edema

  • Both eyes, NO discharge

• T/x:

  • v exposure

  • Topical antihistamines + Mast cell stabilizers

    • Epinastine ophtalmic

    • Remove lenese, wait 10 mins before switching them

    • Air purifier, cool compresses, rinse w/water/saline

Foreign-body:

• Sudden redness, excessive tearing, urge to rub → removal → redness + tearing + v pain → for 24-48 hours

• T/x:

• Flush w/sater, saline, fake tears

• iF chemical: flush

Stomatitis:

Inflammaito of moral/oral tissues

Herpetic Gingivostomatits:

• HSV-1

• DIrect contact w/saliva or lesions; HIGHLY CONTAGIOUS

• S/s:

  • Painful oral lesions in gums, toungues, inside cheeks

    • Bleeding gums, high fever,

    • Poor nutrition & dehydration

• D/x:

  • VIral culture of tissue = GOLD STANDARD

• T/x:

  • Acyclovir w/in 72 hrs of infection

Aphthous Stomatitis:

• >10 years

• T-cell immune dysregulation from stress, malnutrition, trauma, genes → v Vitamin D, C & zinc

• NOT CONTAGIOUS

• S/s:

  • Painful, flat, round sores in inner lips, cheeks, toungue and floor of mouth

• T/x:

  • v pain + inflammation

  • Corticostreioids like acetonide (topical)

  • Cool liquids, hydration, soft foods, gentle oral hygiene, saline warm rinses

Antibody/Immunoglobin:

Y-shaped protein made by B cells

• Neutralize, Osponize (tag), Activate complement, ADCC

Types:

• IgM: First one introduced during infection

• IgG: most abundant in blood stream; important for long term immunity

• IgA: Bodily secretions; localized protection

• IgE: Allergic reactions + defense against parasites

• IgD: Found on B-cell surfaces

M = Made first
G = Greatest amount in blood
A = At secretions
E = Eczema/allergies
D = Development/surface of B cells

Antigen Types:

Exogenous: outsid eof the body

• Bacteria, Viruses, Pollen, Food proteins

Autoantigen: from own

• Autoimmune disease

Important Immunology Terms:

Antitoxin: neutralizes

• Botulism, Tetanus, Snake bite uses

• Immediate passive immunity effect: providing ready antibodies to use

Attenuation: weakening pathogen while making it capable of making a immune response

• live-vaccines “varicella vaccines”

Cocooning: protecting immunocompromised ppl by immunizing group circle

Innate immunity: immediate nonspecific defense one is born with

• Skin, Mucous

• Macrophages, Neutrophils, NK cells

• INFLAMMATION

Adaptive:

• B + T lymphocytes

Immunomodulators: meds that modify it

• Suppress or enhance immune activity

Monoclonal antibodies: Lab produced antibodies

• For cancer, AI, Infectious disease

T-cell therapy: use of own immune cells + new ones to destroy cancer or pathogens

Immunization types:

Immunoglobulin Therapy: giving donor antibodies

• IVIG → IV

• SCIG → subcut

• HBIG → IM

• Provides passive immunity

Toxoids: inactivated toxins to stimulate immune response

• Diphtheria or Tetanus toxoids

Vaccines:

Combination vaccines

COnjugate vaccines: polysaccharide antigen attached to carrier protein → stronger response

• Helps kids develop antibodies

• Strep. pneumonia, H. influenzae, N. menigitis

Monovalent: one pathogen/strain

Polyvalent: antigens from multiple strains

• Influenza vaccine

Haemophilus Influenzae Type B (Hib):

Prevents menigitis AND epiglottits:

Schedule:

• 2 months → 4 → 6 → 12-15 months final booster

• IM

  • Vastus lateralis for infants

  • Deltoid for >3 yrs

• DO NOT GIVE IF <6 weeks

• A/E:

  • Erythema, Edema, Fever

Hepatitis A & B Vaccine:

A:

• 12-23 months → 2nd 6 months later

• Early travels may have earlier dose but still stick to routine series

B:

• within 24 hrs of birth → 1-2 months → 6-18 months

  • Low birthweight first is 1 month

• IM

• Mild fever

Polio Vaccine:

IPV: inactivated

• Injectable

• 2 → 4 → 6-18 → 4-6 years

  • at least 6 months between doses 3 and 4

• DO NOT GIVE if bebe has acute febrile illness (^ temp, resp illness)

OPV: oral drops

Pneumococcal Vaccine:

For strep pneumoniae:

• Prevents pneumonia, meningitis, sepsis

PCV: pneumoccocal conjugated

• 2→ 4 → 6 → 12-15

PPSV: pneumoccocal polysaccharide

• Recommended for higher risk patients

  • Sickle, Asplenia, Immunocompromised

IM

Possible soeness, fever, sleep issues

• MONITOR 15 mins after due to possible allergic reaction OR syncopy

Rotavirus Vaccine:

Prevents gastroenteritis, whcich can lead to diarrhea → vomiting → dehydration

• Live-attenuated + Oral drops

• 2 → 4 OR 2 → 4 → 6

• Must be given before 15 weeks; avoid after 8 months

Contradictions:

• Intussuspetion, SCID, allergies

Possible mild Vomiting or diarrhea

Varicella Vaccine:

Protects against chickenpox 🐔

• 12-15 → 4-6 years

• Live-attenuated

• Subcut or IM

  • Subcut in triceps or anterolateral thigh

Avoid giving w/pregnancy or poor immunity

POSSIBLE febrile seizure or pneumonia from it

DTaP vs Tdap:

DTAP: <7 years

• 2 → 4 → 6 → 15-18 → 4-6 years

Tdap: >7 years

• 11-12 years → q10 years for boosters

IM

Caution with

• Guillian Barre syndrome; or severe pain after dose

MMR vaccine:

Protects against Measles, Mumps, Rubella

• 12-15 → 4-6 years

• Live vaccine iven Subcut (triceps)

Avoid if:

• Pregnancym, poor immune

• SEVERE allergy to neomycin

May cause febrile seizures

HPV vaccine:

Prevents warts, cervical/anal/vaginal/penile cancer

• Start at 9-14 years first dose → 2nd 6-12 months later → 3 doses after → dose 1 is month 0 → 1-2 months after 2nd → 6 months in 3rd

• IM: deltoid

• Syncope, Muscle pain, fever may occur

Meningoccal Vaccine:

Protects against meningitis or bloodstream infection

MenACWY:

• 11-12 years → booster at 16years

• If older than 16; only give one dose

MenB:

• 16-18 years; 2-3 doses

• More for college students, military recruits, high-risk travelers

IM

Influenza Vaccine:

Every year beginning at 6 months of age

• after 9 years → 1 dose qyear

• <9 years: 2 doses first

LAIV contraindications:

• Gelatin allegy, v immune, aspirin therapy, wheezing/asthma

COVID vaccine:

Given at 6 months of age → 2-3 doses

5-11 years: one dose of current vaccine

>12 years: one dose

Annual boosters used

May lead to myocarditis or Pericarditis

Scabies:

Infection of mites → burrow to skin → lay eggs there → eggs hatch → inflammatory response → INTENSE pruritus

• Eggs hatch w/in 2-3 weeks

• Prolonged direct skin to skin contact or via linens/clothing/bedding

S/s:

• INTENSE night itchin

  • w/in interdigitals, wrists, genitals

• Tiny linear burrows

• Possible impettigo or cellulitis

T/x:

• Permithirin cream → disrupts sodium ion influx in them

  • Avoid placing near eye, nose, ear, mouth, vagina

  • X for <2 months old

• Cool baths, cold + damp compresses

• Trim nails

Perducolis/Lice:

Via close contact or personal things/items/bedding

• Pruritus, nits, small red bumps

T/x:

• Premethrin

  • Apply 1 week after too to prevent resistance

• avoid lindane with children

Pinworms:

Small-white thread worms that lay eggs in anys

• Takes 4-8 weeks to mature

S/s:

• Perianal itching at night

D/x:

• Tape test: collects eggs w/tape in early morning

t/x:

• Mebendazole

  • Possible abd pain

• Bath in morning

Giardiasis:

Protozoan parasite; fecal-oral

• entersc → affects intestinal epithelium → malabsorption → watery diarrhea, abd cramps, bloating, gas, fatigue, v weight, deHYDRATION

D/x:

• Giardia cysts via 3 stool samples

T/x:

• Metrodinazole

  • Possible Nausea and/or metallic taste and/or flu s/s

• Sanitation, Boil water

POSSIBLE temporary Dairy intolerance