PEDIA REVIEWER_FINALS

Health Problems Common in Toddlers

Burns

Burns are common and serious injuries in toddlers due to their curiosity, limited understanding of danger, and increasing mobility.

Types of Burns

  • Thermal Burns: Caused by contact with hot surfaces, liquids, steam, or flames.

    • Examples: hot beverages, bathwater that is too hot, hot stove tops, open flames.

  • Scalds: A type of thermal burn caused by hot liquids or steam; the most common type in toddlers.

    • Examples: toddler pulling down a cup of hot coffee.

  • Electrical Burns: Occur when a child bites or puts objects into electrical outlets or cords; may cause internal injuries.

  • Chemical Burns: Caused by exposure to strong cleaning agents or household chemicals.

  • Friction Burn: Result from skin rubbing against a rough surface.

Severity Classification

  • First Degree: Affects the epidermis; red and painful but heals without scarring (e.g., mild sunburn).

  • Second Degree: Affects the epidermis and dermis; causes blisters, swelling, and pain.

  • Third Degree: Penetrates all layers of the skin and may appear white or charred; often requires surgical intervention and can result in scarring or disfigurement.

Signs and Symptoms

  • Redness, swelling, or blistering of the skin.

  • Pain or tenderness in the affected area.

  • Peeling skin (especially in second-degree burns).

  • In severe cases: shock, pale/clammy skin, difficulty breathing.

Risk Factors

  • Age and Development: Toddlers explore their environment without understanding danger.

  • Parental Distraction: Even a few seconds of unsupervised activity can result in injury.

  • Unsafe Home Environment: Lack of childproofing increases risk (e.g., uncovered outlets, unattended hot liquids).

Immediate First Aid

  • Cool the burn under cool running water for 10-20 minutes.

  • Remove clothing or jewelry near the burn unless stuck to the skin.

  • Cover the burn with a clean, non-stick bandage or cloth.

  • Health Problems Common in Preschoolers

Leukemia

LeukemiaAvoid applying butter, oils, toothpaste, or ice directly on the burn.

  • Seek medical attention for burns larger than the size of the toddler's palm, burns on the face, hands, feet, genitals, or joints, electrical or chemical burns, or signs of infection.

Treatment

  • Minor Burns: Clean, apply a burn ointment, and dress the wound; monitor for infection.

  • Moderate - Severe Burns: Require hospitalization, possibly fluid replacement, antibiotics, and skin grafting.

  • Pain Management: Acetaminophen or ibuprofen as advised by a pediatrician.

Prevention Tips

  • Kitchen Safety: Turn pot handles inward, keep hot drinks and sharp items out of reach.

  • Bathroom Safety: Set water heaters to a safe temperature (below 120°F or 49°C).

  • Electrical Safety: Use outlet covers and keep cords out of reach.

  • Supervision: Never leave a toddler alone near fire, heaters, or hot objects.

  • Chemical Safety: Store cleaning agents and medications in locked cabinets.

Psychosocial Support

  • Severe burns can lead to psychological trauma, especially if the child experiences long hospital stays or visible scarring; supportive care and counseling may be necessary for both the child and parents.

Preventability

  • Burns are a preventable health issue in toddlers; early recognition, prompt first aid, and vigilant prevention can greatly reduce the risk and severity of burns.

  • Parents and caregivers must be proactive in creating a safe environment, understanding the hazards, and knowing what to do in the event of a burn.

Poisoning

Poisoning is a serious and potentially life-threatening health issue common among toddlers, due to their curiosity, hand-to-mouth behavior, and tendency to explore their environment without understanding the risk.

Poisoning can occur through ingestion, inhalation, or skin contact with toxic substances commonly found in households.

Common Causes

  • Medications: Over-the-counter and prescription medications (e.g., painkillers, vitamins, antihistamines), iron supplements.

  • Household Cleaning Products: Bleach, ammonia, toilet bowl cleaners, drain openers, laundry detergent pods.

  • Personal Care Products: Perfumes, mouthwash, nail polish remover, hand sanitizers (products containing alcohol).

Modes of Exposure

  • Ingestion: Most common route; children often swallow substances unknowingly.

  • Inhalation: Breathing in fumes or gases (e.g., cleaning sprays, carbon monoxide).

  • Dermal: Some substances can be absorbed through the skin.

  • Ocular: Contact with the eyes can cause irritation or damage.

Signs and Symptoms

  • Sudden vomiting or nausea.

  • Drooling or foaming at the mouth.

  • Abdominal pain.

  • Difficulty breathing or swallowing.

  • Unusual drowsiness or unconsciousness.

  • Seizures.

  • Burns or redness around the mouth and lips.

  • Confusion or changes in behavior.

  • Unusual odors on the breath.

First Aid and Immediate Actions

  • If the child has swallowed a substance, do not induce vomiting unless instructed by a healthcare provider; call the poison control center.

  • If the child is unconscious, seizing, or having trouble breathing, call emergency services immediately.

  • If the substance is on the skin, remove contaminated clothing and rinse the skin with lukewarm water for at least 15 minutes.

  • If the substance is in the eyes, rinse the eyes with room-temperature water for at least 15-20 minutes.

  • If inhaled, move the child to fresh air immediately; monitor for difficulty breathing.

Diagnosis and Medical Treatment

  • Clinical Evaluation: Based on symptoms and history provided by the caregiver.

  • Laboratory Tests: May include blood and urine tests to determine the toxin.

  • Treatment Options:

    • Activated charcoal (to absorb certain poisons if ingested recently).

    • Antidotes (e.g., naloxone for opioid poisoning).

    • Supportive care (oxygen, IV fluids, medications to manage symptoms).

    • Hospital observation or intensive care in severe cases.

Prevention Strategies

  • Safe Storage: Keep all medicines, cleaning products, and chemicals in locked cabinets.

  • Store products in their original containers with clear labels.

  • Childproofing the Home: Use safety latches on drawers and cupboards; install carbon monoxide detectors in living spaces.

Long-Term Effects and Psychosocial Impact

  • Long-term organ damage (e.g., liver, kidney).

  • Neurological issues if the brain is affected.

  • Emotional trauma for both the child and caregivers.

  • Need for ongoing medical treatment or therapy in severe cases.

Conclusion

  • Poisoning remains a significant health risk for toddlers, but it is largely preventable; awareness, vigilant supervision, safe storage practices, and quick response in emergencies are essential.

  • Caregivers must be proactive in making their homes safe and knowing what to do if an incident occurs.

Cerebral Palsy

Cerebral palsy (CP) is a group of neurological disorders that affect a child's ability to move, maintain posture, and coordinate muscles, caused by abnormal brain development or damage to the developing brain, often occurring before, during, or shortly after birth.

While not as immediately common as infections or injuries in toddlers, it is one of the most prevalent causes of long-term physical disability in children.

Causes

  • Prenatal Causes (Before Birth):

    • Maternal infections (e.g., rubella, cytomegalovirus, toxoplasmosis).

    • Poor oxygen supply to the fetus (hypoxia).

    • Genetic mutations affecting brain development.

    • Exposure to toxic substances or drugs during pregnancy.

  • Perinatal Causes (During Birth):

    • Birth asphyxia (lack of oxygen during labor/delivery).

    • Premature birth and low birth weight.

    • Complicated labor and delivery.

  • Postnatal Causes (After Birth):

    • Brain infections (e.g., meningitis, encephalitis).

    • Head injuries.

    • Severe jaundice (kernicterus).

Types of Cerebral Palsy

  • Spastic CP: Most common (70-80%); muscle stiffness (spasticity), poor coordination and movement difficulty; can affect one limb (monoplegia), one side (hemiplegia), both legs (diplegia), or all four limbs (quadriplegia).

  • Dyskinetic: Involuntary, uncontrolled movements; muscle tone varies between too tight and too loose.

  • Ataxic: Affects balance and depth perception; difficulty with coordinated movements (e.g., walking, writing).

  • Mixed: Combination of symptoms from more than one type (most commonly spastic and dyskinetic).

Signs and Symptoms

  • Delays in sitting, crawling, or walking.

  • Stiff or floppy muscle tone.

  • Poor coordination and balance.

  • Weakness in arms or legs.

  • Favoring one side of the body.

  • Difficulty with fine motor skills (grasping objects).

  • Seizures (in some cases).

  • Difficulty with speech, hearing, or vision (depending on severity).

  • Problems with swallowing or feeding.

Diagnosis

  • Developmental screening.

  • Observing the child's growth, movement, and motor milestones.

  • Neurological Examination.

  • Imaging Tests:

    • MRI or CT scan to detect brain abnormalities.

    • Ultrasound (especially in preterm infants).

  • Other Tests:

    • EEG (if seizures are present).

    • Blood tests to rule out metabolic or genetic conditions.

Treatment and Management

  • Physical Therapy: To improve muscle strength, flexibility, and movement.

  • Occupational Therapy: Helps the child perform daily tasks independently.

  • Behavioral Therapy and Special Education: Supports cognitive and social development.

  • Medical:

    • Medications: Muscle relaxants (e.g., baclofen, diazepam), antiepileptic drugs (for seizures).

    • Orthopedic surgery: To correct joint or bone deformities.

    • Assistive devices: Walkers, braces, wheelchairs, communication aids.

Impact on Child and Family

  • Mild Cases: May only involve slight motor challenges with minimal impact on daily life.

  • Moderate to Severe Cases: May require lifelong care, assistive devices, and support.

  • Emotional, financial, and psychological strain is common among families, making support systems crucial.

Prognosis

  • CP is non-progressive, meaning the brain damage does not worsen; however, symptoms may evolve as the child grows.

  • With the right interventions, many children with CP can lead fulfilling lives, attend school, and participate in various activities.

Prevention

  • Not all cases of CP can be prevented, but certain steps may reduce the risk:

    • Prenatal Care: Proper nutrition, vaccinations (e.g., rubella), and monitoring during pregnancy.

    • Safe Labor and Delivery: Managing risk factors like premature birth and oxygen deprivation.

    • Newborn Care: Treating jaundice promptly, preventing infections, and protecting from head injuries.

    • Maternal Education: Avoiding alcohol, drugs, and other harmful substances during pregnancy.

Conclusions

  • Cerebral palsy is a complex but manageable health condition that affects toddlers in varying degrees; early recognition and intervention are critical to maximizing a child's potential and improving their quality of life.

  • With proper support from healthcare professionals, educators, and family, children with CP can thrive and lead meaningful lives.

Child Abuse

Child abuse is a deeply concerning and serious health issue that can affect toddlers physically, emotionally, developmentally, and psychologically.

At this vulnerable age, toddlers are entirely dependent on caregivers for their well-being and protection; abuse—whether physical, emotional, sexual, or neglectful—can have both immediate and long-term consequences on a child's health, growth, and development.

Types of Child Abuse

  • Physical Abuse: Involves the intentional use of physical force that results in (or has the potential to result in) bodily injury.

    • Examples: hitting, shaking, burning, pinching, or slapping; toddlers may present with bruises, burns, fractures, or internal injuries.

  • Emotional (Psychological) Abuse: Includes behaviors that harm a child's self-worth or emotional well-being.

    • Examples: verbal abuse, rejection, constant criticism, threats, isolation, or intimidation; often harder to detect but equally damaging.

  • Sexual Abuse: Involves engaging a child in sexual acts, exploitation, or exposure to inappropriate content.

    • This type of abuse may not present with visible injuries but can cause severe emotional and developmental trauma.

  • Neglect: The most common form of child abuse involves failure to meet a child's basic needs—food, shelter, clothing, medical care, supervision, and emotional support.

    • Chronic neglect can lead to malnutrition, developmental delays, poor hygiene, and illness.

Signs and Symptoms

  • Physical Signs:

    • Unexplained bruises, burns, fractures, or bite marks.

    • Frequent injuries in various stages of healing.

    • Injuries that don't match the explanation given.

    • Delay in seeking medical care for obvious injuries.

  • Behavioral Signs:

    • Fearfulness or extreme withdrawal.

    • Aggressiveness or anxiety.

    • Regression to earlier behaviors (e.g., bedwetting, thumb-suckling).

    • Avoidance of certain people or places.

    • Flinching when approached suddenly.

  • Developmental Delays:

    • Delays in motor, speech, or cognitive development.

    • Lack of social responsiveness or emotional expression.

  • Neglect Indicators:

    • Poor hygiene, body odor, or dirty clothes.

    • Constant hunger or hoarding food.

    • Frequent absences from scheduled check-ups or therapies.

Causes and Risk Factors

Child abuse can stem from various social, emotional, and environmental factors, including:

  • Parental stress or mental illness.

  • Substance abuse in caregivers.

  • Domestic violence in the home.

  • Lack of parenting skills or education.

  • Poverty or financial strain.

  • Isolation or lack of support networks.

  • History of abuse in the caregiver's own childhood.

Health Impacts of Abuse

  • Short-Term Effects:

    • Physical injuries (cuts, bruises, broken bones).

    • Fear, anxiety, or aggression.

    • Sleep disturbances and feeding problems.

  • Long-Term Effects:

    • Developmental delays (speech, motor, cognitive).

    • Mental health disorders (depression, PTSD, anxiety).

    • Difficulty forming trusting relationships.

    • Poor academic performance later in life.

    • Increased risk for substance abuse and risky behaviors.

Diagnosis and Identification

Professionals such as pediatricians, teachers, daycare providers, and social workers are trained to recognize the signs of abuse.

Diagnosis may involve:

  • Medical examination: to identify patterns or signs of physical trauma

  • Developmental screening: to detect emotional or developmental delays

  • Child Protective Services (CPS) report: required if abuse is suspected

  • Multidisciplinary assessments: including psychological and social evaluations

Prevention Strategies

  • Parental education and support: parenting classes, support groups, and home-visiting programs

  • Education about child development and positive discipline

  • Community involvement: strong community networks and access to family resources

  • Public awareness campaigns to educate about child abuse

  • Early intervention programs: programs like Early Head Start that promote child well-being

  • Regular pediatric visits: for monitoring development and health

  • Mandatory reporting laws: requiring healthcare providers, teachers, and caregivers to report suspected abuse

  • Creating a culture of safety and accountability

Role of Healthcare Providers and Caregivers

  • Healthcare providers must remain vigilant during checkups, noting any inconsistencies between injury explanations and findings.

  • Caregivers must be aware of stress triggers and seek support before they escalate into harmful actions.

  • Professionals must advocate for policies and resources that protect children.

Recovery and Support

  • Counseling and therapy (especially trauma-informed care) are essential to help toddlers recover emotionally and developmentally.

  • Family interventions may be implemented when safe and appropriate.

  • In severe cases, protective custody or foster care may be necessary to ensure the child's safety.

Conclusion

Child abuse in toddlers is a tragic but preventable public health issue. Recognizing the signs early and taking immediate action can save a child from long-term physical and psychological harm.

It is the collective responsibility of families, professionals, and communities to create safe, nurturing environments where all children can thrive.

is a type of cancer that affects the blood and bone marrow. It occurs when the body produces too many abnormal white blood cells, which do not function correctly and crowd out healthy cells.

Leukemia is the most common type of cancer in children, especially ages 2-5, and can occur even when a child seems perfectly healthy.

Leukemia Breakdown

  1. Leukemia starts in the bone marrow, where blood cells are made.

  2. Something goes wrong in the DNA of white blood cells, causing them to:

    • Grow too fast

    • Live too long

    • Not function properly

  3. These abnormal cells crowd out the healthy ones.

Causes in Children

The exact cause of leukemia in children is not fully known, but it is believed to happen when genetic changes (mutations) occur in the cells that make blood.

Signs and Symptoms

  • Tiredness or weakness

  • Frequent infections

  • Easy bruising or bleeding

  • Bone or joint pain

  • Swollen belly or lymph nodes

  • Pale skin

Diagnostic Tools

  • Blood Tests

  • Bone Marrow Tests

  • Physical Exam

  • Medical History Review

Outlook and Support

Most children with leukemia respond well to treatment. Ongoing care is needed for a while. Support from family, doctors, and counselors is key.

Wilms’ Tumor

Wilms’ tumor is a rare kidney cancer that mostly affects children under age 6; it’s also called nephroblastoma. It usually affects one kidney, but sometimes both.

Common In

  • Children ages 2 to 5

  • Slightly more common in girls than boys

  • Some children are born with genetic conditions that raise their risk

Causes and Risk Factors

Exact cause is unknown, but some factors include:

  • Genetic conditions like WAGR syndrome or Beckwith-Wiedemann syndrome

  • Family history of Wilms' tumor

  • Certain birth defects (e.g., missing iris in the eye)

Common Signs & Symptoms

  • A swollen belly or lump in the abdomen

  • Pain in the stomach area

  • Fever

  • Nausea or vomiting

  • Blood in the urine

  • Loss of appetite or tiredness

Diagnostic Tools

  • Physical exam

  • Ultrasound or CT scan of the belly

  • Blood and urine tests

  • Biopsy (small tissue sample for testing)

Treatment

Most children receive a combination of treatments:

  • Surgery to remove the tumor (and sometimes the kidney)

  • Chemotherapy to kill remaining cancer cells

  • Radiation therapy (in some cases)

Outlook & Support

With early treatment, Wilms' tumor has a high cure rate: About 9 out of 10 children recover fully. Long-term follow-up is needed to monitor kidney health and watch for relapse.

When to See a Doctor

If you notice:

  • A firm lump in your child's belly

  • Ongoing belly pain

  • Unexplained fever or weight loss

See a pediatrician right away.

Urinary Tract Infection (UTI)

A urinary tract infection (UTI) happens when germs (usually bacteria) enter the urinary tract and can affect the bladder, urethra, or kidneys. UTIs are common in preschool-aged kids, especially during toilet training.

Causes

Causes include:

  • Bacteria from the skin or stool getting into the urethra

  • Poor wiping technique (especially for girls)

  • Holding pee for too long

  • Not fully emptying the bladder

  • Wearing tight or dirty clothes

Who Is at Risk?

More common in:

  • Girls (shorter urethra)

  • Kids with urinary reflux (pee flows backward)

  • Children with constipation

  • Kids who are not yet toilet trained or recently trained

Common Signs & Symptoms

  • Pain or burning when peeing

  • Fever (sometimes the only sign!)

  • Urinating more often than usual

  • Pee that smells bad or looks cloudy

  • Belly or back pain

  • Bedwetting or accidents after being potty trained

  • Fussiness in younger kids

Diagnosis

  • Urine sample to check for bacteria

  • In younger children, urine may be collected with:

    • A bag

    • A catheter (thin tube)

  • Sometimes, an ultrasound is done to check for problems in the urinary tract

Treatment

  • Antibiotics (liquid or pills)

  • Pain relievers if needed

  • It's important to:

    • Finish all the medicine

    • Follow up if symptoms don't improve

    • Encourage your child to drink plenty of fluids

Can UTIs Be Serious?

Yes - if left untreated, UTIs can spread to the kidneys, causing serious problems like:

  • Kidney infections

  • Scarring

  • High blood pressure later in life

Early treatment prevents complications!
Prevention

  • Teach proper wiping: front to back

  • Encourage kids to pee regularly

  • Keep the diaper area clean and dry

  • Avoid tight underwear or pants

  • Offer plenty of water and fluids

When to See a Doctor

Call your pediatrician if your child has:

  • Fever with no known cause

  • Pain while peeing

  • Changes in bathroom habits

  • Unusual-smelling or cloudy urine

Asthma

Asthma is a chronic (long-term) lung condition that causes the airways to become inflamed and narrow, making it hard to breathe. It can start at any age, including during the preschool years.

How Does Asthma Affect Preschoolers?

In young kids, asthma can cause:

  • Trouble breathing, especially during play

  • Frequent coughing, especially at night

  • Wheezing (a whistling sound when breathing)

  • Fatigue from poor sleep or breathing difficulty

Common Triggers of Asthma

  • Colds or viruses

  • Dust, pollen, or pet dander

  • Smoke or air pollution

  • Exercise or cold air

  • Strong smells (like perfumes or cleaning products)

Signs & Symptoms

  • Frequent coughing

  • Wheezing (especially when exhaling)

  • Shortness of breath

  • Tightness in the chest

  • Symptoms get worse with activity or at night

Diagnosis

In preschoolers, diagnosis is based on:

  • Medical history (family history of asthma or allergies)

  • Symptoms pattern (when and how often)

  • Physical exam

  • Lung function tests are hard at this age, but may be tried.

Treatment

Asthma is treated with two main types of medicine:

  • Quick-relief inhalers (used during attacks)

  • Daily controller medicines (to reduce inflammation)

Other Treatments

  • Nebulizer for younger children

  • Allergy medicine if allergies are a trigger

Asthma Attack

An asthma attack is when symptoms suddenly get worse.

Signs:

  • Severe coughing or wheezing

  • Fast or hard breathing

  • Trouble talking or eating

  • Lips or fingernails turning blue

How Parents Can Help

  • Follow the asthma action plan from the doctor

  • Give medicines on time

  • Watch for early symptoms

  • Avoid known triggers at home or school

  • Keep regular doctor checkups

Can Asthma Be Outgrown?

  • Some children outgrow symptoms, but not all.

  • Asthma may improve with age, but needs monitoring.

  • Early treatment helps prevent lung damage.

  • Many kids live healthy, active lives with good asthma care!

Health Problems Most Common in School-Aged Children

Diabetes Mellitus

Diabetes Mellitus is the most common endocrine disorder in school-aged children.

Types of Diabetes Mellitus in Children
Type 1 Diabetes (T1D)

  • Etiology: Autoimmune destruction of pancreatic B-cells leading to absolute insulin deficiency.

  • Epidemiology: Accounts for approximately 90% of pediatric diabetes; incidence peaks between ages 4-7 and 10-14.

Type 2 Diabetes (T2D)

  • Etiology: Insulin resistance combined with relative insulin deficiency.

  • Epidemiology: Historically rare in children but increasing, especially among adolescents with obesity and family history.

Clinical Presentation
Type 1 Diabetes

  • Onset: Acute (days to weeks).

  • Classic Symptoms: Polyuria, polydipsia, polyphagia, weight loss, fatigue.

  • Complications: Diabetic ketoacidosis (DKA) common at diagnosis.

Type 2 Diabetes

  • Onset: Insidious (months to years).

  • Classic Symptoms: May have few classic symptoms; often overweight or obese; acanthosis nigricans, fatigue.

  • Complications: DKA less common; may present with a hyperosmolar state.

Diagnostic Criteria

According to the American Diabetes Association (ADA):

  • Fasting Plasma Glucose (FPG) \geq 126 mg/dL

  • 2-Hour Plasma Glucose \geq 200 mg/dL during an OGTT

  • Random Plasma Glucose \geq 200 mg/dL with classic symptoms

  • Hemoglobin A1c \geq 6.5% (Confirm with repeat testing unless unequivocal hyperglycemia present)

Management
Insulin Therapy (Type 1)

  • Basal-Bolus Regimens: Long-acting basal insulin (e.g., glargine) plus rapid-acting boluses at meals.

  • Insulin Pumps: Continuous subcutaneous insulin infusion offers flexible dosing and can reduce hypoglycemia.

  • Continuous Glucose Monitoring (CGM): Real-time glucose tracking improves glycemic control.

Lifestyle Agents (Type 2)

  • Lifestyle modification: Nutrition counseling, increased physical activity, weight management.

  • Metformin: First line in pediatric T2D; may improve insulin sensitivity.

  • Additional agents: Insulin or other antihyperglycemics if glycemic targets are not met.

School-Based Considerations

  • Individualized Health Plans (IHPs):

    • Outline daily management, insulin administration times, blood glucose checks, hypoglycemia treatment.

    • Identify responsible staff and emergency protocols.

  • Hypoglycemia Management:

    • Symptoms: Sweating, tremors, irritability, confusion.

    • Ensure quick-acting carbohydrates (juice, glucose tablets) are readily available.

  • Hyperglycemia Awareness:

    • Symptoms: Excessive thirst, frequent urination, fatigue.

    • Know when to contact parents or seek medical help (e.g., suspected DKA).

  • Education & Training:

    • Train teachers and school nurses in recognizing symptoms, administering insulin, and using CGM or pumps.

    • Foster peer awareness to reduce stigma.

  • Psychosocial Support:

    • Children may feel different or anxious about injections.

    • Encourage supportive environments, and if needed, counseling resources.

Prevention & Screening
Type 1

No proven primary prevention; however, research trials (e.g., Teplizumab) are exploring delay of onset in high-risk children.

Type 2

Screen overweight/obese children with additional risk factors beginning at age 10 or puberty onset. Emphasize a healthy diet and physical activity to prevent insulin resistance.

Rheumatic Fever

Acute rheumatic fever (ARF) is an immunologically mediated, multisystem inflammatory disease that can develop as a sequel to untreated or inadequately treated infection with group A \beta -hemolytic Streptococcus (GAS), most commonly pharyngitis. It predominantly affects children aged 5-15 years and remains a significant cause of acquired heart disease in this age group in many parts of the world.

Etiology & Pathogenesis

  • Trigger: GAS pharyngitis strains carrying M-protein epitopes that cross-react with host tissues.

  • Autoimmune response: Molecular mimicry leads to antibodies and T-cells targeting both streptococcal antigens and host tissues (heart, joints, skin, central nervous system).

Epidemiology

  • Global burden: Estimated 325,000 new ARF cases annually worldwide.

  • High prevalence in low- and middle-income countries; decreased incidence in high-income regions due to better access to antibiotics and public health measures.

Clinical Manifestations
Clinical Features (Jones Criteria)

Major Criteria

  • Carditis

    • Pancarditis: endocarditis (murmurs, regurgitation), myocarditis (heart failure signs), pericarditis (pericardial rub).

  • Polyarthritis

    • Migratory, predominantly affecting large joints (knees, ankles, elbows, wrists).

  • Sydenham's Chorea

    • Involuntary, jerky movements of the face and limbs; emotional lability; onset can be months after infection.

  • Erythema Marginatum

    • Non-pruritic, serpiginous rash on the trunk and proximal limbs; rings with clear center.

  • Subcutaneous Nodules

    • Painless, firm, over extensor surfaces (e.g., elbows, knees).

Minor Criteria

  • Fever

  • Arthralgia

  • Elevated Acute-Phase Reactants:

    • ESR (erythrocyte sedimentation rate)

    • CRP (C-reactive protein)

  • Prolonged PR interval on ECG

  • Evidence of preceding GAS infection:

    • Positive throat culture

    • Rapid antigen test

    • Elevated/recently rising anti-streptolysin O (ASO) titer.

Diagnosis

Two major criteria, or one major and two minor criteria, AND evidence of preceding GAS infection.

Complications

  • Cardiac: Chronic rheumatic heart disease (valvular stenosis/regurgitation), heart failure.

  • Recurrence: Subsequent GAS infections can precipitate further ARF episodes, worsening cardiac damage.

Management
A. Eradication of GAS

  • Antibiotic Therapy

    • Penicillin V orally for 10 days

    • Single-dose Benzathine Penicillin G intramuscularly

B. Anti-Inflammatory Treatment

  • Arthritis: High-dose aspirin until symptom resolution, then taper.

  • Carditis: Aspirin or NSAIDs for mild cases; Corticosteroids if severe myocarditis or heart failure.

C. Secondary Prophylaxis

  • Long-Term Antibiotics: To prevent recurrence and rheumatic heart disease progression.

  • Benzathine Penicillin G IM every 3-4 weeks for:

    • At least 5 years or until age 21 (whichever is longer) for carditis without residual valvular disease.

    • Up to 10 years or until age 40 if persistent valvular disease

School-Based Considerations

  • Early Detection: Educate staff to recognize joint pain, new heart murmurs, choreiform movements.

  • Adherence Support: Coordinate IM prophylaxis schedules; ensure children receive on-time injections.

  • Emergency Protocols: Recognize signs of heart failure (e.g., dyspnea, fatigue) and know when to seek immediate care.

  • Education: Promote completion of the full antibiotic course for sore throats; skin GAS infections are NOT precursors to ARF.

Prevention

  • Primary Prevention: Prompt diagnosis and complete treatment of GAS pharyngitis.

  • Secondary Prevention: Lifelong emphasis on adherence to prophylactic regimens in children with a history of ARF.

Juvenile Idiopathic Arthritis (JIA)

Juvenile Idiopathic Arthritis (formerly "juvenile rheumatoid arthritis") is the most common chronic rheumatic disease in children, characterized by persistent arthritis of unknown etiology beginning before age 16 and lasting at least six weeks.

Early recognition and management are key to preventing joint damage and ensuring normal growth and development.

Clinical Presentation

  • Joint Symptoms: Swelling, pain, stiffness (worse in the morning), and limited range of motion.

  • Systemic Signs (Systemic JIA): High, spiking fevers (often daily), evanescent salmon-pink rash, lymphadenopathy, hepatosplenomegaly, serositis.

  • Extra-Articular Manifestations:

    • Uveitis: Especially in oligoarticular subtype - requires regular slit-lamp exams.

    • Growth Delay & Osteopenia: Chronic inflammation and glucocorticoid use impact bone health.

Diagnosis

  • Clinical Criteria: Arthritis in \geq 1 joint for \geq 6 weeks, onset < 16 years, exclusion of other causes.

  • Laboratory Tests:

    • Inflammatory Markers: ↑ ESR, ↑ CRP

    • Autoantibodies: RF