76 pages

PEDIATRICS
BUNDLE
13 TOPICS
 INDEX
Pediatric Vital Signs Bronchiolitis (RSV)
Neural Tube Defects Reye Syndrome

Sudden Infant Death Syndrome (SIDS)

Variations In Pediatric Anatomy & Physiology

Intussusception Hypertrophic Pyloric Stenosis

Laryngotracheobronchitis
Epiglottitis “Croup”

Fever Management
Pediatric Vaccine Schedule Hacks

Safety Promotion
 Pediatric
Vital Signs
 Pediatric Vital Signs
Pediatric vital signs vary depending on the age of the child. The following are
the typical ranges for vital signs in children:

Newborns (0-28 days old) Infants (1-12 months old)

Heart rate: 70-190 beats per Heart rate: 80-160 bpm
minute (bpm) Respiratory rate: 20-40 bpm
Respiratory rate: 30-60 breaths Blood pressure: 70/50 to 100/70
per minute (bpm)
mmHg
Blood pressure: 60/30 to 90/60
mmHg Temperature: 97.9-100.4°F (36.6-
Temperature: 97.7-99.5°F (36.5- 38°C)
37.5°C)

Toddlers (1-3 years old) Preschoolers (3-5 years old)

Heart rate: 80-130 bpm Heart rate: 80-120 bpm
Respiratory rate: 20-30 bpm Respiratory rate: 20-30 bpm
Blood pressure: 80/50 to 110/75 Blood pressure: 80/50 to 110/75
mmHg mmHg
Temperature: 97.9-100.4°F (36.6- Temperature: 97.9-100.4°F (36.6-
38°C) 38°C)

School-age children (6-12 years old):

Heart rate: 70-110 bpm
Respiratory rate: 18-25 bpm
Blood pressure: 90/60 to 120/80 mmHg
Temperature: 97.9-100.4°F (36.6-38°C)
It is important to note that these ranges are just general guidelines, and
individual variations are possible. Any significant deviation from these
ranges may indicate an underlying medical problem and should be evaluated
by a healthcare provider.
 Heart rate
This refers to the number of times the heart beats per minute. In pediatric
patients, the heart rate is an important indicator of cardiac function and can
be affected by various factors such as fever, pain, anxiety, and medications.
Respiratory rate
This refers to the number of breaths a child takes per minute. It is an
important indicator of respiratory function and can be affected by various
factors such as fever, dehydration, and lung disorders.
Blood pressure
This refers to the pressure exerted by the blood on the walls of the arteries.
In pediatric patients, blood pressure is an important indicator of
cardiovascular function and can be affected by various factors such as
dehydration, medications, and underlying medical conditions.
Temperature
This refers to the body's internal temperature and is measured using a
thermometer. In pediatric patients, fever is a common symptom of many
illnesses and can be an indicator of infection or inflammation.

In addition to these vital signs, healthcare providers may also assess other
parameters such as oxygen saturation (the amount of oxygen in the blood),
capillary refill time (the time it takes for the blood to refill in capillaries after
pressure is applied), and pain assessment.

It is important to monitor pediatric vital signs regularly, especially in

critically ill children or those with chronic medical conditions. Any
significant changes in vital signs should be promptly reported to a
healthcare provider.
Pain assessment

Pain assessment is an important aspect of pediatric care, and healthcare

providers may use various tools to assess a child's pain level, such as the
Wong-Baker FACES Pain Rating Scale. Pain can affect a child's vital signs,
such as increasing heart rate and respiratory rate, and it is important to
manage pain appropriately to improve a child's comfort and well-being.
 Piaget's Stages of Cognitive Development
Piaget was a Swiss psychologist who developed a theory of cognitive
development that explains how children develop their intellectual abilities
from infancy through adolescence. According to Piaget, there are four stages
of cognitive development:

Sensorimotor stage (birth to 2 years)

In this stage, children learn about the world through their senses and
motor actions. They develop object permanence, which is the
understanding that objects continue to exist even when they are no
longer visible.
Preoperational stage (2 to 7 years)
In this stage, children develop symbolic thought and language. They
can use symbols, such as words and images, to represent objects and
events, and they can engage in pretend play. However, their thinking
is still egocentric and they have difficulty understanding other
people's perspectives.
Concrete operational stage (7 to 12 years)
In this stage, children develop the ability to think logically about
concrete objects and events. They understand the concept of
conservation, which is the understanding that the amount of a
substance remains the same even when its appearance changes. They
can also perform mental operations, such as addition and subtraction.

Formal operational stage (12 years and up)

In this stage, adolescents develop the ability to think abstractly and

hypothetically. They can reason about complex problems and use
deductive reasoning to draw logical conclusions. They can also engage
in metacognition, which is the ability to think about their own
thinking and reasoning processes.
Piaget's theory has been influential in the field of developmental psychology,
and his stages of cognitive development have been used to guide educational
practices and the development of curricula for children of different ages.
However, his theory has also been criticized for not fully accounting for
cultural and individual differences in cognitive development

In the sensorimotor stage, infants gradually learn to coordinate their

sensory experiences with their physical actions. They start to develop
simple concepts of cause and effect and begin to understand that they
can cause things to happen in their environment. The development of
object permanence is a major achievement during this stage, as it enables
infants to understand that objects continue to exist even when they are
not directly perceived.
In the preoperational stage, children become more adept at using
symbols to represent objects and events, and their language skills
develop rapidly. They engage in pretend play, which allows them to
explore different roles and scenarios. However, their thinking is still
characterized by egocentrism, which means they have difficulty
understanding other people's perspectives. They also have a tendency to
focus on one aspect of a satution and ingnore other relevant aspects
 In the concrete operational stage, children become more logical and
systematic in their thinking. They are able to perform mental operations,
such as reversibility, which means they can mentally undo an action. They
can also understand the concept of conservation, which means they
recognize that the amount of a substance remains the same even if its
shape changes. They become more adept at classifying objects and
understand relationships between different categories.

In the formal operational stage, adolescents develop the ability to think

abstractly and hypothetically. They can understand complex concepts
and engage in deductive reasoning, which means they can draw logical
conclusions from a set of premises. They become more skilled at
metacognition, which means they can think about their own thinking
and reasoning processes.

It's worth noting that Piaget's stages of cognitive development are not
precise age ranges, and children may progress through the stages at
different rates or experience them differently depending on their cultural
background and individual experiences. Nonetheless, Piaget's theory has
been influential in shaping our understanding of how children develop
intellectually and has influenced educational practices around the world.
Variations In
Pediatric
Anatomy &
Physiology
Variations In Pediatric Anatomy & Physiology
Pediatric anatomy and physiology are different from that of adults in several
ways. Children's bodies undergo significant changes in size, shape, and
function as they grow and develop. Here are some of the key differences:

Size and Proportion Development of Organs

Children have smaller body sizes and Children's organs are still
different body proportions than developing and may not function in
adults. For example, a child's head is the same way as adult organs. For
larger in proportion to their body example, a child's liver is not as
than an adult's head. Children also efficient at metabolizing drugs as an
have smaller airways, making them adult's liver, which can affect how
more susceptible to respiratory medications are dosed.
issues.

Nervous System Musculoskeletal System

Children's brains are still developing, Children's bones are still growing
and the nervous system is not fully and developing, which makes them
mature. This can affect how children more flexible than adult bones.
process information, their ability to However, this also means they are
regulate emotions, and their motor more susceptible to fractures.
skills.

Immune System Metabolism:

A child's immune system is Children's metabolic rates are
still developing and may not be higher than adults, which means
as effective at fighting off they require more calories and
infections as an adult's nutrients to fuel their growth and
immune system. development.

Understanding these variations in pediatric anatomy and physiology is

important for healthcare professionals who care for children, as it can impact
how they diagnose and treat illnesses in children.
 Cardiovascular System
Children's hearts are smaller and have a higher heart rate than adults, which
means they have a lower stroke volume (amount of blood pumped per
heartbeat). Their blood vessels are also more elastic, which can affect their
blood pressure.
Renal System
Children's kidneys are smaller and have a lower glomerular filtration rate
(GFR) than adults, which means they may not be able to filter waste
products from the blood as efficiently as adults.
Respiratory System
Children's airways are narrower than adults, making them more susceptible
to respiratory infections and asthma. Additionally, children have a higher
respiratory rate than adults, which can affect their oxygen and carbon
dioxide levels.
Gastrointestinal System
Children have a smaller stomach and intestines than adults, which means
they may need to eat more frequently to maintain adequate nutrition.
Additionally, their digestive enzymes are not fully developed, which can
affect their ability to digest certain foods.

Endocrine System
Children's hormonal systems are still developing, which can affect their growth
and development. They may also be more susceptible to hormonal imbalances
and disorders, such as diabetes.
Skin

Children's skin is thinner and more sensitive than adult skin, making them
more susceptible to skin irritations and sunburn.

Understanding these differences in pediatric anatomy and physiology is

important for providing appropriate and effective medical care to children.
It is essential to consider these variations when diagnosing and treating
medical conditions in children, as well as when administering medications
or performing medical procedures.
 Differences in pediatric anatomy and physiology
Reproductive System: Children's reproductive systems are not yet fully
developed, and their hormone levels are different from those of adults.
Puberty triggers significant changes in the reproductive system, including
the development of secondary sexual characteristics and the onset of
menstruation or sperm production.

Immune System: Children's immune systems are still developing, which

means they may not respond to vaccines and infections in the same way as
adults. They may also be more susceptible to certain types of infections, such
as respiratory infections and gastroenteritis.

Mental Health: Children's brains are still developing, which can affect their
mental health. They may experience developmental and behavioral
disorders, such as ADHD and autism, as well as mental health conditions
such as anxiety and depression.

Growth and Development: Children's growth and development follow a

predictable pattern, with significant milestones occurring at different ages.
For example, children typically start walking between 9 and 15 months of age
and reach puberty between 8 and 13 years of age.

Nutritional Requirements: Children have different nutritional requirements

than adults, with specific needs for macronutrients (protein, carbohydrates,
and fat) and micronutrients (vitamins and minerals) to support growth and
development.

Dental Health: Children's teeth and gums are still developing, and they may
be more susceptible to tooth decay and gum disease than adults. It is
essential to establish good oral hygiene habits early to promote lifelong
dental health.
 Sudden
Infant Death
Syndrome
(SIDS)
 Sudden Infant Death Syndrome (SIDS)
Sudden Infant Death Syndrome (SIDS) is the sudden and unexplained death
of an apparently healthy infant under one year of age, most commonly
occurring during sleep. The exact cause of SIDS is unknown, but it is
thought to be related to abnormalities in the infant's respiratory control
system or brainstem function, which may be triggered by an external
stressor such as a respiratory infection or environmental factors like
sleeping on the stomach or exposure to tobacco smoke.

There are several risk factors associated with SIDS, including:

Age: SIDS is most common in infants between 2 and 4 months of age.

Gender: Boys are more likely than girls to die from SIDS.

Sleeping position: Infants who sleep on their stomach or side are at a

higher risk of SIDS than those who sleep on their back.

Overheating: Infants who are dressed too warmly or who sleep in a warm
room are at an increased risk of SIDS.

Maternal smoking: Infants born to mothers who smoke during pregnancy

or are exposed to tobacco smoke after birth are at an increased risk of
SIDS.

Prematurity: Premature infants or those with a low birth weight are at an

increased risk of SIDS.
There is no specific treatment for SIDS. The best way to prevent SIDS is by
following safe sleep practices, including:

Always placing infants on their backs to sleep.

Avoiding loose bedding or soft objects in the crib.

Keeping infants in a smoke-free environment.

Avoiding overheating.

Encouraging breastfeeding.

Providing a pacifier during sleep.

Avoiding bed-sharing or co-sleeping.

It is also important to ensure that infants receive regular well-child visits to

monitor their growth and development and to identify any risk factors for
SIDS. Additionally, parents should seek medical attention if their infant
shows any signs of illness, including fever, difficulty breathing, or changes in
behavior or appetite.

Sudden infant death syndrome (SIDS) is the sudden and unexplained

death of a baby younger than 1 year old. A diagnosis of SIDS is made
if the baby's death remains unexplained even after a death scene
investigation, an autopsy, and a review of the clinical history.
 How Boston Children's Hospital approaches SIDS
All parents can significantly reduce the risk of SIDS by being informed
about, and implementing, simple but specific risk reduction strategies.

And for younger parents, Children’s Young Parents Program (YPP) and the
Children's Hospital Primary Care Center (CHPCC) provide quality medical
care and health education to teen parents and their children in low-income
and at-risk environments. We’re dedicated to helping young parents learn
positive parenting skills, attitudes and behaviors so their child has healthy
development and growth during the critical first years.

Children’s is also a world leader in SIDS research, investigating the key

questions about this mysterious syndrome, including:

what causes SIDS

how to identify which babies are most at risk, and
why SIDS strikes boys more often than girls

Children’s Young Parents Program (YPP)

Becoming a parent is full of challenges, even in the best of circumstances.
Those challenges are even greater for teen parents. Our Young Parents
Program (YPP) is a special clinic dedicated to helping teen mothers and
fathers from low-income and at-risk environments, since these young
parents have the highest rates of pregnancies and the greatest risk of giving
birth to babies with health problems. Our program includes doctors, social
workers, nurses and nurse practitioners who have years of experience
working with urban parents, adolescents, and children.

Symptoms & Causes

If you’re concerned that your child or grandchild is in danger of SIDS, it will
comfort you to know that Boston Children’s Hospital has a tremendous
amount of experience counseling parents on techniques to greatly reduce the
risk.
Neural
Tube
Defects
 Neural Tube Defects
CDC urges all women of reproductive age to get 400 micrograms (mcg) of folic
acid every day, in addition to consuming food with folate from a varied diet, to
help prevent neural tube defects (NTDs).

NTDs occur when the neural tube does not close properly. The neural tube
forms the early brain and spine. These types of birth defects develop very
early during pregnancy, often before a woman knows she is pregnant.

The two most common NTDs are spina bifida (a spinal cord defect) and
anencephaly (a brain defect).
Neural tube defects (NTDs) are a group of birth defects that affect the
development of the neural tube, which is the embryonic structure that
eventually forms the brain and spinal cord. NTDs occur when the neural tube
fails to close properly during the first few weeks of embryonic development,
which can lead to serious problems with the brain and spinal cord.

Neural Tube Defects (NTDs) are a group of congenital malformations that

occur during embryonic development when the neural tube fails to close
properly. The neural tube is the structure that gives rise to the brain and
spinal cord, and it develops very early in embryonic life, typically within the
first month after conception.
 SYMPTOMS AND CAUSES

Causes neural tube defects (NTDs)

Healthcare providers and scientists don’t yet know the exact cause of
neural tube defects (NTDs), but they believe it’s a complex combination of
genetic, nutritional and environmental factors.

In particular, low levels of folic acid in a person’s body before and during
early pregnancy appear to play a part in this type of congenital condition.
Folic acid (or folate) is important for the fetal development of the brain and
spinal cord.
Symptoms of neural tube defects (NTDs)
Each type of neural tube defect (NTD) has different symptoms.

Some babies with NTDs have no symptoms, while others experience serious
disabilities. Babies with iniencephaly and anencephaly are typically stillborn
or die shortly after birth due to complications from the defect.

General symptoms of NTDs can include:

Physical problems, such as paralysis and urinary and bowel control

issues.
Blindness.
Deafness.
Intellectual disability.
Lack of consciousness and, in some cases death.
 Signs of neural tube defects (NTDs) during pregnancy
The signs of neural tube defects (NTDs) during pregnancy can vary
depending on the type and severity of the defect. In some cases, there may
be no visible signs or symptoms until after birth. However, some signs and
symptoms that may indicate the presence of an NTD during pregnancy
include
Abnormal levels of alpha-fetoprotein (AFP) in the mother's blood or
amniotic fluid, which can be detected through prenatal screening tests.

An abnormal appearance of the spine or head on an ultrasound exam.

Presence of a bulging sac on the back of the baby's head, which may
indicate anencephaly or encephalocele.

Excessive fluid buildup in the brain (hydrocephalus), which may indicate

an NTD affecting the brain.

Weak or absent fetal movements, which may indicate a severe NTD

affecting the spinal cord.

Treatments for neural tube defects (NTDs)

Treatment for spina bifida depends on the severity of the condition and the
presence of complications. For some people, treatment needs may change
over time, depending on the condition’s severity or complications.
Open spina bifida. An infant with myelomeningocele, in which the spinal
cord is exposed, can have surgery to close the hole in the back before
birth or within the first few days after birth.
Hydrocephalus. If an infant with spina bifida has hydrocephalus (excess
fluid surrounding the brain), a surgeon can implant a shunt—a small
hollow tube to drain fluid—to relieve pressure on the brain. Treating
hydrocephalus can prevent problems such as blindness.
Encephaloceles. People with encephaloceles—sac-like bulges where the
brain and surrounding membranes protrude through the skull—are
sometimes treated with surgery. During the surgery, the bulge of tissue is
placed back into the skull. Surgery also may help to correct abnormalities
in the skull and face.
Tethered spinal cord. Surgery can separate the spinal cord from
surrounding tissue.1
Paralysis and limitations in mobility. People with spina bifida use different
means to get around, including braces, crutches, walkers, and wheelchairs.
Urinary tract infections and lack of bladder and bowel control. People with
myelomeningocele often have nerve damage that keeps the bladder from
completely emptying. This can cause urinary tract infections and damage
to the kidneys. Health care providers may address this problem by using a
tube to fully empty the bladder. Medications, injections, and surgery also
can help prevent urine from leaking accidentally and keep the kidneys and
bladder working for the long term.
There is no treatment for anencephaly or iniencephaly.2 Infants with these
conditions usually die shortly after birth.

Some common treatments for NTDs include:

Surgery: Surgical repair may be an option for some types of NTDs, such as
spina bifida and encephalocele. Surgery may involve closing the opening in
the spine or skull, repairing the exposed tissue, or removing excess fluid
from the brain.

Shunts: In some cases, a shunt may be placed to help drain excess fluid from
the brain in babies with hydrocephalus.

Medications: Medications may be used to manage symptoms and prevent

complications associated with NTDs, such as seizures or urinary tract
infections.

Physical therapy: Physical therapy can be beneficial for improving mobility

and strength in individuals with NTDs affecting the spinal cord.
Bronchioliti
s (RSV)
 Bronchiolitis (RSV)
Bronchiolitis is a common lung infection in young children and infants. It
causes swelling and irritation and a buildup of mucus in the small airways of
the lung. These small airways are called bronchioles. Bronchiolitis is almost
always caused by a virus.

Bronchiolitis starts out with symptoms much like a common cold. But then
it gets worse, causing coughing and a high-pitched whistling sound when
breathing out called wheezing. Sometimes children have trouble breathing.
Symptoms of bronchiolitis can last for 1 to 2 weeks but occasionally can last
longer.

Most children get better with care at home. A small number of children
need a stay in the hospital.
 Symptoms of bronchiolitis (RSV)
Symptoms of bronchiolitis typically develop within a few days of exposure
to the virus and may include:
1. Runny or stuffy nose
2. Cough, which may produce phlegm or mucus
3. Rapid or shallow breathing
4. Wheezing, a high-pitched whistling sound when breathing out
5. Difficulty breathing or shortness of breath
6. Fever, typically low-grade but may be higher in some cases
7. Poor feeding or decreased appetite, especially in infants
8. Irritability or restlessness, particularly in infants and young children
9. Fatigue or lethargy

Symptoms of bronchiolitis may develop gradually and usually peak

between days three to five after onset. The severity of symptoms can range
from mild to severe, and complications can occur, especially in high-risk
individuals such as infants, young children, and individuals with weakened
immune systems. If you or your child develops any symptoms of
bronchiolitis, it is essential to seek medical attention promptly.
 Causes of Bronchiolitis (RSV)
Bronchiolitis is a respiratory illness that is most commonly caused by a viral
infection. The most common cause of bronchiolitis is the Respiratory
Syncytial Virus (RSV), which accounts for about 70% of all cases of
bronchiolitis. However, other viruses can also cause bronchiolitis, including:
1. Rhinovirus
2. Influenza virus
3. Parainfluenza virus
4. Adenovirus
5. Human metapneumovirus
Bronchiolitis is highly contagious and can spread easily from person to
person through respiratory secretions, such as saliva, mucus, or nasal
discharge, when an infected person coughs or sneezes. The virus can also
survive on surfaces for several hours, making it possible to contract the
infection by touching a contaminated surface and then touching one's
mouth or nose.

Bronchiolitis is usually caused by the respiratory syncytial virus (RSV). RSV is

a common virus that infects just about every child by 2 years of age.
Outbreaks of RSV infection often happen during the colder months of the
year in some locations or the rainy season in others. A person can get it more
than once. Bronchiolitis also can be caused by other viruses, including those
that cause the flu or the common cold.
 Treatment of Bronchiolitis (RSV)
Bronchiolitis is a viral infection that affects the small airways in the lungs,
typically in infants and young children. The treatment of bronchiolitis
primarily involves supportive care to manage the symptoms and help the
child breathe more easily. Here are some common approaches
Increase fluids: Encourage the child to drink plenty of fluids, such as
breast milk or formula, to prevent dehydration.

Monitor breathing: Keep a close eye on the child's breathing, and seek
medical attention immediately if there are signs of breathing difficulties
or if the child appears to be in distress.

Use a humidifier: Use a cool mist humidifier to help keep the air moist and
relieve congestion.

Give acetaminophen or ibuprofen: These medications can help reduce

fever and ease discomfort, but they should only be given under a doctor's
supervision.

Avoid smoke: Keep the child away from smoke or other irritants that
could aggravate their condition.

Consider nebulized saline: In some cases, nebulized saline may be used to

help loosen mucus and make it easier to cough up.

Antiviral medication: Although bronchiolitis is caused by a virus, there is

no specific antiviral medication that can treat the infection. However, in
some cases, doctors may prescribe antiviral medication if the child is at
high risk of complications.

It's important to note that antibiotics are not effective against

bronchiolitis because it is a viral infection, and antibiotics only work
against bacterial infections.
 Risk factors Bronchiolitis (RSV)
Bronchiolitis usually affects children under the age of 2 years. Infants
younger than 3 months have the highest risk of getting bronchiolitis because
their lungs and their ability to fight infections aren't yet fully developed.
Rarely, adults can get bronchiolitis.

Other factors that increase the risk of bronchiolitis in infants and young
children include:

Being born too early.

Having a heart or lung condition.
Having a weakened immune system. This makes it hard to fight
infections.
Being around tobacco smoke.
Contact with lots of other children, such as in a child care setting.
Spending time in crowded places.
Having siblings who go to school or get child care services and bring
home the infection.

Complications of bronchiolitis (RSV)

Complications of severe bronchiolitis may include:

Low oxygen in the body.

Pauses in breathing, which is most likely to happen in babies born too
early and in babies under 2 months old.
Not being able to drink enough liquids. This can cause dehydration, when
too much body fluid is lost.
Not being able to get the amount of oxygen needed. This is called
respiratory failure.
If any of these happen, your child may need to be in the hospital. Severe
respiratory failure may require that a tube be guided into the windpipe. This
helps your child breathe until the infection improves.
 Prevention of Bronchiolitis (RSV)
Because the viruses that cause bronchiolitis spread from person to person,
one of the best ways to prevent infection is to wash your hands often. This is
especially important before touching your baby when you have a cold, flu or
other illness that can be spread. If you have any of these illnesses, wear a face
mask.

If your child has bronchiolitis, keep your child at home until the illness is past
to avoid spreading it to others.

Wash hands often. Cover coughs and

sneezes
Frequently wash your own Cover your mouth and
hands and those of your nose with a tissue.
child. Wash with soap and Throw away the tissue.
water for at least 20 Then wash your hands.
seconds. Keep an alcohol- If soap and water aren't
based hand sanitizer handy available, use a hand
to use when you're away sanitizer. If you don't
from home. Make sure it have a tissue, cough or
contains at least 60% sneeze into your elbow,
alcohol. not your hands.

Limit contact with people who have a fever or cold.

If your child is a newborn,

especially a premature
newborn, avoid being
around people with colds.
This is especially important
in the first two months of
life.
Clean and disinfect surfaces Use your own drinking glass.

Clean and disinfect Don't share glasses with

surfaces and items that others, especially if
people often touch, such as someone in your family is
toys and doorknobs. This is ill.
especially important if a
family member is sick.

Breastfeed, when possible

Respiratory infections are
less common in breastfed
babies.

Cover your mouth and nose when coughing or sneezing: Use a tissue or
the crook of your elbow to cover your mouth and nose when you cough
or sneeze. This can help prevent the spread of RSV and other
respiratory infections.

Avoid sharing personal items: Do not share cups, utensils, or other

personal items with someone who has cold-like symptoms. This can
help prevent the spread of RSV and other infections.

Stay home when you are sick: If you or your child has cold-like
symptoms, stay home and avoid contact with others. This can help
prevent the spread of RSV and other respiratory infections.
 Reye
Syndrome
 Reye Syndrome
Reye's syndrome is a very rare disorder that can cause serious liver and
brain damage. If it's not treated promptly, it may lead to permanent brain
injury or death.

Reye's syndrome mainly affects children and young adults under 20 years
of age.
Reye syndrome is a rare but serious condition that can affect children
and teenagers, usually following a viral infection such as influenza or
chickenpox. It is characterized by sudden onset of severe brain damage
and liver dysfunction, which can lead to seizures, coma, and even death
if left untreated.
The exact cause
of Reye
syndrome is not
fully understood,
but it is believed
to be associated
with the use of
aspirin or other
salicylates
during the viral
illness.

The cause of RS is unknown. Studies have shown a link between aspirin

(salicylate) and the onset of Reye's syndrome. Because of this association,
healthcare professionals do not recommend the use of aspirin for children.

There is no cure for RS. Treatment focuses on preventing brain damage.

Recovery is directly related to the severity of the swelling of the brain.
Some individuals recover completely, while others may sustain varying
degrees of brain damage.
 Symptoms of Reye's syndrome
The symptoms of Reye's syndrome usually begin a few days after a viral
infection, such as a cold, flu or chickenpox.

Initial symptoms can include:

repeatedly being sick

tiredness and lack of interest or enthusiasm
rapid breathing
seizures (fits)
As the condition progresses, the symptoms may get more severe and more
wide-ranging, and can include:

irritability, or irrational or aggressive behaviour

severe anxiety and confusion that's sometimes associated with
hallucinations
coma (loss of consciousness)

The symptoms of Reye syndrome can vary in severity, but they typically
include:

Nausea and vomiting: These symptoms are often the first signs of Reye
syndrome and may be severe.

Lethargy and confusion: Children with Reye syndrome may become

very tired and confused, and may have difficulty staying awake.

Seizures: Seizures are a common symptom of Reye syndrome and can

range from mild to severe.

Loss of consciousness: In severe cases, children with Reye syndrome

may lose consciousness and become comatose.

Agitation and irritability: Children with Reye syndrome may become

agitated, irritable, or restless.
 Causes Reye's syndrome
The exact cause of Reye's syndrome is unknown, but it most commonly
affects children and young adults recovering from a viral infection – for
example a cold, flu or chickenpox.

In most cases, aspirin has been used to treat their symptoms, so aspirin may
trigger Reye's syndrome.

In Reye's syndrome, it's thought that tiny structures within the cells called
mitochondria become damaged.

Mitochondria provide cells with energy and they're particularly important for
the healthy functioning of the liver.

If the liver loses its energy supply, it begins to fail. This can cause a dangerous
build-up of toxic chemicals in the blood, which can damage the entire body
and can cause the brain to swell.

In most cases, aspirin has been used to treat their symptoms, so aspirin
may trigger Reye's syndrome.

In Reye's syndrome, it's thought that tiny structures within the cells
called mitochondria become damaged.
 Diagnosing Reye's syndrome
There's no specific test for Reye's syndrome. Screening usually begins with
blood and urine tests. It also may include testing for fatty acid oxidation
disorders and other disorders.
Sometimes other tests are needed to check for other possible causes of liver
problems or problems with the nervous system. For example:

Spinal tap, also known as a lumbar puncture.

spinal tap can help identify or rule out other diseases with similar
symptoms. A spinal tap can uncover an infection of the lining that
surrounds the brain and spinal cord, known as meningitis. Or it can
help diagnose inflammation or an infection of the brain, called
encephalitis.

During a spinal tap, a needle is inserted through the lower back into
a space between two bones. A small sample of the fluid that
surrounds the brain and spinal cord is removed and sent to a lab for
analysis.

Liver biopsy. CT scan or MRI.

A liver biopsy can help identify A head CT scan or MRI scan
or rule out conditions that may can help identify or rule out
be affecting the liver. In people other causes of behavior
with Reye's syndrome, a liver changes or decreased alertness.
biopsy can show a buildup of These tests may show swelling
fats in liver cells. in the brain, which may be
caused by Reye's syndrome.
During a liver biopsy, a needle
A CT scan uses a series of X-
is inserted through the skin on rays taken from different
the upper right side of the angles to create a detailed
abdomen and into the liver. A image of the brain. An MRI
small sample of liver tissue is scan uses a strong magnetic
removed and sent to a lab for field and radio waves rather
analysis. than X-rays to generate images
of the brain.
 Treatment Reye"s Syndrome

Reye's syndrome is usually treated in the hospital. Severe cases may be

treated in the intensive care unit. The hospital staff will closely monitor your
child's blood pressure and other vital signs. Specific treatment may include:

Intravenous (IV) fluids. Sugar — also called glucose — and an

electrolyte solution may be given through an IV line.
Diuretics. These medicines may be used to decrease pressure from
fluids around the brain. Diuretics also increase fluid loss through
urination.
Medicines to prevent bleeding. Bleeding due to liver problems may
require treatment with vitamin K, plasma and platelets.
Cooling blankets. These blankets help maintain internal body
temperature at a safe level.
A breathing machine called a ventilator can help if your child has
trouble breathing.

Prevalence and risk factors Reye's Syndrome

Children and teenagers with underlying fatty acid oxidation disorders are
those at highest risk for Reye’s syndrome. Screening tests can reveal if your
child has this disorder. According to the Mayo Clinic, in some cases Reye’s
may be an underlying metabolic condition that is exposed by a virus.

If you use aspirin to treat symptoms of your child or teenager’s viral

infection, they are at high risk for developing Reye’s syndrome.

Reye’s syndrome is extremely rare, which is partially why our knowledge

about it is still limited. Fewer than 20 cases have been reported annually
since 1988. The survival rate for Reye’s syndrome is about 80 percent.
Intussusception
 Intussusception
Intussusception is a life-threatening illness and occurs when a portion of the
intestine folds like a telescope, with one segment slipping inside another
segment. This causes an obstruction, preventing the passage of food that is
being digested through the intestine.

If left untreated, it can cause serious damage to the intestines, intestinal

infection, internal bleeding and a severe abdominal infection called
peritonitis.

Intussusception is the most common cause of intestinal obstruction in

children between the ages of three months and six years.

Intussusception is a medical condition in which one segment of the

intestine (usually the small intestine) invaginates into another section of
the intestine, causing an obstruction. This condition is more common in
children than in adults, and it is considered a medical emergency that
requires prompt treatment.
 Causes Intussusception
The cause of intussusception is not known, although viral infections may be
responsible in some cases. It may be caused by an abnormality (such as a
polyp) in the intestines or as a result of recent intestinal surgery.

In most children there is no abnormality present, and the cause is unknown.

Sixty percent of those who develop intussusception are between 2

months and 1 year of age. Intussusception is rarely seen in newborn
infants.

Boys develop intussusception four times more often than girls.

Although 80 percent of the children who develop the condition are less
than 2 years old, intussusception can also occur in older children,
teenagers and adults.
 Symptoms Intussusception
The symptoms of intussusception can vary depending on the age of the
person affected and the severity of the condition. In children, the most
common symptoms include:
Sudden episodes of severe abdominal pain that come and go in waves
Crying, irritability, or inconsolable fussiness
Drawing the legs up to the chest
Vomiting, which may be yellow or green in color
Bloody, mucous or currant jelly-like stools (stools that contain blood and
mucus)

Infants and children may strain, draw their knees up, act very irritable and
cry loudly. Your child may recover and become playful between bouts of
pain, or may become tired and weak from crying.
In adults, the symptoms of intussusception can be less specific and may
include:

Abdominal pain, which may be crampy or intermittent

Nausea or vomiting
Diarrhea or constipation
Rectal bleeding, which may be bright red or contain mucus
It is important to note that intussusception is a medical emergency and
requires prompt medical attention, regardless of age or symptoms. If you or
your child experience any of these symptoms, seek medical help
immediately.
 Diagnosis Intussusception
If your child is in abdominal pain, call your doctor for an appointment as
soon as possible. If your child cannot be seen soon, go to the Emergency
Department to be evaluated.

A physician will obtain your child’s medical history and perform a physical
examination to determine if he has intussusception.

Imaging studies are also done to examine the abdominal organ and aid in
making an accurate diagnosis of your child. These tests may include:

Abdominal X-ray: This diagnostic test may show the intestinal obstruction.
A radiologist may see an increased density of the telescoped bowel or other
sights indicative of bowel obstruction.
Ultrasound: This radiologic test of choice uses sound waves to create
pictures of the inside of the body. On ultrasound, a target-like sign can be
seen that is indicative of intussusception.

Air or contrast enema: This procedure can be diagnostic, and in some cases
serve as the treatment for intussusception. Air or a contrast fluid is given
into the rectum as an enema. An X-ray of the abdomen shows narrow areas,
blockages and other issues. On some occasions, the pressure exerted on the
intestine while inserting air or contrast will help the intestine to unfold,
correcting the intussusception.
 Treatment Intussusception
Treatment of intussusception typically happens as a medical emergency.
Emergency medical care is required to avoid severe dehydration and
shock, as well as prevent infection that can occur when a portion of
intestine dies due to lack of blood.

Treatment options for intussusception may include:

A water soluble contrast or air enema. This is both a diagnostic procedure

and a treatment. If an enema works, further treatment is usually not
necessary. This treatment can actually fix intussusception 90% of the time
in children, and no further treatment is needed. If the intestine is torn
(perforated), this procedure can't be used.

Intussusception recurs up to 20% of the time, and the treatment will have
to be repeated. It is important that a surgeon be consulted even if treatment
with enema is planned. This is because of the small risk of a tear or rupture
of the bowel with this therapy.

Surgery. If the intestine is torn, if an enema is unsuccessful in correcting

the problem or if a lead point is the cause, surgery is necessary. The surgeon
will free the portion of the intestine that is trapped, clear the obstruction
and, if necessary, remove any of the intestinal tissue that has died. Surgery
is the main treatment for adults and for people who are acutely ill.
Hypertrophic
Pyloric
Stenosis
 Hypertrophic Pyloric Stenosis
Hypertrophic pyloric stenosis (HPS) is a medical condition that affects
infants and causes blockage or narrowing of the opening between the
stomach and the small intestine. The pylorus is a muscular ring that controls
the flow of food from the stomach into the small intestine. In infants with
HPS, the muscle surrounding the pylorus becomes thickened, causing a
blockage that prevents food from passing through.

The pylorus is a muscular sphincter (muscle that opens and closes). It’s
located at the end of the stomach, where the stomach meets the small
intestine.

The pylorus contracts (closes) when food and liquid need to get digested
in the stomach. It then relaxes (opens) to let food and liquid pass into the
small intestine.

When the pyloric muscle is too thick, it narrows the passageway. Liquid
and food can’t move from the stomach to the small intestine. Babies with
pyloric stenosis often forcefully vomit since formula or breast milk can’t
leave the stomach. Many babies have difficulty gaining weight because
they have many episodes of vomiting.
 Risk factor Hypertrophic Pyloric Stenosis
Hypertrophic pyloric stenosis (HPS) is a medical condition that typically
affects infants, with a higher incidence among males than females. Some
risk factors that may increase the likelihood of developing HPS include:

Age HPS is most common in infants between 3 and 6 weeks old.

Males are up to 4 times more likely to develop HPS than

Gender
Gender
females.

Family HPS tends to run in families, with a higher risk if a first-

history degree relative (parent or sibling) had the condition.

Prematurity Premature infants have a higher risk of developing HPS.

Infants who have been treated with erythromycin, a

Certain
medications commonly used antibiotic, may have an increased risk of
developing HPS.

While the exact cause of HPS is not fully understood, it is believed to be

related to a combination of genetic and environmental factors.
Understanding these risk factors can help healthcare providers
identify infants who may be at an increased risk of developing HPS and
monitor them more closely for signs and symptoms. Early diagnosis
and treatment can lead to better outcomes for infants with HPS.
 Symptoms of Hypertrophic Pyloric Stenosis
Hypertrophic pyloric stenosis (HPS) is a condition that affects infants,
typically between 2 and 12 weeks old. It is characterized by an obstruction in
the outlet of the stomach due to thickening of the pylorus muscle.

The most common symptoms of hypertrophic pyloric stenosis include:

Projectile vomiting Poor weight gain

Infants with HPS typically Due to the vomiting and

experience projectile the difficulty in feeding,
vomiting after feedings. The infants with HPS may
vomit is usually forceful and have difficulty gaining
can travel several feet. weight.

Abdominal distension Dehydration

The abdomen may appear Frequent vomiting can

swollen and distended due to lead to dehydration,
the obstruction in the stomach. which can be
dangerous for infants.

Hunger Visible peristalsis

Infants with HPS may In some cases, the

appear hungry even after infant's stomach muscles
feeding, as the obstruction may be visible
in the stomach prevents contracting in an attempt
adequate absorption of to move food through the
nutrients. obstructed pylorus.
 Infrequent bowel movements

HPS can lead to

infrequent or even
absent bowel
movements, as the
obstructed stomach
cannot push food into
the small intestine.

Electrolyte imbalances

Frequent vomiting
can lead to
imbalances in the
body's electrolytes,
which can be
dangerous if left
untreated.

Jaundice

In rare cases, infants with

HPS may develop
jaundice, which is a
yellowing of the skin and
eyes due to an excess of
bilirubin in the blood.

If you suspect that your child may have HPS, it is important to seek
medical attention right away. HPS is treatable with surgery, but early
intervention is critical to prevent complications such as dehydration and
malnutrition.
 Diagnosed of Hypertrophic Pyloric Stenosis
As an AI language model, I cannot diagnose medical conditions. Hypertrophic
pyloric stenosis (HPS) is a medical condition that occurs in infants, usually
within the first few weeks of life. HPS is characterized by a thickening of the
muscle in the pylorus, which is the opening between the stomach and the
small intestine.

Symptoms of HPS include projectile vomiting, which may occur after

feeding, weight loss, dehydration, and a decrease in the frequency of bowel
movements. If you suspect that your infant may have HPS, it is important to
seek medical attention immediately. A doctor can perform a physical exam,
review your infant's medical history, and order diagnostic tests, such as an
ultrasound, to confirm the diagnosis and develop an appropriate treatment
plan.
In addition to a complete medical history and physical examination,
diagnostic procedures for pyloric stenosis may include:

Blood tests. These tests evaluate dehydration and mineral imbalances.

Abdominal X-rays. A diagnostic test that uses invisible electromagnetic

energy beams to produce images of internal tissues, bones, and organs
onto film.

Abdominal ultrasound. A diagnostic imaging technique that uses high-

frequency sound waves and a computer to create images of blood
vessels, tissues, and organs. Ultrasounds are used to view internal
organs as they function, and to assess blood flow through various
vessels.

Barium swallow/upper GI series. A diagnostic test that examines the organs

of the upper part of the digestive system: the esophagus, stomach, and
duodenum (the first section of the small intestine). A fluid called barium (a
metallic, chemical, chalky, liquid used to coat the inside of organs so that
they will show up on an X-ray) is swallowed. X-rays are then taken to
evaluate the digestive organs.
 Causes of hypertrophic Pyloric Stenosis
Pyloric stenosis is considered a multifactorial trait. Multifactorial
inheritance means that many factors are involved in causing a birth defect.
The factors are usually both genetic and environmental. Often one gender
(either males or females) is affected more frequently than the other in
multifactorial traits. There appears to be a different threshold of expression,
which means that one gender is more likely to show the problem, over the
other gender. For example, pyloric stenosis is four times more common in
males than females. Once a child has been born with pyloric stenosis, the
chance for it to happen again depends on the gender of the child already
born with the condition, as well as the gender of the next child.

There is evidence that HPS may be an inherited

Genetics condition. Studies have found that infants with a family
history of the condition are at a higher risk of developing
it themselves.

The thickening of the muscle in the pylorus is the

Abnormal hallmark feature of HPS. It is thought that this abnormal
muscle growth growth may be due to an overstimulation of the muscle
by certain hormones, such as gastrin.

HPS is more common in males than females, with boys

being affected approximately 4 times more often than
Gender
girls.

HPS typically occurs in infants within the first few

weeks of life, with the majority of cases diagnosed by 6
Age
weeks of age.

The exact cause of hypertrophic pyloric stenosis (HPS) is not fully

understood, but it is believed to be a combination of genetic and
environmental factors. Here are some potential causes:
 Treatment of Hypertrophic Pyloric Stenosis
The most common and effective treatment for hypertrophic pyloric stenosis
(HPS) is surgery, specifically a procedure called pyloromyotomy.
Pyloromyotomy is a surgical procedure that involves making a small incision
in the thickened muscle in the pylorus to relieve the obstruction. This allows
food to pass from the stomach into the small intestine.

Pyloromyotomy is usually performed under general anesthesia, and in most

cases, it is done using minimally invasive techniques such as laparoscopy. In
a laparoscopic procedure, the surgeon makes a few small incisions in the
abdomen and inserts a laparoscope, which is a small tube with a camera
attached that allows the surgeon to see inside the abdomen. Specialized
surgical instruments are then used to make a small incision in the muscle of
the pylorus.

Specific treatment for pyloric stenosis will be determined by your baby's

doctor based on:

Your baby's gestational age, overall health, and medical history

The extent of the problem

Your baby's tolerance for specific medications, procedures, or therapies

Expectation for the course of the problem

Your opinion and preference

Pyloric stenosis must be repaired with an operation. However, doctors may
need to treat your baby's dehydration and mineral imbalances first. Water
and minerals can be replaced through intravenous (IV) fluid.

Once your baby is no longer dehydrated, surgery can be performed. Under

anesthesia, a small incision is made above the navel and the tight pyloric
muscle is repaired.

Recovery Time for Pyloric Stenosis Surgery

Babies can often begin drinking small amounts of clear liquids in the first
24 hours. Generally, clear liquids, such as an electrolyte drink, will be
given to your baby first. However, babies may still vomit for several days
after surgery due to swelling of the surgical site of the pyloric muscle. The
swelling goes away within a few days.

Most babies will be taking their normal feedings by the time they go
home. Babies are usually able to go home within two to three days after
the operation.

Following the surgery, the infant is usually monitored in the hospital for
a short period to ensure that they are able to tolerate feedings and are
recovering well. The infant may also receive pain medication and fluids to
prevent dehydration.

Most infants recover quickly from pyloromyotomy, and there are few
long-term complications associated with the surgery. In some cases,
there may be minor complications, such as infection or bleeding, but
these are rare. In general, infants who have undergone pyloromyotomy
can resume normal feeding within a few days of the surgery.

Long-Term Prognosis for Pyloric Stenosis

This problem is unlikely to reoccur. Babies who have undergone the
surgery should have no long-term effects from it.
Epiglottitis
 Epiglottitis
Epiglottitis is a serious condition where the epiglottis, which is a flap of
cartilage located at the base of the tongue, becomes inflamed and swollen,
often leading to breathing difficulties. This condition is most commonly
caused by an infection with the bacteria Haemophilus influenzae type B (Hib),
but it can also be caused by other bacteria, viruses, or fungi.

Epiglottitis is inflammation and swelling of the epiglottis. It's often

caused by an infection, but can also sometimes happen as a result of a
throat injury.

The epiglottis is a flap of tissue that sits beneath the tongue at the back
of the throat.

Its main function is to close over the windpipe (trachea) while you're
eating to prevent food entering your airway.
 Symptoms of Epiglottitis
The symptoms of epiglottitis usually develop quickly and get rapidly worse,
although they can develop over a few days in older children and adults.

Symptoms include:

a severe sore throat

difficulty and pain when swallowing
difficulty breathing, which may improve when leaning forwards
breathing that sounds abnormal and high-pitched (stridor)
a high temperature
irritability and restlessness
muffled or hoarse voice
drooling
The main symptoms of epiglottitis in young children are breathing
difficulties, stridor and a hoarse voice.

In adults and older children, swallowing difficulties and drooling are the
main symptoms.

Causes of epiglottitis
In most cases, Haemophilus influenza type b (Hib) bacteria cause epiglottitis.
This is sometimes called acute bacterial epiglottitis. Hib bacteria can also
cause pneumonia and meningitis.

Other possible epiglottitis causes include:

Bacterial infections from non-Hib sources, such as those from

streptococcus pneumonia.
Fungal infections, particularly in people with a weak immune system.
Viral infections from varicella zoster virus (which causes chickenpox) or
herpes simplex virus (which causes cold sores).
Injury to your throat, either through a physical blow or by drinking a very
hot liquid.
 Epiglottitis of treatment
Epiglottitis is a medical emergency. If you or someone you know exhibits
epiglottitis symptoms — such as difficulty breathing, difficulty swallowing,
hoarseness or drooling — call 911 or head to your nearest emergency room.

At the hospital, healthcare providers will begin epiglottitis treatment:

The first step is to restore your airways to full capacity. Your healthcare
provider will place an oxygen mask over your mouth and nose so your
lungs can start getting air. If your air passages are already blocked,
they’ll place a tube down your throat to deliver oxygen into your lungs.
In severe cases, a person may need a tracheostomy (where your
healthcare provider makes a small incision in your windpipe).
Once your lungs are getting oxygen, your provider may insert a
breathing tube through your nose and into your windpipe to make
breathing more natural.
Your medical team will give you plenty of fluids through an intravenous
(IV) drip (a needle inserted into a vein).
If you have a bacterial infection, they’ll give you antibiotics to help fight
off infection.

Is epiglottitis contagious
It can be. If epiglottitis is the result of a bacterial, fungal or viral infection,
then it can spread from person to person through droplets of saliva or
mucus. When an infected person coughs or sneezes, droplets move through
the air. If another person breathes in those droplets, or comes into contact
with a surface where the germs have landed, they can also develop an
infection.

People who develop epiglottitis from injury or from smoking can’t pass the
condition to others.
 Epiglottitis of diagnosed
Your healthcare provider will perform a physical examination and ask about your
symptoms. They may also request certain tests that can help diagnose
epiglottitis.

These tests may include:

Laryngoscopy:
During this test, your healthcare provider uses a small camera at the end of
a flexible tube to examine your throat.

Culture tests
Your provider takes a swab of your throat to test for bacteria or viruses.

Blood tests

Your provider may perform a variety of blood tests to count your white
blood cells or see if there are any bacteria or viruses in your blood.

Imaging tests
An X-ray or CT (computed tomography) scan can help determine the level of
swelling and to see if there’s an unwanted object in your airway.

Epiglottitis often shares a number of common symptoms with other

conditions, such as croup. As a result, proper diagnosis and treatment are
key.
Laryngotrach
eobronchitis
“Croup”
 Laryngotracheobronchitis “Croup”
Croup, or acute laryngotracheobronchitis, is an acute infectious respiratory
disease of infants and children caused by infection of the larynx or the
trachea - alone or together. It can cause partial or severe obstruction of the
airway, which results in breathing difficulties and coughing. In some
children it can be life-threatening.

Croup is a common childhood illness, and most children recover fully

within a few days to a week. However, in rare cases, complications can
occur. These may include pneumonia, dehydration, and respiratory
failure.

Children who are at higher risk of developing severe croup include those
with underlying respiratory conditions, such as asthma or
bronchopulmonary dysplasia, as well as those with weakened immune
systems.

Laryngotracheobronchitis, commonly known as croup, is a viral infection

that affects the upper respiratory system, primarily the larynx, trachea, and
bronchi. It is most commonly seen in children between the ages of 6 months
and 3 years, but can also occur in older children and adults.
 Cases of Laryngotracheobronchitis “Croup”
Croup is most often caused by the parainfluenza virus, but may also be the
result of infection with respiratory syncytial virus (RSV), adenoviruses, or
the measles virus. Bacterial croup is also known to occur, as is croup due to
allergic reactions, acid reflux or irritation of the airway by a foreign body.
Croup usually affects children simply because their airways are narrower
than in adults, making any swelling more dangerous and likely to block the
air flow.

Croup is a common respiratory illness in young children and usually

occurs in the fall and winter months. It is estimated that approximately
5-6% of children will experience at least one episode of croup during their
childhood.

Factors that may increase the risk of developing croup include:

Age: Croup is most common in children between the ages of 6 months

and 3 years.
Season: Croup is more common in the fall and winter months when
respiratory viruses are more prevalent.
Exposure to other children: Croup is a viral illness and can be spread
through contact with respiratory secretions of infected individuals.
Children who attend daycare or have older siblings are at a higher risk of
exposure.
History of croup: Children who have had croup before are more likely to
develop it again.
Most children with croup will experience mild to moderate symptoms and
recover fully within a few days to a week. However, in rare cases, severe
croup can be life-threatening and requires urgent medical attention.

If you suspect your child has croup or if you have concerns about their
breathing, it is important to contact your healthcare provider for guidance
on how to manage their symptoms and when to seek further medical
attention.
 symptoms of Laryngotracheobronchitis “Croup”

The affected child is most often between 3 months and 5 years of age, with
the incidence peaking at around 24 months. Croup starts usually as an
ordinary cold, but worsens after a few days. It is characterized by noisy
breathing and a hoarse voice, although the most impressive feature is the
barking cough, often likened to a seal barking. In addition, there may be
difficulty with breathing, especially at night. The symptoms start mildly in
most cases. They may last for up to a week, and are especially severe on the
first and second nights.

A harsh, barking cough that sounds like a seal or a dog.

Difficulty breathing or noisy breathing, especially when inhaling.

A hoarse voice or a change in the sound of the voice.

A fever, usually mild.

Stridor, a high-pitched sound that can be heard when the child breathes in.

Retractions, or pulling in of the muscles between the ribs or under the

breastbone when breathing.

Nasal flaring, or the widening of the nostrils when breathing.

 Diagnosis of Laryngotracheobronchitis “Croup”
Croup is diagnosed on the basis of the symptoms and the cough. Physical
examination will show various signs related to laryngeal inflammation and
respiratory difficulty.

Croup in most cases responds to home care, under the advice of a medical
professional. The child should be comforted because anxiety and fear
exaggerate the obstruction and increase the breathing rate.

In many cases, moist air in the form of steam is used to relieve the
obstruction. Cool air vaporizers may be helpful. This time-hallowed form of
treatment has, however, no scientific backing.
Fever is treated with acetaminophen titrated according to the child’s body
weight and age. In certain instances, antibiotics or steroid inhalers may be
required, on the prescription of a doctor. Steroids help to relieve the airway
obstruction, but require some time to act when taken systemically. Inhaled
steroids act much faster.

Medical treatment is essential when the child is seriously distressed, tired

out from the effort of breathing, or cyanosed because adequate oxygen is not
reaching the body. Admission is required for approximately 5% of croupy
children.

Hospital treatment may include nebulization with epinephrine to urgently

bring down the inflammation in severe cases. Other measures include:

The use of an oxygen tent to improve the oxygenation and thus reduce
the work of breathing, consequently relieving the child
Glucocorticoids to further reduce and keep down inflammatory swelling
have been found to be highly effective in decreasing the need for hospital
admission of such children; they may be given by inhalation, orally or
intravenously
Fluids for dehydration, either orally or more often intravenously
Antibiotic therapy if there is actual or likely secondary infection
 Fever
Management
 Fever Management
Fevers are usually treated when a child is in discomfort.

This applies to both children and adults. It’s also important to remember
that fever is a sign that something is happening within the body, and
treating it does not treat the underlying cause of the fever.1,2

However, children less than 3 months old, with a body temperature of

≥ 38.0°C, presenting with other “red flag” symptoms should be seen by a
doctor.

Assessment of fever in adults

To determine if a patient has a fever, the most common and accurate route
of taking a temperature in adults is a thermometer placed under the tongue
(oral route).

For practical clinical purposes, a patient is considered febrile or pyrexial if

the oral temperature exceeds 37.5°C (99.5°F) or the rectal temperature
exceeds 38°C (100.5°F).

If the temperature is >39.4°C, the patient should seek medical attention.2

Do not forget to ask the patient for other symptoms they are experiencing
to help determine the cause of the fever (such as “red flag” symptoms), and
if they require any other treatment recommendations, other than
medications to treat fever.
 symptoms of Fever Management
There are no specific symptoms of fever management since fever
management is a treatment method rather than a symptom of an illness.
However, when managing a fever, it is important to monitor the symptoms
that are associated with the underlying illness causing the fever. Some
common symptoms that may indicate the presence of a fever include:

High body temperature Chills and shivering

A temperature The body may

reading of shiver and
100.4°F (38°C) or experience cold
higher is chills, as the body
considered a tries to raise its
fever. temperature.

Sweating Headache

The body may Headaches are

common with fever
sweat as it
and can be caused by
tries to cool dehydration or
itself down. increased blood flow
to the brain.
 Muscle aches Weakness and fatigue
Muscle aches can be Feeling tired and weak
caused by the release of is common with fever
chemicals called and can be caused by
cytokines in response to dehydration and other
infection. metabolic changes in
the body.

If you are managing a fever, it is important to monitor these symptoms and

seek medical attention if they become severe or if the fever persists for an
extended period of time.

Stay hydrated: Drink plenty of fluids, such as water, tea, and clear
broths, to help replace fluids lost through sweating and to prevent
dehydration.

Rest: Get plenty of rest and avoid overexertion, as this can make the
fever worse.

Medications: Over-the-counter fever-reducing medications, such as

acetaminophen (Tylenol) or ibuprofen (Advil, Motrin), can help reduce
fever and alleviate discomfort. Always follow the dosing instructions
carefully and talk to your doctor before giving any medications to
children.

Cool compresses: Apply cool compresses to the forehead, neck, and

armpits to help bring down the fever.

Dress appropriately: Wear lightweight clothing and use lightweight

blankets to avoid overheating.
 Treatment of Fever Management

Fever is a natural response of the body to fight off infections and other
illnesses. However, in certain cases, a fever can become dangerous and
requires treatment. The treatment of fever management involves both
medication and non-medication interventions. Here are some approaches:

Medication
Over-the-counter medications such as acetaminophen (Tylenol) or ibuprofen
(Advil, Motrin) can help to reduce fever and relieve associated symptoms
such as headache, body aches, and chills. Follow the recommended dosage on
the label or as directed by a healthcare provider.

Cool compresses
Applying cool compresses or taking a cool bath can help to bring
down a fever. Be sure to avoid very cold temperatures, which can
cause shivering and increase body temperature.

Tepid sponging
A tepid sponge bath with lukewarm water can also help to reduce fever,
especially in children.

Rest
Rest is important when experiencing a fever. It can help to conserve energy
and promote healing.

It is important to seek medical attention if a fever persists for more than a

few days, is accompanied by other symptoms such as severe headache, rash,
or difficulty breathing, or is very high (over 103°F/39.4°C).
Pediatric
Vaccine
Schedule
Hacks
 Pediatric Vaccine Schedule Hacks
Vaccination is an important part of preventive healthcare for children.
Following the recommended pediatric vaccine schedule can help protect
children from serious diseases. Here are some hacks to help you stay on track
with your child's vaccine schedule:

Use a reminder app Group vaccines

There are many free Ask your healthcare provider if
smartphone apps that it's possible to administer
can help you track your multiple vaccines at the same
child's vaccine schedule visit. This can help minimize the
and send you number of appointments you
reminders when a need to schedule and ensure your
vaccine is due. child is fully vaccinated.

Make it fun Talk to other parents

Let your child pick out a Connect with other parents
special toy or treat to in your community to share
reward them after their information and support
vaccine appointment. This each other in staying on
can help make the track with the vaccine
experience less stressful and schedule.
more positive.

Schedule well-child visits in advance

Make well-child appointments in advance, and ask the healthcare provider
which vaccines are due at each visit. This will help you plan ahead and ensure
your child stays up-to-date on their vaccines

Remember, vaccines are a safe and effective way to protect children from
serious diseases. Talk to your healthcare provider if you have any concerns
or questions about your child's vaccine schedule.
 Childhood Vaccination Schedule
Routine Vaccinations for Infants, Children, and Adolescents
The childhood vaccination schedule varies depending on the country and
region, but the following is a general guideline for the recommended
childhood vaccines in the United States:
Birth: Hepatitis B
2 months: Rotavirus, Diphtheria, Tetanus, and Pertussis (DTaP),
Haemophilus influenzae type b (Hib), Pneumococcal conjugate vaccine
(PCV), Inactivated poliovirus vaccine (IPV)
4 months: Rotavirus, DTaP, Hib, PCV, IPV
6 months: Rotavirus, DTaP, Hib, PCV, IPV, Influenza (annual)
12-15 months: Hib, PCV, Measles, Mumps, and Rubella (MMR), Varicella,
Hepatitis A
18 months: DTaP, Influenza (annual)
4-6 years: DTaP, IPV, MMR, Varicella

It's important to note that some children may need additional vaccines based on their
individual circumstances, such as travel or certain medical conditions. Also, the schedule
may be adjusted during a disease outbreak or for other public health reasons.

Parents should consult with their healthcare provider to ensure that their child receives
all of the recommended vaccines on schedule. Vaccines are safe and effective, and can
protect children from serious and potentially life-threatening diseases.

Hepatitis B: A viral infection that can cause liver damage and liver cancer.
Rotavirus: A viral infection that causes severe diarrhea and vomiting,
especially in infants and young children.
DTaP: A combination vaccine that protects against diphtheria, tetanus, and
pertussis (also known as whooping cough).
Hib: A bacterial infection that can cause serious illnesses, such as meningitis
and pneumonia.
 PCV: A vaccine that protects against pneumococcal disease, which can
cause pneumonia, meningitis, and other serious infections.
IPV: A vaccine that protects against polio, a viral infection that can cause
paralysis.
Influenza: An annual vaccine that protects against the seasonal flu.
MMR: A combination vaccine that protects against measles, mumps, and
rubella.
Varicella: A vaccine that protects against chickenpox, a viral infection
that causes itchy blisters and can lead to serious complications.
Hepatitis A: A viral infection that can cause liver damage and is spread
through contaminated food and water.
The recommended childhood vaccine schedule is designed to protect
children from serious and potentially life-threatening diseases. Vaccines are
thoroughly tested and proven to be safe and effective. It's important for
parents to keep their children up-to-date on their vaccines to ensure they are
protected from these illnesses.

Minimum valid dose schedules

ATAGI advises that the absolute minimum interval between the first and
second dose of any COVID-19 vaccine is 14 days. Dose intervals of at least 14
days are considered acceptable and valid, and the person will be considered
fully vaccinated in the Australian Immunisation Register (AIR).
Use of an additional COVID-19 vaccine dose as a replacement dose if
the second dose was given less than 14 days after the first dose
A second dose of a COVID-19 vaccine administered <14 days after the first
dose is considered an invalid dose. An additional COVID-19 vaccine dose
should be administered as a replacement dose.

The aim of this replacement dose is to attain a level of immune response that
is comparable to that expected after completing a 2-dose primary course of a
COVID-19 vaccine according to the recommended dosage and schedule.
The same COVID-19 vaccine brand should be used for the replacement dose
to complete the primary vaccination course, unless there are special
circumstances indicating the use of an alternative vaccine. See Mixed
(heterologous) schedules

The interval between the invalid second dose and the replacement dose is
flexible but is recommended at 4 to 12 weeks after the invalid second dose.
Timing of the replacement dose should be informed by an individual risk-
benefit assessment that considers:

risk of exposure to SARS-CoV-2

local disease epidemiology
mandatory vaccination requirements for work (such as aged care or
healthcare workers)
individual medical conditions associated with increased risk of severe
COVID-19 (such as immunocompromise).

There are no direct clinical trial data on vaccines used in Australia regarding
a second dose being administered at <14 days after the first dose. The
recommendation for a replacement dose is based on first principles. It takes
into consideration the small amount of preliminary data in trials where
participants received a third dose of the vaccine (at various intervals), and
the potential incremental benefits outweighing the potential adverse effects.

These recommendations do not apply to booster doses.

 Safety
Promotion
 Safety Promotion
Safety promotion for pediatrics is crucial for ensuring the well-being and
protection of children. Here are some key areas and tips to consider when
promoting safety for pediatric populations:

Home Safety

Install safety gates: Place safety gates at the top and bottom of
staircases to prevent falls and keep young children from accessing
areas that may pose a danger.
Hazardous substances: Store cleaning products, medications, and other
potentially harmful substances in locked cabinets or high shelves out of
children's reach. Use childproof caps on medications.
Electrical outlets: Cover electrical outlets with safety plugs or outlet
covers to prevent children from inserting objects into them.
Window safety: Use window guards or safety netting on windows to
prevent falls. Keep furniture away from windows to discourage
children from climbing.
Furniture stability: Anchor heavy furniture, such as bookshelves and
dressers, to the wall to prevent tipping if a child tries to climb on them.

Car Safety

Car seats: Use the appropriate car seat or booster seat based on the
child's age, weight, and height. Follow the manufacturer's instructions
for installation and ensure it is securely fastened. Rear-facing car seats
are recommended for infants and toddlers.
Rear seat positioning: It is safest for children to ride in the back seat
until they reach the appropriate age and size for using a front seat with
a seat belt.
Never leave a child unattended: Never leave a child alone in a vehicle,
even for a short period. Heatstroke can occur quickly, with potentially
fatal consequences.
 Water Safety

Supervision: Never leave children unattended near water, whether it's a

bathtub, swimming pool, or any other water source. Designate a
responsible adult to actively supervise children while they are in or near
water.

Pool safety: Install a fence around the pool with a self-closing gate and
latching mechanism out of children's reach. Consider using pool alarms
and safety covers when the pool is not in use.

Swimming lessons: Enroll children in age-appropriate swimming lessons

to teach them essential water skills and improve their water safety
awareness.

Flotation devices: Use properly fitting life jackets or personal flotation

devices (PFDs) when participating in boating or water activities.

Playground Safety

Safe equipment and surfacing: Choose playgrounds with equipment

that meets safety standards and has appropriate surfacing, such as
rubber mats or mulch, to cushion falls.
Age appropriateness: Ensure that the playground equipment is
suitable for your child's age and developmental stage. Younger
children should have access to age-appropriate equipment.
Supervision: Always supervise children while they play on the
playground to ensure they use the equipment safely and avoid
potential hazards.
Playground rules: Teach children to follow playground rules, including
sharing, taking turns, and using equipment as intended.
 Bicycle Safety

Helmets: Ensure that children wear properly fitted helmets whenever

they ride bicycles, scooters, or skateboards. The helmet should meet
safety standards and be securely fastened.
Road safety education: Teach children the rules of the road, including
traffic signs, signals, and the importance of staying visible to
motorists.
Supervision and safe routes: Supervise young children while they ride
and choose safe routes away from heavy traffic. Encourage them to
ride in designated bike lanes or on sidewalks where permitted.

Internet and Digital Safety

Online education: Educate children about online safety, including

responsible internet use, avoiding sharing personal information with
strangers, and understanding the potential risks of interacting with
others online.
Parental controls: Set up parental controls on devices and internet
browsers to restrict access to age-inappropriate content. Regularly
review and update these controls as needed.
Communication and trust: Foster open communication with children,
encouraging them to talk about their online experiences and concerns.
Establish trust.

Fire Safety

Smoke detectors: Install smoke detectors on every level of your home,

including inside and outside sleeping areas. Test them regularly to
ensure they are working properly.
Fire escape plan: Create and practice a fire escape plan with your
family. Identify two exits from each room and establish a designated
meeting point outside the home. Teach children how to crawl low
under smoke and feel doors for heat before opening them.
Fire extinguishers: Keep fire extinguishers in key areas of the
home, such as the kitchen, and teach older children how to use
them responsibly in case of a small fire.

Choking and Suffocation Prevention

Safe toys and objects: Choose toys that are age-appropriate and do not
have small parts that could pose a choking hazard. Keep small objects,
such as coins, buttons, and batteries, out of children's reach.
Safe sleep environment: Ensure that infants sleep on their backs in a
crib or bassinet with a firm mattress and fitted sheet. Remove pillows,
blankets, bumper pads, and stuffed animals from the crib to reduce the
risk of suffocation.

Poisoning Prevention

Poison control: Keep the contact information for your local poison
control center readily available. Call them immediately if you suspect a
child has ingested a potentially harmful substance.
Medication storage: Store medications, including vitamins and over-
the-counter drugs, in child-resistant containers and out of children's
reach. Never refer to medication as "candy" to avoid confusion.

Sun and Heat Safety

Sun protection: Apply sunscreen with at least SPF 30 to children's

exposed skin before they go outside. Encourage them to wear wide-
brimmed hats, sunglasses, and lightweight clothing that covers their
skin.
Hydration: Ensure that children drink plenty of water, especially
during hot weather or when participating in physical activities.
 Sports and Recreation Safety

Protective gear: Make sure children wear appropriate protective gear,

such as helmets, knee pads, and elbow pads, when participating in
sports or recreational activities.
Proper training and supervision: Ensure that children receive proper
training and supervision when engaging in sports and recreational
activities to minimize the risk of injuries.

Mental Health and Emotional Safety

Create a supportive environment: Foster open communication,

understanding, and emotional support within the family to promote
positive mental health for children. Encourage them to express their
feelings and seek help when needed.
Monitor screen time: Limit screen time and encourage a healthy
balance between online activities, physical activity, and social
interactions. Monitor content to ensure it is age-appropriate and does
not contribute to emotional distress.

Remember, safety promotion should be tailored to the age, developmental

stage, and individual needs of each child. Regularly evaluate and update
safety measures as children grow and new risks emerge.