Peds exanthems Clinical Guide

U of Chigos Pends Topics Quick Reference / Residency

Childrens Hospital Philadelphia Clinical Pathways - Inpt / Output / ED
http://www.pediatricpartnerskc.com/patient-education

>
Anticipatory Guidance
>
Parenting Tips by Topic
> May TEXT the topic to the family or copy/paste into custom printout.
> Banner Phoenix Poison Control #: 1.800.222.1222

*** WCC Forms (adapt from AZ forms) | Anticipatory Guidance
*** Car Seat
*** Childrens Tylenol / Ibuprofen dosing



Doernbecher Tom Sargent Safety Center
Doernbecher.com/childsafety
M-F 9.30AM-3.30PM; 503.418.5666
Many pets home safety products @ cost? Appears to be cheaper than amazon.

Pediatric Rx dosing --> See Rx section

Well-Child Checks
Screen w/ WCC questionnaire.
Fill out AHCCSS EPSDT form - scan in (box)
WCC anticipatory guidance (print out or texting).

Fluoride use - polyvisol w/ fluoride for Oregon. *** when to start & up to what age
Lead testing - ***

Standard WCC Information:
#. Acute: no acute complaints
#. Medical: no interval hospitalizations, imm UTD
#. Dental:
#. Activity:
#. Growth:
#. Diet:
#. Safety: car, sun, water, home.
#. Social:
#. Learning:
#. Family:

Additional:
Newborn: feeds, #diapers, NBS#1/#2
If <1 yo: all close contacts & caregivers need TDAP vaccines!!
If only breastfeeding, ***
Infants: feeds, #diapers
Toddlers: home safety
Teens: sex/BCM/STI/vehicle/substances/school/friends
HPV 3x series : from 11 - 21 yo F,M.
Flu vaccine starts at 6mo; 1st ever dose followed by 2nd dose 28d later (true from 6mo to 8yo)



AGE
RECOMMENDED VACCINES, TESTS, AND OFFICE VISITS
Birth
Newborn Screen; Need NBS1,2
(Hep B)
3-5 days
Well-child visit
7-14 days
Well-child visit
- No water. No cows milk until 1yo.
2 months
Well-child visit
Hep B, DTAP, HIB, PCV, Rota (PO), IPV
4 months
Well-child visit
DTaP, Hib, PCV, Rotavirus (given by mouth), IPV
6 months
Well-child visit
Hep B, DTAP, HIB, PCV, Rota (PO), IPV
9 months
Well-child visit
12 months
Well-child visit
Lead level
MMR, hep A, Varicella, HIB, PCV
15-18 months
Well-child visit
DTaP
Any 12-month immunizations not already given
2 years
Well-child visit
Hep A
3 years
Well-child visit
4 years
Well-child visit

Vision screen, Hearing screen

DTaP, IPV, Varicella, MMR
5 years
Well-child visit
6, 8, and 10 years
Well-child visit
11 years
Well-child visit
Tdap booster, MCV; HPV x3 doses q6 mo.
12 years
Well-child visit
13 years
Well-child visit
Varicella blood test, if vaccine not given and no history of chickenpox
14 and 15 years
Well-child visit
16 years
Well-child visit
MCV booster
17 years
Well-child visit
Vaccination Schedule @ CDC

#. Circumcisions
HPI:
- Birth hx:
- Last feeding: (2hr prior)
- no acute concerns from mom
- feeding well
- received Vit K at birth
- vaccines UTD
- denies fhx of bleeding

AP:
- reviewed risks/benefits w/ family.
- circ well-tolerated; good cosmetic outcome; hemostatic
- given f/u care package and precautions to RTC/ED; including bleeding, fevers.
> RTC 1wk for circ check

AP: circ check
- good appearance, no complications
- family pleased w/ results
> return to routine WCC


#. Autism
• Autism Screening Tool: at 18-24 mo: M-CHAT-R Online Tool


#. FTT

• defined as <5% wt for age or crossing >2 curves
• etiology - 90% = psych-social-feeding issue; 10% organic (2/3 organic cause is GERD)
• figure out the median weight and current weight; 75-90% is ok for close obs, 60-75% really close obs, <60% admit to inpatient
• infants decrease 8-10% of BW need evaluation for hydration, [Na]
• can increase feeds; ensure ok caloric AND fluid intake
- caloric:
- fluid:
• formula powder can go Sim19 to Sim22 first.
• log feeds

Colic
 
 
Sleep
 
 
PM enuresis

 
Toilet Training
 
 
Car seats
 
 
child-seat-tips

 Lead testing:
> if home built <1978, has increased risk of lead paint; present with HA, anorexia, abdominal pain, palsies, n/v constipation > lead screening recommendations :
All Medicaid enrolled or eligible children (age 1-2 years or catch-up at age 36-72 months).
> High risk defined as houses <1950. <1978 if undergoing renovations in past 6 mo > alternative / homeopathic medicine is a risk as well; may rec screening for them.

Feeding / Stooling
  • Breastfeeding:
  • Latching:
  • Frequency:
  • Benefits:
 
  • Stooling:
  • Breastfed babies can stool 6x/d or 1x/6d; variable. As long as feeding well, no straining, colicky, hard pebble stool, then likely ok.
  • Consistency:
  • Formula fed babies more constipation.
 
  • Iron Supplement
  • At 4 months, if breast feeding or <1L (34oz) of formula per day, start Fe supplement. If partial breast-fed, start Fe.
  • Dose: at 4 months, start at 1mg/kg/d liquid Fe until solid foods, such as Fe-fortified cereals are introduced.
  • Dose: Typically, 6-12 mo olds should receive 11mg  Fe /d.
  • Term babies received enough Fe store from mother in T3 to last first 4 mo. Human milk contains little Fe.
 
  • Vitamin D
  • All breastfed infants, starting within first few days, should get Vit D 400 IU/d.
  • Breastmilk has Vit D <23 IU/L.
 
  • Poly-Vi-Sol
  • Per ml (drop) = 10mg Fe, 400 IU Vit D. Additionally has A/E/C / thiamin / niacin / riboflavin / B6.
  • Fe overdose >40mg/kg (20mg/lb) has toxicity.
 
  • Misc
  • Cow's milk do not start until >12 mo. Nutritionally not enough.
  •  
 
Consider doing a polyvisol course if less than 1L (34 oz) formula /d or breast feeding.

 
Weight Gain:
Normal weight gain goals 1st 12 months: 0-4 mo: 5-7oz / week ---> 4-6mo : 4-5oz / week ---> 6-12 mo : 2-4 oz /week.
*16oz = 1lb


Dietary Habit
  • Picky eater? Parents control what (healthy foods) and when (meal times). Children can control how much. Children will eat if they are hungry, they will not starve (unless something else is wrong).
 
Seatbelt Use
  • Extremely important; 40%  of all childhood deaths are 2/2 unintentional injury and 60% of these deaths are 2/2 MVA!
 
Causes of death in children
  • 40% unintentional injuries; of these --> 60% MVA; 10% drowning; 8% poison; 6% fires.

Umbilical Hernia
- surgical indications : 1. incarceration; 2. >1-1.5cm; 3. ø resolve by 3-5 yo
- typically self-resolve.

Constipation:




developmental milestones




Common Complaint / Dx > Common Related Dx DDx















Cough

pneumonia
croup
bronchiolitis
bronchitis
asthma
sinusitis
cystic fibrosis
pertussis
tuberculosis
foreign body aspiration
GE reflux
Chlamydia pneumonitis
Feveroccult bacteremia
UTI, pyelonephritis
viral exanthems
varicella
measles
fifth disease
roseola
scarlet fever
osteomyelitis
meningitis
febrile convulsions
septic arthritis
Kawasaki's disease
JRA
viral exanthem - rubella
tuberculosis
Sore throatpharyngitis, strep
scarlet fever
pharyngitis, other
mononucleosis
rheumatic fever
cervical adenitis
pharyngeal and retropharyngeal abscesses
recurrent tonsillitis
Otitismiddle ear effusion
recurrent otitis media
otitis media
otitis externa
deafness
speech and language delay
mastoiditis
URIconjunctivitis
allergic rhinitis
sinusitis
periorbital/orbital cellulitis
Abdominal painappendicits
UTI/pyelonephritis
gastroenteritis
constipation
PID
gastritis
colic
intussusception
vasculitis, e.g. HS purpura
pregnancy
encopresis
inflammatory bowel disease
ulcer
hepatitis
ovarian/testicular torsion
psychogenic abdominal pain
abdominal mass/malignancy
Wilm's tumor
neuroblastoma
lymphoma
hydronephrosis
incarcerated hernia
VomitingGE reflux
pyloric stenosis
gastroenteritis
2nd to infections -
strep pharyngitis
otitis
volvulus/bowel obstruction
diabetic ketoacidosis
increase intracranial pressure
hepatitis
pyelonephritis
pregnancy
Diarrhea +/- vomitinggastroenteritis
viral
bacterial
Giardia
failure to thrive
hemolytic uremic syndrome
dehydration
Skin problemsacute urticaria
atopic dermatitis
contact dermatitis
Monilial skin infections
scabies
impetigo/cellilitis
tinea infections
anaphylaxis
drug reaction rash
Stevens Johnson syndrome
seborrheic dermatitis
Skin woundscellulitis
animal wounds
trauma
burns
child abuse
tetanus
rabies
Lower extremity problemsankle injury
knee injury
congenital hip dislocation
non-accidental trauma
Osgood-Schlatter disease
Legg-Calvé-Perthes disease
slipped femoral capital epiphysis
Limp/limb paintendonitis
toxic synovitis
infectious -
septic arthritis
osteomyelitis
cellulitis
Nurse's maid elbow
arthritis (JRA)
sickle cell crisis
rheumatic fever
leukemia/tumors
CNS problemsheadaches
migraine
tension
seizure disorders
febrile convulsions
increased intracranial pressure
 












Common Complaint / Dx

Common Related Diagnoses
Significant Other Dx to Consider

Heart murmur

innocent murmurs
cardia septal defects
acute rheumatic fever
coarctation of the aorta
valvular stenosis
Lymphademopathyinfectious mononeucleosis
bacterial adenitis
viral infections
Kawasaki's disease
lymphoma/leukemia
HIV/AIDS
cat scratch disease
mycobacterial infections
Splenomegalysystemic infectious disease
mononeucleosis
tumors
hemolytic anemias
sickle cell disease
Hepatomegalyhepatitis
congestive heart failure
cirrhosis
Impaired visionstrabismus/amblyopia
myopia/hyperopia
leucocoria
retinoblastoma
cataracts
Pallor/anemiairon deficiency anemia
lead poisoning
hemolytic anemia - hereditary acquired
malignancy
sickle cell disease
occult blood loss
Bruising/petechiaetrauma
vasculitis
hemophilia/Von Willebrand's
HS purpura
leukemia
secondary to infection
Hematuriatrauma
UTI
acute glomerulonephritis
   post streptococcal
hemolytic uremic syndrome
HS purpura
lupus
Proteinuriaorthostatic proteinuria
nephrotic syndrome
glomerulonephritis
lupus