PEDIATRICS
INTRODUCTION
In Birmingham,
pediatrics is split between one month of inpatient (spent at Children’s
Hospital) and one month of outpatient (spent at outside clinics, in the
nursery, and on electives). Students on
the inpatient rotation are divided among three teams: Green, Gold, and
Pulmonary. Call is taken every fourth
night on Green and Gold, and is negotiated on Pulmonary. During the outpatient month, each week is
spent on a different rotation: Ambulatory (outpatient clinics), Adolescent
(clinics and detention facilities), Nursery (UAB), and Elective (you can request
a variety of pediatric subspecialties).
Additionally, students on the outpatient rotations take 2-3 evening ER
“calls” from 5 pm – 11 pm.
1.
Assess
severity – does the patient need a breathing treatment immediately, or can you
obtain the history first?
2.
Is this the
first time the patient has wheezed? Get
a CXR.
3.
Does the
patient have a fever? If not, and they
have chronic reactive airway problems, you can administer steroids sooner.
4.
Have they ever
been admitted to the hospital or the ICU for wheezing/asthma? Ever been intubated?
5.
What is their
home asthma treatment regimen?
6.
Treatment
a.
Short-acting
aerosol (15 minutes) – Albuterol 0.03 cc/kg plus saline to make a total volume
of 3 cc.
b.
Long-acting
aerosol – Albuterol 0.09 cc/kg plus saline to make a total volume of 12
cc. (Minimum albuterol dose is 1 cc;
max is 3 cc).
c.
Steroids –
Start with 2 mg/kg/day initially, divided BID.
Use Solumedrol IV/IM or Prelone syrup (15mg/5cc, max dose is 80mg/dose).
Sepsis Workup (SWU)
1.
CXR, CBC with
differential, blood cultures, lumbar puncture
2.
Treatment
a.
Ampicillin 50
mg/kg q6h
b.
Cefotaxime 50
mg/kg q8h
3.
Treat for 48
hours or until cultures are negative.
If patient looks good clinically, sometimes they can be managed at home
on Rocephin after 24 hours on IV antibiotics and if cultures are negative.
Apparent Life Threatening Event (ALTE)
² Check for sepsis (SWU).
² Check for reflux (Upper GI).
² Check for seizure (EEG).
² Check for cardiac disease (EKG).
Viral Respiratory Panel (VRP)
P = Parainfluenza
A = Adenovirus
I = Influenza
Birth HepB
2 months DtaP, Hib, IPV, Prevnar, HepB
4 months DtaP, Hib, IPV, Prevnar
6 months DtaP, IPV, Prevnar, HepB
12 months Hib, Prevnar, MMR, Varicella
15 months DtaP
4–6 years DtaP, IPV, MMR
11-16 years Tetanus/diphtheria
Body Surface Area
(m2): [(4 * weight in kg) + 7] / [wt. in kg + 90]
Intake:
neonates (1-28 days old) in cc/kg/day
(note: 1 oz = 30 cc)
All other children in cc/ m2
/day
Output: cc/kg/hr (note: anything <1 cc/kg/hr is too
little, report it to a resident)
Maintenance IVF
> 1500 cc/ m2 /d to prevent dehydration
àuse ¼ NS for pt. £ 6 mo
àuse ½ NS for 6 mo – 2 yrs
Developmental Milestones
One month old
|
Gross motor: |
Raises head
slightly |
|
Language: |
Alerts to sound
(blinks, startles) |
|
Fine motor: |
Tight grasp,
follows to midline |
|
Personal/social: |
Regards face |
Two months
old
|
Gross motor: |
Holds head
midline, lifts chest off table |
|
Language: |
Smiles after
being stroked or talked to |
|
Fine motor: |
Follows objects
past midline |
|
Personal/social: |
Recognizes parent |
Three months
old
|
Gross motor: |
Supports on
forearms in prone, holds head up steadily |
|
Language: |
Coos |
|
Fine motor: |
Holds hands open
at rest, follows in circular fashion |
|
Personal/social: |
Reaches for
familiar people or objects |
Four to five
months old
|
Gross motor: |
Rolls front to
back, back to front, sits well when propped, shifts weight |
|
Language: |
Orients to voice |
|
Fine motor: |
Moves arms in
unison to grasp, touches cube |
|
Personal/social: |
Enjoys looking
around |
Six to eight
months old
|
Gross motor: |
Sits well
unsupported, puts feet in mouth |
|
Language: |
Babbles |
|
Fine motor: |
Reaches with
either hand, transfers, uses raking grasp |
|
Personal/social: |
Recognizes
strangers |
Nine months
old
|
Gross motor: |
Creeps, crawls,
cruises, pulls to stand |
|
Language: |
Understands no,
waves bye-bye, dada, mama |
|
Fine motor: |
Pincer grasp,
holds bottle, finger feeds |
|
Personal/social: |
Explores
environment, plays patty-cake |
Twelve months
old
|
Gross motor: |
Walks alone |
|
Language: |
Two words other
than dada and mama 13 months = 3
words 14 months =
follows one step commands |
|
Fine motor: |
Throws objects,
lets go of toys, mature pincer grasp |
|
Personal/social: |
Imitates actions,
comes when called |
Fifteen
months old
|
Gross motor: |
Creeps up stairs,
walks backwards |
|
Language: |
Uses 4 to 6 words |
|
Fine motor: |
Builds tower of
two blocks |
|
Personal/social: |
Cooperates with
dressing |
Eighteen
months old
|
Gross motor: |
Runs, throws toys
from standing |
|
Language: |
Knows eight body
parts |
|
Fine motor: |
Fills spoon and
feeds self |
|
Personal/social: |
Copies parents in
tasks (sweeping, dusting) |
Twenty-one
months old
|
Gross motor: |
Squats in play,
goes up steps |
|
Language: |
Two word
combinations, 50 word vocabulary |
|
Fine motor: |
Builds tower of
five blocks, drinks well from cup |
|
Personal/social: |
Asks for food and
to go to the toilet |
Two years old
|
Gross motor: |
Walks up and down
steps without help |
|
Language: |
Uses pronouns
inappropriately, understands two step commands; one-half of speech can be
understood |
|
Fine motor: |
Removes shoes and
pants |
|
Personal/social: |
Parallel play |
Three years
old
|
Gross motor: |
Pedals tricycle,
can alternate feet when going up steps |
|
Language: |
Three word
sentences, uses plurals, past tense, 250 words, ¾th of speech can
be understood |
|
Fine motor: |
Dresses and
undresses partially, dries hands, draws a circle |
|
Personal/social: |
Group play,
shares toys, plays well with others, knows name, age, and sex |
Four years
old
|
Gross motor: |
Hops, skips,
alternates feet going down stairs |
|
Language: |
Knows colors,
says song or poem from memory, asks questions |
|
Fine motor: |
Buttons clothing
fully, catches ball |
|
Personal/social: |
Tells tales,
plays cooperatively with a group |
Five years
old
|
Gross motor: |
Skips alternating
feet, jumps over low obstacles |
|
Language: |
Prints first name |
|
Fine motor: |
Ties shoes,
spreads with knive |
|
Personal/social: |
Plays competitive
games, abides by rules, likes to help in household tasks |