Peds

Peds #

Newborn #

GBS #

  • If positive, adequate tx = 4hrs prior to delivery (minimum), ideally since ROM
    • Ampicillin 2g, then 1g q4h

Jaundice #

Risk Factors:

  • Blood group incompatability with mom
  • Cephalohematoma
  • <36 weeks gestational age
  • Hx of sibling with jaundice

If the TSB does not fall or continues to rise despite intensive phototherapy, very likely hemolysis is occurring.

BiliTool

Feeding/Weight Loss #

  • Can track/plot using NEWT
  • Max weight loss usually day 3
  • Normal breastfed infants loose 6.1% ± 2.5% @ day 3
  • Evidence of adequate intake
    • 4-6 wet diapers per 24 hrs
    • 3-4 stools per day by day 4
    • Stools changing to “mustardy” on day 3-4

SGA #

Causes:

  • placental insufficiency
  • CMV

LGA #

  • Maternal diabtes

Discharge Criteria #

  • Normal and stable vital signs for at least 12 hours before discharge
    • peeing, + pooping
  • Two or more successful feedings
  • No physical abnormalities requiring continued care
  • No evidence of excessive bleeding (i.e. circumcision)
  • Family confident and trained to care for baby

Misc. #

  • Cord falls off in between 3 days and 3 weeks.

NSAID Dosing #

  • Tylenol => 15mg/kg
    • Children’s/Infant’s => 160mg/5mL (32mg/mL) Q4-6h
    • Max: 75 mg/kg/day, not to exceed 4,000 mg/day
  • Ibuprofen => 10mg/kg
    • Children’s => 100mg/5mL (20mg/mL)
    • Infant’s => 50mg/1.25mL (40mg/mL)
    • Max: 40 mg/kg/day

Allergies #

  • Cobblestoning in posterior oropharnyx
  • Purple-ish hue to nasal mucosa with erythema

Schedule for Well Child Visits #

  • First week (3 to 5 days old)
  • 1-2 week (if concern for weight gain or first time parents)
  • 1 month old
  • 2 months old
  • 4 months old
  • 6 months old
  • 9 months old
  • 12 months old
  • 15 months old
  • 18 months old
  • 2 years old (24 months)
  • 2 1/2 years old (30 months)
  • 3 years old
  • Yearly thereafter

Constipation #

  • Clean out:
    • 1 cap Miralax q2h until watery (usually 1-3 days)
    • Senna BID (AM and PM)
  • Video to help explain things

UTI #

UTICalc

Cardiac #

Chest Pain #

Vast majority benign.

Red flags:

  • only occurs with exertion
  • abnormal EKG
  • abnormal phsyical exam
  • FHx cardiac issues
  • Personal history of cardiac issues if 0-1 of these => ok

Pediatric Obesity/Weight Loss #

  • Workup/Labs
    • blood pressure
    • fasting lipids
    • hemoglobin A1c or fasting plasma glucose
    • alanine aminotransferase (ALT)
      • for nonalcoholic fatty liver disease (NAFLD)
  • The Children’s Hospital Lifestyle Medicine Program
    • Any age
    • Get medical provider, dietician, activity specialist, RN, psychologist, social worker and group exercise
    • Billable to insurance
    • Order “Amb ref Pediatrics”
      • Comments: “Lifestyle Medicine Program”
  • YMCA’s Healthy Weight & Your Child Program (Now cancelled…)
    • 7yo and up
    • x15 week evidenced-based program (25 sessions), led by a content leader, with family physical activity led by an activity leader
    • $40 per month, scholarships also available (not billable to insurance)
    • Order “Amb ref Care Management”
      • Comments: “YMCA Healthy Weight Program”

Peds Supplimentation #

  • GI likes Kate Farms over Pedalyte (better and better tasting)

Pearls #

  • Tachypnea w/o fever in peds concerning for PNA
  • Tachypnea w/ fever can be normal (due to fever)
  • Pen K tastes like crap