PHAR 840 Pediatrics Tabar

Tabar – Pediatrics Thursday, February 13, 2025 12:40 PM • Age Classification • Premature Neonate: Born < 37 weeks • Neonate: First 28 days of life • Infant: 1–12 months old • Toddler: 1–2 years old • Preschooler: 3–4 years old • School-age: 5–12 years old • Adolescent: 13–18 years old • Growth & Development • Growth velocity: change in weight or height over time • Weight ○ Neonates commonly lose up to 10% of body weight during first few days of life ○ Should regain by 10-14 days of age • Nutrition • First 6 months → exclusive breastfeeding ○ Provides antibody = less risk of getting infection • 6 – 23 months → introduction of complementary foods (solid food) ○ Initiate at 6 months • Vitamin Supplementation • Vitamin D: 400 IU (10 mcg) daily ○ All infants ○ Duration: until infant consumes at least 1 liter (~34 oz.) of vitamin D fortified formula or milk daily • Iron: 1 mg/kg daily ○ Breastfed infants, starting 4 months of age ○ Formula-fed infants → do not require additional iron supplementation • Vitamin B12 ○ At-risk populations ▪ Infants + children on strict vegan diets • Dosing Considerations • Hydrophilic drugs = IBW ○ Aminoglycosides ○ Vancomycin • Lipophilic drugs = TBW ○ Anesthetics • BSA = more accurate due to inclusion of height and weight in equation Pediatric Conditions: Diagnosis & Treatment Condition Non-Pharmacological Pharmacological (ALWAYS 1st-line) Acute Constipation • Prevention Strategies • Toilet Habits • Fiber Supplements • Helps absorb water in stool → increasing bulk and movement • Ensure proper hydration for effectiveness • Risk of overuse (looks like candy) • Docusate (Colace) - stool softener • Best for: hard, dry stools • Common SE: throat irritation (take w/ water) • Osmotic Laxatives • Both acute and chronic constipation • Pediatric 1st-line/Gold Standard: ○ Polyethylene Glycol 3350 (Miralax) ▪ Best for chronic constipation (> 3 months) ▪ Note: • Acute: < 1 month • Subacute: 1-3 months • Magnesium Hydroxide (Milk of Magnesia) ○ Avoid in kidney disease • Alternative: Lactulose & Sorbitol ○ May cause bloating • Monitor electrolytes, especially w/ prolonged use • Lubricant Laxatives (Mineral Oil) • AVOID in young children (aspiration risk) • Rectal onset: 2-15 minutes ○ Enema = fastest onset • Stimulant Laxatives • Bisacodyl & Senna ○ Occasional constipation ○ Use sparingly (prevent dependency) ○ DO NOT crush/chew tablets ○ AVOID w/ antacids/dairy ○ Bisacodyl faster onset than Senna (natural plant derivation) Acute Gastroenteritis (AGE) • Major causes: Viruses ○ Noroviruses ○ Rotaviruses ○ Enteroviruses • Major concern: Dehydration • Oral rehydration therapy (ORT) Gastroesophageal Reflux (GER) & GERD • Uncomplicated GER (“Happy Spitter”) ○ Infant has good weight gain, feeds well, not irritable ○ No medical treatment needed ○ Non-pharmacological recommended • Gastroesophageal Reflux Disease (GERD) ○ Poor weight gain, Feeding refusal, marked irritability • Lifestyle Modifications • Nutritional Adjustments • 1st-line for mild-moderate dehydration from diarrhea • Pedialyte (carbs + elextrolyte) • Antiemetics (ondansetron) may be used only when N/V preventing ORT • Use over 4 hours • Resume age-appropriate diet • Probiotics • IV fluid resuscitation • 1st : H2RAs (famotidine) • 2nd : PPIs (omeprazole, lansoprazole) • Used for 4-8 weeks to reduce stomach acid Intestinal Gas Pain • Prevention • Live vaccines ○ RotaTeq® (RV5): ▪ 3-dose series: ages 2, 4, and 6 months ○ Rotarix® (RV1): ▪ 2-dose series: ages 2 and 4 months ○ C/I: severe combined immunodeficiency (SCID) ○ Interchangeability ▪ If any dose in the series was RotaTeq®, or the vaccine product is unknown for any dose, a total of 3 doses should be administered • Simethicone • Gripe water (no confirmed safety and effectiveness) • • • • Distraction Techniques Therapeutic Touch Swaddling & Sucking for Infants Art & Play Therapy • Mild Pain: Acetaminophen (APAP) and/or NSAIDs • Tylenol Dosing Guidelines ○ Infants & Children <12 years ▪ Oral/Rectal: 10-15 mg/kg/dose every 4-6 hours as needed ▪ Maximum: 75 mg/kg/day (not to exceed 4 g/day) ○ Children ≥12 years, Adolescents & Adults ▪ Oral/Rectal: 325-650 mg every 4-6 hours as needed ▪ Maximum: 3 g/day for adolescents and adults • Ibuprofen (Advil, Motrin) ○ Weight-based dosing: 5-10 mg/kg per dose Q 6-8 hours PRN ○ Maximum dose: 40 mg/kg/day (do not exceed 4 doses/day) ○ Give w/ food or milk to minimize GI upset ○ Caution/Contraindications ▪ Do NOT use in infants <6 months (risk of kidney injury) ▪ Avoid in: • Dehydration or renal impairment (risk of acute kidney injury) • Suspected viral infections (e.g., varicella, influenza) ○ potential link to Reye’s syndrome • Chronic use without GI protection (consider PPI or H2-blocker for prolonged therapy) • Naproxen (Naprosyn, Aleve) ○ OTC: 220 mg tablets ○ Rx: 125 mg/5 mL suspension, various tablet forms ○ Longer half-life than ibuprofen → ↓ frequency • Ketorolac (Toradol) ○ Use short-term due to severe sx → Max: 5 days ○ Boxed warning: GI, renal, thrombotic risks (CV event) • Indomethacin (Indocin) ○ IV use • Aspirin ○ NOT recommended for children & adolescents ▪ Risk of Reye's Syndrome ▪ Can lead to brain swelling, hepatic damage • Moderate Pain: Weak opioids • Severe Pain: Strong opioids • FDA: AVOID in children • Prodrugs ○ Codeine ▪ CYP2D6 substrate ▪ Poor metabolizers → no pain relief ▪ Ultra-rapid metabolizers → high morphine levels → respiratory depression, death ○ Tramadol Teething • Starts ~ 6-10 months • Use chilled teething rings • Offer a cold, wet washcloth for chewing Fever • Temperature ○ Rectal: 100.4F ▪ MOST accurate for infants < 3 months • Neonates (0-28 days) • ER • DO NOT treat fever w/ OTC medications • Older Children • Managed at home with fluids, rest, and fever control (acetaminophen/ibuprofen as needed) • Fluids → Keep child hydrated • Cool measures (Not necessary) • Sponge with tepid (not cold) water • No alcohol baths Acute Otitis Media • Bacterial Pathogens ○ Streptococcus pneumoniae ○ Haemophilus infuenza ○ Moraxella catarrhalis • Acetaminophen: 10-15 mg/kg per dose every 4-6 hours as needed • Ibuprofen: 5-10 mg/kg per dose every 6 hours as needed • Caution: NOT recommended for infants <6 months • 1st-line analgesics • Ibuprofen • Acetaminophen • Topical analgesics • 2% lidocaine (1-2 drops) • Benzocaine w/ phenazone (Auralgan) • Immediate Antibiotic Treatment Recommended For: • Children aged ≥ 6 months ○ Severe signs or symptoms ▪ moderate to severe otalgia ▪ otalgia for at least 48 hours, or ▪ temperature ≥ 39°C [102.2°F]) • Children < 24 months ○ bilateral AOM without severe signs or symptoms • Observation Option • Children aged 6 to 23 months ○ with unilateral AOM without severe signs or symptoms • Children aged 24 months and older ○ without severe signs or symptoms • Antibiotic Therapy • 1st-line: : High-dose amoxicillin ○ 80 to 90 mg/kg per day in two divided doses ○ Children < 2 years or those with severe symptoms: 10 days ○ Children ≥ 2 years with mild to moderate symptoms: 5 to 7 days • Penicillin Allergy ○ Cephalosporin: Cefdinir ○ Macrolide: Azithromycin • Treatment Failure • 1st-line: Amoxicillin-Clavulanate (Augmentin) ○ Infants ≥ 3 months, Children, and Adolescents: ▪ Oral suspension 600 mg per 5 mL ▪ 80 to 90 mg amoxicillin/kg/day divided every 12 hours ○ Children < 2 years or those with severe symptoms: 10 days ○ Children ≥ 2 years with mild to moderate symptoms: 5 to 7 days • 2nd-line (or for severe cases): Ceftriaxone, Clindamycin, or Levofloxacin Respiratory Illnesses • Upper Respiratory Infections (URIs): Colds, viral infections • Infuenza: Seasonal fu, potential complications • Bronchiolitis: Common in infants, often caused by RSV • Pneumonia: Viral or bacterial, requiring different treatments • Asthma & Reactive Airway Disease: Triggered by infections, allergens, or irritants • • • • • • • • Adequate Hydration Humidifier Nasal saline Bulb suction Cough drops (children > 6 y/o) Honey Nose strips Aromatic vapors (do not aply inside nostrils) • • • • When to Seek Medical Attention: Persistent high fever Labored breathing or wheezing Signs of dehydration (dry mouth, reduced urination) Symptoms worsening or not improving after several days • No officially approved dosing for children under 6 years old • The Common Cold • Fever & Pain Relief (Antipyretics): ○ Ibuprofen (if age-appropriate) ○ Acetaminophen • Nebulizers or inhalers for asthma/reactive airway issues • Avoid OTC cold medications in young children due to safety concerns