𝑆𝐸𝐿𝐹 𝐷𝐸𝑃𝐸𝑁𝐷𝐸𝑁𝑇^^أطفال^^💚

➡️ Head circumference with age · Remember 3, 9, and multiples of 5: Newborn 35 cm 3 mos 40 cm 9 mos 45 cm 3 yrs 50 cm 9 yrs 55 cm ➡️ Weights of children with age Newborn 3 kg 6 mos 6 kg (2x birth wt at 6 mos) 1 yr 10 kg (3x birth wt at 1 yr) 3 yrs 15 kg (odd yrs, add 5 kg until 11 yrs) 5 yrs 20 kg 7 yrs 25 kg 9 yrs 30 kg 11 yrs 35 kg (add 10 kg thereafter) 13 yrs 45 kg 15 yrs 55 kg 17 yrs 65 kg ➡️ Pediatric milestones in development 1 year: –single words 2 years: –2 word sentences -understands 2 step commands 3 years: –3 word combos -repeats 3 digits -rides tricycle 4 years: -draws square -counts 4 objects ➡️ Short stature: differential ABCDEFG: Alone (neglected infant) Bone dysplasias (rickets, scoliosis, mucopolysaccharidoses) Chromosomal (Turner’s, Down’s) Delayed growth Endocrine (low growth hormone, Cushing’s, hypothyroid) Familial GI malabsorption (celiac, Crohn’s) ➡️ Dentition: eruption times of permanent dentition “Mama Is In Pain, Papa Can Make Medicine”: 1st Molar: 6 years 1st Incisor: 7 years 2nd Incisor: 8 years 1st Premolar: 9 years 2nd Premolar: 10 years Canine: 11 years 2nd Molar: 12 years 3rd Molar: 18-25 years ➡️ Cerebral palsy (CP): most likely cause CP: Cerebral Palsy Child Premature · The premature brain is more prone to all the possible insults. ➡️ Breast feeding: benefits ABCDEFGH: · Infant: Allergic condition reduced Best food for infant Close relationship with mother Development of IQ, jaws, mouth · Mother: Econmical Fitness: quick return to pre-pregnancy body shape Guards against cancer: breast, ovary, uterus Hemorrhage (postpartum) reduced ➡️ Vitamin toxicities: neonatal Excess vitamin A: Anomalies (teratogenic) Excess vitamin E: Enterocolitis (necrotizing enterocolitis) Excess vitamin K: Kernicterus (hemolysis) ➡️ Rubella: congenital signs “Rubber Ducky, I’m so blue!” (like the “Rubber Ducky” song): Rubber: Rubella Ducky: Patent Ductus Arteriosus, VSD and pulmonary artery stenosis. I’m: Eyes (cataracts, retinopathy, micropthalmia, glaucoma). Blue: “Blueberry Muffin” rash (extramedullary hematopoesis in skin +purpura) · Also, deafness, growth retardation, and some more. ➡️Measles: complications “MEASLES COMP” (complications): Myocarditis Encephalitis Appendicitis Subacute sclerosing panencephalitis Laryngitis Early death Sh!ts (diarrhoea) Corneal ulcer Otis media Mesenteric lymphadenitis Pneumonia and related (bronchiolitis-bronchitis-croup) ➡️ Septic Arthritis: most common cause Staphylococcus Aureus is the most common cause of Septic Arthritis in the pediatric population. ➡️ Croup: symptoms 3 S’s: Stridor Subglottic swelling Seal-bark cough ➡️ Cough (chronic): differential When cough in nursery, rock the “CRADLE”: Cystic fibrosis Rings, slings, and airway things (tracheal rings)/ Respiratory infections Aspiration (swallowing dysfunction, TE fistula, gastroesphageal reflux) Dyskinetic cilia Lung, airway, and vascular malformations (tracheomalacia, vocal cord dysfunction) Edema (heart failure) ➡️ yanotic heart diseases: 5 types · Use your five fingers: 1 finger up: Truncus Arteriosus (1 vessel) 2 fingers up: Dextroposition of the Great Arteries (2 vessels transposed) 3 fingers up: Tricuspid Atresia (3=Tri) 4 fingers up: Tetralogy of Fallot (4=Tetra) 5 fingers up: Total Anomalous Pulmonary Venous Return (5=5 words) ➡️ Cyanotic congenital heart diseases 5 T’s: Truncus arteriosus Transposition of the great arteries Tricuspid atresia Tetrology of Fallot Total anomalous pulmonary venous return ➡️ Cyanotic heart diseases: 5 types · 5 T‘s: Tetralogy of Fallot Transposition of the great arteries Truncus arteriosus Tricuspid atresia, pulmonary aTresia Total anomalous pulmonary venous drainage ➡️ Hemolytic-Uremic Syndrome (HUS): components “Remember to decrease the RATE of IV fluids in these patients”: Renal failure Anemia (microangiopathic, hemolytic) Thrombocytopenia Encephalopathy (TTP)

Childhood immunization program of Yemen : 1) Already After birth:  (BCG) vaccine ----------- (the only shot).  Polio vaccine (OPV) ------ (the introductory shot). 2) One & half a month after birth:  Polio vaccine (OPV) ------- (the first shot).  DTaP - Hib - HepB & PCV----------- (the first shot). 3) Two months & half after birth :  Polio vaccine (OPV) ------- (the second shot).  DTaP - Hib - HepB & PCV ----------- (the second shot). 4) Three months & half after birth:  Polio vaccine (OPV) ------- (the third shot).  DTaP - Hib - HepB & PCV ----------- (the third shot). 5) Nine months after birth:  Measles vaccine-------- (the first shot).  Vit. A (100,000 unit). 6) One & half a year after birth:  Measles vaccine-------- (the second shot).  Vit. A (200,000 unit).

hurler syndrom. Mucopolysaccharidoses

• Significant Cough in neonates is (Pneumonia) till proved otherwise • Unilatral weeze , steridor, SOB "shorteness of breath" is ( forign body ) till proved otherwise • Recurrent Painful Orogenital ulcer is (Behcet syndrome) till proved otherwise • Prolonged fever in patient with shunt=infected shunt until proved otherwise • Infants recurrent attack wheezy chest ,early childhood is (br .asthma ) until proved otherwise • Pallor ,jaundice, dark urine g6pg def ( hemolytic anemia ) untill proved other wise • Prolonged fever in Rh heart pt is considered (Infective endocarditis ) until proven other wise • Fever with rash +cough +red eye + runny nose is ( measles ) until proved otherwise • Fever more than week +abdominal pain & distention +constipation +bradycardia means typhoid fever (enterica) untill prove other wise • Fever + vomiting + convulsions= ( Meningitis ) until proved otherwise. • Child with recrrent UTI ( vesicoureteric reflux ) until proved other wise • Fever+ dyspnea+cough= ( Pneumonia ) till proved other wise • Recurrent chest infection +recurrent gastroentritis+ failur to thrive= (cystic fibrosis )until proven otherwise • Tachycardia, Tachypnea, Tender hepatomegaly >>> ( Heart failure ) untill proved otherwise • Billious vomiting in neonate is (volvulous )till proved otherwise ___________ #Pediatric

✳️Clinical Evaluation of UTI 🔸️ History ▪︎ لابد نسأل عن fever و duration ▪︎ نسال عن Urinary symptoms ▪︎ اذا فيه abdominal pain او suprapupic pain أو back pain ▪︎ اذا تم اخد اي antibiotic ▪︎ نسأل عن risk factors for UTI ☆ Chronic urinary symptoms lack of proper stream , incontinence ☆ Bowel and Bladder dysfunction including chronic constipation ☆ previous UTI أو اذا فيه hx ل حرارة لم يتم معرفة مصدرها ولم يتم اخد culture حينها. ☆ Vesicoureteral reflux ☆ family hx of frequent UTI , VUR or genitourinary abnormalities ☆ Antenatally diagnosed renal abnormality 🔸️physical examination اي طفل عنده suspected UTI لابد ان يتضمن الفحص الآتى ☆ Bp , tempreature measurement - اذا كانت الحرارة 39 او اكتر قد تكون acute pyelonephritis وقد تسبب renal scaring - اذا كان فيه elevated Bp قد يكون indication of renal scaring . ☆ Growth parameters - اذا كان فيه poor weight gain قد يكون indication ل chronic renal failure نتيجة renal scaring . ☆ Abdominal and Flank examination - ال suprapupic و costovertebral tenderness بيكون مع UTI - اذا كان فيه enlarged bladder او kidney قد يكون هناك urinary obstruction . ☆ examination of external genitalia اذا فيه vulvovaginitis او hypospadias قد يكون predispose للUTI. ☆Evaluatiom of lower back for signs of occult myelomeningocele اذا فيه lipoma او vascular lesion او sinus او midline pigmenentation . ☆Evaluation for other sources of fever . #UTI

Clinical Presentation In UTI ▪︎ Younger children في infants و young children بيجوا الأطفال ب nonspecfic symptoms مثل fever , irritability و ممكن الأطفال يجوا ب foul smelling urine او gastrointestinal symptoms مثل ♤Vomiting ♤diarrhea ♤poor feeding ▪︎ ال fever ممكن تكون sole manifestation لل UTI في الأطفال الاقل من سنتين فلابد من عمل evaluation to UTI اذا الطفل كان عنده fever فقط . ☆ كل ما زادت مدة fever بزيد risk لل renal scaring قبل بداية ال antiobiotic . 🔹️Pedictors of culture confirmed UTI ☆ ال age أقل من 12 شهر ☆ ال maximum reported temperature أعلى أو تساوي 39 ☆ال female child ☆ال male child اذا كان uncirumcised ☆انه لا يوجد اي source لل fever 🔸️ factors that increase risk of UTI ☆ يكون فيه Hx لل UTI ☆ مدة fever أكتر من 48 ساعة ▪︎older children ♤ fever ♤Urinary symptoms -dysuria -urgency -frequency -new onset incontinence ♤abdominal pain ♤suprapupic pain 🔸️اذا كان فيه fever , chills , flank pain قد يكون pyelonephritis . 🔸️Findings that help in identifying children with UTI : ♤ Abdominal pain ♤Back pain ♤Dysuria , frequency ♤ New onset urinary incontinence #UTI

✳️Evaluation and dignosis for UTI 🔸️ال laboratory evaluation لل suspected UTI هي -Urine dipstick - microscopic analysis -Urine culture 🔸️ ال decision to obtain urine sample تختلف حسب العمر و history و sex وحسب clinical presentation . اذا لا يوجد اي urinary tract abnormalities بناخد sample حسب العمر ... ▪︎ اذا كان العمر أقل من شهر لابد من اخد sample ▪︎ اذا كان عمره من 2-11 month بناخد sample اذا فيه fever تساوي او اعلى من 38 ▪︎ اذا كان عمره من 12-23 month بناخد sample اذا كانت female لانهم اكتر risk لل UTI واذا uncircumcised males واذا كان فيه الآتي : ☆ fever > or = 38 and hx of UTI ☆ Fever > or = 38 and no other source of fever ☆fever > or = 39 and fever > 48 hours ▪︎اذا اكتر من 24 شهر بناخد sample حسب clinical finding اذا فيه اعراض لل UTI . وكيفية اخد Sample تم ذكرها سابقا .... 🔹️Urine dipstick ☆ ال leukocyte esterase اذا كان + قد يكون suggestive لل UTI لكن nonspecfic . ☆ ال nitrite اذا كانت + بتكون indication انها UTI ويعتبر highly specfic ولكن قد يكون هناك false negative results لانه لابد ان يبقى urine في bladder لمدة عالاقل 4 ساعات حتى يحدث accumulation for detectable amounts of nitrite لذلك اذا كانت negative nitrite لا تستثني UTI . 🔹️Microscopic examination ▪︎ standard microscopy a centrifuged sample of unstained urine is examined for WBC and bacteria . ☆ال pyuria تعرف بوجود 5 او اكتر من WBC\hpf ▪︎Enhanced microscopy refer to examination of an uncentrifuged urine specimen ☆ ال pyurua تعرف هنا بوجود 10 او اكثر من WBC\mm3 🔹️Urine Culture ☆ اذا عمر الطفل اقل من سنتين بيتم عمل culture بشكل روتيني حتى لو dipstick او standard microscopy كانت negative . ☆اذا عمر الطفل أكثر من سنتين وذلك حسب results of dipstick and microscopic analysis . #UTI

✳️Clinical Features of UTI in neonates 🔸️ Term infants غالبا بتكون symptoms و signs في neonates nonspecfic . ☆ lethergy ☆ tachypnea ☆irritability ☆ cynosis and appear acutely ill. ✳️Most common clinical findings are 🔹️Fever 🔹️poor weight gain 🔹️Jaundice 🔹️vomiting 🔹️loose stool 🔹️poor feeding ☆ ال hyperbilrubinemia التي تحدث في UTI تكون conjugated و قد تكون Jaundice هي اول sign للUTI . 🔸️preterm infants هي نفس manfestation في term infants ولكن بالاضافة الى ☆ apnea ☆ hypoxia #UTI

✳️ indications for hospitalization and/or parenteral therapy in UTI include : 🔹️Age <2 months 🔹️Clinical urosepsis (eg, toxic appearance, hypotension, poor capillary refill) 🔹️Immunocompromised patient 🔹️Vomiting or inability to tolerate oral medication 🔹️Lack of adequate outpatient follow-up (eg, no telephone, live far from hospital) 🔹️Failure to respond to outpatient therapy #UTI

Cardiology ⭕ Tachycardia: is the 1st sign of heart failure ⭕ Congenital heart disease is the commonest structural malformation (8:1000 of full term live births) ⭕ VSD is the most common congenital heart disease (25-30%) ⭕ Congenital acyanotic heart disease is the most common type of congenital heart disease (80%) ⭕ Perimembraneous VSD is the most common type of VSD (80%) ⭕ Ostium secundum: Most common type of ASD (80%) ⭕ Atrioventricular septal defect (AVSD) is the most common cardiac defect in Down syndrome ⭕ Commonest site of coarctation of the aorta: just distal to the origin of the left subclavian artery ⭕ Rheumatic fever is the most common cause of acquired heart disease in children ⭕ Polyarthritis is the most common presentation of rheumatic fever ⭕ Carditis is the most serious presentation of rheumatic fever (Endocarditis is the most consistent) (Mitral regurge is the most common lesion) ⭕ Rheumatic fever is the most common cause of chorea in children IM Benzathine penicillin is the best treatment for rheumatic fever ⭕ Streptococcus viridians is the most common organism that causes infective endocarditis ⭕ Staph. aureus is the most common organism affecting normal heart ⭕ (75%) of cases of infective endocarditis occur in patients with preexisting cardiac disease ⭕ Failure to thrive and cardiac failure are the most common features in infants with pediatric hypertension #Short_Note_pediatrics