Barely Surviving, Definitely Not Thriving
What is the clinical definition of failure to thrive?
A weight or weight-for-height below the 3rd or 5th percentile or crossing down two major percentile lines over 3–6 months.
It can also be defined as a significantly prolonged cessation of appropriate weight gain compared with recognized norms for age and gender after achieving a stable pattern
What is the definition of pediatric fever of unknown origin (FUO)?
A fever higher than 38.3°C (101°F) lasting more than 2–3 weeks without an identified cause despite evaluation.
Definition Of Mild (non severe) Vs Severe Otitis Media ?
Severe: Moderate to severe ear pain or fever ≥39°C in a child with AOM
Mild: Mild ear pain and fever< 39°C in a child with AOM
FYI: Uncomplicated AOM is AOM without otorrhea.
What defines chronic cough in pediatric patients <15 years old?
A cough lasting more than 4 weeks in children.
FYI: A cough that accompanies most common respiratory infections typically resolves in 7 to 10 days and is rarely a cause for concern. However, a patient with frequent viral infections might complain of a "chronic" cough, but a careful history will show shorter, repetitive episodes with complete resolution between infections. Prolonged cough in infants is always unusual and warrants investigation.
What is the clinical definition of nocturnal enuresis
Voiding on beds or clothing at least twice per week for three consecutive months in a child aged 5 years or older.
It can be classified as primary or secondary. Primary nocturnal enuresis (PNE) is defined as nocturnal wetting in a child who has never been dry on consecutive nights for longer than 6 months. Secondary nocturnal enuresis is the recurrence of nighttime wetting after 6 months or longer of dryness. Monosymptomatic nocturnal enuresis (MNE) is a normal void occurring at night in bed without other urogenital tract symptoms or daytime symptoms. Polysymptomatic nocturnal enuresis (PNE) is bed-wetting associated with other bladder symptoms like urgency, frequency, instability, or voiding dysfunction.
What is the most common cause of failure to thrive in the United States?
Inadequate calorie intake.
What is the most common cause category of FUO in children?
Infections, accounting for 40–60% of pediatric FUO cases.
Other common etiologies include collagen-inflammatory (autoimmune), oncologic, neurologic, genetic or congenital, pharmacologic, miscellaneous, and iatrogenic diseases
What is the definition of otitis media with effusion (OME) vs chronic otitis media with effusion
OME: Nonpurulent fluid in the middle ear without acute infection, typically presenting with hearing fullness rather than pain or fever.
Chronic OME: Persistence of middle-ear effusion for more than three months.
What duration defines chronic cough in individuals 15 years and older?
A cough lasting more than 8 weeks.
What is the prevalence of enuresis among 5-year-old children?
The prevalence of bedwetting is around 20% at age 5
The prevalence of bedwetting is around 20% at age 5, up to 10% at age 7, and between 1% and 3% in the late teens.
The spontaneous resolution rate of nocturnal enuresis is approximately 15% per year, with 1% of teenagers at 15 years of age still wetting the bed.
What is the greatest single risk factor for failure to thrive worldwide and in the United States?
Poverty.
What is the most common infectious cause of pediatric FUO in the United States?
Epstein–Barr virus (EBV). followed by osteomyelitis and bartonellosis.
Other infectious causes includes: Bacterial of Lyme disease, occult abscesses, salmonellosis, and sinusitis.
Fungal such as blastomycosis, coccidioidomycosis, and histoplasmosis.
Parasitic such as malaria, toxoplasmosis, and tick-borne infections
What is recurrent acute otitis media?
three or more episodes of AOM within six months or four episodes within one year with at least one in the past six months.
What is the most common cause of chronic cough in pediatric patients?
Asthma
Age is an important factor in diagnosing the etiology of a cough. In infants and children younger than 3 years, protracted bacterial bronchitis (PBB) and postinfectious causes account for a combined 68% of cases. In children younger than 15 years of age, common causes of chronic cough include asthma, protracted bacterial bronchitis (PBB), upper airway cough syndrome (UACS), and nonspecific cough. In adolescents 15 years and older and adults, asthma, upper airway cough syndrome (e.g., postnasal drip from rhinitis or sinusitis), and GERD are the most common etiologies.
Behavioral therapy for enuresis?
1-Limiting nighttime fluid intake 2 hours before bedtime.
2-Limiting dairy products 4 hours before bedtime
3-Voiding prior to going to sleep.
What is the fundamental pathophysiologic mechanism of failure to thrive
Nutritional deficiency due to:
1-inadequate intake
2-excessive losses
3-increased metabolic requirements.
Which age group is most likely to have FUO due to infection?
Children younger than 6 years old.
Autoimmune diseases account for 7% to 20% of cases and become more common after 6 years of age, though infection remains the most frequent cause of FUO at all ages.
Cancer is a much less common cause of FUO in children (1.5–6%) than in adults (7–16%). Malignancies such as leukemia and neuroblastoma are part of the differential diagnosis.
The age range in which the peak incidence of acute otitis media?
6 to 12 months of age.
Approximately 50% of children will have one episode of AOM by age 2 years, and 80% will have had at least one episode by age 3 years.
Risk is highest in young children due to shorter, more horizontal eustachian tubes.
What clinical features strongly suggest habit cough (psychogenic cough ) in children?
honking quality, lack of a clear trigger, and absence during distraction or sleep.
Diagnosis is often by exclusion, requiring chest imaging and PFTs to rule out other causes. Suggestion therapy, self-hypnosis, speech therapy, and behavioral interventions have been described as successful treatments.
What major mechanisms have been proposed to explain nocturnal enuresis?
Genetic factors, abnormal vasopressin secretion, sleep factors, and abnormal bladder dynamics.
What are the four fundamental requirements necessary for normal child growth?
Answer: Oxygen, nutrition, hormones, and emotional support.
What proportion of children with FUO never receive a definitive diagnosis?
About one-third of pediatric FUO cases.
The recommended duration of antibiotic therapy for children older than 5 years with mild AOM symptoms?
5 days
High-dose amoxicillin is the recommended first-line treatment for most children with AOM. It is used because it is inexpensive, safe, has an acceptable taste, and covers a narrow antimicrobial spectrum. For children younger than 24 months, a 10-day course is recommended. For children 2 to 5 years of age, a 7-day course is recommended. For children older than 5 year,5-7 course is recommended.
AOM may be treated with close observation only in children without severe signs or symptoms (severe otalgia or fever >39°C (102.2°F)) who are 6 to 24 months of age with unilateral or bilateral otitis media, or those older than 24 months with bilateral otitis media.
Ceftriaxone?
What condition can occur from prolonged use of topical nasal decongestants like oxymetazoline or pseudoephedrine?
Rhinitis medicamentosa.
Rhinitis medicamentosa is a type of drug-induced rhinitis. It is caused by the overuse of decongestant medications. This overuse leads to rebound congestion when the medication is withdrawn, creating a cycle of continuous medication use. Specifically, it is caused by the overuse of intranasal decongestants. Prolonged therapy with nasal decongestants can induce this rebound congestion.
Medication for polysymptomatic nocturnal enuresis ?
oxybutynin
Three commonly used drugs are imipramine, desmopressin (DDAVP), and oxybutynin. Imipramine and DDAVP have been evaluated for Monosymptomatic nocturnal enuresis, while oxybutynin is primarily used in polysymptomatic enuresis.