What are the initial steps and treatment options for common pediatric conditions?

Initial Steps and Treatment Options for Common Pediatric Conditions

The most effective approach to managing common pediatric conditions begins with proper triage to identify emergency signs, followed by condition-specific interventions targeting the most common pediatric illnesses including respiratory distress, fever, and gastrointestinal complaints. 1

Initial Assessment and Triage

Emergency Signs Recognition

• Assess for life-threatening conditions requiring immediate intervention:
  • Respiratory: severe respiratory distress, silent chest, cyanosis
  • Circulatory: poor peripheral perfusion, weak pulse
  • Neurological: reduced consciousness, seizures
  • Severe dehydration 2

Priority Assessment

• Identify priority signs requiring prompt evaluation:
  • Respiratory rate >50 breaths/min (in young children)
  • Heart rate >140 beats/min
  • Temperature >38.5°C
  • Inability to feed or drink
  • Persistent vomiting 2, 1

Common Pediatric Conditions and Management

1. Acute Respiratory Conditions

Asthma Management

• For acute severe asthma:

  • High-flow oxygen via face mask
  • Salbutamol 5 mg or terbutaline 10 mg via oxygen-driven nebulizer (half doses for very young children)
  • Intravenous hydrocortisone or oral prednisolone 1-2 mg/kg (maximum 40 mg)
  • Add ipratropium 100 μg nebulized every 6 hours if not improving
  • Monitor oxygen saturation (maintain >92%) 2

• For life-threatening features:

  • Consider IV aminophylline 5 mg/kg over 20 minutes followed by maintenance infusion
  • Transfer to intensive care if deteriorating PEF, worsening hypoxia, exhaustion, or altered consciousness 2

2. Fever Management

• Initial approach:

  • Antipyretics (acetaminophen or ibuprofen) for temperatures >38.5°C
  • Evaluate for source of infection
  • For infants <3 months with fever, consider full sepsis evaluation 1

• For fever without source:

  • In well-appearing children >3 months: observation with follow-up
  • In toxic-appearing children: blood cultures, empiric antibiotics
  • Consider urinalysis in children <2 years 1, 3

3. Gastrointestinal Conditions

Gastroenteritis/Dehydration

• Assessment of dehydration:

  • Mild: <5% weight loss, slightly dry mucous membranes
  • Moderate: 5-10% weight loss, decreased urine output, sunken eyes
  • Severe: >10% weight loss, significantly decreased urine output, altered mental status

• Treatment:

  • Oral rehydration therapy for mild to moderate dehydration
  • IV fluids for severe dehydration or inability to tolerate oral fluids
  • Avoid antimotility agents in children 3

Gastroesophageal Reflux Disease (GERD)

• For infants with GERD symptoms:
  • Lifestyle modifications: smaller, more frequent feedings
  • Consider 2-4 week trial of maternal exclusion diet (milk, eggs) for breastfed infants
  • For formula-fed infants: consider hydrolyzed protein formula or thickened feedings (1 tablespoon rice cereal per ounce) 2

4. Infectious Disease Management

Acute Otitis Media

• First-line treatment:

  • Amoxicillin 80-90 mg/kg/day divided twice daily for 10 days (standard course) 4
  • Alternative: Azithromycin 10 mg/kg on day 1, followed by 5 mg/kg daily for 4 days (if penicillin allergic) 5

• For treatment failure:

  • High-dose amoxicillin-clavulanate (90 mg/6.4 mg per kg per day) 2

Acute Bacterial Rhinosinusitis

• For mild disease without recent antibiotic use:

  • High-dose amoxicillin (90 mg/kg/day)
  • For penicillin allergy: cefdinir, cefuroxime, or azithromycin 2

• For treatment failure or recent antibiotic use:

  • High-dose amoxicillin-clavulanate (90 mg/6.4 mg per kg per day) 2

5. Musculoskeletal Infections

Osteomyelitis/Septic Arthritis

• Initial evaluation:

  • Consider Kocher criteria for hip pain: fever >101.3°F, ESR ≥40 mm/hr, WBC ≥12,000/mm³, inability to bear weight
  • Elevated CRP >2.0 mg/dL is an accurate predictor of septic arthritis 2

• Management:

  • Empiric IV antibiotics after appropriate cultures
  • Surgical drainage for septic arthritis
  • MRI is preferred imaging modality when available 2

Special Considerations

Diabetic Children

• For newly diagnosed or established diabetes:

  • Regular monitoring of blood glucose
  • Screen for complications based on duration:
    • Dyslipidemia: Start at age 10, then every 3 years
    • Nephropathy: Start at age 10 or after 5 years of diagnosis
    • Retinopathy: Start at puberty or after 5 years of diagnosis
    • Hypertension: Monitor at every visit 2

• For hypertension in diabetic children:

  • ACE inhibitors or angiotensin receptor blockers are first-line pharmacologic treatment 2

Common Pitfalls to Avoid

1. Delayed recognition of serious illness:

   • Don't rely solely on temperature; assess overall appearance and vital signs
   • Remember that young infants may not present with typical signs of serious infection

2. Inappropriate antibiotic use:

   • Avoid antibiotics for viral illnesses
   • Consider local resistance patterns when selecting antibiotics

3. Inadequate pain management:

   • Assess pain in all pediatric patients
   • Use age-appropriate pain scales and provide analgesia when indicated

4. Overlooking social determinants:

   • Assess food security, housing stability, and safety at home
   • Consider these factors in management plans and follow-up 1

Follow-up Care

• Provide clear discharge instructions including:

  • When to return for worsening symptoms
  • Expected course of illness
  • Follow-up appointment timing (typically within 1-2 weeks for acute conditions)
  • Medication administration instructions 2, 1

• For chronic conditions, establish regular follow-up schedule based on disease-specific guidelines 2