Initial Treatment Approaches for Common Pediatric Conditions
For common pediatric conditions, treatment should follow evidence-based guidelines with appropriate medication selection and dosing specific to children's age, weight, and condition severity.
Respiratory Conditions
Asthma Management
Initial treatment for acute asthma exacerbations should include:
- Oxygen (to maintain saturation >90%)
- Short-acting beta-agonists (salbutamol/albuterol 5-10 mg nebulized every 15-30 minutes as needed)
- Consider adding ipratropium bromide 0.5 mg nebulized every 6 hours for severe exacerbations 1
- Systemic corticosteroids for moderate to severe exacerbations
For chronic asthma management:
- Follow stepwise approach with inhaled corticosteroids (ICS) as cornerstone therapy
- Treatment based on severity:
- Mild: Low-dose ICS-formoterol as needed or daily low-dose ICS plus as-needed SABA
- Moderate: Low-dose ICS-formoterol as maintenance and reliever or medium-dose ICS plus as-needed SABA
- Severe: High-dose ICS plus LABA 1
Community-Acquired Pneumonia
For mild-moderate community-acquired pneumonia:
- Amoxicillin as first-line therapy (45 mg/kg/day divided twice daily for lower respiratory infections) 2
- Duration typically 7-10 days
For severe pneumonia requiring hospitalization:
- Intravenous antibiotics with coverage for Streptococcus pneumoniae and atypical pathogens
- For pneumonia with parapneumonic effusion:
- Small effusion: Antibiotics alone
- Moderate/large effusion: Consider drainage procedures based on respiratory compromise 3
Infectious Diseases
Upper Respiratory Tract Infections
For acute otitis media:
- Amoxicillin 45 mg/kg/day divided twice daily (severe infection) or 25 mg/kg/day divided twice daily (mild/moderate) 2
- Duration: 10 days for children <2 years; 5-7 days for older children
For pharyngitis with confirmed Group A Streptococcus:
Febrile Neutropenia in Pediatric Cancer Patients
- For high-risk febrile neutropenia:
- Use monotherapy with an antipseudomonal β-lactam or a carbapenem as empiric therapy 3
- Reserve addition of a second Gram-negative agent or glycopeptide for:
- Clinically unstable patients
- When resistant infection is suspected
- Centers with high rates of resistant pathogens 3
- Diagnostic workup should include blood cultures and appropriate site-specific cultures
Hypertension Management
For stage 1 hypertension:
- Initial management with lifestyle modifications
- For children <13 years: Target BP below 90th percentile
- For teens ≥13 years: Target BP <130/80 mm Hg 3
For stage 2 hypertension (BP >140/90 mm Hg in those >13 years):
- Pharmacologic treatment with ACE inhibitor, ARB, long-acting calcium channel blocker, or thiazide diuretic
- Consider trial of weight reduction in obese children before starting medication 3
Special Considerations
Neonates and Young Infants (<12 weeks)
- Antibiotic dosing:
Renal Impairment
- For children with severe renal impairment (GFR <30 mL/min):
- Avoid 875 mg dose of amoxicillin
- Adjust dosing based on severity of renal impairment 2
Common Pitfalls to Avoid
Inappropriate antibiotic selection or duration:
- Ensure complete 10-day course for Group A streptococcal infections
- Avoid unnecessary broad-spectrum antibiotics for viral infections
Inadequate asthma control:
- Underuse of inhaled corticosteroids for persistent asthma
- Failure to provide written asthma action plans 1
Unnecessary diagnostic testing:
Inappropriate monitoring:
- Monitor height and weight velocities in children on inhaled corticosteroids
- Use validated tools like Asthma Control Test for ongoing assessment 1
By following these evidence-based approaches to common pediatric conditions, clinicians can provide optimal care while minimizing unnecessary interventions and potential harms.