1st peer: Table 1: Rome IV Criteria for Functional Constipation in Infants and C

Criteria

Description

Frequency

At least once per week for at least 1 month

Stool Consistency

Hard or lumpy stools that are difficult to pass

Painful Defecation

Pain or discomfort associated with passing stools

Large Stool Volume

Parents report passage of large stools that clog the toilet or require digital evacuation

Stool Retentive Posture

Child may withhold stool or adopt unusual postures to avoid defecation

Physiologic Factors

Psychosocial Factors

1. Low-fiber diet

1. Stress or anxiety

2. Dehydration

2. Changes in routine

3. Delayed toileting skills

3. Family dynamics

4. Intestinal motility disorders

4. Trauma or abuse history

5. Medication side effects

5. Parental attitudes toward toilet training

Jaundice Appears

Jaundice Disappears

Peak Bilirubin Concentration (days)

Diagnostic Studies

Management and Prevention

Physiologic

Within the first few days after birth

Typically within 1 to 2 weeks after birth

Usually occurs around day 3 to day 5 after birth

Bilirubin level measurement, sometimes blood type tests

Phototherapy, breastfeeding, monitoring

Full-term

Within the first few days after birth

Typically within 1 to 2 weeks after birth

Usually occurs around day 3 to day 5 after birth

Bilirubin level measurement, sometimes blood type tests

Phototherapy, breastfeeding, monitoring

Premature

Within the first few days after birth

Typically within 1 to 2 weeks after birth

Usually occurs around day 3 to day 5 after birth

Bilirubin level measurement, sometimes blood type tests

Phototherapy, breastfeeding, monitoring

Question

Answer

1. American Academy of Pediatrics recommendation for breastfeeding?

Exclusive breastfeeding for the first 6 months, then continued breastfeeding with complementary foods up to 1 year or longer.

2. Common weight loss percentage after birth?

Around 5-10%

3. Newborns should regain birth weight by?

By 2 weeks of age

4. What do the Letters PURPLE stand for?

Peak, Unexpected, Resists Soothing, Pain-like Face, Long-lasting, Evening crying

5. Birth weight at 6 months and 12 months?

Birth weight is typically doubled by 6 months and tripled by 12 months

6. Percentage of mothers experiencing “baby blues”?

Around 70-80%

7. Screening tool/scale for perinatal depression?

Edinburgh Postnatal Depression Scale (EPDS)

8. Daily dose for vitamin D in an infant?

400 IU

9. Breast milk or formula calories per ounce?

Approximately 20 calories per ounce

10. When can infants start solid foods?

Around 6 months of age

11. Principles for introduction of solids?

Gradual introduction, single-ingredient foods, watch for allergic reactions, avoid added sugar and salt, monitor texture and consistency

12. Avoidance of cow’s milk and why?

Until 1 year old due to risk of allergy and difficulty digesting

13. Clinical findings of dehydration in infants?

Sunken fontanelle, decreased urine output, dry mucous membranes, lethargy

Name

Clinical Features

Differential Diagnoses

Treatment/Management

Herpes Simplex Virus

Fever, painful blisters on lips or genitals

Impetigo, Hand, foot, and mouth disease

Antiviral medications, supportive care

Mononucleosis

Fever, sore throat, swollen lymph nodes

Streptococcal pharyngitis

Supportive care, rest, pain management

Roseola Infantum

High fever followed by rash

Measles, Rubella

Supportive care, antipyretics for fever

Varicella

Itchy rash, fever, fatigue

Measles, Scabies

Antiviral medications (acyclovir), supportive care

Influenza

Fever, cough, sore throat, body aches

Common cold, COVID-19

Antiviral medications (oseltamivir), supportive care

Measles (Rubeola)

High fever, cough, runny nose, rash

Rubella, Scarlet fever

Supportive care, vitamin A supplementation

Mumps

Swollen salivary glands, fever, headache

Parotitis, Epstein-Barr virus

Supportive care, pain management, MMR vaccination (prevention)

Erythema Infectiosum (Fifth disease)

Slapped cheek rash, fever, flu-like symptoms

Rubella, Scarlet fever

Supportive care, antipyretics for fever

Rubella

Mild fever, rash, swollen lymph nodes

Measles, Scarlet fever

Supportive care, MMR vaccination (prevention)

Principle

Description

1. Age and Weight Appropriateness

Dosage and formulation should be suitable for the child’s age and weight

2. Pharmacokinetics and Pharmacodynamics

Consideration of how medications are absorbed, metabolized, and excreted in children’s bodies

3. Safety and Efficacy

Balance between potential benefits and risks, with careful consideration of adverse effects

4. Formulation and Administration

Selection of appropriate formulations and routes of administration for pediatric patients

List possible physiologic and psychosocial factors related to encopresis

Physiologic

Psychosocial

1. Chronic constipation, characterized by persistent difficulty in passing stools, can lead to fecal impaction and subsequent encopresis.

1. Emotional stress, stemming from stressful life events such as family conflict, divorce, school problems, or abuse, can trigger or exacerbate encopresis.

2. Delayed toilet training, which refers to inadequate or delayed training in using the toilet, can contribute to the development of encopresis.

2. Anxiety, whether related to anxiety disorders or specific anxieties about toileting, such as fear of using public restrooms, can contribute to encopresis.

3. Bowel dysfunction, including issues such as abnormal bowel motility or sensation, can disrupt regular bowel movements and contribute to encopresis.

3. Parental reactions, such as overly punitive or critical responses to soiling accidents, can increase anxiety and worsen encopresis.

4. Dietary factors, such as poor diet, low fiber intake, and inadequate fluid consumption, can lead to constipation and fecal retention, increasing the risk of encopresis.

4. Trauma, including experiences of physical or sexual abuse, can contribute to encopresis through the development of psychological issues or dysfunctional coping mechanisms.

5. Medical conditions, including Hirschsprung’s disease, spinal cord abnormalities, or neurological disorders, can affect bowel function and increase the likelihood of encopresis.

5. Environmental factors, such as disruptions in routine, changes in living situations, or lack of access to appropriate toileting facilities, can impact bowel habits and contribute to encopresis.

Jaundice Appears

Jaundice Disappears

Peak Bilirubin Concentration (days)

Diagnostic Studies

Management and Prevention

Physiologic

Typically, it appears after 24 hours of age.

Usually, it resolves by the end of the first week.

Peak bilirubin concentration occurs around day 3 to day 5.

Generally diagnosed clinically, but may include bilirubin level measurement if necessary.

No specific treatment is needed; frequent breastfeeding or feeding helps eliminate bilirubin, and phototherapy may be used in severe cases.

Full-term

Typically, it appears after 24 hours of age.

Usually, it resolves within two weeks.

Peak bilirubin concentration occurs around day 3 to day 5.

Bilirubin level measurement if jaundice persists or appears severe.

Management involves frequent feeding and monitoring; phototherapy may be used in severe cases. Prevention includes ensuring adequate intake and monitoring for signs of jaundice.

Premature

It may appear within the first 24 hours but typically within the first few days.

It may take longer to resolve compared to full-term infants, usually within two to three weeks.

Peak bilirubin concentration may occur later than in full-term infants, around day 5 to day 7.

Bilirubin level measurement and possibly other tests to determine the cause of jaundice.

Management involves close monitoring, frequent feeding, phototherapy if bilirubin levels are high, and addressing any underlying medical conditions contributing to jaundice. Prevention may include early feeding initiation and close monitoring of bilirubin levels in premature infants.

Complete the information requested.

1. What is the American Academy of Pediatrics recommendation for breastfeeding?

The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of a baby’s life, followed by continued breastfeeding along with the introduction of complementary foods until at least 12 months of age, and continuation of breastfeeding for as long as mutually desired by the mother and baby.

2. How much weight loss is common after birth – what percentage? ________

7% to 10% of their birth weight within the first few days.

3. Newborns should regain birth weight by ______ (when?)

two weeks of age

2. What do the Letters PURPLE stand for:

The peak of crying, Unexpected, Resists soothing, Pain-like face, Long lasting, Evening

3. Birth weight _________ at six months and _______ at 12 months.

double birth weight at six months and triple at12 months

4. How does one distinguish caput succedaneum and cephalohematoma? What percentage of mothers experience” “baby blue” after birth?

Caput succedaneum is a diffuse swelling of the scalp, typically caused by pressure exerted on the baby’s head during labor and delivery. It often crosses suture lines and can be identified by its soft, puffy appearance. Caput succedaneum usually resolves on its own within a few days after birth.

Cephalohematoma is a collection of blood between the skull and the periosteum (the membrane covering the bones). Unlike caput succedaneum, cephalohematoma does not cross suture lines and feels like a firm lump on the baby’s head. It’s usually caused by trauma during delivery, such as the use of forceps or vacuum extraction. Cephalohematoma may take weeks or even months to resolve as the body gradually reabsorbs the blood.

5. What percentage of mothers experience” “baby blue” after birth?

About 70% to 80% of mothers experience” “baby blue” after giving birth. This is a temporary and mild mood disturbance characterized by feelings of sadness, anxiety, irritability, and mood swings. It typically peaks around the fourth or fifth day after birth and resolves on its own within a couple of weeks.

6. What screening tool/scale is used to identify mothers at risk for perinatal depression?

The screening tool/scale commonly used to identify mothers at risk for perinatal depression is the Edinburgh Postnatal Depression Scale (EPDS). It consists of ten questions designed to screen for depressive symptoms experienced during the perinatal period.

7. What is the daily dose of vitamin D in an infant? Breast milk or formula contains________ calories per ounce?

400

8. Breast milk or formula contains________ calories per ounce?

20 calories per ounce

9. When can infants start solid foods?

six months of age

10. What are the five principles for the introduction of solids into an infant’s diet?

Introduce solid foods around six months of age, when the baby shows signs of readiness, such as being able to sit with support and showing interest in food.

Offer a variety of foods to expose the baby to different flavors and textures, starting with single-ingredient purees and gradually introducing more complex combinations.

Begin with smooth purees and gradually increase the texture as the baby becomes more accustomed to eating solids, preventing choking and promoting chewing and swallowing skills.

Ensure foods are prepared and served safely to prevent choking hazards, avoid small, hard foods, and supervise the baby during feeding.

Please pay attention to the baby’s hunger and fullness cues, allowing them to lead the feeding process and explore different foods at their own pace.

11. How long should newborns avoid cow’s milk and why?

first year

12. What are the clinical findings of dehydration in infants?

● Decreased urine output or fewer wet diapers than usual.

● Dry mouth and lips.

● Sunken fontanelle (soft spot on the baby’s head).

● Sunken eyes with dark circles around them.

● Irritability or lethargy.

● Poor skin turgor (skin that does not spring back when gently pinched).

● Rapid breathing or heart rate.

● Cool or mottled skin.

Complete the table

Name

Clinical Features

Differential Diagnoses

Treatment/Management

Herpes Simplex Virus (Whitley & Baines, 2018)

Presents with painful vesicular lesions on the lips or genitalia, often preceded by a tingling or burning sensation.

Oral or genital ulcers due to other causes such as aphthous stomatitis or syphilis.

Antiviral medications like acyclovir or valacyclovir can help shorten the duration and severity of symptoms. Pain management and supportive care are also critical.

Mononucleosis (Mohseni et al., 2023)

Fever, sore throat, swollen lymph nodes, fatigue, and sometimes a rash following antibiotic use.

Streptococcal pharyngitis, cytomegalovirus (CMV) infection, HIV seroconversion illness.

Symptomatic treatment with rest, hydration, and pain relievers. Avoidance of contact sports due to the risk of splenic rupture in some cases.

Roseola Infantum (Exanthem Subitum) (Pippin & Laws, 2024)

High fever followed by a rash, usually on the trunk, which may spread to the extremities.

Measles, rubella, and other viral exanthems.

Supportive care for fever and hydration. Antipyretics like acetaminophen or ibuprofen can help manage fever.

Varicella (Kennedy & Gershon, 2018)

It is characterized by an itchy rash starting on the trunk and spreading to the extremities, along with fever and malaise.

Other viral exanthems, such as measles or rubella.

Symptomatic treatment with antiviral medications (acyclovir) and antipyretics for fever. Calamine lotion or oatmeal baths can soothe itching.

Influenza (Boktor & Hafner, 2023)

Sudden onset of fever, chills, headache, muscle aches, sore throat, cough, and fatigue.

Other viral respiratory infections, such as respiratory syncytial virus (RSV) or adenovirus.

Antiviral medications (oseltamivir, zanamivir), if started early in the course of illness, supportive care for symptom relief.

Measles (Rubeola) (Krawiec & Hinson, 2023)

Fever, cough, coryza, conjunctivitis “three C”), and a characteristic maculopapular rash starting on the face and spreading downward.

Other viral exanthems, such as rubella or roseola.

Supportive care, including rest, hydration, and fever management. Vitamin A supplementation may be beneficial in some cases.

Mumps(Davison & Morris, 2023)

Parotitis (swelling of the parotid glands), fever, headache, and malaise.

Other causes of parotitis, such as bacterial parotitis or HIV infection.

Supportive care for fever and pain relief. Vaccination is the primary means of prevention.

Erythema infectiosum (Fifth disease) (Kostolansky & Waymack, 2023)

“Slapped cheek” rash on the face followed by a lacy rash on the trunk and extremities, sometimes preceded by mild fever or cold-like symptoms.

Other viral exanthems, such as rubella or roseola.

Supportive care for fever and rash. Usually self-limiting, but severe cases may require treatment for anemia in immunocompromised individuals.

Rubella (InformedHealth.org, 2023)

Mild fever, sore throat, lymphadenopathy, and a fine maculopapular rash that starts on the face and spreads to the trunk and extremities.

Measles and other viral exanthems, such as roseola or erythema infectiosum.

Supportive care for fever and rash. Vaccination is the primary means of prevention, as rubella infection during pregnancy can lead to congenital rubella syndrome.

What are the four critical fundamental principles to consider when prescribing medications for children?

1. Children vary greatly in weight and age, which can significantly affect drug dosages. Medication doses should be calculated based on the child’s weight whenever possible rather than relying solely on age. This helps to ensure that the dose is appropriate for the child’s size and metabolism. Children’s

1. bodies metabolize medications differently than adults. Factors such as organ function, enzyme systems, and body composition can influence how a drug is absorbed, distributed, metabolized, and eliminated. It is essential to understand these differences to determine appropriate dosages and potential side effects.

1. Many medications are not available in pediatric-friendly formulations, such as liquids or chewable tablets. It may be necessary to compound or manipulate medications to create suitable doses for children. Additionally, the route of administration should be carefully considered to ensure that it is safe and appropriate for the child’s age and condition.

1. Children may respond differently to medications over time due to growth and changes in physiology. Regular monitoring of the child’s response to treatment is essential, including assessing for efficacy and monitoring for adverse effects. Dosages may need to be adjusted as the child grows or if there are changes in their health status.