PIT FALLS IN PAEDITRIC PIT FALLS IN PAEDITRIC PRACTICEPRACTICE

Prof. Dr. Sharad Agarkhedkar

Prof. & HOD Dept. of PaediatricsDr. D.Y. Patil Med. College

Hon. Paediatrician -Sanjeevan Hospital

Deenanath Mangeshkar HospitalSutika Seva Mandir

Ordinance Factory Hospital

NEWBORNS

Gest age assessment - Weight is not the criteria.There are physical & neurological criteria.Don't forget - “ Not every LBW is Premature “I.U.G.R.s are more common problems.Separating cord looks shaggy- It's not sepsis.Icterus look at the tip of the noseFace - 5 mgChest – 10 mgThighs – 15 mgPalms / Soles – 20 mgWeight loss 15% - Preterms10% Term babies

Post Neonatal

- Jaundice 3 wks – Clay coloured stools of biliary obst. To be diagnosed & operated in 6 wks. Beyond that it's too late.

- Post fontanel – closure 2 months if not then think of Hypothyroidism.

- Every weeks delay of treatment can cause loss of IQ by 5 points.

- Sepsis – with rash – urgency Meningitis – AF bulging in quiet state shrill cry.

- Pneumonia – Chlamydia Pneumonia – Macrolides

Paraxysmal Cough like whooping cough

Vomiting

If yellowish , greenish think of Surgical cause.Vomiting with satisfactory wt gain ignore it.Vomiting with full AF – look for intracranial cause

Vomiting with lump in Rt. Hypochondriac region with visible peristalsis CHPS.

Projectile vomits with shrill cry – Raised ICPRule out intracranial lesions ICH, IVH, SOL

CardiacNo murmur at birth.Sudden appearance of murmurs at 2 months indrawing at 4th ICS with each Heart beat indicates L – R shunt

Bounding pulses ? VSD ? PDAAbsent pulses – coarctation single 2nd sound in PA ? T.O.F.- Every murmur is not CHD- No murmur doesn't rule out CHD

Weight gain doubles by 5 months Triples by 1 year Qudruples by 3 yrs.

Height 50 cms at birth 75 cms at 1 year 85 cms at 2 year 5 To 7 cms/year thereafter Assess Growth Velocity

HC - 33 – 35 cm at birth Increase 2 cm/ month for 3 months Increase 1 cm/ month 4 – 6 months Increase 0.5 cm / month 6 – 12 months

HC > Chest Circumference at birthHC = Chest at 9 months to 1 yearCC increase thereafter

DEHYDRATION

Wight loss is the best judge Upto 5% No DehydrationInfants - 5 – 10% Some dehydration

> 10 % Severe dehydration

Older Children > 3% No dehydration > 6% Some dehydration > 9% Severe dehydration

Dehydration difficult to assess in obese & malnourished children

- assess pulse rate - assess weight

SHOCK IN CHILDREN IS ALWAYS DUE TO DEHYDRATION UNLESS PROVED

OTHERWISE.

INTUSUSCCEPTION

H/O AGEScreaming AttacksRed current jelly stoolsProlapse rectumSausage ( Banana ) shapedLump in Para umbilical region

Baby becomes quiet in between – Do USG Abdomen

Pulled Elbow 6 months – 2 yrs

Three months Colic.Viral Group – Typical History Epiglotitis – Red EpiglottisTorsion TestisObstructed HerniaDiaper Dermatis

WHEEZE

EVERYTHING THAT WHEEZES IS NOT EVERYTHING THAT WHEEZES IS NOT ASTHMAASTHMA

IT COULD BE - * BRONCHIIOLITIS* EVENTERATION* LARYNGOMALACIA* C.H.D. / VASCULAR RINGS* SEVERE AIRWAY OBST. - NO AIR ENTRY AT ALL

SILENT CHEST* BAD SIGN – ACT FAST

PUOVIRAL – Conjuctival injection - All mucosae involved - Post Cervical nodes - Macular rash - soft Hepatospleenomegaly - Palatal bleedsENTERIC – CAECAL GURGLING- - Spleno – Hepatomegaly - Step – ladder pattern - Toxic look2nd Week Widal Test – Rising Titres Blood culture

in 1st Week.

URINARY TRACT INFECTION No signs / symptomsUrine Routine - > 10 cells / HPF Culture - > 105 organism / ml

Males Screening for renal anomaliesMCUG for VUR

Malaria - Intermittent fever Firm spleen No rigors

NUEROLOGICAL - Brisk DT Jerks - Upgoing planters - Ankle & patelar clonusAre you thinking of spinal cord lesion ? Yes.

But it could be a mere sign of raised ICP.

Raised ICP – Think of Cushing's TraidBradycardia HypertensionIrregular respirationPapilloedema is seen in only 2% of patients with raised ICP.

Pain in Abdomen

- Cause can be in Lungs Empyema Lower lobe Pneumonia- Cause can be in skin shigelles ( Herpes )- Cause can be in Brain Abdominal epilepsy- Cause can be porphyria

Pneumococcal BacteraemiaAge Group – 3 months – 2 years

Presentation – Fever, mild coldNo positive findings on clinical examination

X Ray Chest, Haemogram - normalEventual localisation – AOMHigh index of suspicion is necessary

Penicillin is the drug of choice.

Uncosolable Crying After DPT

High pitched shrill cryCan occure within 7 days max.

Always observe & admit if necessary.

Hypotensive Hyporesponsive syndrome can occur – Hypoglycaemia is a sign - qua non

Rehydration – Dextrose infusion is the treatment.

Todd's Paralysis

* Lateralisation after GTC* Hypo / Hypertonia

Areflexia / HyperreflexiaLasts for upto 7 daysRecovers on its own.

No investigations or treatment required.

Kawasaki Disease* Fever > 5 days* Bulbar conjuctivitis* Cervical Lymphadenopathy* Strawberry tongue* Maculo Papular Rash* Periungual exfoliation * Oedema Hands / Feet* High index of suspicion required* No diagnostic test* Coronary Aneurysin on Echo

Treatment – IV IgG, AspirinWaterloo for Paediatrician

Thank YouThank You