Pediatric

• Pica is associated with multiple risk factors including stress, nutritional deficiencies (e.g., iron), low socioeconomic status, mental health disorders, child neglect, and pregnancy. 
• PICA tx: Behavioral therapy is the treatment of choice.

  Refractory symptoms -> SSRIs
• All patients with pica should be screened for iron deficiency and lead poisoning. Pica is a risk factor for lead poisoning. For patients with mildly elevated blood lead levels (i.e., < 45 μg/dL), addressing risk factors for lead poisoning (e.g., by treating pica) and limiting lead exposure by removing the source (e.g., paint, furniture, water, toys, soil, dust, secondhand exposure) suffices. Chelation therapy (e.g., with oral succimer) is only recommended in children with a blood lead level > 45 μg/dL.
• MECP2 gene mutation cause Rett syndrome
• Erythema toxicum neonatorum

  • Birth to 3 days
  • Pustules with erythematous base on trunk and proximal extremities
  • Observation; Resolves within a week
• Milia

  • Birth
  • Firm, white papules on face
  • Observation; Resolves within a month
• Miliaria rubra

  • Any age, not present at birth
  • Erythematous, papular rash on occluded and intertriginous areas
  • Avoid overheating
  • If severe, topical corticosteroids
• Neonatal pustular melanosis

  • Birth
  • Nonerythematous pustules -> evolve into hyperpigmented macules with collarette of scale
  • Diffuse, may involve palms and soles
  • Observation; pustules resolve with days, hyperpigmentation may last months
• Neonatal cephalic pustulosis

  • Around age 3 weeks
  • Erythematous papules and pustules on face and scalp only
  • Observation; resolves in weeks-months
  • If severe, topical corticosteroid or ketoconazole
• Congenital syphilis

  • Maculopapular rash on torso and extremities (including soles)
  • Hepatomegaly, rhinitis, LAP
  • Treat with IV penicillin
• Staphylococcus pustulosis

  • localized erythematous pustules, vesicles, or bullous lesions -> rupture and form erosions and honey-colored crusts
  • Rash in diaper area and prior wound site
  • Treat with topical mupirocin
• CHARGE syndrome

  • Coloboma
  • Heart defect
  • Atresia choanae
  • Retardation of growth/dev
  • GU anomalies
  • Ear abnormalities
• CHARGE syndrome assoc findings

  • Anosmia
  • Cleft lip/palate
  • Hypotonia
• CHARGE syndrome Dx

  • Clinical
  • CHD7 gene testing
• VACTERL syndrome

  • Vertebral
  • Anal atresia
  • Cardiac
  • TracheoEsophageal fistula
  • Renal
  • Limb
• 3 year-old: Socio-emotional


  • Notices other children and joins them to play
• 4 year-old- Socio-emotional


  • Pretends to be something else during play
  • Comforts others who are hurt or sad
  • Likes to be a helper
• 5 year-old- Socio-emotional


  • Follows rules or takes turns when playing games with other children
  • Does simple chores at home
• 3 year-old communication


  • Speech is 75% understandable
  • Talks with you in conversation using at least 2 back and forth exchanges
  • Asks who, what, where, or why questions
• 4 year-old communication


  • Most speech clearly understandable
  • Says sentences with more than 4 words
  • Says some words from a song, story, or nursery rhyme
• 5 year-old communication


  • Articulates well
  • Tells a simple story using full sentences
  • Answers simple questions about a book or story after you read or tell it to them
• 3 year-old cognitive


  • Draws a circle when shown how
• 4 year-old cognitive


  • Names colors
  • Draws a person with three or more parts
  • Tells what comes next in a well-known story
• 5 year-old cognitive


  • Prints some letters and numbers
  • Counts to 10
• 3 year-old motor


  • Strings items together, like large beads or macaroni
  • Uses a fork
  • Puts on some clothes by themselves
• 4 year-old motor


  • Catches a large ball most of the time
  • Unbuttons some buttons
  • Holds crayon or pencil between fingers and thumb (not in fist)
• 5 year-old motor


  • Hops on one foot
  • Buttons some buttons
• Thyroglossal duct cyst or ectopic thyroid


  Difficulty swallowing, especially after URIs

  
• Erythema migrans

  -May have assoc mult 5-8mm erythematous papules on lower legs + forearms

  
• Primary amenorrhea evaluation

  A) Hypothyroidism

  B) Prolactinoma

  C) FHA

  D) Imperforate hymen

  E) POI

  F) Turner syndrome

  G) Karyotype

  
• Hirschprung disease

  
• Meconium ileus and SB perf

  
• Pediatric Constipation - Alarm signs

  • Delayed passage of meconium
  • Fever or vomiting
  • "Ribbon" stools
  • Poor growth
  • Severe abdominal distension
  • Abnormal examination findings (eg, displaced anus, tuft at gluteal cleft)
• Wiskott-Aldrich syndrome

  A) X-linked recessive

  B) Impaired cytoskeleton changes

  C) small platelets

  D) stem cell transplant

  
• Congenital Toxoplasmosis


  • Chorioretinitis
  • Hydrocephalus
  • Diffuse intracranial calcifications (ring-enhancing lesions)
  • Petechiae and purpura (blueberry muffin rash)
  • HSM
  • LAP
  • Intellectual disability
  • SNHL
• Early congenital syphilis

  • Jaundice and hepatosplenomegaly
  • Lymphadenopathy
  • Nasal discharge (sniffles)
  • Maculopapular rash
  • Skeletal abnormalities
• Late congenital syphilis

  • Frontal bossing, rhagades
  • Hutchinson teeth
  • Interstitial keratitis
  • Sensorineural deafness
  • Saber shins
• Congenital listeriosis

  • Spontaneous abortion and premature birth
  • Meningitis, sepsis
  • Vesicular and pustular skin lesions (granulomatosis infantiseptica)
• Congenital varicella

  • IUGR, premature birth
  • Chorioretinitis, cataract
  • Encephalitis
  • Pneumonia
  • CNS abnormalities
  • Hypoplastic limbs
  • cicatricial skin lesions
• Congenital parvovirus B19

  • Aplastic anemia
  • Fetal hydrops