Failure to Thrive & Colic in Infants

Failure to Thrive (Reactive Attachment Disorder)

• Syndrome where infant falls below the 5th percentile for weight/height or is dropping in percentiles.
• Organic and non-organic causes are possible, including parent-child relationship disturbances.
• Clinical signs: lethargy, poor muscle tone, subcutaneous fat loss, skin breakdown, diminished crying.
• Infants stare hungrily, show little cuddling, and have delays in motor and speech development due to lack of interaction.
• Child must be removed from parent's care, ensure proper nutrition, nurture the child, and support the parents.

Colic

• Paroxysmal abdominal pain in infants under 3 months.
• Uncertain causes possibly related to overfeeding or excess air intake during feeding.
• Symptoms: pulling legs to abdomen, red flushed face, clenched fists, tense abdomen.
• Colic begins at 2-3 weeks, peaks at 6-8 weeks, and ends at 3-4 months, potentially extending to 6 months of age.
• Assessment involves thorough history including feeding type, small frequent feedings are encouraged.

Assessing Respiratory Illness in Children

• Key indicators: cough, restlessness, cyanosis, finger clubbing, adventitious sounds, and chest diameter.

Acute Nasopharyngitis (Common Cold)

• Most common infectious disease in children.
• Incubation lasts 2-3 days with symptoms fading after about a week.
• Common causative agents: rhinovirus, coxsackievirus, RSV, adenovirus, parainfluenza, and influenza viruses.
• Assessed by nasal congestion, watery rhinitis, low-grade fever, sore throat, cough, swollen cervical lymph nodes, and purulent nasal discharge, or vomiting/diarrhea.
• No specific treatment is needed, and antibiotics are ineffective without secondary bacterial invasion.
• Focus on symptomatic care, and saline drops may be used.

Croup (Laryngotracheobronchitis)

• Inflammation of the larynx, trachea, and major bronchi caused by viral infections; often Parainfluenza virus.
• Characterized by barking cough, inspiratory stridor, and marked retractions.
• Symptoms subside after a few hours except a rattling cough, which subsides by morning.
• Treatment Methods: Using a humidifier, cool mist combined with a corticosteroid nebulizer, and intravenous therapy.

Respiratory Syncytial Virus (RSV)

• Common respiratory virus causing mild, cold-like symptoms.
• Most frequent cause of bronchiolitis and pneumonia among children younger than 1 year.
• Spreads via contact with respiratory droplets or contaminated surfaces.
• Incubation lasts 4 to 6 days after exposure.
• Manifestations: runny nose, decreased appetite, coughing, sneezing, fever, and wheezing.
• Treatment: Focus on managing fever, pain, and ensuring adequate hydration.

Acute Otitis Media

• Middle ear infection often caused by Streptococcus pneumoniae, Haemophilus influenzae (in children <5 y/o), or Streptococcus pyogenes.
• Children with cleft palate, formula-fed infants, and infants are highly susceptible.
• Symptoms: rhinitis, fever, sharp ear pain, ear pulling, increased crying, and disrupted sleep.
• Management: analgesic, antipyretic, decongestant nose drops.

Bronchiolitis

• Inflammation impacts fine bronchioles and small bronchi, typically due to RSV.
• Infants initially exhibit URTI symptoms for 1-2 days.
• Progress to include increased respiratory rate, nasal flaring, intercostal and subcostal retractions, and wheezing.
• Treatments involve adequate hydration, antipyretics, patient isolation; hospitalization for (+) severe distress
• Anti-RSV immunoglobulin is administered.

Viral Pneumonia

• Caused by viruses associated with upper respiratory tract infections: RSVs, myxoviruses, and adenoviruses.
• Initial upper respiratory tract infection progresses to low-grade fever, nonproductive cough, and tachypnea.
• Chest X-rays indicate diffuse infiltrated areas may be present.
• It is a viral infection so antibiotic therapy is unnecessary, and maintain hydration.

Necrotizing Enterocolitis (NEC)

• Intestinal dysfunction affecting approximately 5% of infants in intensive care nurseries.
• Characterized by necrotic patches in the bowel and may leads to paralytic ileus, perforation, and peritonitis.
• Commonly affects the ileum and proximal colon.
• Cause: Unknown but related to immaturity and rate of NEC increases with decreased gestational age.
• radiographs (+) loops of bowel dilated with air.
• Clinical signs: increased abdominal girth, reduced or absent bowel sounds, visible bowel loops, and vomiting.
• Treatment: probiotics, antibiotics, discontinuation of oral feeding, continuous or intermittent gastric suction, and parenteral nutrition.

Infectious Gastroenteritis

• Causes inflammation of stomach, small and large intestines.
• May be viral, bacterial, or parasitic.
• Symptoms: diarrhea, vomiting, irritability, dehydration, abdominal distention, sunken fontanels, poor skin turgor, weak/rapid pulse.
• Stool culture may reveal E. coli and Rotavirus.
• Therapy includes: oral rehydration with Pedialyte or IVF with electrolytes.

Pyloric Stenosis

• Hypertrophy or hyperplasia of the pyloric sphincter causes gastric outlet obstruction.
• Exact cause is unknown.
• Infants (4-6 weeks) vomit immediately after feeding and projectile vomitous that smells sour (+) signs of dehydration
• Diagnosed through observation, ultrasound and endoscopy.
• Treated surgically with laparoscopic pyloromyotomy.

Febrile Seizures

• Seizures related to high fever (38.9-40.0°C).
• Generalized tonic-clonic pattern is common; lasts 15-20 seconds.
• Only lasts 1 to 2 minutes or less.
• Management: ibuprofen or acetaminophen and tepid sponge baths.

Bacterial Meningitis

• Infection of cerebral meninges often from Streptococcus pneumoniae or group B Streptococcus.
• Pathogens spread to the meninges via upper respiratory tract or indirect introduction.
• Long term complications: blindness, hearing impairment, or facial paralysis, hydrocephalus.
• Initial manifestations include headache, positive Brudzinski's and Kernig's signs, bulging fontanelles, poor sucking, weak cry, or lethargy.
• Symptoms progresses to cardiovascular shock, seizures, and nuchal rigidity.
• Confirmed by CSF analysis from lumbar puncture.

Intussusception

• One part of the intestine invaginates into another.
• Children draw up their legs and cry, may vomit.
• In stool and vomitus blood looks like "currant jelly".
• Right upper quadrant may have a palpable mass "sausage shape."
• Diagnosis suggested by history but confirmed via X-ray, MRI, ultrasound, computed tomography.
• Managed by enema (water-soluble solution, barium, or air).

Hirschsprung Disease (Aganglionic Megacolon)

• Absence of ganglionic innervation prevents peristalsis in the lower sigmoid colon.
• Typically affects males.
• Assessment reveals inability to pass meconium, thin appearance, and being undernourished.
• Diagnosis: rectal exam and biopsy.
• Treatment Method" pull-through operation; includes temporary colostomy, followed by bowel repair at 12 to 18 months.

Omphalocele

• Protrusion of abdominal contents through the abdominal wall at umbilicus.
• Organs usually include intestines, sometimes stomach and liver.
• Diagnosed perinatally with sonogram.
• Elevated Maternal Serum-Fetoprotein (MAFP)
• Therapeutic treatment is Total Parenteral Nutrition (TPN).

Esophageal Atresia and Tracheoesophageal Fistulas

• Esophageal atresia involves incomplete formation of esophageal lumen.
• Tracheoesophageal fistula involves an opening between lower esophagus and trachea.
• Esophageal atresia suspected with maternal hydramnios.
• Diagnosed if catheter cannot pass to stomach and X-ray shows coiled catheter in esophagus.
• Position upright, insert nasogastric tube, perform gastrostomy, provide IV fluids, and administer medication/antibiotics.

Atopic Dermatitis (Infantile Eczema)

• Primarily in infants, starts early (2nd month of life) lasting until it is 2 to 3 years old.
• Very pruritic, papular and vesicular skin eruptions with surrounding erythema with extreme itching.
• Clinical intervention includes: eliminate allergenic food, Hydrate the skin, apply wet for 15 to 20minutes, Antihistamine and topical corticosteroids given.

Infantile Hemangiomas (Birthmarks)

• Nevus Flammeus: macular purple or dark-red lesion, and the laser may need to remove and fix issues.
• Strawberry Hemangioma: elevated and created from immature capillaries, rarely needs a surgery, but tends to expand for 1 year with age.
• Cavernous Hemangioma: Dilated vascular spaces appears like a strawberry hemangioma, the MGT is surgery, radiation therapy

Impetigo

• Caused by hemolytic streptococcus, group A; Staphylococcus aureus (bullous).
• Incubation is 2 to 5 days.
• Spreads through direct contact.
• Begins as a single papulovesicular lesion which is surrounded by localized erythema.
• Management involves: oral administration of penicillin, erythromycin or the application of mupirocin (Bactroban) ointment.

Hydrocephalus

• Excessive CSF accumulates in the ventricles or subarachnoid space.
• Communicating hydrocephalus allows CSF to reach spinal cord, while obstructive hydrocephalus blocks circulation.
• Monitor for signs: head enlargement, separated suture lines, bulging fontanelles, prominent scalp veins; administer diuretics, and do a tumor removal.

Trisomy 13 Syndrome

• Presence of an extra chromosome 13.
• Results in cleft palate, midline heart/body disorders and abnormal genitalia.
• Associated with microcephaly, small eyes and low-set ears.

Marfan Syndrome

• Tall and thin appearance with unusually long limbs and digits may indicate Marfan Syndrome.
• Damage affects can be mild or severe.
• Treatment targets specific conditions with medication or surgery.

Genitourinary System Disorder

• Epispadias: urinary meatus is misplaced on the penis's dorsal side.
• Hypospadias: urinary meatus is misplaced on the underside of the penis.
• Occurs in approxiamely 1 out of 300 male newborns.

Cryptorchidism

• Failure of one or both testes to descend into the scrotum.
• Diagnosed through palpating.
• Increased likelihood of decreased fertility.
• Early detection needed to prevent spermatogenesis issues.
• Laparoscopy.

Nephroblastoma (Wilms Tumor)

• Malignant kidney tumor rising from metanephric mesoderm.
• Associated with a gene abnormality.
• (+)Tumor felt as a firm mass.

Congenital Clubfoot (Talipes Disorders)

• Ankle-foot disorders are popularly termed as clubfoot.
• More common among boys than girls.
• Can be classified into plantar flexion, dorsiflexion, varus variants, and valgus variants.
• Treatments include: casts, braces, splints, and passive foot exercises.

Developmental Hip Dysplasia

• Subluxation or dislocation of the head of the femur that cause congenital hip dysplasia.
• Treatment includes hip spica cast and harness bracing.

Sickle Cell Disease

• Autosomal recessive genetic disorder caused by inheritance of hemoglobin S gene from both parents.
• Common symptoms: anemia, pain episodes, swelling hands/feet, frequent infections, vision problems; therapeutic and nursing management is related to a acute abdominal tenderness.

Congenital Hypothyroidism

• (+) Inadequate hormone production by thyroid gland in infants
• Assess for: excessive sleeping with noisy respirations.
• (+) tongue and lack of perspiration
• Low T3 and T4 hormone levels, and elevated thyroid-stimulating factor

Sudden Infant Death Syndrome (SIDS)

• Sudden and unexplained death of a baby younger than 1 year old.
• Autopsy: petechiae in the lungs and mild inflammaiton and congestion in the respiratory tract.
• Nursing Considerations: counsel the parents, and continuous apnea