Pediatrics Review Notes

Breastfeeding

• Benefits to mother: improved postpartum weight loss, delayed onset of menses, decreased breast and ovarian cancer risk, and cost-effectiveness
• Benefits to baby: immune protection, cognitive development, decreased SIDS risk, and possibly decreased risk of diabetes, atopy, and acute lymphoblastic leukemia/acute myeloid leukemia
• Composition: 20 kcal/oz (0.67 kcal/mL), high in IgA in colostrum, high in fat in hind milk, and 60:40 whey-to-casein ratio
• Contraindications: mother with HIV, mother receiving cytotoxic chemotherapy or radiation, infant with galactosemia (PKU is not an absolute contraindication)
• Recommendations: exclusive breastfeeding until 6 months, with 400 IU/day vitamin D, and continued breastfeeding along with solids until 2 years and beyond

Infant Nutrition

• First complementary foods should be iron-rich
• Introduce lumpy textures no later than 9 months to avoid aversions
• Responsive feeding: cue-based feeding, promote finger feeding, and open cups
• Cow's milk-based, iron-fortified formula can be introduced around 9-12 months, with a maximum of 750 mL/24 oz daily
• Avoid honey until 12 months due to botulism risk, and avoid added salt, sugar, and juice
• Promote healthy eating habits with a regular schedule, and encourage parents to role-model healthy eating
• For high-risk infants, introduce common allergens (e.g., peanuts, eggs) early (around 4-6 months), in appropriate textures, and maintain for tolerance

Pediatric Growth, Obesity, and Screens

• Use WHO growth curves
• BMI categories: overweight (≥85th percentile), obesity (≥97th percentile), and severe obesity (≥99.9th percentile)
• Obesity management: multi-disciplinary, with a focus on "5-2-1-0" rule (5+ fruits/veggies, ≤2 hours recreational screens, 1+ hour physical activity, and 0 sugar drinks)
• Optimize sleep

Allergy

• Non-IgE food allergy (FPIES): profuse vomiting, pallor, lethargy, and hypotension within 1-4 hours of ingestion, with a peak incidence between 2-7 months
• FPIAP (previously CMPA): intermittent mucous/bloody stools in otherwise well infants, with a strict elimination diet required for both baby and mother
• Mastocytosis: rare condition with excessive mast cells, presenting with urtication and increased tryptase levels
• Vaccine allergy: rare, but can occur with large local reactions
• Allergic rhinitis: generally due to environmental allergies, with treatment involving antihistamines, nasal steroid sprays, and montelukast
• Pollen-food allergy syndrome: localized IgE-mediated reaction, with no need for an EpiPen
• Poison Ivy: type IV hypersensitivity reaction, with onset usually within 4-96 hours, and treatment involving high-potency topical steroids
• Hereditary angioedema: episodic angioedema without itch or urticaria, with a high risk of airway compromise

Toxicology

• Four main toxidromes: cholinergic, anticholinergic, sympathomimetic, and opioid
• Cholinergic toxidrome: DUMBBELLS (diaphoresis, urination, miosis, bronchorrhea, bradycardia, emesis, lacrimation, lethargy, salivation)
• Anticholinergic toxidrome: "mad as a hatter, hot as a hare, blind as a bat, dry as a bone, red as a beet" (confusion, hyperthermia, mydriasis, dry mouth, urinary retention, flushed skin)
• Sympathomimetic toxidrome: up and wet (mydriasis, diaphoresis, hypertension, tachycardia, hyperthermia, psychosis)
• Opioid toxidrome: bradycardia, hypotension, respiratory depression, pinpoint pupils, coma
• Decontamination: activated charcoal, intravenous lipids, and specific antidotes
• Other toxins and toxicities: hydrocarbons, diabetes medications, acetaminophen, salicylates, iron, and cannabinoids

Burns and Submersion Injuries

• Submersion injuries: often preventable, with a higher risk in males, particularly in children under 9 years old
• Burns: superficial partial thickness burns, with a focus on calculating the percentage of total body surface area (TBSA) affected
• Electrical injuries: high-tension wires can cause extensive damage, with a risk of rhabdomyolysis, CNS injuries, and fatal arrhythmias
• Inhalational injuries: suspect in the setting of singed nasal hairs, soot in the airway, and hoarseness, with a risk of CO, CN-, and HCl poisoning

Child Maltreatment

• Risk factors: having a caregiver who is a victim of intimate partner violence, as well as other child-specific, caregiver-specific, and household-specific factors
• Child maltreatment and adverse childhood experiences (ACEs) predispose to worse health outcomes
• Physical examination in cases of sexual abuse is often normal or nonspecific
• Hymenal injuries: hymenal notches can be normal if above 3 and 9 o'clock or below these positions, but without extending to the base of the hymen