PEDIATRICS

● ↑ head circumference
OUTLINE ○ Fluid in the brain deposits into the
I. Neurologic Disorders F. Heart Failure cranium
A. Increased ICP III. Gastrointestinal ○ Na goes, water follows; ↑ fluid, ↑
B. Seizure Disorders pressure
Disorder/Epilepsy A. Cleft lip VS Cleft ○ Put tape measure at the bedside;
C. Head Trauma Palate measure q8
II. Cardiovascular B. Hirschsprung's ○ E.g., hydrocephalus
Disorders Disease
● Headache
A. Patents Ductus IV. Normal Pedia
Arteriosus A. Infancy ○ Nerves are compressed due to
B. Septal Defects B. Toddler pressure > pain
C. Coarctation of C. Preschooler ○ An initial sign of ↑ ICP (headache
Aorta D. Schooler is first; communicated through
D. Tetralogy of Fallot E. Adolescent crying by infant)
E. Rheumatic Heart ● Projectile vomiting
Fever
○ Medulla is compressed > triggers
CTZ (chemoreceptor trigger
zone)–vomiting center > vomit
NEUROLOGIC DISORDERS reflex
A. Increased ICP
○ Possible cerebral edema causes
● Pressure inside the brain
compression of medulla
● Normal pressure: 5-15 mmHg (mmHg
● Diplopia
always talks about pressure)
○ Presence of double vision
● Cushing’s Triad (hyper brady brady)
○ ↑ ICP > ↑ IOP (intraocular
○ HTN > bradycardia > bradypnea
pressure) proximity to the brain >
○ Opposite of Shock Triad
optic nerve damaged > blurring of
● Widened pulse pressure
vision > blindness
○ Difference of systolic and diastolic
● Pupillary changes
○ Normal pulse pressure: 30-40
○ Normal: PERRLA (Pupil is equal,
○ Example: BP 120/80 = 40 pulse
round, reactive to light and
pressure
accommodation)
Signs and symptoms
○ Can experience three (3):
● Bulging fontanels
1. Anisocoria: uneven pupils
○ Infants has 2 fontanels
2. Dilated: big pupils (shock)
■ Anterior: bigger, diamond,
3. Constricted: small pupils
12-18 mos closed
(narcotic overdose)
■ Posterior: smaller,
● Sunset eyes
triangular, 2-3 mos closed
○ Pressure in the brain pushes eyes
○ ↑ ICP > fontanels won’t close
downward
○ Aggravated by crying
● Anorexia, nausea, weight loss
■ Minimize crying
○ Infants should gain weight only
● High pitch cry
● Seizures
○ Universal language of infants is
1. ↑ Neural impulses > erratic
crying
transmission of electrical impulses
○ An early sign of ↑ ICP
> seizures
2. Vomiting > ↓ fluid level >
Early signs of ↑ ICP per age group dehydration > ↑ temp > convulsion
Infant: high pitch cry
> seizures
Child: irritability and agitation
Adult: restlessness Management
Geriatric: confusion ● Position: semi Fowlers

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 PEDIATRICS
○ HOBE to drain fluid > ↓ ICP by
gravity
● Coughing and sneezing is avoided
○ Can aggravate pressure going up to
the brain
● Limit fluid intake by 1200-1500 ml/day
○ Normal: 2000-3000 ml/day
○ ↓ fluid = ↓ pressure
Pharmacotherapy
1. Diuretics: both potassium-wasting; release
excess fluid
● Mannitol: generalized,
osmotic-osmosis-pooling
● Lasix: localized, loop diuretic
● WOF: hypokalemia
2. Decadron (Dexamethasone): steroid;
anti-inflammatory
● Prevent cerebral edema
3. Anticonvulsants
● Prevent seizure episodes
4. Antacids
● Neutralize acidity due to stress >
hydrochloric acid & prolonged use
of decadron > GI ulceration
● Mg based: diarrhea
● Al based: constipation
5. Anticoagulants
● Prevent clumping of blood
● ↑ ICP > ↑ BP/flow > rupture
vessels > bleeding > clotting >
thromboembolism > dislodge
● Heparin: IV/SubQ; ptt (partial
thromboplastin time)
● Warfarin: oral; pt (prothrombin
time)
★ Opiates and sedatives are contraindicated:
depressants already (↑ICP is Cushings, may
cause cardiac and respiratory depression)
B. Seizure Disorder/Epilepsy
● Erratic transmission of electrical impulses >
alternating contraction and relaxation of muscle
movement
Types of seizure
1. Grand Mal (generalized)
● Has 2 phases
● Tonic clonic: mild to severe
contractions; period during seizure
○ Position: flat/supine, to
protect the head
● Post ictal: exhaustion phase; period
after seizure
○ Position: side lying, to
prevent aspiration of
retrieved saliva
2. Petite Mal/Absent seizure
● Small body part seizure
● Not obvious
● (+) Blank facial expression
● (+) Automatisms: repeated
purposeless behavior
● (+) Lips smacking
3. Jacksonian
● Tonic clonic of a group of muscle
then grand mal
● 1 body part > whole body
4. Psychomotor seizure
● Not common in pedia
● Mental clouding/intoxication
● “Hallucinating”
5. Febrile
● Most common in pedia
● Under 5 seizure: underdeveloped
hypothalamus > cannot regulate
body’s temperature
6. Status epilepticus
● Most dangerous
● Can last for 30 minutes
● On & off or continuous
● Can cause brain damage–a form of
emergency
★ Primary: use medications to control seizure;
but not all types are controlled
★ Secondary: surgery
Management
● Hydantoin/Phenytoin: for seizures
○ WOF: gingival hyperplasia
○ Use soft bristle toothbrush
○ Have meticulous oral care
○ Inform SO: (+) pinkish red urine as
normal side effect
● Benzodiazepines: “pam”/”lam”
○ Relaxants
○ Minimize seizure episodes
● Iminostilbenes: Carbamazepine
○ For refractory/recurring seizures
○ Prevent seizure recurrence
● Valproates: Valproic acid
○ Last resort only
○ Side effect: hepatotoxicity
○ Pedia has immature liver
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 PEDIATRICS

○ Never given in pregnancy (1st ● Parietal: outer

trimester) – can cause neural tube ● Pericardial space: pericardial fluid prevent
defect friction rub – prevent pericarditis
● Surgery: Neurectomy Chambers of the Heart
○ Cranial nerve removal
○ Surgical resection of the cranial
nerve involved in the seizure
C. Head Trauma
● Common to children
2 Types:
● Concussion
○ Jarring of the brain;
nabagok/nakalog
○ Sudden forceful contact in a rigid
skull
○ Transient loss of consciousness due
to head traumatic injury
● Ductus arteriosus: point of intersection of aorta and
● Contusion
pulmonary artery; (+) mix of blood
○ Bruising
Congenital Heart Conditions
○ Bukol
● Acyanotic: (-) cyanosis; no bluish color; one problem
○ Structural alteration caused by
in the heart
extravasation of blood
● Cyanotic: (+) cyanosis; bluish; has two or more
Management
problems in the heart
● Safety (Prevention)
A. Patent Ductus Arteriosus (PDA)
○ Wear bike helmets, seat belts, safe
● Ductus arteriosus not closing
driving for parents
● Acyanotic, (-) blue
○ Infant car seat
● (+) mixing of blood
■ < 3 yrs old: rear facing to
● Oxygenated blood > unoxygenated
protect spine
Signs and symptoms
■ > 3 yrs old: front/forward
● Machinery-like murmur
facing booster seat
○ pathognomonic/hallmark;
● Assess cerebral functioning
distinguishing characteristic
○ GCS/PERRLA
● s/sx of heart failure
○ LOC: most important prognostic
○ Looks normal and acyanotic at first
(chances of surviving) indicator; ↓
because heart is still compensating
LOC = ↓ survival
○ Until heart gets tired > s/sx of HF
● Assess cervical neck injury
● Poor feeding through sucking
○ (+) neck injury: immobilize to
○ Pedia needs oxygen to suck
prevent further damage
properly
○ (-) neck injury: HOBE 30 degrees
○ (+) easy fatigue
to ↓ ICP by gravity
● Poor weight gain
○ 6 mos: birth weight is doubled
CARDIOVASCULAR DISORDERS
○ 1 yr: birth weight is tripled
Layers of the Heart
● Irritability
1. Endocardium: innermost
○ Cerebral hypoxia
2. Myocardium: muscle; cannot be controlled
○ ↓ O2 in the brain > ↓ LOC
● Responsible for contraction of the heart and
Management
cardiac output
● Drug of choice: Indomethacin
● ↓ CO = ↓ tissue perfusion
○ Facilitate closure of PDA
3. Pericardium: outermost
● Second option: Ibuprofen
● Visceral: inner
B. Septal Defects

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PEDIATRICS

● ASD: atrial septal defect ○ Angioplasty: repair of artery

● VSD: ventricular septal defect ○ Stent: scaffolding; support; made of
● (+) hole in septum > blood bypass mesh; extending; forever
● Acyanotic; it’s only either ASD or VSD, (-) ○ Through jugular/femoral
blue ○ Deflated balloon with stent is
● Oxygenated blood > unoxygenated inserted > inflated in the narrowed
○ PA is still bigger than hole defect area
so there’s more blood going to the D. Tetralogy of Fallot
lungs for oxygenation ● Cyanotic; (+) blue
○ Osmosis and diffusion: lungs pulls ● Unoxygenated blood > oxygenated
more blood ● 4 Questions:
Signs and symptoms 1. Primary problem?
● Fatigue > poor feeding > poor weight gain 2. Compensatory mechanism?
● Dyspnea on exertion 3. Allows mixing of blood?
○ Activity intolerance 4. Keeps the patient alive?
● Failure to thrive ● 4 Problems:
○ Delayed milestone 1. Pulmonary stenosis
○ s/sx of heart failure 2. Right ventricular hypertrophy
Management 3. Overriding of aorta
● Surgery by suture 4. Ventricular septal defect
○ Bypass, not an open surgery
○ For small hole only
○ Through large vessel:
jugular/femoral
● Dacron patch
○ Big hole
○ 2 types:
■ Tissue: normal flora; ↓
rejection rate; favorable
but can tear
■ Plastic: foreign; ↑
rejection rate; last resort if
tissue tears
Signs and symptoms
C. Coarctation of Aorta
● Cyanosis
● Acyanotic, (-) blue
○ Altered tissue perfusion
● Oxygenated blood > unoxygenated
● Squatting
● Narrowing of descending aorta
○ Allow child to squat
● ↑ pressure = ↓ output; sumisirit
■ ↓ venous return (blood
Signs and symptoms
from body to heart) > ↓
Upper Lower cardiac workload >
extremity extremity cardiac rest
■ Conserves O2 to the upper
BP increased decreased
body area (vital organs)
pulse bounding weak/absent ● Tet spells (pathognomonic sign)
○ Group of s/sx that represents ↓ of
●Rib notching > rib deformity
oxygenation
○ Narrow aorta > heart compensates
○ Has irritability, blackouts (↓O2 to
> strong contractions > deform rib
brain > hypoxia > ↓LOC), pallor
(soft bone) > heartbeat can be seen
(↓O2 in blood > hypoxemia),
Management
convulsions
● Balloon angioplasty with coronary stenting
● Cardiomegaly

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PEDIATRICS

○ Overworked RV > enlarged RV not overwork

● Clubbing > (-) hypertrophy
○ Long standing ↓ O2 > chronic ○ Dacron patch:
hypoxia close VSD > (-)
● Pan systolic murmur overriding of
○ Pan: pangkabuuan aorta
○ (+) murmur in every contraction ★ Palliative is for infants
Diagnostics who cannot tolerate
● 2D Echo: (+) boot shaped heart Brocks yet
Management ★ Blalock (subclavian) is not
● Allow child to squat removed
○ Form of compensation E. Rheumatic Heart Fever
● Surgery ● Infectious; (+) bacteria
1. Palliative ● Cause: GABHS (Group A Betahemolytic
● Relieves signs and Streptococcus)
symptoms only ○ Can also cause sore throat or AGN
● Goal: oxygenated blood > (Acute Glomerulonephritis)
unoxygenated ● Jones Criteria
● Blalock taussig shunt: ○ To know if (+) RHF or not
anastomosis (pagdugtong) ○ Either: 2 major symptoms + Hx or
of pulmonary artery and 1 major symptom + 2 minors + Hx
aorta using subclavian
artery to bypass the
Major Minor
stenosis
○ RV > AO > PA > 1. Carditis: due to 1. Low grade fever
osmosis & infection 2. Arthralgia: painful
diffusion > lungs 2. Polyarthritis: diff joint but no swelling
● 4 problems still present joints inflamed 3. Elevation of ASO
3. Chorea (St. Vitus titer:
Dance): worm-like - Antistreptolysin
fingers - O titer
4. SubQ nodules: - GABHS
seen in bony areas; specific
knuckles, elbows, - If ↑ ASO titer:
knees can also cause
5. Erythema sore throat &
marginatum: red AGN
trunk 4. Elevation of
inflammatory markers:
- C-reactive
CHON
- ESR
(erythrocyte
sedimentation
rate)
2. Curative
● Cures the condition; Management
resolves the problems ● DOC: Penicillin
● Intracardiac ○ 5-10 days duration: should still
surgery/Brocks finish duration to avoid drug
procedure: 2 surgeries resistance
○ Balloon ○ If (+) allergy:
angioplasty: Clindamycin/Erythromycin
dilates stenosis >

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PEDIATRICS

○ If (+) exacerbation & remission: ○ Tachycardia: compensation and

treatment is continued up to 10 early sign
years – follow up, monitoring, etc. Diagnostic
per month; antibiotic; change ● Chest x-ray: Cardiomegaly
dosage/route ● 2D Echo
● Salicylates (ASA): for pain and swelling; ○ Hypokinetic heart (↓ movement of
Aspirin heart due to tachycardia); late sign
○ 4 As of Aspirin ● Pulse oximetry:
■ Antiplatelets ○ ↓ O2 Sat: concentration of oxygen
■ Antipyretics in the blood
■ Analgesics: pain ○ (+) HF = ↓ O2 Sat
■ Anti-inflammatory: ● PCWP (Pulmonary Capillary Wedge
swelling Pressure)
★ Monitor bleeding ○ (+) LSHF
● Corticosteroids: to relieve carditis ○ Normal: 4-12 mmHg
F. Heart Failure ● CVP (Control Venous Pressure)
● Heart fails to contract ○ (+) RSHF
● Insufficient cardiac output (↓CO = ↓ ○ Normal: 8-12 mmHg
oxygenation) Management
Two sides: ● Fowler's position: HOBE > maximize lung
1. RSHF (right side) expansion > ↑ O2
● RV damage > RA damage > ● Administer high O2: Venturi mask (precise
systematic and accurate)
2. LSHF (left side) ● Inotropic drugs: strengthens heart
● LV damage > LA damage > lungs > contractions > ↑ CO > promotes cardiac rest
pulmonary ● Lanoxin/Digoxin
Signs and symptoms ○ Monitor digoxin toxicity (NAVDA)
● RSHF (systemic) ■ Nausea, Anorexia, Visual
○ Peripheral/dependent pitting edema disturbances/Vomiting,
○ Weight gain Diarrhea, Abdominal
○ Distended neck vein (JVD) cramps
■ R side > SVC > jugular ○ Antidote: Digibind or Digoxin
○ Hepatomegaly immune fab
■ Liver: most sensitive if (+) ● Urine output & intake monitoring
poor circulation and ○ Due to (+) fluid retention
pressure ● Record daily weight
○ Portal HTN ○ (+) fluid retention > ↑ weight
■ Complication: esophageal ○ Same time, clothes, weighing scale,
varices, ascites, patient
hemorrhoids ● Edminister diuretics
○ Body weakness (body malaise: ○ Release excess fluid > (-) edema
feeling only)
○ Anorexia, nausea
● LSHF (pulmonary) GASTROINTESTINAL DISORDERS
○ Dyspnea on exertion: activity A. Cleft Lip VS Cleft Palate
intolerance
○ Orthopnea: cannot breathe properly
Cleft Lip Cleft Palate
when lying
○ Crackles/rales Heredity
○ Cough
● Both RSHF & LSHF Common in Maternal Common in

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PEDIATRICS

males smoking females

Problem
Problems ● Failure to pass meconium for the first 24-48
hours
- Difficulty of Speech problem ● Imperforated anus
feeding Diagnostics
- Risk for ● Barium enema
aspiration
- Risk for ○ (+) megacolon seen
infection ● Rectal biopsy (confirmatory)
(URTI) ○ Actual tissue is being studied
○ (-) ganglionic cells seen
Responsibilities Surgery
● Swenson Pull Through
Large nipple: Training cap/ Medicine
○ End to end
- Synthetic dropper:
- ↑ nipple = ↑ suction - Precise fluid flow anastomosis with
- Crisscross cut > ↓ effort - Rubber tip: avoid temporary
to suck > ↑ output traumatizing palate colostomy
○ One end will be
Surgery exposed first
(colostomy) to
Cheiloplasty Monitor Palatoplasty/Pala heal both end >
● Surgical frequent torrhaphy anastomosis
repair of CL swallowing ● Rule:
○ 1-3 mos, max 6 mos
● Rule of 10: ● Swallowin Not too
(qualitficatio g reflex > early Management (Post op)
n) (+) bleed > (reopen) ● Colostomy care
10 weeks call for Not too late ○ Habang lumalapit sa pwet
10 pounds physician (speech bumabaho/tumitigas
10,000 problem)
WBC 18-24 mos:
10g/dL hgb learning to RIGHT TRANSVERSE LEFT
● Position post speak starts
op: ● Position post ● Liquid ● Mushy ● Solid
Position on op: ● Without odor ● Semi solid, ● With odor
unaffected Prone to ● Irrigation: semi liquid ● Irrigation:
side drain NO ● Slight odor YES
If bilateral: ● Continue ● If ↑ liquid: ● Continue
HOBE flat appliance of irrigate appliance of
bag: YES ● If ↓ liquid: bag: YES
NO Infant has no
B. Hirschsprung's Disease bowel training
★ Wedding song: Hirschsprung’s disease > If adult: NO
Megacolon > Aganglionic > Ribbon-like stool
● AKA: Congenital Aganglionic Megacolon
10 Herbal Medicines Approved by the DOH
Cause
(SANTA LUBBY)
● Aganglion: absence of ganglion cells/nerves
● Sambong: SADA
● Ganglion: responsible for peristalsis
● Akapulko: Akati > Fungal
● Niyog-niyogan: Uod > Antihelminthic
● Tsaang Gubat: Tyan > Stomach
● Ampalaya: DM II
● Lagundi: ASthma COugh Fever
● Ulasimang Bato: Uric acid > gouty arthritis
● Bawang: Anti HTN
● Bayabas: Antiseptic

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PEDIATRICS

● Yerba Buena: Rheumatoid arthritis ○ Major rule: (1) audible timer (2) 1
★ RA 8423: Medicine(8) Para(4) Sa(2) Tao(3) minute per year of age
★ Play: Parallel play: side by side play; play
together but different type; no borrowing
NORMAL PEDIA ★ Fear: separation anxiety
A. Infancy (0-1 year old) C. Preschooler (3-6 years old)
Erikson ● Highest imagination
● Trust vs Mistrust Erikson
● Basic needs > build infant’s trust ● Initiative vs Guilt
○ With consistency ● Allows them to participate with therapeutic
Freud use of play
● Oral Freud
● Mouth > risk for aspiration ● Phallic
● Satisfy oral needs: pacifier, feeding, teethers ● Complexes – Attention
Piaget ● Masturbation is normal
● Sensory motor ● Oedipal: baby boy likes mother more
● Learning through senses ● Electra: baby girl likes father more
● ↑ senses = ↑ learning Piaget
○ Rattles, mobiles ● Preoperational
Kohlberg ● Egocentric but has symbols
● None
● Eg., stick > sword
★ Play: solitary play
★ Fear: stranger anxiety Kohlberg
B. Toddler (1-3 years old) ● Preconventional (self only)
Erikson ★ Play: associative/cooperative play
● Anatomy vs Shame & Doubt ★ Fear: body mutilation/castration (wound)
● Offer choices D. Schooler (6-12 years old)
Freud Erikson
● Anal ● Industry vs Inferiority
● Anus > toilet training Freud
● Criteria for readiness for toilet training ● Latent (same sex orientation)
○ Sit and squat ● Boys vs Girls
○ Remain dry for two hours Piaget
○ Verbalize need to defecate and ● Concrete operational (Logical)
urinate Kohlberg
○ Willingness to please parents ● Conventional
○ Solid diapers > changed ● Want to be good to the eyes of others
immediately ★ Play: competitive (indoor): board games
★ 2 factors above only > achieved ★ Fear: death
toilet training E. Adolescent (12-19 years old)
★ Attitude and approach of parents Erikson
should have consistency and ● Identity vs Role Confusion
patience ● Focus: body image
Piaget Freud
● Pre-operational ● Genital
● Egocentric: inability to see other’s point of ● Sexual curiosity
view ● Sexual questions
Kohlberg ● Experimentations
● Preconventional Piaget
● Punishment & obedience ● Formal operational
● Best punishment: timeout (face the wall) ● Hypothetical
● Abstract thinking; (+) rationalizing

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PEDIATRICS

Kohlberg
● Post conventional
● Morals
● Laws
● Responsible
★ Play: competitive (outdoor): sports
★ Fear: peer rejection