Normal Vital Signs for Children (Nelson Textbook of Pediatrics, 18th ed.

) Age Heart Blood Respiratory Rate Pressure Rate Prematu 120-170 55-75/35-45 40-70 re 0-3 mos 100-150 65-85/45-55 35-55 3-6mos 90-120 70-90/50-65 30-45 680-120 80-100/5525-40 12mos 65 1-3yrs 70-110 90-105/5520-30 70 3-6yrs 65-110 95-110/6020-25 75 6-12yrs 60-95 100-120/6014-22 75 12yrs 55-85 110-135/6512-18 85

Ability to follow-up 4. Complian t caregiver 3. 2004) Variables 1. Age 7.Pediatric Community Acquired Pneumonia (CPG in the evaluation and management of PCAP. Presence of DHN 5. >60/min >50/min >35/min PCAP D Present No Not Possible Severe Unable <11mos. RR: 2-12 mos 1-5 years > 5 years PCAP A None Yes Possible None Able >11 mos. Ability to feed 6. >70/min >50/min >35/min . Comorbid illness 2. ≥50/min ≥40/min ≥30/min PCAP B Present Yes Possible Mild Able >11mos ≥50/min ≥40/min ≥30/min PCAP C Present No Not Possible Moderate Unable <11mos.

Sensorium None None None None None Awake None None None None None Awake Intercostal/ subcostal Present Present None None Irritable Supraclavicul ar/ Intercostal/ Subcostal Present Present Present Present Lethargy/ Stupurous/ Comatose Present Admit to critical care unit Refer to specialist 9. Complica tions None OPD Follow up at end of treatment None OPD Follow up after 3 days Present Admit to regular ward 10. Apnea f.Sunken eyes . Grunting e.Not able to drink or drinking poorly .8. Cyanosis d.Skin pinch goes back very slowly Sever Dehydration  If child has no other severe classification: . Signs of respiratory failure a. Headbob bing c.Lethargic or unconscious .Give fluid for severe dehydration (Plan C) OR If child also has another severe classification: . Retractio n b.Action Plan Dehydration Classification 2 of the following signs: .

Advise the mother to continue cholera  If child is 2 years or older and there is cholera in your area.Skin pinch goes back slowly Some Dehydration  Give fluid and food for some dehydration (Plan B)  If child also has a severe classification: . give antibiotic for cholera 2 of the following signs: .Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way. Advise the mother to continue breastfeeding  Advise mother when to return immediately  Follow-up in 5 days if not improving . irritable .Refer URGENTLY to hospital with mother giving frequent sips of ORS on the way.Restless. thirsty .Drinks eagerly.Sunken eyes .

Do not use your fingertips because this will cause pain. Pinch the skin for one second and then release it. Firmly pick up all of the layers of skin and the tissue under them. 4 Rules of Home Treatment: Give Extra Fluid. Continue Feeding.Not enough signs to classify as some or severe dehydration No Dehydration  Give fluid and food to treat diarrhea at home (Plan A)  Advise mother when to return immediately  Follow up in 5 days if not improving How to test for skin turgor Locate the area on the child’s abdomen halfway between the umbilicus and the side of the abdomen. decide that the skin pinch goes back slowly. To do the skin pinch. use your thumb and first finger. Give Zinc Supplements. the fold of skin will be in a line up and down the child’s body and not across the child’s body. When you release the skin. look to see if the skin pinch goes back: — very slowly (longer than 2 seconds) — slowly (skin stays up even for a brief instant) — immediately If the skin stays up for even a brief time after you release it. Place your hand so that when you pinch the skin. When to Return .

Continue Feeding . Then continue. Show the mother how much fluid to give in addition to the usual fluid intake: o Up to 2 yrs – 50 to 100 ml after each loose stool and between them 2 yrs or more – 100-200 ml after each loose stool and between them o - Tell mother to o o Give frequent small sips from a cup If the child vomits. but more slowly Continue giving extra fluid until the diarrhea stops o 2.Treatment Plan A 1. Give Extra Fluid Breastfeed frequently Give ORS or clean water in addition to breastmilk Teach the mother how to mix and give ORS. Give Zinc supplements Tell the mother how much Zinc to give o o Up to 6 mos – 10mg elemental Zn per day for 14 days 6 mos or more – 20mg elemental Zn per day for 14 days Remind the mother to give Zn supplements for the full 14 days 3. wait 10 minutes.

9 (30.4. Treatment Plan B Give in-clinic recommended amount of ORS over 4-hour period 75ml/kg body weight Reassess the child after 4 hours and reclassify the child for dehydration then select appropriate plan to continue treatment If the mother must leave before completing treatment o o Show how to prepare ORS Show how much ORS to give to finish 4-hour treatment at home Give enough ORS packets to complete rehydration Explain 4 rules of Home treatment - o o Age-Specific Blood Cell Indices MCHC(g /dL RBC) WBCs (x103/ uL) Platel ets (103/u L) 254 (180327) 275 290 290 Age Hb(g/ dL) HCT (%) MCV( fL) Reticuloc ytes 26-30 wk gestati on 28 wk 32 wk Term 13.0 - 4.5 15.4 (2..2 (106.7) 18. When to return.7 ) 120 118 108 37.1 (5-10) (3-10) (3-7) .5 (34.4(1 1) 14.0 16.6) 31 32 33.. 9) 45 47 51 118.5 41.

5) 11.3) 35.5-1.4 (28.0) Age Hb(g/ dL) HCT (%) MCV( fL) 1218yr Male 14.0) (4.6 (13.8-4.5) 16.0) 31.513.5) 18.5) 8.9 (10.0 (10.5 (14.5-1.5 (515.0) MCHC(g /dL RBC) (1.0) 34.5-1.9 (9.7) 11.5) 7.513.1) 12.5 (11.7) 33.0 (12) 15.1 (4.1) 31.9 (0.4) 12.434) 11.6 (6-17) 8.8 (0.5) 7.0 (31.5 43 (36) 41 (37) 47 88 (78) 90 (78) 90 34.0) 34.0 (31.8 (28.0 (30.5) 13.513.8-2.5) (42) 56 (45) 53 (41) 44 (33) 35 (28) 36 (31) 36 (33) 37 (34) 40 (35) (98) 108 (95) 105 (88) 101 (91) 95 (84) 76 (68) 78 (70) 81 (75) 86 (77) (30.0) 34.2 (9.8 (0.5) 12.1-1.0 (31.0 (29.0) (4.3) (617.4) 13.5 (13) 14.5) 10.0) 6-12yr (0.0) 33.7-2.5 (11.4 (150350) (150350) (150- Female Adult Male .1) 31.6) (9-30) 18.5-1.0 7.6 (11.(cord) 1-3 day 2 wk (13.0) 34.8 (28.0 (31.4 (5-20) 10.5) Reticuloc ytes WBCs (x103/ uL) (150350) (150350) (150350) Platel ets (103/u L) 192 - 252 1 mo (0.8 (419.5) (0.7) - 2 mo 6 mo 6mo2yr 2-6yr (0.0 (32.

50 0.50 Allowance (Kcal/kg/d ay) 115 110 100 100 in Head . A total of 6 or more items from 1.4 (0. 2.5) (4.00 0.511) 350) (150350) Female Growth and Caloric Requirements Ag e Approxim ate Weight gain (g) Approxim ate monthly weight gain 0-3 mo 3-6 mo 6-9 mo 912 mo 1-3 yr 4-6 yr Autistic Disorder A.0 (31.(13.5 1.25 1cm/yr 100 90-100 30 20 15 12 2 lbs 1.2 Lengt Growth in Recommen ded Daily Circumfer ence (cm/mo) 2.8-2.0) 34.5) 14.0) (4. with at least 2 from 1 and 1 each from 2 and 3: 8 6 8 oz 6 oz 1.25 lb 1 lb 13 oz Growt h h (cm/m o) 3.0 3cm/yr 0.0 (12) (41) 41 (36) (80) 90 (80) (31.511) 7.0 1.5 2. and 3.00 1.

Qualitative impairments in communication. as manifested by at least 1 of the following: a. such as gesture or mime) adequate speech. as manifested by at least 2 of the following: a.1. expression. Failure to develop peer relationships appropriate to developmental level c. Lack of varied.g. Sterotyped and repetitive use of language or idiosyncratic language d. or pointing out objects of interest) d. Qualitative impairment in social interaction. facial to postures. such body as eye-to-eye and gaze. interests. by a lack of showing. In individuals through with alternative modes of communication. marked impairment in ability to initiate or sustain a conversation with others c. develppment of spoken language (not accompanied by an attempt to compensate b. Lack of social or emotional reciprocity 2. bringing. gestures regulate social interaction b. or achievements with other people (e. Lack of spontaneous seeking share enjoyment. or total lack of. Delay in. Marked impairment in the use of multiple nonverbal behaviors. spontaneous make-belive play or social imitative play appropriate to developmental level .

and activities. Apparently inflexible adherence to specific. or (3) symbolic or imaginative play C. Restricted. hand or finger flapping or twisting or complex whole body movements) d. as manifested by at least 1 of the following: a.3. Persistent preoccupation with parts of objects B. (1) social interaction. Delay or abnormal functioning in at least 1 of the following areas. The disturbance is not better accounted for by Rett disorder or childhood disintegrative disorder Table 1. and stereotyped patterns of behavior. Encompassing preoccupation with >/= 1stereotyped and restricted pattern of interest that is abnormal in either intensity or focus b. with onset < age 3yr. Comparison of the Current WHO/PPS Case Definition and Case Classification for Dengue with the Proposed 2009 WHO Case Classification .g. nonfunctional routines or rituals c. (2) language as used in social communication. repetitive. interests. Steroetyped and receptive and repetitive motor mannerisms (e.

Evidence of plasma leakage due to increased vascular permeability. injection sites or other locations d. ascites and hypoproteinemia PROPOSED WHO Classification and Levels of Severity 2009 Nonsevere Dengue without Warning signs Probable dengue: live in /travel to dengue endemic area. manifested by at least one of the following: a. occasionally biphasic 2. Petechiae. Sins of plasma leakage such as pleural effusion. Fever. (+) tourniquet test b. GIT. vomiting • Rash • Aches and pains • Tourniquet test positive • Leukopenia Laboratory-confi rmed dengue (important when no sign of plasma leakage) . Hemorrhagic tendencies evidenced by at least one of the following: a. Thrombocytopenia ( 100. or history of fever. and population b. purpura c. AND Supportive serology ( a reciprocal HI antibody titer >1280. sex. lasting for 2-7 days. A rise in the hematocrit equal to or greater than 20% above average for age. Fever and 2 of the following criteria: • Nausea. a comparable IgG assay ELISA titer or (+) IgMantibody test on a late or acute convalescent phase serum specimen Confirmed: A case confirmed by laboratory criteria Case Definition for Dengue Hemorrhagic Fever (DHF) The following must all be present: 1.000 cells/mm3 or less) 4. A drop in the hematocrit following volume replacement treatment equal to or greater than 20% of baseline c.CURRENT WHO Case Definition of Dengue and Levels of Severity (1997) as adapted by the PPS Clinical Practice Guidelines on Dengue 2008 Case Definition for Dengue Fever Probable: an acute febrile illness with 2 or more of the following: Headache Retro-orbital pain Arthralgia Rash Hemorhagic manifestations Leukopenia. ecchymosis. Hematemesis or melena 3. Bleeding from the mucosa.