Common Illnesses of infants and children

1
Common Illnesses of Infants and Children Part 1

• P.Naina Mohamed
• Pharmacologist

2
Introduction

• Common Illnesses of Infants and Children
• Neonatal Hyperbilirubinemia (Physiologic
  Jaundice)
• Colic
• Common cold and flu
• Ear Infection
• Fever
• Nausea and Vomiting
• Spitting up in babies
• Diarrhea
• Diaper rash
• Oral thrush
• Shortness of Breath
• Mouth Problems
• Feeding Problems
• Elimination Problems
• Cradle cap

3
Introduction

• Illnesses discussed in this presentation
• Neonatal Hyperbilirubinemia (Physiologic
  Jaundice)
• Colic
• Common cold and flu
• Cough
• Sore Throat
• Ear Infection
• Fever

4
Neonatal Hyperbilirubinemia

• Neonatal Hyperbilirubinemia (total serum
  bilirubin level above 5 mg per dL (86 µmol per L)
  is one of the most common problems encountered in
  newborns.
• Newborns produce bilirubin at a rate of
  approximately 6 to 8 mg per kg per day.
• Newborns produce twice the rate of adults due to
  increased red blood cell turnover in neonates.
• Bilirubin production typically declines to the
  adult level within 10 to 14 days after birth.
• The average full-term newborn will have a peak
  bilirubin level of 6mg/dl on the third or fourth
  day of life.
• Levels usually go down to about 2-3mg/dl by the
  end of the first week, gradually reaching the
  adult value of 1mg/dl by the end of the second
  week.
• Phototherapy should be initiated when the total
  serum bilirubin level is at or above 15 mg per dL
  (257 mol per L) in infants 25 to 48 hours old, 18
  mg per dL (308 mol per L) in infants 49 to 72
  hours old, and 20 mg per dL (342 mol per L) in
  infants older than 72 hours.
• Jaundice typically results from the deposition of
  unconjugated bilirubin pigment in the skin and
  mucus membranes.

5
Pathophysiology

• Babies in womb need higher Hb (RBCs) to get
  oxygen from mothers blood
• After birth, fetal hemoglobin (Hb) broken down
• Bilirubin is the final product of degradation of
  heme of these extra red blood cells (RBCs)
• Excess bilirubin is removed from the bloodstream
  by the liver and excreted in the stool
• The newborns immature liver may not excrete the
  bilirubin fast enough in the first days after
  birth
• Hyperbilirubinemia (Physiological Jaundice)
  (especially common in premature and low birth
  weight infants and Babies who dont feed and
  stool often enough during the early days )

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Treatment

• Feed the baby early and often.
• colostrum acts as a laxative, and frequent
  stooling lowers bilirubin levels.
• Keep track of urine and stool output
• Avoid water supplements. Only 2of the bilirubin
  is excreted in the urine, and 98 in the stools.
  Colostrum and milk contain fat, which stimulates
  bowel movements, and water can just fill the baby
  up so that he is less interested in nursing.
• Encourage the baby to stay awake and to feed at
  least every two hours. Jaundice makes the baby
  sleepy.
• Supplement with the expressed milk. If the baby
  is sleepy at the breast, and is having fewer than
  three large bowel movements in 24 hours, consider
  expressing the milk after feedings and give it to
  him (preferably not with a bottle at this stage
  he may become confused by rubber nipples if he is
  only a few days old). Use a dropper, syringe,
  cup, or tube-feeding device if possible.
• Expose the baby to indirect sunlight. Undress him
  down to his diaper and put him in a room that
  gets a lot of light. His skin is very sensitive,
  so never put him in direct sunlight.
• Avoid medications such as aspirin and sulfa
  drugs.

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Colic

• Colic is defined as a crying lasts for more than
  3 hours a day, 3 days per week for more than 3
  weeks.
• Colicky babies usually get fussy toward the end
  of the day, but colic can happen at any time.
• Colic affects as many as 25 percent of babies.
  Colic usually starts a few weeks after birth and
  often improves by age 3 months. By ages 4 to 5
  months, the majority of babies with colic have
  improved.

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Possible Mechanisms of Development

• Infants swallow air Mothers diet
  Infants have
• During feeding containing gas
  immature
• and crying producing foods
  digestive
• cabbage,
  boroccoli, system and
• cauliflower,
  volatile lack of probiotics
• chemicals,
  allergens, etc
• Increase gas and Trace elements
  Indigestion
• Bloating passed to the
  baby
• through
  the breast milk
• Gas
  Bloating
• COLIC

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Colic

• Symptoms
• Predictable crying episodes. A baby who has colic
  often cries about the same time every day,
  usually in the late afternoon or evening. The
  crying usually begins suddenly and for no clear
  reason. The baby may have a bowel movement or
  pass gas near the end of the colic episode.
• Intense or inconsolable crying. Colic crying is
  intense and often high pitched. The baby's face
  may flush, and he or she is extremely difficult
  to comfort.
• Posture changes. Curled up legs, clenched fists
  and tensed abdominal muscles are common during
  colic episodes.

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Colic

• Causes
• The cause of colic is unknown. Researchers have
  explored a number of possibilities, including
  allergies, lactose intolerance, an immature
  digestive system, maternal anxiety, and
  differences in the way a baby is fed or
  comforted. Yet it's still unclear why some babies
  have colic and others don't.
• Risk factors
• Infants of mothers who smoke during pregnancy or
  after delivery have a greater risk of developing
  colic.
• Colic doesn't occur more often among firstborns
  or formula-fed babies.
• Complications
• Colic doesn't cause any lasting medical
  consequences. Babies who have colic grow and
  develop normally.

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Colic Treatment

• Drugs
• Colic improves on its own, often by age 3 months.
  
• Some physicians prescribe medications, like
• Simethicone is probably the only harmless
  medication, but it has not been shown to provide
  significant benefit compared with placebo.
• Dicyclomine hydrochloride (Bentyl) was previously
  widely used but was later found to be associated
  with apnea, coma, and death.
• Hyoscyamine sulfate (Levsin) may cause
  anticholinergic toxicity.
• Diphenhydramine (Benadryl) causes sedation but
  may cause paradoxical agitation and should not be
  used in children younger than 1 year old.
• Other drugs that are no longer recommended for
  colic include phenobarbital and paregoric, mainly
  because of the dangerous side effect of
  oversedation.
• Some research suggests that treatment with
  probiotics (substances that help maintain the
  natural balance of "good" bacteria in the
  digestive tract) can soothe colic. More research
  is needed to determine the effects of probiotics
  on colic.

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Colic Treatment

• Alternative medicine
• Some parents report soothing their crying
  infants with alternative remedies. The remedies
  include
• Herbal teas
• Herbal remedies, such as fennel, caraway, ginger,
  aloe vera, peppermint, chamomile, black thorn,
  etc.
• Glucose
• Massage therapy
• Coping and support
• Alternative therapies for colic haven't proved to
  be consistently helpful, however, and some might
  even be dangerous. Talk to your baby's doctor
  before trying any alternative therapies for
  colic.

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Colic Treatment

• Gripe water, has significant amounts of
  bicarbonate that could alter the acid-base
  balance with regular use.
• Honey is contraindicated in infants because of
  the risk for botulism.
• Lifestyle and home remedies
• The baby's doctor may not be able to fix colic or
  make it go away sooner, but there are many ways
  you can try to soothe your baby. Consider these
  suggestions
• Feed the baby
• Feed the baby in an upright position.
• Feed the baby more often and less at a time.
• Avoid feeding the baby too quickly.
• Burp your baby often.
• Empty one breast completely before switching
  sides. This will give the baby more hindmilk,
  which is richer and potentially more satisfying
  than the foremilk, which is present at the
  beginning of a feeding.

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Colic Treatment

• Offer a pacifier
• For many babies, sucking is a soothing activity.
  Even if you're breast-feeding, it's OK to offer a
  pacifier to help the baby calm down.
• Hold the baby
• Cuddling helps some babies.
• Try a baby sling, backpack or other type of baby
  carrier.
• Don't worry about spoiling your baby by holding
  him or her too much.
• Keep the baby in motion
• Gently rock the baby in your arms or in an infant
  swing.
• Lay your baby tummy down on your knees and then
  sway your knees slowly.
• Take a walk with the baby.
• Buckle your baby in the car seat for a drive.
• Use a vibrating infant seat or vibrating crib.

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Colic Treatment

• Sing to the baby
• A soft tune (lullaby) might soothe the baby.
  Recorded music may help, too.
• Turn up the background noise
• Some babies cry less when they hear steady
  background noise.
• When holding or rocking your baby, try making a
  continuous "shssss" sound.
• Turn on a kitchen or bathroom exhaust fan, or
  play a tape or CD of environmental sounds, such
  as ocean waves, a waterfall or gentle rain.
• Sometimes the tick of a clock or metronome does
  the trick.
• Use gentle heat or touch
• Give the baby a warm bath.
• Softly massage the baby, especially around the
  tummy.
• Give your baby some private time
• Put the baby in his or her crib for five to 10
  minutes.
• Consider dietary changes
• If you breast-feed, change your diet by
  eliminating certain foods such as dairy products,
  citrus fruits, spicy foods or drinks containing
  caffeine.
• If you use a bottle, a new type of bottle or
  nipple might help.

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Colic Treatment

• Take a break
• Ask your spouse or partner or another loved one
  to take over for a while.
• Take advantage of baby-sitting offers from
  friends or neighbors.
• Even an hour on your own can help refresh you.
• Express your feelings
• It's normal for parents in this situation to
  feel helpless, depressed or angry.
• Confide in your spouse, partner or other good
  listener.
• Make healthy lifestyle choices
• Eat healthy foods.
• Make time for exercise, such as a brisk daily
  walk.
• Sleep when the baby sleeps even during the day.
• Avoid alcohol and other drugs.
• Remember that it's temporary
• Colic episodes often improve by age 3 months.

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Cold and Flu

• It is Contagious
• No wonder it's called the common cold, the
  average child suffers between six and 10 colds
  per year.
• Symptoms
• sore throat,
• cough,
• sneezing,
• fatigue
• The symptoms can last for a few
  days to a few weeks.
• How it spreads
• Cold viruses reach kids via droplets in the air
  when a sick person coughs or sneezes.
• Kids also pick up colds through direct contact
  with sniffly friends or by touching germy
  surfaces like toys or classroom desks and then
  touching their face, especially their mouth or
  eyes.

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Pathophysiology

• Rhinovirus is typically acquired by direct
  contact
• It binds to human ICAM-1 receptors through
  unknown mechanisms
• Trigger the release of inflammatory mediators
• These inflammatory mediators then produce the
  cold symptoms

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Cold and Flu

• Prevention
• Getting your child a yearly flu vaccine is the
  best way to prevent the flu.
• You can also reduce her risk of cold or flu by
  teaching her to wash her hands frequently with
  soap and warm water.
• Children should also learn to avoid close contact
  and sharing food and utensils with other people.
• Treatment
• Give the baby acetaminophen for pain and fever.
• Plenty of fluids.
• Salt water gargles can ease a sore throat
• Steam helps clear congestion.
• oral honey (in children older than 1 year of age)
• Vapor rub applied to the chest (in children older
  than 2 years)
• Gentle nasal cleansing with OTC normal saline
  nose drops.
• If cold symptoms are
  accompanied by a high fever, severe muscle aches,
  and exhaustion, your child may have the flu. Talk
  to her doctor about other ways to ease symptoms.

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Cold and Flu

• Alternatives to cough and cold medicines for
  infants
• FDA warns Parents of infants about cough and cold
  products in young children, after the 2007
  findings.  
• Well-informed physicians can offer parents a
  variety of alternative treatments for infants to
  help with cough and cold symptoms.  For instance,
  here are some commonly used recommendations
• A cool mist humidifier helps nasal passages
  shrink and allow easier breathing (do not use
  warm mist humidifiers as they can cause nasal
  passages to swell and make breathing more
  difficult)
• Saline nose drops or spray keep nasal passages
  moist and helps avoid stuffiness
• Nasal suctioning with a bulb syringe either with
  or without saline nose drops, works especially
  well for infants less than a year old. Older
  children often resist its use
• Acetaminophen or ibuprofen can be used to reduce
  fever, aches and pains. Parents should carefully
  read and follow the products instructions for
  use label
• Drinking plenty of liquids will help the child
  stay well hydrated.

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Cold and Flu

• Antihistamine/Decongestant combinations HAVE BEEN
  BANNED BY THE FDA FOR CHILDREN lt 2 YEARS OF AGE.
  THE ACADEMY OF PEDIATRICS STRONGLY RECCOMENDS
  AGAINST THE USE OF THESE PRODUCTS IN PATENTS lt 6
  YEARS OF AGE. SIDE EFFECTS FROM THESE MEDICATIONS
  RESULT IN 1000's OF ER VISITS AND 100's OF
  DEATHS/YEAR!
• THE ACADEMY OF PEDIATRICS STRONGLY RECCOMENDS
  AGAINST THE USE OF COUGH SUPPRESSANTS SUCH AS
  DEXTROMETHORPHONE (DELSYM) AND CODEINE FOR
  NIGHTIME COUGH CONTROL IN CHILDREN. THESE
  PRODUCTS ARE OF QUESTIONABLE EFFICACY AND CAN
  CAUSE UNPREDICTABLE RESPIRATORY DEPRESSION
  LEADING TO DEATH WHEN GIVEN IN AMOUNTS THAT
  EXCEED RECOMMENDED DOSAGES.
• ORAL OR NASAL SPRAY DECONGESTANTS ARE NO MORE
  EFFECTIVE THAN PLACEBO IN THE RELIEF OF COLD
  SYMPTOMS AND ARE CAPABLE OF CAUSING SERIOUS SIDE
  EFFECTS INCLUDING DEATH. THEY ARE NOT RECOMMENDED
  FOR CHILDREN UNDER 12 YEARS OF AGE.
• Other products promoted for the relief of cold
  symptoms that are of unproven efficacy include
  Guafenisin (Mucinex), Echinacea, Ipatropium
  Bromide Nasal Spray, Zinc and the use of
  vaporizers.
• Signs and symptoms with a cold that would
  suggest the need for a physician visit include
• significant fever beyond 48 hours
• severe irritability
• poor fluid intake
• severe cough consistently interfering with sleep
  and/or causing vomiting
• elevated respiratory rate and
• persistence of troublesome respiratory symptoms
  continuously beyond ten days.

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Coughs

• Cough is a protective mechanism to protect the
  airways from harmful irritants.
• If the child is feeding, drinking, eating and
  breathing normally and theres no wheezing, a
  cough isnt usually anything to worry about.
• If the child has a bad cough that wont go away,
  see your GP.
• If the child also has a high temperature and is
  breathless, they may have a chest infection. If
  this is caused by bacteria rather than a virus
  your GP will prescribe antibiotics to clear up
  the infection. Antibiotics wont soothe or stop
  the cough straight away.
• If a cough continues for a long time, especially
  if its worse at night it could be a sign of
  asthma. Some children with asthma also have a
  wheeze or breathlessness.
• coughing helps clear away phlegm from the
  chest or mucus from the back of the throat.
• Try a warm drink of lemon and honey for the baby
  more than 1 year.

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Pathophysiology

• Cold
• Mucous trickling down the back of the throat
• Stimulation of Cough receptors
• Impulses are transmitted along the
  glossopharyngeal nerves to the cough center of
  medulla
• Initiation of cough
• Efferent impulses to the abdominal muscles,
  intercostal muscles, diaphragm, glottis and vocal
  cords
• Deep inspiration
• Glottis and vocal cord closes
• Diaphragm relaxes
• Abdominal muscles and intercostal muscles
  contract

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Sore throats

• A sore throat is also known as pharyngitis.
• Paracetamol or ibuprofen can be given to reduce
  the pain.
• Most sore throats clear up on their own after a
  few days.
• If the child has a sore throat for more than four
  days, has a high temperature and is generally
  unwell, or is unable to swallow fluids or saliva,
  see your GP.
• Avoid food or drink that is too hot as this could
  irritate your throat.
• Eat cool, soft food and drink cool or warm
  liquids.
• Adults and older children can suck lozenges, hard
  sweets, ice cubes or ice lollies.
• Avoid smoking and smoky environments.
• Regularly gargle with a mouthwash of warm, salty
  water to reduce any swelling or pain.

25
Possible mechanism

• Cold or Flu
• Heavy breathing to meet oxygen demand
• Drying of mucosal membranes of respiratory tract
• Sore throat (Pharyngitis)

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Ear infections

• Ear infection is not Contagious. But children can
  catch colds, which make ear infections more
  likely.
• Most children have at least one middle ear
  infection by age 2.
• A child may pull or rub at an ear
• Prevention
• Help the child keep a healthy distance from
  people who are sick
• wash his hands frequently.
• Avoid exposing him to cigarette smoke, which can
  increase the risk of ear infection.
• Treatment
• If the child has pain and fever from an ear
  infection, give acetaminophen to make him
  comfortable and see a doctor.
• Dont put any oil, eardrops or cotton buds into
  your childs ear unless your GP advises you to do
  so.
• Most ear infections are caused by viruses, which
  cant be treated with antibiotics. They will just
  get better by themselves.

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Possible Mechanism

• Colds or allergies
• Bacteria grows in a child's middle ear
• Blocking the eustachian tubes, which connect the
  middle ear to the throat
• Ear infection
• Pain, fever, and sometimes, difficulty hearing

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Fever

• Fever is a very common symptom of illness all
  through infancy and childhood. 
• Young children are notorious for having high
  fevers with minor viral illnesses more often than
  adults do the reason for this is not known, but
  it is true. 
• Fever is defined as a temperature greater than
  101 degrees Fahrenheit.  The range from 100
  degrees Fahrenheit to 101 degrees Fahrenheit is a
  gray or intermediate zone that must be
  interpreted in the light of the childs overall
  condition.
• If your baby is under 3 months old and has a
  temperature of 100.4 degrees F (38 degrees C) or
  higher, call the doctor immediately. A baby this
  young needs to be checked for serious infection
  or disease.
• If your baby is 3 months old or older, the most
  important thing is how he looks and acts. If he
  appears well and is taking fluids, there's no
  need to call the doctor unless the fever persists
  for more than 24 hours or is very high.
• if your baby's fever reaches 104 degrees, call
  the doctor regardless of symptoms.
• The American Association of pediatrics (AAP)
  suggests calling the doctor if a baby is between
  3 months and 6 months old and has a fever of 101
  degrees F (38.3 degrees C) or higher, or is older
  than 6 months and has a temperature of 103
  degrees F (39.4 degrees C) or higher and has
  symptoms such as a loss of appetite, cough, signs
  of an earache, unusual fussiness or sleepiness,
  or vomiting or diarrhea.

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Mechanism of Development of Fever

• Microorganisms (Bacteria, Virus)
• WBCs nearby the site stimulates the release
  pyrogens
• Release of Prostaglandin E2 (PGE2)
• PGE2 acts on hypothalamus (Thermostat) to
  increase the set point
• Vasoconstriction of
  Induce shivering
• Skin blood vessels
  
• Reduction of heat loss
  Muscle movements
• Retain more Heat
  Generation of Heat
• Elevation of body temperature (Fever)
• Fight against infection (Assist the healing
  process)

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Fever

• Immediately call the doctor if
• The baby is noticeably pale or flushed, or has
  fewer wet diapers.
• The notice an unexplained rash, which could
  indicate a more serious problem when coupled with
  a fever. Small, purple-red spots that don't turn
  white or paler when you press on them, or large
  purple blotches, can signal a very serious
  bacterial infection.
• The baby has difficulty breathing (working harder
  to breathe or breathing faster than usual) even
  after you clear his nose with a bulb syringe.
  This could indicate pneumonia or bronchiolitis.
• The baby seems sick and his temperature is lower
  than normal (less than 97 degrees F/36 degrees
  C). Very young babies sometimes become cold
  rather than hot when they're ill.
• extreme and persistent irritability
• disorientation
• prolonged inconsolability
• bulging fontanel (soft spot)
• stiff neck persistently rapid breathing
• persistently blue or mottled skin color
• prolonged decreased fluid intake and/or signs of
  dehydration
• pinpoint red skin rash which does not blanche
  (disappear) when the skin is pulled taut.

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Fever

• Measuring Temperature
• Temperature may be measured under the arm
  (axillary) or rectally in infants under six
  months of age. 
• Beyond six months, if the temperature is not over
  101 degrees Fahrenheit in a child who feels very
  warm with axillary reading, this reading should
  be confirmed with a rectal temperature.
• Ear thermometers should be adjusted to the
  rectal setting if there seems to be a
  discrepancy between the ear reading and how warm
  the baby feels, reconfirm the reading with a
  mercury thermometer.
• These thermometers can give erratic readings due
  to the fact that it may be difficult to aim the
  sensor directly at the tympanic membrane or from
  interference from ear wax in the external ear
  canal.
• The newest technology is the temporal artery
  thermometers which read a core temperature
  analogous to the rectal temperature.
• some children have febrile convulsions which
  often occur at the onset of an illness as the
  temperature rises very abruptly often before the
  parent is aware that the child is ill. 
•  When dealing with a febrile infant or child it
  is much more important to assess the nature and
  severity of the underlying illness. 
• If a child is alert, making eye contact, is
  consolable in the parents arms and is able to
  take fluids it is likely that the child has a
  mild illness for which symptomatic therapy is all
  that is necessary initially. 

32
Fever

• Treatment
• Acetaminophen (3 months to 1 year 60-125mg, 1-5
  years 125-250mg, 5-12 years 250-500mg. Doses
  may be repeated every 4-6 hours)
• Ibuprofen (Not to be used under 6 months of age,
  6 months -1 year 50mg, 1-4 years 100mg, 4-7
  years 150mg, 7-10 years 200mg, 10-12 years
  300mg. Doses may be repeated every 8 hours). 

33
References

• CURRENT Diagnosis Treatment Pediatrics, 21e
  William W. Hay, Jr., Myron J. Levin, Robin R.
  Deterding, Mark J. Abzug, Judith M. Sondheimer
• Pediatric Clinical Advisor Instant Diagnosis
  and Treatment , Second Edition
• Lynn C. Garfunkel, Jeffrey M.
  Kaczorowski, and Cynthia Christy

34
References

• http//www.cdc.gov/parents/infants/diseases_condit
  ions.html
• http//www.nlm.nih.gov/medlineplus/commoninfantand
  newbornproblems.html
• http//www.nichd.nih.gov/health/topics/infantcare/
  conditioninfo/Pages/basics.aspx
• http//children.webmd.com/treating-common-illness-
  10/slideshow-infant-symptoms
• http//www.clinicalpediatrics.com/Management-of-Co
  mmon-Illnesses-of-Infants-and-Ch.html