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Common Illnesses of infants and children

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Title: 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 )

6
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.

7
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.

8
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

9
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.

10
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.

11
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.

12
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.

13
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.

14
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.

15
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.

16
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.

17
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.

18
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

19
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.

20
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.

21
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.

22
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.

23
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

24
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)

26
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.

27
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

28
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.

29
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)

30
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.

31
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
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