Pedi Facts


Feeding

Newborn
  • Newborn - 110Kcal/kg/day
  • 12 Month - 10 Kcal/kg/day
  • q2-3h, monitor Urine output & wt. gain.
  • Max. overnight interval - 4 hr.
  • Signs of hunger: suckling of hand or fingers, arm movement towards mouth = feed baby now.
 

Weight Gain

Avg DAILY Weight Gain
Age Ounce Grams
0-3 Mo 1 oz 26-31 gm
3-6 Mo 1/2 oz 17-18 gm
6-9 Mo 1/3 oz 12-13 gm
9-12 Mo 1/4 oz 9 gm
1-3 yr 1/4 oz 7-9 gm
4-6 Yr 1/8 - 1/4 oz 6 gm
Avg. MONTHLY weight gain
Age Pounces Kg
0-3 Mo 2.2 lb/mo 1 kg/mo
3-6 Mo 1.1 lb/mo 1/2 lb/mo
6-9 Mo 3/4 lb/mo 1/3 lb/mo
9-12 Mo 1/2 lb/mo 1/4 lb/mo
Avg. YEARLY Gain in Length
Years Inches Centimeters
1st year 9 in/yr 25 cm/yr
2nd year 4.5 in/yr 12.5 cm/yr
3 yrs - puberty 2 in/yr 5-6 cm/yr
Puberty 4.5 in/yr 12.5 cm/yr
 

When to operate?

Cleft lip with or without cleft palate
  • Associated w/ alcohol use during pregnancy
  • Tx: Surgery @ 10 lb, 10 wks of age, 10 g of Hb.

Inguinal hernia

  • Elective Repair ASAP

Undescended testies

  • Surgical/Urology referral @ 6 Month of age.

 

ITE 2013, Q#171.
 A 6-month-old male is brought in for a routine checkup. Only one testicle is palpable. The genital examination is otherwise within normal limits.
Which one of the following would be most appropriate at this time?

A) Observation only, until 18 months of age
B) Abdominal ultrasonography
C) Urologic referral for surgical exploration
D) HCG treatment for 3 months

ANSWER: C

  • Treatment for a unilateral undescended testis should be started at 6–12 months of age to avoid testicular damage. It was once thought that delaying descent lowered the incidence of testicular cancer, but it is now believed that orchiopexy allows for early cancer detection.
  • HCG treatment may promote descent into the distal canal, but the testicle often ascends again. Hormonal treatments have been used in Europe but randomized, controlled trials have not shown them to be effective.
  • Ultrasonography will not show an undescended testis in many cases and is therefore not recommended.
 

Lead poisoning:

  • S/S: Anorexia, decreased activity, irritability, vague abd. pain & insomnia.
  • Test: CBC, Serum iron & ferritin, Retic count. Lead level  

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Delayed Puberty:

  • Most common cause: Constitutional
  • No testis enlargement by 14yr age   
    OR
  • Testis 2.5 cm or less in diameter   
    OR
  • Delay in development for 5 years or more from onset of genital enlargement.
    • Next step --> determine bone age (x-ray left wrist) --> if bone age older or equal to chronological age --> r/o chromosomal & endocrine causes.
 

Battery ingestion

  • In the esophagus -- Endoscopic removal
  • In the stomach -- will pass on it's own.
 

Infant Polycythemia

  • Infant Polycythemia = Hct > 65%

Positional Skull Deformity

  • The deformity can be prevented by routine switching of the dependent side of the infant’s head.
  • Supervised “tummy time” for 30–60 minutes each day can also decrease the amount of flattening and can increase the child’s motor development.
  • Children who have positional skull deformity should also be screened for torticollis.
    • This condition can prevent correct positioning and is remedied with physical therapy techniques
  • Most infants with positional skull deformity improve within 2–3 months with the institution of positional changes and tummy time.
    • If the condition does not significantly improve after this amount of time, referral to a pediatric neurosurgeon with expertise in craniofacial malformations would be appropriate.