PEDS NOTES:

- Stranger anxiety 6 mo, peaks 8-9 mo and resolves by age 2

- Separation anxiety: 18-24 mo
- Infant does not respond to name by 12 mo sign for early autism
- Acute hemiplegia in children
o Seizure:
 Symptoms self resolve
 TODD paralysis: self limited focal weakness or paralysis that occurs
after a focal r generalized seizure
 Resolves within 36 hrs
o Intracranial hemorrhage
 History of trauma or bleeding disorders (hemophilia)
 Signs of increased ICP (vomiting, bradycardia)
o Ischemic stroke
 History of prothrombic disorder (anti-thrombin III def) or cardiac disase
PFO
 Focal neurologic deficit (hemiplegia, aphasia, ataxia)
o Hemiplegic migraine
 Onset in adolescence and often positive family history
 History of hA and visual aura
 Symptoms resolve
- JIA is a RF for septic arthritis because underlying oint inflammation predisposed to
bacterial seeding

GI:
- SANDIFER SYNDROME:
o TORTICOLLIS with arching of the back caused by painful esophagitis
- Diagnosis of GERD
o Ph probe: esophagitis ph monitored for 18 hr
o Bronchoscopy with alveolar lavage: performed when aspiration expeted
- Pancretitis in children
o Blunt trauma (most common)
o Infections
 Mumps
 Enterovirus
 EBV
 HIV
 Hep A and Hep B
 Drugs and toxins
 Congential anomalie and obstructions
 Sle or CF
 Idiopathic pancreatitis 25%
o Clx
  Grey turner sign and Cullen sign: bluish discoration of the flanks and
periumbilical area
o Increased amylase also from: gastritis, reeated vomiting, renal failure
o Serum lipase more specific
o COMPLICATIONS
 Formation of pancreatic pseducyst
 Small resolves on own, large surfical drainage
 ARDS
 RF
 SHOCK
 GI bleed
- Cholestatis: in children with sickle cell or CF
- Iron deficiency anemia in celiacs because  pooor iron absorption  deudonal atrophy
- Why is GERD more popular in infants
o Shorter esophagus
o Incomplete closure of the LES
o Greater time spent in supine position
- Biliary atresia
o age 2-8 wk
o MX
 US of right upper quad
 Abnormal/absent gullbladder
 Absent common bile duct
 Triangular cord sign (fibrous remnants seen aboe the porta
hepatis)
 Liver biopsy: to extinguish from other cholestatic conditions like Alagille
syyndroe
 Revels:
o Intrahepatic duct proliferation
o Portal tract edema
o Fibrosis
 Gold standard: intraoperative cholangiography
o Tx:
 Hepatoportenterstomy (kasai procedure)
- Volvulus
o <1 years
o Bilious vomiting
o Initially the abdomen is soft and distended  ischemia twisted bowel can cause
bloddy stools and bowel perforation, abdominal distention and peritonitis
o Predisposing factor is MALROTATION
o Treatment:
 Cessatinon of enteral feeds, nasogatric tube decompression, IV fluids
 XRAY rule out pneumoperitonum
  Intestation per and emergency surgery
 If no evidence of free air and bowel gas pattern is not suggestive of
duodenal atresia or distal obstruction then an upper GI series should be
performed. Then an
 DX:
 upper GI series (barium swallow) should be performed.
 Upper GI series is the fastest and most accurate method of
diagnosing malrotation with midgut volvuls
o MALROTATION: FINDING OF LIGAMENT OF TREITZ ON
THE RIGHT SIDE OF THE ABDOMEN
o VOLVULUS: Corkscrew pattern
 TX:
 Ladd prodceudre: fixing the bowel in the non-rotated postion to
reduce the risk of recurrent voluvus
- Jejnum atresia
o Etiology:
 Vascular accident in utero causes necrosis and resorption of the fetal
intestine leaving behind blind proximal and distal ends of intestine
o RF: poor gut perfusion
 Vasoconstrictive meds by mon
 Coke and tobacoo
o DX
 Triple bubble
o Tx:
 Rusucitation and stabilitzion surgical correction
U world: 12/15 wrongs

- Causes of pediatric stroke

o Sickle cells #1
o Prothrombotic disorders
o Congential cardiac disase
o Bacterial meningitis
o Vasculitis
o Focal cerebral arteriopathy
o Head and neck trauma
- What are postural deformities that are associated with prenatal positioning:
o Developmental dysplasia of the hip
o Metatarsus adductus
o Clubfoot
o Muscular tortociollus
 Frontal bossing, ear displaced anteriorly, right occipital flattening,
occipital bossing
 Evident from birth medical attention at age 1-6 mo
- Cystic hygromas:
 o Congential lymh malformation locate in the postierior triangle of the neck
 Aneuploidy assoiated
 Fluctuant mass that transilluminates
o Hypothenuria:
 Inability of the kidenys to concentrate urine
 Low specific gravity
 Sicle cell trait
- Alpha reductase defieicney
o Cant convert testrsterone to DHT TESTERONE IS NORMAL
o XY with female or undervirilized external genitalia
- Androgen insensitity
o XY undervirilized, ambiguous or female external genitaila
- CAH
o XX WITH excess androgen leading to virilizationof gentypically female infants
- Placental aromatase def
o Conversion of placental androgens into estrogens
o Virulization of fetus and mom
- Sertoli Leydig

- Pneumothorax

o Hemodynampically stable  CXR

o Unstable em thoracstomy
- Posterior urethral valve
o Reduced urine output
o Distended bladder
o Weight gain
o Respiratory distress  oligohydramnios  lung hypoplasia  post natel
respiratory distress
KASABACH-MERRITT SYNDROME:
- Hemangiomas, thrombocytopenia, consumptive coagulopathy
- Infrequent but fatal complication of rapidly growing vascular lesion in infants
Cold septic shock: septic shock that turned into cardiogenic shock (myocardial dysfunction from
inflame cytokine)
- Dopamine increase CO  INCREASE RBF