VITAL SIGNS AT VARIOUS AGE

AGE HR BP RR
Premature 120-170 55-75/ 35-45 40-70
0-3 mos 100-150 65-85/ 45-55 35-55
3-6 mos 90-120 70-90/ 50-65 30-45
6-12 mos 80-120 80-100/ 55-65 25-40
1-3 yr 70-110 90-105/ 55-70 20-30
3-6 yr 65-110 95-110/ 60-75 20-25
6-12 yr 60-95 100-120/ 60-75 14-22
12 (*) yr 55-85 110-135/ 65-85 12-18

MNEMONICS FOR WEIGHT

Infants < 6 months old Wt. in grams= (age in mos x 600) + BW
Infants 6-12 months old Wt. in grams= (age in mos x 500) + BW
≥ 2 years old Wt. in Kg= (age in year x 2) + 8
6 to 12 years old Wt. in Kg= ((age in year x 7) – 5) / 2

MNEMONICS FOR HEIGHT

Height in 1st year = 1.5 x birth length
Height in 2nd year= 30 inches or ½ of mature height (boys)
Height in 3rd year = 36 inches (3 ft)
Height in 4th year = 40 inches or 2 x birth length
Height in 13th year = 3 x birth length
Height in cm = (age in years x 5) + 80
 IMMUNIZATIONS Provided that last dose is 3 months apart from
BCG last dose
Intradermal Influenza
< 12 months: 0.05 ml Intramuscular or Subcutaneous
> 12 months: 0.1 ml February – June
HBV 2 doses separated by 4 weeks
Intramuscular HAV
1st dose: at birth (within 24 hours): 0.5ml Intramuscular
2nd dose: 1 month Recommended at 12 months
3rd dose: 6 months 2nd dose: 6-12 months from 1st dose
4th dose: 3rd dose given < 6 months; No birth Rotavirus
dose given; Preterms, < 2 kg Monovalent: oral, 2 doses, 3 weeks – 14 weeks
Measles Vaccine (<15weeks), minimum
Subcutaneous interval: 4 week, not later than 24 weeks
9 months but can be given as early as 6 months Pentavalent: oral 3 doses
MMR Typhoid
12 months Intramuscular
Booster: 4-6 years old History of travel
Given earlier: 4 weeks apart Exposure to Salmonella typhi
MMR + Varicella 2 years old, repeat every 2-3 years
Subcutaneous
12-15 months
Booster: 4-6 years old
RECOMMENDED ENERGY and NUTRIENT INTAKE PER DAY (RENI)
From 0-18 years old
Population Group Weight (kg) Energy (kcal) Protein (g)
Infants, mos 69 560 9
Birth - <6 720 14
6- <12
Children, y 13 1070 28
1-3 19 1410 38
4-6 24 1600 43
7-9
Males, y 34 2140 54
10-12 50 2800 71
13-15 58 2840 73
16-18 59 2490 67
19-29 59 2420 67
30-49 59 2170 67
50-64 59 1890 67
65+
Females, y 35 1920 49
10-12 49 2250 63
13-15 50 2050 59
1618
TPN Estimated Blood Volume
Compute for electrolytes first (Na, K, Ca, AA) Age Total Blood Volume (ml/kg)
AA of milk = 10.48 x volume of feeding/1000 Preterm 90-105
AA of milk – AA required = AA TPN Term 78-86
1-12 mos 73-78
Feeding 1-3 years 74-82
Breastmilk: 20 cal/30ml or 1 oz. 4-6 years 80-86
Formula: 24 cal/3oml or 1 oz. 7-18 year 83-90

TPR of Newborns WHO Treatment Plan for Dehydration

BW 1-2 3-4 7-30 Plan A ORS
days days days <24 months 50-100ml 500ml/day
<750 g 100-250 150-300 120-180 2-10 years 100-200ml 1000ml/day
750- 80-150 100-150 120-180 10 years or As 2000ml/day
1000g more tolerated
1000- 60-100 80-150 120-180 Plan B Moderate or Some Dehydration
1500g ORS to be given in the 1st 4 hours
>1500g 60-80 100-150 120-180 * 75ml/kg BW
Plan C Severe Dehydration: IV
Blood component Replacement 100ml/kg PLRS or PNSS
Volume of PRBC’s = EBV (ml) x DHCT – Actual <12 mos Older
HCT of PRBC’s (0.55) 30ml/kg 1 hr 30 mins
70ml/kg 5 hours 2 1/2hours
CLASSIFICATION of SEX MATURITY STATES in GIRLS
SMR STAGE PUBIC HAIR BREASTS
1 Preadolescent Preadolescent
2 Sparse, lightly pigmented, Breast and papilla elevated as
straight, medial border of labia small mound; diameter of
areola increased
3 Darker, beginning to curl, Breast and areola enlarged, no
increased amount contour separation
4 Coarse, curly, abundant, but Areola and papilla form
less than in adult secondary mound
5 Adult feminine triangle, spread Mature, nipple projects, areola
to medial surface of thigh part of general breast contour

CLASSIFICATION of SEX MATURITY STATES in BOYS

SMR STAGE PUBIC HAIR BREASTS
1 None Preadolescent
2 Scanty, long, slightly pigmented Enlarge scrotum, pink, texture
altered
3 Darker, starting to curl, small Larger
amount
4 Resembles adult type, but less Larger, scrotum dark
quantity, coarse, curly
5 Adult distribution, spread to Adult size
medical surface of thigh
DRUGS EMPIRIC DOSE FREQUENCY PREPARATION
AMIKACIN IV / IM: 15-22.5 mkd Q8
AMOXICILLIN 30-50 mkd TID 50/1
40-80 mkd 100mg/ml - drops
40: for virgin PN 125/5
cases 250/5 - suspension
AMPICILLIN 100-200 mkd Q6 125/5
250/5
CEFACLOR 20-40 mkd BID-TID 125/5 187/5
/Q8 250/5 375/5
CEFALEXIN 25-100 mkd Q6 125/5
250/5
CEFIXIME 6-8 mkd BID 100/5
20/1
CEFTAZIDIME IV: 90-150 Q8
CEFTRIAXONE IM/IV: 50-75 mkd BID
CEFUROXIME O: 20-40 BID/Q12 125/5 (750mg/vial)
I: 75-150 Q8 250/5
CETIRIZINE <6y: 0.25 OD 2.5/ml
>6y: 5-10 5/5
CHLORAMPHENICOL O: 50-75 QID 125/5
CLARITHROMYCIN O: 15 mkd BID 125/5
250/5
COTRIMOXAZOLE 6-8 BID 400/80/5
200/40/5
CLOXACILLIN O: 50-100 QID 125/5
IV:100-200 Q4/Q6
CO-AMOXICLAV 30-50 mkd Q12 156.25/5
20-40 mkd BID 228/5ml
25-40 mkd TID 312.5/5 – 250mg
BID Amox
457/5 – 400mg Amox
DIAZEPAM IV: 0.04-0.2 Q2-4 1/1
PO: 0.12-0.8 mkd Q6-8 5/1
Rectal: 0.5
DIPHENHYDRAMINE 1mkd Stat 6.25/5
5 mkd Q6 12.5/5
DILOXANIDE 20-40 mkd TID
ERYTHROMYCIN 30-50 mkd Q6-8
FUROSEMIDE 1-2 mkd
GENTAMICIN 7.5 mkd Q8 10/1
IV: 5-8 40/1
IBUPROFEN 5-10 Q6 100/5
200/5
INH (ISONIAZID) 10-15 QID 50/5
MEROPENEM 60
METRONIDAZOLE 35-50 TID 125/5
15-20 Giardia
OXACILLIN 50-100 mkd Q6 250/5
IV: 100-200 Q4/Q6
PARACETAMOL 10-20 Q4 100/1 -drops
120/5
250/5
PEN G NA 100,000-400,000 ukd Q4-6
300,000-400,000 ukd
–
meningitic dose
PIPERACILLIN <6y: 150-300 mkd IV
TAZOBACTAM >6y: 300-400 mkd IV
PPA (PHENYL 12 BID-TID 12.5/5
PROPANOLAMINE) 250/5
PYRAZINAMIDE 15
RANITIDINE O: 2-4 IV: 2-6
RIFAMPICIN 10-20
SMX-TMP 6-8 mkd BID 200/40/5
ZINC 10: < 6 months old OD 55/5
20: > 6 months old
GENERIC BRAND PREP EMPIRIC DOSE FREQUENCY
ALUMINUM HYDROXIDE MAALOX <6 mos: 0.5ml QID
+ MAGNESIUM >6 mos: 1ml
HYDROXIDE
ALUMINUM HYDROXIDE MAALOX <6 mos: 0.5ml QID
+ MAGNESIUM PLUS >6 mos: 1ml
HYDROXIDE +
SIMETHICONE
AMBROXOL HCL AMBROLEX 30mg/5ml Wt x 0.2 TID
15mg/5ml
7.5mg/1ml
AMOXICILLIN HIMOX 250mg/ 5ml 30-50 mkd TID at
GLOBAPEN 100mg/1ml lowest dose
BID at high
dose
AZITHROMYCIN PEDIAZITH 200mg/5ml 10mkd OD
100mg/1ml
BROMPHENIRAMINE + PEDIATAPP Wt x 0.2 TID
PHENYL ZEDITAPP
PROPANOLAMINE
BACILLUS CLAUSII ERCEFLORA 1-2 plastic tube BID
BETAMETHASONE + TRIDERM BID for 2 weeks
GENTAMYCIN +
CLOTRIMAZOLE
BROMHEXINE BISOLVON 2mg/ 1ml Wt x 0.2
4mg capsule
CEFACLOR RITE MED 250mg/ 5ml 20-40mkd Q8
125mg/5 ml
50mg/1ml
CEFALEXIN CEFALIN 250mg/ 5ml 25-100mkd Q6
125mg/5ml
100mg/1ml
CEFIXIME TERGECEF 100mg/5ml Infant: 8mkd Q12
20mg/1ml Acute UTI: Q12 for 1st
16mkd day
8mkd Q24 for 13
days
CEFTRIAXONE XTENDA 1gm + 10ml vial 1-5mos: 100- Q6
200mkd Q6
>/=6mos-child:
150-200mkd
CEFUROXIME KEFOX 750mg/vial Neonates: 50- Q12
250mg/vial 100mkd Q8
Children: 75-
150mkd
CETIRIZINE DIHCL ALNIX 5mg/5ml <6y/o: 2.5mkd OD
>6y/o: 5-10mkd
CETIRIZINE + ALNIX PLUS 5mg/5ml >6y/o: 5 <6y/o: OD
PHENYLEPHRINE 2.5mkd -10mkd
CHLORAMPHENICOL CHLOROCAIRE 125mg/5ml </= 2kg: 25mkd Q12 OD
PALPITATE >2kg: 50mkd
CHLORPHENAMINE + DISUDRIN WT X 0.2
PHENYLEPHRINE
CHLORPHENAMINE + DYNATUSSIN WT X 0.2
DEXAMETHASONE +
GUAIFENESIN +
PARACETAMOL +
PHENYLPROPANOLAMINE
CLOXACILLIN RITE MED 125mg/5ml 25-50mkd QID
CO-AMOXICLAV NATRAVOX 250mg/625mg/ <3mos: 30mkd BID
(AMOXICILLIN + AUGMENTIN 5ml >3mos: 20- TID
CLAVULANIC ACID) 625mg/tab 40mkd BID
25-45mkd
DIPHENHYDRAMINE BENADRYL 12.5mg/5ml 5mkd Q6
DOMPERIDONE VOMETA 5mg/5ml Wt x 0.2
5mg/1ml
FERROUS SULFATE + Ferlin drops 15ml Premature: 2- OD-BID
FOLIC ACID + B Ferlin syrup 120ml 4mkd OD-TID
COMPLEX Child: 3-6mkd
GENTAMYCIN + COMDIDERM BID for 2 weeks
BETAMETHASONE +
CLOTRIMAZOLE
GENTIANE RADIX SINUPRET Wt x 0.2
IBUPROFEN DOLAN 200mg/5ml 5-10mkd Q6
100mg/5ml
forte
LEVETIRACETAM KEPPRA 100mg/5ml 10-30mkd BID
500mg/tab
MUPIROCIN FUSKINA TID for 7
OINTMENT days
MUPIROCIN + FUSKINA BID for 2
BETAMETHASONE B weeks
MONMTELUKAST MONTAIR 4mg 6mos-5yrs: OD
5mg 4mg
10mg 6-14yrs: 5mg
>14yrs: 10mg
MOMETASONE ELICA OD
FUROATE
RACECADOTRIL HIDRASEC 10mg/sachet 1.5mkd TID
30mg/sachet
100mg/cap
RACEMIC 2.25% 0.5ml <4yrs: Q1-2
EPINEPHRINE via nebulizer 0.05mkd + 3ml Q3-4
NSS over 15
min PRN
>4yrs:
0.5ml/dose
+3ml NSS over
15 mins PRN
RIFAMPICIN KIDZKIT 3 200mg/5ml 10mkd OD
ISONIAZID + (1st 2 200mg/5ml 10mkd
PYRAZINAMIDE mos) 250mg/5ml 15mkd
RIFAMPICIN KIDZKIT2 200mg/5ml 10mkd 10mkd
ISONIAZID 200mg/5ml
SALBUTAMOL + PECOF WT X 0.2
GUIAFENASIN+
BROMHEXIN
ZINC OXIDE + Calmo TID for 3-5
CALAMINE septine days
ZINC SULFATE E-Zinc 55mg/5ml
27.5mg/1ml
ZINC SULFATE + PEDZINC 10 elemental
VITAMIN C zinc
 MODIFIED GLASGOW COMA SCALE FOR INFANTS AND CHILDREN
Area Infants Children Score
Assessed
Open spontaneously Open spontaneously 4
Eye Open in response to verbal stimuli Open in response to verbal stimuli 3
Opening Open in response to pain only Open in response to pain only 2
No response No response 1
Coos and babbles Oriented, appropriate 5
Irritable cries Confused 4
Verbal Cries in response to pain Inappropriate words 3
Response Moans in response in pain Incomprehensible words or 2
nonspecific sound
No response No response 1
Moves spontaneously and Obeys commands 6
purposefully
Withdraws to touch Localizes painful stimuli 5
Withdraws in response to pain Withdraws in response to pain 4
Motor
Responds to pain with decorticate Responds to pain with flexion 3
Response
posturing (abnormal flexion)
Responds to pain with decerebrate Responds to pain with extension 2
posturing (abnormal extension)
No response No response 1
Normal Heart Rate by Age (beats/minute) Normal Blood Pressure by Age (mm Hg)
Reference: PALS Guidelines, 2015 Reference: PALS Guidelines, 2015
Awake Sleeping Systolic Diastolic
Age Age Pressure Pressure
Rate Rate
Birth (12 h, <1000 g) 39-59 16-36
Neonate (<28 d) 100-205 90-160
Birth (12 h, 3 kg) 60-76 31-45
Infant (1 mo-1 y) 100-190 90-160
Neonate (96 h) 67-84 35-53
Toddler (1-2 y) 98-140 80-120
Infant (1-12 mo) 72-104 37-56
Preschool (3-5 y) 80-120 65-100
Toddler (1-2 y) 86-106 42-63
School-age (6-11 y) 75-118 58-90
Preschooler (3-5 y) 89-112 46-72
Adolescent (12-15 y) 60-100 50-90
School-age (6-9 y) 97-115 57-76
Preadolescent (10-11 y) 102-120 61-80
Normal Respiratory Rate by Age
Adolescent (12-15 y) 110-131 64-83
(breaths/minute)
Reference: PALS Guidelines, 2015
Normal Respiratory Normal Temperature Range by Method
Age Reference: CPS Position Statement on
Rate
Infants (<1 y) 30-53 Temperature Measurement in Pediatrics, 2015
Toddler (1-2 y) 22-37 Method Temperature (°C)
Preschool (3-5 y) 20-28 Rectal 36.6-38
School-age (6-11 y) 18-25 Ear 35.8-38
Adolescent (12-15 y) 12-20 Oral 35.5-37.5
Axillary 36.5-37.5
 PRIMITIVE REFLEXES
REFLEX APPEARS AT DISAPPEARS AT
Suck Birth 3 mos
Root Birth 3 mos
Monro Birth 4-6 mos
Tonic Neck Birth 6-7 mos
Babinski Birth 2 years
Landau 3 mos 12 mos
Parachute 7-9 mos Persists throughout
life
Walking/ Birth 6 weeks
Stepping
Palmar grasp Birth 5-6 mos
Galant Birth 4-6 mos
Swimming Birth 4-6 mos
Babkin Birth
Palmomental Present in various neurologic conditions such as Down’s
syndrome
Shout/ pouting Infancy 1 year
 DEHYDRATION
SYMPTOMS MINIMAL OR MILD NTO MODERATE SEVERE
NONE (3-9% Loss of BW) (>9% BW)
(<3% Loss of BW)
Mental Status Well; alert Normal, fatigued or Apathetic, lethargic,
restless, irritable unconscious
Thirst Drinks normally, Thirsty; eager to drink Drinks poorly; unable
might refuse to drink
liquids
Heart Rate Normal Normal to increased Tachycardia with
bradycardia in most
severe cases
Quality of Pulse Normal Normal to decreased Weak, thread, or
impalpable
Breathing Normal Normal; fast Deep
Eyes Normal Slightly sunken Deeply sunken
Tears Present Decreased Absent
Mouth and Tongue Moist Dry Parched
Skinfold Instant recoil < 2 secs >2 secs
Capillary refill Normal Prolonged Prolonged, minimal
Extremities Warm Cool Cool; mottled, cyanotic
Urine Output Normal to Decreased Minimal
decreased
 CLINICAL CORRELATES OF DEHYDRATION
Severity Fluid Deficit in ml/kg SIGNS
Infants Adolescents
Typically minimal findings but
may have slightly dry, buccal
MILD 50 (5%) 30 (3%)
mucus membranes, increased
thirst, slightly decreased UO
Dry buccal mucus membranes,
tachycardia, little or no UO,
MODERATE 100 (10%) 50-60 (5-6%)
lethargy, sunken eyes and
fontanelles, loss of skin turgor
Same as moderate plus a rapid
thread pulse, no tears, cyanosis,
SEVERE 150 (15%) 70-60 (7-6%) rapid breathing, delayed capillary
refill, hypotension, mottled skin,
coma

HOLLIDAY SEGAR METHOD

0-10 kg 100ml/kg
10-20 kg 50ml/kg
>20kg 20ml/kg
** total ml/kg divided by 24 hours
< 10y/o or < 40kg: D5IMB
> 10y/o or >40kg: D5NM
 RECOMMENDED ENERGY and NUTRIENT INTAKE PER DAY (RENI) From 0-18 years old
Population Group Weight (kg) Energy (kcal) Protein (g)
Infants, mos
Birth - <6 6 560 9
6- <12 9 720 14
Children, y
1-3 13 1070 28
4-6 19 1410 38
7-9 24 1600 43
Males, y
10-12 34 2140 54
13-15 50 2800 71
16-18 58 2840 73
19-29 59 2490 67
30-49 59 2420 67
50-64 59 2170 67
65+ 59 1890 67
Females, y
10-12 35 1920 49
13-15 49 2250 63
1618 50 2050 59
 Epinephrine
Neonate
Asystole and Bradycardia
0.1 – 0.03 mkdose 1:10,000
0.1 – 0.3 ml/kg/dose IV/ET
Infants and Children
1st dose: 0.01 mg/kg 1:10,000
0.1 ml/kg max dose: 1 mg (10ml)
ET
Uncuffed in patients ≤ 8 y/o
Age in years + 4 (uncuffed)
4 + 3 (cuffed)
16 + age/4
Depth: 3x FT size
Dopamine
IVRF x (dopa) x 60
800 or 400
800 – 1 cc dopa + 49cc D5W
400 – 0.5 cc dopa + 49 cc D5W
Anion Gap
[Na] – ([HCO3] + [Cl])
Normal: 12 meqs/L (range: 8-16meqs/L)
Increased Anion Gap
DKA
Renal Failure
Lactic acidosis
Hyperglycemic Nonketotic Coma
Disorders of AA metabolism
Large amount of Penicillin
Salicylate poisoning
Ethylene glycol/methanol ingestion
Decreased Anion Gap
Nephrotic syndrome
Lithium ingestion
Multiple myeloma
 Z-SCORES
Length/Height Weight for
Weight for AGE BMI for Age
for AGE Length/Height
Above 3 Very tall Use weight for OBESE
Above 2 length, BMI for age OVERWEIGHT
NORMAL chart
Above 1 POSSIBLE RISK OF OVERWEIGHT
Median
NORMAL
Below -1
Below -2 STUNTED Underweight WASTED
Severely Severely
Below -3 SEVERELY WASTED
Stunted Underweight

CRITERIA FOR DISCHARGE

All of the following must be met:
1. No fever for at least 24-48 hours
2. Improvement in clinical status (general well-being, appetite, hemodynamic status, urine output,
no respiratory distress)
3. Stable hematocrit
4. Increasing trend of platelet count (usually preceded by rising WBC)
 pCAP C pCAP D
PEDIATRIC COMMUNITY ACQUIRED pCAP A or B
Pneumonia I Pneumonia II
PNEUMONIA CLASSIFICATION Non-Severe
SEVERE VERY SEVERE
VARIABLES
CLINICAL
1. Dehydration NONE MILD MODERATE SEVERE
2. Malnutrition NONE MODERATE SEVERE
3. Pallor NONE PRESENT PRESENT
4. Respiratory rate
 3 to 12 mos ≥50/min to ≤60/min >60/min to ≤ 70 >70/min
 1 to 5 y/0 ≥40/min or ≤ 50/min >50/min >60/min
 > 5 y/o ≥30/min or ≤ 35/min >35/min >35/min
5. Signs of respiratory failure
a) Retraction NONE IC/ Subcostal Supraclavicular/IC/SC
b) Head bobbing NONE PRESENT PRESENT
c) Cyanosis NONE PRESENT PRESENT
d) Grunting NONE NONE PRESENT
e) Apnea NONE NONE PRESENT
f) Sensorium NONE IRRITABLE Lethargic/ Stuporous/
Comatose
Diagnostic aid at site-of-care
1. Chest X-ray findings of any of the
ff: effusion, abscess, air leak, or NONE PRESENT PRESENT
lobar consolidation
2. Oxygen saturation at room air
95% <95% <95%
using pulse oximetry
ACTION PLAN
1. Site-of-care Outpatient Admit to Ward Admit to critical care
2. Follow-up End of treatment
Albumin >1 day 50-90 mg/dl
Premature 1 day 1.8-3.0 g/dl Child 60-100 mg/dl
Full term <6 days 2.5-3.4 g/dl Adult 70-105 mg/dl
<5 years old 3.9-5.0 g/dl Creatinine
5-19 years 4.0-5.3 g/dl Cord blood 0.6-1.2 mg/dl
Sodium Newborn 0.3-1.0 mg/dl
Newborn 134-146 mmol/L Infant 0.2-0.4 mg/dl
Infant 139-146 mmol/L Child 0.3-0.7 mg/dl
Child 138-145 mmol/L Adolescent 0.5-1.0 mg/dl
Thereafter 136-146 mmol/L Adult M 0.6-1.2 mg/dl
Potassium Adult F 0.5-1.1 mg/dl
<2 months 3.0-7.0 mmol/L Creatinine clearance: newborn 40-65 ml/min/1.73 m2 | <40
2-12 months 3.5-6.0 mmol/L yr, M: 97-137, F: 88-128
>12 months 3.5-5.0 mmol/L Calcium Total
Chloride Cord blood 9.0-11.5 mg/dl
Cord blood 96-105 mmol/L Newborn (3-24 hours) 9.0-10.6 mg/dl
Newborn 97-110 mmol/L 24-48 hours 7.0- 12.0 mg/dl
Thereafter 98-106 mmol/L 4-7 days 9.0-10.9 mg/dl
Bicarbonate (HCO3) Child 8.8-10.8 mg/dl
Arterial 21-28 mmol/L Thereafter 8.4-10.2 mg/dl
Venous 22-29 mmol/L Calcium Ionized
Carbon Dioxide Partial Cord blood 5.0-6.0 mg/dl
Pressure (PCO2) 27-40 mmHg Newborn (3-24 hours) 4.3-5.1 mg/dl
Newborn 27-41 mmHg 24-48 hours 4.0-4.7 mg/dl
Infant 35-48 mmHg Thereafter 4.8-4.92 mg/dl
Thereafter M 32-45 mmHg Blood Urea Nitrogen
Thereafter F Cord blood 21-40 mg/dl
Glucose Premature (1 wk) 3-25 mg/dl
Cord blood 45-96 mg/dl Newborn 3-12 mg/dl
Premature 20-60 mg/dl Infant or child 5-18 mg/dl
Neonate 30-60 mg/dl Thereafter 7-18 mg/dl
Newborn
1 day 40-60 mg/dl
 RABIES EXPOSURE
CATEGORY EXPOSURE MANAGEMENT
CATEGORY 1 Feeding or touching an animal Wash exposed skin immediately
Licking of intact skin with soap and water
Exposure to patients with s/sx of rabies by NO VACCINES OR RIG NEEDED
sharing or eating or drinking utensils May opt to give pre-exposure
Casual contact to patients with s/sx of rabies prophylaxis
CATEGORY 2 Nibbling or nipping of uncovered skin with COMPLETE VACCINATION UNTIL
bruising DAY 30
Minor scratches or abrasions without bleeding (If animal is rabid, died, killes, or
Licks on broken skin unavailable for 14 day
observation or died during
period of observation within 14
days)
CATEGORY 3 Transdermal bites or scratches START VACCIONE AND RIG
Mucous membranes contamination with saliva IMMEDIATELY
Handling of infected carcass or ingestion of raw
infected meat
Category II on head and neck area
Exposure to rabies patient contamination of
mucous membranes with saliva or fluid through
platerring
 GINA CLASSIFICATION OF ASTHMA SEVERITY
Symptoms/Day Symptoms/ Nights PEF/ FEV1 PEF Variability
STEP 1 <1 times a week
Intermittent Asymptomatic and normal </= 2 times a month >/= 80% <20%
PEF between attacks
STEP 2 >1 times a week but <1 time
Mild Persistent a day >2 times a month >/= 80% 20-30%
Attacks may affect activity
STEP 3 Daily
Moderate Attacks affects activity >1 times a week 60-80% >30%
Persistent
STEP 4 Continuous
Severe Limited physical activity Frequent </= 60% >30%
Persistent
LEVELS OF ASTHMA CONTROL
Characteristics Controlled (All of Partly Controlled (Present in Uncontrolled
the Following) any week)
Daytime symptoms None (≤ twice/week) >twice/ week Three or more
Limitations of activities None Any features of partly
Nocturnal symptoms/ None Any controlled asthma
awakening present in any
week
Need for reliever/ rescue None (≤ twice/week) >twice/ week
treatment
Lung function* (PEF or Normal <80% predicted or personal best
FEV1)
Exacerbation None One or more/year One in any week
 Classification of asthma severity (0-4 years of age)
Components of severity Persistent
Intermittent
Mild Moderate Severe
<2 >2 days/week but Throughou
Symptoms Daily
days/week not daily t the day
Impairment

Nighttime awakenings 0 1-2x/month 3-4x/month >1x/week

Short-acting beta2-agonist Several
<2 >2 days/week but
use for symptom control Daily times per
days/week not daily
(not prevention of EIB day
Interference with normal Extremely
None Minor limitation Some limitation
activity limited
>2 exacerbations in 6 months requiring oral systemic
0-1/year corticosteroids, or >4 wheezing episodes/1 year lasting >1
day AND risk factors for persistent asthma
Exacerbations requiring oral
Risk

Consider severity and interval since

systemic corticosteroids
last exacerbation, frequency and severity
may fluctuate over time.
Exacerbation of any severity may occur in patients in any severity category.
Step 3 and consider short course
Step 1 Step 2
of oral systemic corticosteroids
Recommended step for initiating
In 2-6 weeks, depending on severity, evaluate level of asthma control that is
therapy
achieved. If no clear benefit is observed in 4-6 weeks, consider adjusting
therapy or alternating diagnoses
Hematocrit (Hct) Neutrophils-bands 3-5%
1 day 48-69% Neutrophils- 54-62%
2 days 48-75% segmenters
3 days 44-72% Lymphocytes 25-33%
2 months 28-42% Monocytes 3-7%
6-12 months 35-45% Eosinophils 1-3%
12-18 months M 37-49% Basophils 0-0.75%
12-18 months F 36-46% Plt ct NEWBORN: Plt ct ADULT: 150-
18-49 years M 41-53% 84-478 x 10^6 (after 400x10^6
18-49 years F 36-46% 1 wk, same as adult)
Hemoglobin (hgb)
1-3 days 14.5-22.5 g/dl
2 months 9.0-14.0 g/dl
6-12 years 11.5-15.5 g/dl
12-18 years M 13.0-16.0 g/dl
12-18 years F 12.0-16.0 g/dl
18-49 years M 13.5-17.5 g/dl
18-49 years F 12.0-16.0 g/dl
WBC
Birth 9.0-30.0 x 1,000/mm3
12 hours 9.4-34.0 x 1,000/mm3
1 month 5.0-19.5 x 1,000/mm3
1-3 years 6.0-17.5 x 1,000/mm3
4-7 years 5.5-15.5 x 1,000/mm3
8-13 years 4.5-13.5 x 1,000/mm3
Adult 4.5-11.0 x 1,000/mm3
Myelocytes 0%
 HEMODYNAMIC ASSESSMENT
PARAMETERS Stable condition Compensated Shock Hypotensive Shock
Sensorium Clear and lucid Clear and lucid Change of mental status (restless
and combative)
Capillrary refill time Brisk < 2 sec Prolonged > 2 sec Very prolonged, mottled skin
Extremities Warm and pink Cool peripheries Cold and clammy
Peripheral pulses Good volume Weak and thread Feeble or absent
Heart Rate Normal for age Tachycardia Severe tachycardia with
bradycardia in the late shock
BP Normal for age Normal systolic pressure but Narrowed PP < 20
rising diastolic pressure
RR Normal Tachypnea Hyperpnea, Kussmaul breathing
STRICT 1. Throw cans or tires to avoid breeding grounds for
DENGUE mosquitoes
PRECAUTIONS 2. Cover water containers
3. Use insecticides to kill the vector
4. Use mosquito repellants and mosquito nets
STRICT 1. Avoid exposure to cold air, smoke, and pollens
ALLERGIC 2. Avoid hair sprays, gel, strong perfume, fabric
PRECAUTIONS softener, powders, cosmetic, and chalk dust
3. Wear warm clothing
4. Use hypoalleregenic sheets and pillows
5. Do not use wool blankets and furry stuffed toys
6. Keep child away from dogs, cats, hamsters, mice
and other pets
7. Wash curtains and shampoo rugs
8. Clean child’s room regularly
STRICT 1. Proper hand washing before eating and after using
ENTERIC the toilet
PRECAUTIONS 2. Proper hand washing before handling and preparing
food and cleaning utensils used for preparation and
cooking of food
3. Boil drinking water for 15 minutes or more
4. Cook food thoroughly
5. Wash all fruits and vegetables to be eaten raw
6. Keep fingernails clean and short
 FINDINGS: BACTERIAL MENINGITIS
1. See Nigrovic Clinical Decision Rule
2. CSF Color: Cloudy CSF
3. CSF Glucose much less than 50
4. CSF Protein much greater than 45
5. CSF Leukocytes: Markedly increased Neutrophils
6. CSF Opening Pressure: increased >200
FINDINGS: FUNGAL MENINGITIS
1. CSF Color: Clear to Cloudy Fluid
2. CSF Glucose <50
3. CSF Protein >45
4. CSF Leukocytes: Monocytes increased
5. CSF Opening Pressure: increased
FINDINGS: VIRAL MENINGITIS
1. CSF Color: Clear to Cloudy Fluid
2. CSF Glucose: Normal
3. CSF Protein >45
4. CSF Leukocytes: Increased CSF Lymphocytes
5. CSF Opening Pressure: Normal or increased
FINDINGS: TUBERCULOSIS MENINGITIS
1. CSF Color: Cloudy Fluid
2. CSF Glucose <50
3. CSF Protein >45
4. CSF Leukocytes
a. Early: Neutrophils increased
 b. Later: Lymphocytes increased
FINDINGS: GUILLAIN-BARRE
1. CSF Color: Clear to Cloudy Fluid
2. CSF Glucose: Normal
3. CSF Protein much greater than 45
4. CSF Leukocytes: Lymphocytes normal or increased
5. CSF Opening Pressure: Normal
FINDINGS: NEOPLASM
1. CSF Color: Clear to xanthochromic
2. CSF Glucose: Normal or decreased
3. CSF Protein: Normal or increased
4. CSF Leukocytes: Normal or increased lymphocytes
5. CSF Opening Pressure: increased >200
FINDINGS: NEUROSYPHILIS
1. CSF Color: Clear to Cloudy Fluid
2. CSF Glucose: Normal
3. CSF Protein >45
4. CSF Leukocytes: Monocytes increased
5. CSF Opening Pressure: Normal or increased
FINDINGS: INTRACRANIAL HEMORRHAGE
1. CSF Color: Bloody CSF with xanthocromia
2. CSF Glucose: Normal or decreased
3. CSF Protein >45
4. CSF Leukocytes: Increased
5. CSF Opening Pressure: increased >200
 ANTIBIOTICS USED for TREATMENT of BACTERIAL MENINGITIS
NEONATES INFANTS and CHILDREN
DRUG 0-7 days 8-28 days
Amikacin 15-20 days 20-30 divided q8h 20-30 divided q8h
Ampicillin 200-300 divided q8h 300 divided q4h or q6h 300 divided q4-6h
Cefotaxime 100 divided q12h 150-200 divided q8h or 200-300 divided q8h or
q6h q6h
Ceftriaxone 100 divided q12h or
q24h
Ceftazidine 150 divided q12h 150 divided q8h 150 divided q8h
Gentamicin 5 divided q12h 7.5 divided q8h 7.5 divided q8 h
Meropenem 120 divided q8h
Nafcillin 100-150 divided q8h or 150-200 divided q8h or 150-200 divided q4h or
q12h q6h q6h
Penicillin G 250,000-450,000 divided 450,000 divided q6h 450,000 divided q4h or
q8h q6h
Rifampicin 20 divided q12h
Tobramycin 5 divided q12h 7.5 divided q8h 7.5 divided q8h
Vancomycin 30 divided q12h 30-45 divided q8h 60 divided q6h
 KAWASAKI DISEASE
Diagnostic criteria:
1. Remittent fever (41C) persisting for more than 5 days
2. Bilateral conjunctival infection without exudates
3. Strawberry tongue, erythema and cracking of the lips
4. Erythema and edema od the hands and feet
5. Polymorphous exanthems
6. Unilateral CLAD > 1.5 CM
Treatment:
IVIG - treatment of choice - 2g/kg/day
Aspirin 80-100 mg/kg/day
Diagnosis: serial 2d echo  aneurysm seen
ACUTE STAGE
• Intravenous immunoglobulin 2 g/kg over 10-12 hr
• Aspirin 80-100 mg/kg/day divided every 6 hr orally until patient is afebrile for at least 48 hr
CONVALESCENT STAGE
• Aspirin 3-5 mg/kg once daily orally until 6-8 wk after illness onset
LONG-TERM THERAPY FOR PATIENTS WITH CORONARY ABNORMALITIES
• Aspirin 3-5 mg/kg once daily orally • Most experts add warfarin or low-molecular-
• Clopidogrel 1 mg/kg/day (max 75 mg/day) weight heparin for those patients at particularly
high risk of thrombosis
ACUTE CORONARY THROMBOSIS
• Prompt fibrinolytic therapy with tissue plasminogen activator or other thrombolytic agent under
supervision of a pediatric cardiologist
 RHD
Revised jones criteria
Major Criteria
1. Arthritis most common
2. Carditis
3. Erythema Marginatum
4. Sydenham’s Chorea
5. Subcutaneous nodules
Minor Criteria
1. Arthralgia
2. Fever < 39C
3. Elevated acute phase reactants  ESR, C-reactive CHON
4. Prolonged PR interval
Diagnosis via 2 major or 1 major + 2 minor
Previous grp A streptococcal infection
RHD
1. Mitral regurgitation/ mitral stenosis on PE
2. Left ventricular/ Right ventricular hypertrophy on ECG
3. Irregular cardiac borders on X-ray
 ACTIVE RF
1.Joint symptoms
2. Murmurs
3. Inc. heart size
4. CHF
5. Subcutaneous Nodules
6. Sleeping pulse rate of > 100/min
7. + C-reactive protein
8. Consecutive fever for 3 days
Treatment for RF
1. Pen G/ Benzathine given once (ED: 100K-400K)
2. Penicillin V/Phenoxy methyl Penicillin 2-3 times per day given for 10 days
3. Erythromycin 2-4 times per day given for 10 days
Diagnosis via 2 major or 1 major + 2 minor
Previous grp A streptococcal infection

INFECTIVE ENDOCARDITIS
Infective Endocarditis
1. Strep Viridians – most common, use Pen G and gentamycin
2. Staph Aureus – 2nd most common, use Methicillin and gentamycin
 TREATMENT of TYPHOID FEVER in CHILDREN
OPTIMAL THERAPY ALTERNATIVE EFFECTIVE DRUGS
Daily Dose Daily Dose
ANTIBIOTIC Days Antibiotic Days
(mk/day) (mk/day)
UNCOMPLICATED TYPHOID FEVER
Fluoroquinolone,
Fully
Chloramphenicol 50-75 14-21 eg. Ofloxacin or 15 5-7
Sensitive
ciprofloxacin
Amoxicillin 75-100 14
Multidrug Fluoroquinolone or
cefixime
15 5-7 Azithromycin 8-10 7
resistant
15-20 7-14 Cefixime 15-20 7-14
Quinolone Azithromycin or
8-10 7 Cefixime 20 7-14
resistant ceftriaxone
75 10-14
SEVERE TYPHOID FEVER
Fluoroquinolone,
Fully Ampicillin or
100 14 eg. Ofloxacin or 15 10-14
Sensitive Ceftriaxone
ciprofloxacin
60-75 10-14
Multidrug Cefrtiaxone or
Fluoroquinolone 15 10-14 60 10-14
resistant cefotaxime
80
Quinolone
Ceftriaxone 60-75 10-14 Fluoroquinolone 20-30 14
resistant
 RECOMMENDED ERADICATION THERAPIES for H. pylori
Medications Dose Duration of Treatment
Amoxicillin 50 mg/kg/day in 2 divided doses 14 days
Clarithromycin 15 mg/kg/day in 2 divided doses 14 days
PPI 1 mg/kg/day in 2 divided doses 1 month
or
Amoxicillin 50 mg/kg/day in 2 divided doses 14 days
Metronidazole 20 mg/kg/day in 2 divided doses 14 days
PPI 1 mg/kg/day in 2 divided doses 1 month
or
Clarithromycin 15 mg/kg/day in 2 divided doses 14 days
Metronidazole 20 mg/kg/day in 2 divided doses 14 days
PPI 1 mg/kg/day in 2 divided doses 1 month

KRAMER JAUNDICE SCALE Grade 0 None

Face TSB ~ 5 mg/dl Grade 1 Face and neck only
Mid-abdomen TSB ~ 15 mg/dl Grade 2 Chest and back
Feet excluding soles TSB ~ 20 mg/dl Grade 3 Abdomen below
and palms umbilicus to knees
Including soles and TSB ~ 25 mg/dl Grade 4 Arms and legs below
palms knees
Grade 5 Hands and feet
 PEFR in 6-7 y/o
MALES ( Height in cm – 100 ) 5+ 175
FEMALES ( Height In cm – 100 ) 5+ 170
Peak flow variability
= Highest Reading - Lowest reading x 100
Highest reading

Amino acid
Empiric dose: 2-3g/day
Preparation: 8%/100ml
Calcium
Empiric dose: 200-400/day
Preparation: 100mg/ml
* Wt x ED = mg/d x prep 1ml/100mg
Sodium
Empiric dose:
Preparation: 2.5 meqs/mL
* (Wt x ED)/2.5
Potassium
Empiric dose:
Preparation: 2 meqs/mL
* (Wt x ED)/2