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Pneumonia (Pediatric)

• Definition: Infection of the lung parenchyma, commonly bacterial or viral.

• Etiology:

  • Bacterial: Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus

  • Viral: RSV, influenza, adenovirus

• Clinical Features: Fever, cough, tachypnea, chest retractions, nasal flaring, grunting, auscultatory findings (crackles, decreased breath sounds).

• Investigations: Chest X-ray, CBC, CRP, blood culture, pulse oximetry.

• Management:

  • Mild community-acquired: Oral antibiotics (amoxicillin).

  • Severe/ICU: IV antibiotics, oxygen therapy, supportive care.

• Complications: Pleural effusion, empyema, sepsis, respiratory failure.

Pertussis (Whooping Cough)

• Definition: Highly contagious respiratory infection caused by Bordetella pertussis.

• Clinical Features: Paroxysmal cough, inspiratory “whoop,” post-tussive vomiting, apnea in infants.

• Investigations: Nasopharyngeal swab for PCR/culture, leukocytosis with lymphocytosis.

• Management: Macrolide antibiotics (azithromycin, erythromycin), supportive care, hospitalization for infants.

• Prevention: DTaP vaccination.

Pyloric Stenosis (Infantile Hypertrophic Pyloric Stenosis)

• Definition: Hypertrophy of pyloric sphincter causing gastric outlet obstruction.

• Epidemiology: Typically presents at 3–6 weeks of life, more common in males.

• Clinical Features: Projectile, non-bilious vomiting, visible peristaltic waves, palpable “olive” in epigastrium, dehydration, weight loss.

• Investigations: Ultrasound (thickened pyloric muscle), electrolyte panel (hypokalemic hypochloremic metabolic alkalosis).

• Management: Preoperative correction of fluids/electrolytes, surgical pyloromyotomy (Ramstedt procedure).

Pediatric Asthma

• Definition: Chronic inflammatory disorder of the airways with variable airflow obstruction and bronchial hyperresponsiveness.

• Clinical Features: Recurrent wheezing, cough (especially nocturnal), shortness of breath, chest tightness.

• Investigations: Spirometry (if age ≥5), peak flow monitoring, allergy testing, chest X-ray if atypical.

• Management:

  • Controller therapy: Inhaled corticosteroids

  • Reliever therapy: Short-acting beta-agonists (SABA)

  • Allergen avoidance, patient/caregiver education, action plans.

• Complications: Status asthmaticus, growth suppression (rare with proper therapy), chronic airway remodeling.

Pediatric Diabetes Mellitus

• Type 1 Diabetes: Autoimmune destruction of pancreatic beta cells; insulin-dependent.

  • Clinical Features: Polyuria, polydipsia, polyphagia, weight loss, fatigue.

  • Investigations: Blood glucose, HbA1c, autoantibodies (GAD, IA-2), C-peptide.

  • Management: Insulin therapy, blood glucose monitoring, diet, exercise, education.

  • Complications: Hypoglycemia, diabetic ketoacidosis (DKA), long-term microvascular/macrovascular complications.

• Type 2 Diabetes: Increasing prevalence in adolescents; associated with obesity.

  • Clinical Features: Often asymptomatic, acanthosis nigricans, obesity.

  • Investigations: Blood glucose, HbA1c, fasting insulin, lipid profile.

  • Management: Lifestyle modification, metformin, insulin if severe.

Pediatric Hypertension

• Definition: Systolic and/or diastolic BP ≥95th percentile for age, sex, and height on ≥3 occasions.

• Etiology: Secondary more common than primary (renal disease, endocrine disorders, cardiac anomalies).

• Clinical Features: Often asymptomatic; may present with headache, visual changes, seizures (malignant hypertension).

• Investigations: Serial BP measurements, urinalysis, renal function tests, renal ultrasound, echocardiography.

• Management: Treat underlying cause; lifestyle modification, antihypertensive medications if persistent or symptomatic.

Pediatric Sepsis

• Definition: Systemic inflammatory response to infection in children with organ dysfunction.

• Clinical Features: Fever/hypothermia, tachycardia, tachypnea, hypotension, altered mental status, poor perfusion.

• Investigations: CBC, CRP, blood cultures, lactate, urine cultures, imaging as indicated.

• Management: Prompt IV antibiotics, fluid resuscitation, vasopressors for shock, supportive ICU care.

• Complications: Multiorgan failure, death if untreated.

Pediatric Epilepsy

• Definition: Chronic neurological disorder characterized by recurrent unprovoked seizures.

• Types: Generalized (tonic-clonic, absence), focal, myoclonic, infantile spasms.

• Etiology: Genetic, structural brain abnormalities, metabolic disorders, infections.

• Investigations: EEG, MRI/CT brain, metabolic/genetic testing if indicated.

• Management: Antiepileptic drugs (AEDs) tailored to seizure type, ketogenic diet in refractory cases, surgery for focal lesions, seizure safety education.

Pediatric Burns

• Definition: Thermal, chemical, or electrical injury affecting skin and underlying tissues in children.

• Epidemiology: Most common in toddlers and infants due to scalds.

• Clinical Features: Pain, erythema, blistering, tissue necrosis, systemic signs in severe burns.

• Investigations: Burn depth assessment, TBSA calculation, laboratory studies for fluid/electrolyte balance.

• Management:

  • First-degree: wound care, analgesia.

  • Second/Third-degree: fluid resuscitation (Parkland formula), wound care, infection prevention, surgery for grafting.

• Complications: Infection, contractures, scarring, psychological impact.

Pediatric Constipation

• Definition: Infrequent, difficult, or painful defecation in children.

• Etiology: Functional (most common), dietary, hypothyroidism, Hirschsprung disease.

• Clinical Features: Hard stools, abdominal pain, fecal incontinence, palpable fecal mass.

• Investigations: Abdominal X-ray if chronic, thyroid function, anorectal manometry if Hirschsprung suspected.

• Management: Dietary modification (fiber, fluids), behavioral therapy, osmotic laxatives (lactulose, PEG), treatment of underlying disorders.

Pediatric Diarrhea

• Definition: Passage of ≥3 loose or watery stools per day.

• Etiology: Infectious (rotavirus, bacterial), dietary, malabsorption syndromes.

• Clinical Features: Dehydration (dry mucous membranes, sunken eyes, lethargy), fever, vomiting, electrolyte imbalance.

• Investigations: Stool culture, microscopy, PCR for viral pathogens, electrolytes.

• Management: Oral rehydration therapy (ORT), zinc supplementation, antibiotics only if bacterial etiology confirmed, supportive care.

Pediatric Migraine

• Definition: Recurrent headache disorder with neurological features.

• Clinical Features: Moderate to severe headache, photophobia, phonophobia, nausea, vomiting, aura in some cases.

• Investigations: Clinical diagnosis; neuroimaging only if atypical features or red flags present.

• Management: Lifestyle modification, acute therapy (acetaminophen, ibuprofen), preventive therapy in frequent attacks (propranolol, topiramate).

Pediatric Pneumothorax

• Definition: Accumulation of air in the pleural space causing lung collapse.

• Etiology: Spontaneous (primary or secondary), traumatic, iatrogenic.

• Clinical Features: Sudden onset dyspnea, chest pain, tachypnea, decreased breath sounds, hyperresonance on percussion.

• Investigations: Chest X-ray, ultrasound, CT if complicated.

• Management: Observation for small asymptomatic cases, needle aspiration or chest tube for larger/symptomatic cases, surgical intervention for recurrent pneumothorax.