Anaphylaxis is a serious generalized or systemic hypersensitivity reaction that is rapid in onset and potentially fatal.
Diagnosis can be made if it is acute in onset of minute to several hour duration that involves the skin, mucosal tissue or both plus having signs & symptoms either respiratory or cardiovascular compromise.
It involves immunological response with IgE, IgG or immune complexes. Non-immunological mechanisms are also involved and termed as nonallergic anaphylaxis that is relatively uncommon in children.
Protracted, severe anaphylaxis are reactions occurring up to 32 hours despite aggressive management.
Iron deficiency (ID) is the most common nutritional deficiency in children & reportedly 3x more common than iron-deficiency anemia, but does not always develop into anemia.
Neonates & children may have delayed growth & development; adolescents may show decrements of learning such as behavioral abnormalities.
Iron-deficiency anemia is the most advanced stage of iron deficiency resulted from a protracted imbalance between iron intake & demand.
Characterized by low hemoglobin & hematocrit levels, reduction or depletion of iron stores, low serum iron levels & decreased transferrin saturation.
Asthma is a chronic inflammatory disease of the airways in the lungs of children and adults.
The patient usually complains of shortness of breath, chest tightness and coughing with wheezing.
A diagnosis of asthma in young children is more likely if they have
symptom patterns, presence of risk factors for development of asthma and
therapeutic response to controller treatment.
Goals of treatment are effective symptom control with minimal or no exacerbations, minimal or no nocturnal and daytime symptoms, no limitations on activities, minimal or no need for reliever treatment, and minimal adverse effects of medication.
It is also referred to as atopic eczema.
It is one of the most common skin diseases afflicting both adults and children.
Symptoms that suggest ADHD includes hyperactivity, acting without thinking, inattention/daydreaming, fidgety, restless, excessive talking, aggressive behavior, academic underachievement, disorganized and has difficulty in completing task.
Signs of respiratory illness which may include wheezing, retractions, oxygen desaturation, color change, nasal flaring.
There is also presence of apnea especially in premature or low birthweight infants, signs of dehydration and exposure to persons with viral upper respiratory infections.
Symptoms are usually worst on the 3rd-5th day of illness and then improve gradually.
Chemical burns are due to strong acids, alkalis, detergents or solvents coming into contact with the skin. Tissues are damaged by protein coagulation or liquefaction rather than hyperthermic activity.
Electrical burns are due to electrical current or lightning coming in contact with the body.
First degree burns or superficial burns appears similar to sunburn that is painful, dry, swollen, erythematous without blisters and involves only the epidermis.
Second degree burns or partial-thickness burns has appearance of moist blebs, formation of vesicle and blister; underlying tissue is mottled pink and white with good capillary refill; this involves the entire epidermis and a variable portion of the dermal layer.
Third degree burns or full-thickness burns appears dry, leathery eschar, mixed white waxy, khaki, mahogany and soot stained. It involves the entire epidermis and dermis, leaving no residual epidermis cells, may include fat, subcutaneous tissue, fascia, muscle and bone.
It can manifests from benign mucocutaneous illnesses to invasive process that may affect any organ.
It is considered as normal flora in the gastrointestinal & genitourinary tracts, but when there is an imbalance in the ecological niche they can invade & cause disease.
The immune response of the patient is the important determinant of the type of infection caused by Candida.
Most common risk factors include: prematurity, very low birth weight, use of broad-spectrum antibiotics use, use of central venous catheters, receipt of parenteral nutrition, receipt of renal placement therapy by patients in intensive care unit (ICU), neutropenia, use of implantable prosthetic devices and receipt of immunosuppressive agents.
It typically occurs in areas where the skin integrity has been compromised.
May result from blood-borne spread of infection to the skin and subcutaneous tissues.
It is commonly caused by beta-hemolytic streptococci and Staphylococcus aureus in adults and Haemophilus influenzae type B in patients <3 year of age.
Nerve endings are also stimulated causing pain and itching.
Seasonal allergic conjunctivitis is the most common form in temperate climates. It usually occurs and recurs at a certain period of the year and subjectively more severe than perennial allergic conjunctivitis.
Perennial allergic conjunctivitis manifests and recurs throughout the year with no seasonal predilection. It is most common in tropical climates.
Viral conjunctivitis is the inflammation of the conjunctiva that may be caused by adenovirus, herpses simplex or Molluscum contagiosum.
Infection may cause unilateral or bilateral eye redness, foreign body sensation and follicular conjunctival reaction.
Constipation is a delay or difficulty in bowel movement persisting for ≥2 weeks.
It is a common digestive problem, not a disease, and usually not serious caused by changes in diet and early toilet training.
Constipation in children generally first happens in the toddler stage, between ages 2 and 4 years, with studies showing variation in gender-specific prevalence.
Functional constipation is the one that cannot be explained by any anatomical, physiological, radiological or histological abnormalities.
Organic constipation is with identifiable physiological or organic cause.
Chronic constipation is the constipation that lasts for >8 weeks.
The lesions initially appear on the cutaneous site of principal exposure then may spread to other more distant sites due to contact or autosensitization. Lesions are typically asymmetrical and unilateral.
Specific signs and symptoms will depend on the duration, location, degree of sensitivity and concentration of allergens. The patch test shows reaction to allergen.
Irritant contact dermatitis is a non-immunologic skin reaction to skin irritants.
It is often localized to areas of thin skin eg eyelids, intertriginous areas.
It is a medical emergency in children and requiring immediate treatment.
Most common causes are parainfluenza virus 1&2 and respiratory syncytial virus.
Occurrence of symptoms is usually at night and with abrupt onset and improve during daytime.
There are 4 serotypes (DEN-1, DEN-2, DEN-3, DEN-4). Each serotype provides specific lifetime protective immunity against reinfection of the same serotype, but only temporary (within 2-3 months of the primary infection) and partial protection against other serotypes.
It is transmitted to humans through the bites of infected Aedes mosquitoes. It is primarily transmitted by female Aedes aegypti, a tropical and subtropical species. Humans are the main host of the virus.
After 4-10 days of incubation period, illness begins immediately.
It can occur at any age and the earlier the onset, the more serious is the long-term damage, dysfunction and failure of various organs due to the chronic hyperglycemia with diabetes mellitus patients having <10 year in life span compared to non-DM patients.
Type 1 DM patients have complete insulin deficiency due to beta-cell destruction. It may be immune-mediated or idiopathic. More commonly occurs in children 7-15 year of age, but may occur at any age.
Type 2 DM patients have insulin resistance and relative insulin deficiency.
Neonatal DM is hyperglycemia that occurs in the first 6 months of life.
It is often characterized by an acute, rapidly progressing respiratory disease.
It is a medical emergency in children requiring immediate treatment and typically artificial airway placement.
H. influenzae type B is the most common etiologic agent in children.
Epilepsy is a disorder that is characterized by a persistent predisposition of the brain to generate epileptic seizures.
This condition may cause neurobiologic, cognitive, psychological and social disturbances.
It is recommended that all patients having a first seizure be referred to a specialist as soon as possible.
Immunological mechanisms can be IgE mediated, non-IgE mediated or mixed IgE and non-IgE mediated.
It may be life-threatening and is the most common cause of anaphylaxis in children.
It should be differentiated from food intolerance in which adverse reactions from exposure to food arise from non-immunological mechanisms.
Acute diarrhea lasts ≤14 days while chronic diarrhea lasts >14 days.
Infectious diarrhea is usually associated with symptoms of nausea and vomiting and abdominal cramps.
Some patients may be asymptomatic.
Gastrointestinal symptoms, if present, include diarrhea, abdominal pain, dysentery, flatulence, jaundice, rectal prolapse, dyspepsia, malabsorption, vomiting and biliary colic.
Viruses are one of the common causes of gastroenteritis.
Rotavirus, enteric adenovirus serotypes 40 & 41, astrovirus and calicivirus (eg "Norwalk-like" virus) are the established viral agents causing gastroenteritis.
Rotavirus is the most common pathogen causing diarrhea in patients 3-24 months old.
Patients <3 months old are protected by maternal rotavirus antibodies that are passed transplacentally and possibly by breastfeeding.
Transmission is through fecal-oral route.
Incubation period may vary from 1-10 days depending on the causative agent.
It may occur at any age.
Short stature is often the only feature present in patients with growth hormone deficiency and other causes of subnormal growth rate.
Etiology may be congenital conditions (eg defective pituitary development that leads to pituitary aplasia, empty sella, encephalocele, midline defects) or acquired conditions (eg tumors of the hypothalamic-pituitary region, cranial irradiation, infiltrative disease).
Oral vesicular lesions are 1-3 mm, mostly found on the buccal mucosa, tongue and soft palate.
Each oral lesion is surrounded by erythema and is tender to touch.
Patient may complain of sore throat or sore mouth, fever and may be difficult to feed.
Most common cause of HFMD is coxsackievirus A16 (A16).
Hepatitis A generally causes minor illness in childhood with >80% of infections being asymptomatic. Jaundice and intestinal symptoms usually resolve 2-3 weeks after onset. A patient is infectious 1-2 weeks prior to the clinical illness.
Hepatitis B, C, & D may be symptomatic depending on the mode and time of transmission.
Hepatitis A is predominantly transmitted through oral-fecal by person-person direct transmission and contaminated material or food.
Hepatitis B is transmitted perinatal, horizontal spread, percutaneous, sexual, close person-to-person contact.
Majority of hepatitis C infections are identified in children with repeated exposure to blood products.
Hepatitis D is route of transmission is through sexual, percutaneous especially IV drug use.
Hepatitis E is transmitted primarily through contaminated drinking water and oral-fecal transmission.
Symptoms are of gradual onset.
Earliest signs may be emotional lability and motor hyperactivity; decline in school performance may also be noted.
Causes are autoimmune (Grave's disease), inappropriate stimulation by trophic factors, passive release of preformed thyroid hormone stores in response to infections, trauma, or other offensive factors inside the body, and extra-thyroidal sources.
Primary hypothyroidism is caused by generalized tissue resistance to thyroid hormone and disorders that affect the thyroid gland directly. It is responsible for majority of hypothyroid cases.
Central hypothyroidism is caused by hypothalamic or pituitary disorders.
Most cases resolve spontaneously without scarring in approximately 14 days without treatment.
Ecthyma is deeply ulcerated form of impetigo that extends to the dermis. The ulcers are "punched-out" with yellow crust and elevated violaceous margins.
It may be an infection de novo or a superinfection.
The main type of influenza virus are types A, B & C virus. Types A&B are the main causes of influenza outbreaks.
Patient may appear flushed and have pain on eye movement. Non-exudative pharyngitis, scattered rales or rhonchi may be present.
In the hollow viscera is where common disruptions occur, which allows intraluminal bacteria to invade and proliferate in the usually sterile area (ie peritoneal cavity or retroperitoneum).
Community-acquired intra-abdominal infection is usually secondary to gastroduodenal perforation, ascending cholangitis, cholecystitis, appendicitis, colon diverticulitis with or without perforation, or pancreatitis.
Uncomplicated IAI infectious process involves only a single organ and does not extend to the peritoneum.
Complicated IAI is when infection extends beyond the hollow viscus of origin into the peritoneal space and may be associated with peritonitis or abscess formation.
It presents as chronic joint swelling, pain with functional limitation for at least 6 weeks of unknown cause that starts before 16 year of age.
It is the most common autoimmune-autoinflammatory disease in children.
Around half of the children with juvenile idiopathic arthritis may have active disease until adulthood.
It is also known as mucocutaneous lymph node syndrome.
It affects primarily children <5 years old with peak incidence in 1-2 year of age.
The cause remains unknown but current research supports an infectious origin.
Epidemiological findings suggest that genetic predisposition and environmental factors play a role in the pathogenesis of the disease.
It is characterized by generalized maculopapular rash, fever, cough, rhinitis and conjunctivitis. Transmission is through respiratory tract or conjunctivae following contact with droplet aerosols.
It is highly communicable from 4 days before the rash up to 4 days after its onset.
The incubation period from exposure to prodrome averages 7-21 days.
Common symptoms in newborns are lethargy, fever, seizures, irritability and bulging fontanelle. While in children the common symptoms are fever, nuchal rigidity (incidence increases with age) and altered consciousness.
Meningeal signs are stiff neck, Kernig's or Brudzinski's signs) are not reliably present in infants <6 months of age.
It may also observe the presence of persistent vomiting, changes in behavior or other psychological/neurologic signs.
It commonly affects the children aged 2-12 years and very uncommon in <1 year of age.
It is caused by a single-stranded RNA virus classified under Paramyxoviridae family or mumps virus.
Transmission is through airborne droplets from respiratory secretion of infected persons.
Incubation period is typically 14-21 days.
Jaundice typically presents on the 2nd-3rd day of life. It is usually first seen on the face and forehead then progresses caudally to the trunk and extremities.
Visible jaundice in the feet may be an indication to check bilirubin level.
Visual estimation of bilirubin level is often inaccurate and unreliable.
Danger signs in a newborn infant with jaundice includes changes in brainstem evoked auditory potentials, changes in muscle tone, seizures and altered cry characteristics.
The presence of any of the danger signs require prompt attention to prevent kernicterus.
It is also called neonatal conjunctivitis.
Organisms causing neonatal conjunctivitis are usually acquired from the infected birth canal of the mother during vaginal delivery, though some may acquire the infection from their immediate surroundings.
It is one of the leading cause of blindness in infants via corneal ulceration and subsequent opacification or perforation and endophthalmitis.
The symptoms are usually nonspecific and include otalgia (pulling of ear in an infant), irritability, otorrhea with or without fever.
Symptoms of upper respiratory tract infection may also be present
It occurs most commonly in postpubertal individuals when the sebaceous glands are the most active.
Facial involvement is common in adolescents, but lesions are also found on the upper trunk, neck, arms, dorsum of the hand and pubis.
Patient presents with erythematous, hypo- or hyperpigmented macules or patches that may have a slight scale.
It is caused by the lipophilic yeast Malassezia furfur.
The most common bacterial cause of childhood pneumonia is Streptococcus pneumoniae. It usually causes about 1/3 of radiographically-confirmed pneumonia in children <2 years of age.
Viruses commonly affects children <1 year of age than those aged > 2 years, respiratory syncytial viruses (RSV) being the most frequently detected virus.
Mixed infection may occur in 8-40% of community-acquired pneumonia cases.
It often presents in patients 5-14 years of age and uncommon before 3 years and after 21 years of age.
Patients presenting with acute rheumatic fever are severely unwell, in extreme pain and requires hospitalization.
Allergic rhinitis is most prevalent in childhood and adolescence.
Careful elimination of nonallergic etiologies must be done in preschool children as allergic rhinitis is unusual in <3 years of age.
Nonallergic rhinitis is a diagnosis of rhinitis without any immunoglobulin E (IgE) mediation, as documented by allergen skin testing.
Signs & symptoms are nasal itching, rhinorrhea, nasal congestion with or without obstruction and sneezing.
It is often preceded by a viral upper respiratory tract infection.
Signs & symptoms are nonspecific and it is typically difficult to differentiate from viral upper respiratory tract infection.
Streptococcus pneumoniae is the most common cause followed by nontypeable Haemophilus influenzae.
It is caused by a single-stranded RNA virus classified as a togavirus, genus Rubivirus.
Transmission is through airborne or droplets shed from respiratory secretions.
Highly communicable at the onset of the rash, however viral shedding may also occur 5-7 days before, to 5-7 days or more following appearance of the rash.
The incubation period is 14-21 days.
Pityrosporum ovale infection is common in seborrheic dermatitis.
The characteristic pattern is based on age group.
In infants it appears as cradle cap. It is a diffuse or focal scaling and crusting on the vertex of the scalp that sometimes accompanied by inflammation.
In young children, there is Tinea amiantacea which is one or several patches of dense, plate-like scales, 2-10 cm in size that appear anywhere on the scalp.
While adolescents have dandruff which are fine, dry, white, non-inflammatory scalp scaling with minor itching.
Risk factors include sleeping in prone or side position, male infants are more likely to be affected than female infants, perinatal period and beyond age 6 months, sleeping on soft surfaces or bedding, overheating or thermal stress, maternal smoking during pregnancy, young maternal age and pregnancy-related factors (eg inadequate or absence of prenatal care, higher birth order, preterm birth and/or low birth wt).
It can be suspected when ≥2 organ systems are involved.
It is predominantly diagnosed in females of childbearing age, rarely diagnosed before 8 years old.
Clinical presentation varies in different patients and the disease activity varies over time in a single patient. Majority of patients have arthralgia of the hand.
It is most common in the crowded areas as infection originates from contact with a pet or an infected person and asymptomatic carriage persists indefinitely.
It primarily affects children 3-7 year of age.
The causative agents are the genus Trichophyton and Microsporum.
Cardinal clinical feature is the combination of inflammation with hair breakage and loss.
Etiologies include bacterial and viral pathogens.
Sore throat is the most common presenting symptom in older children.
It is primarily transmitted through airborne route.
The number of tubercle bacilli expelled in the air by a TB infected person is directly related to their infectiousness.
TB transmission is rare in children <10 years old due to their inability to expectorate sputum and low TB bacilli load in their sputum.
TB infection in children is usually obtained from an infectious adolescent or adult depending on the closeness and length of contact and the index case's severity of lung involvement and infectiousness.
Toddlers and preschoolers have unusual odor of urine, abdominal or flank pain, frequency, dysuria, and urgency.
School-age children have the classical symptoms of fever, frequency, urgency and dysuria.
Consider UTI in all seriously ill children even when there is evidence of infection outside the urinary tract.
The average incubation period is 14-16 days. It is transmitted via direct contact with vesicular fluid or inhalation of aerosolized respiratory secretions or via droplet route during face to face contact.
Hallmark sign is pruritic rash that begins in the scalp and face which eventually spreads to the trunks and extremities.