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Pediatric Endocrine
• The body secretes hormones at various times during the day (influences of diurnal and circadian rhythm).
• Normal hormone levels are related to age and stage of puberty.
• The pituitary gland stimulates target organs to produce specific hormones; when sufficient, these in return signal pituitary to stop stimulation (negative feedback loop).
• Untreated infant hypothyroidism will lead to mental retardation.
• Associated terms for hypopituitary function include: short stature, constitutional delay, dwarfism.
• A major concern of precocious puberty is rapid bone growth, which can result in early fusion and short stature.
• Children with SIADH develop an expanded circulatory volume but not edema.
• Because oral potassium tastes very bitter, mix it with a little strongly flavored fruit juice.
• For a child with an endocrine disorder, never discontinue medication abruptly.
• The vast majority of children with new-onset diabetes mellitus type 1 (IDDM) will experience a “honeymoon” period when their bodies secrete insulin and their need for exogenous insulin decreases.
• Blood glucose monitoring by finger-stick reflects glucose currently and for last several hours; glycosylated hemoglobin levels indicate long-term compliance and true diabetic status.
• Never freeze, heat or vigorously shake insulin.
• When insulin is absent, the body cannot properly metabolize fats, proteins and carbohydrates.
• The focus of diabetic management is the inter-relationship of diet, activity and insulin administration.
Pediatric Gastrointestinal
• Infants and children have a much smaller stomach capacity than adults.
• Peristaltic waves may reverse occasionally during infancy; gastric esophageal reflux is very common in infants.
• Secretory cells don’t reach adult levels until two to three years of age.
• The GI tract has both intake (fluid, minerals, vitamins, etc.) and output functions.
• Whenever a newborn coughs, chokes and turns blue with feeding, suspect tracheoesophageal fistula.
• Any newborn failing to pass meconium stool within the first 24 hours of life and who is prone to constipation or decreased frequency of stooling in the first month of life, should be evaluated for Hirschsprung’s Disease.
• The treatment of metabolic acid-base disturbance is oriented toward correcting the underlying problem.
• Dehydration can lead to shock.
• Dehydrated infants and children face greater morbidity risk than adults because children differ in body composition and metabolic rate, and their fluid-regulation systems have not matured.
• Potassium should only be added to IV fluids when the urine output is sufficient.
• One Gm of diaper weight = one cc of urine.
• When assessing diarrhea or constipation, remember the acronym ACCT: amount, color, consistency, and time (duration).
• Bilious vomiting indicates source below the ampulla of Vater.
Pediatric Genitourinary
• The kidney’s function is to maintain, in equilibrium, the composition and volume of body fluids.
• Kidney function in an infant is nearly that of an adult by 12 months of age.
• Children with urine output less than one ml/Kg/hour should be closely monitored for possible renal failure.
• Acute renal failure should be suspected in a child with decreased urine output, edema and/or lethargy, and who is dehydrated, recovering from surgery or in shock.
• In managing HUS, the goals are to control hematologic manifestations and any renal complications.
• UTI management aims to eliminate the underlying cause, detect and correct abnormalities, and prevent recurrences.
• The effects of hypokalemia or hyperkalemia can be devastating.
• UTIs are extremely common in young children, girls more than boys.
• In a child with ambiguous genitalia, the criterion for choice of gender and rearing is not genetic sex, but the infant’s anatomy.
Pediatric Musculoskeletal
• Since many musculoskeletal disorders begin with trauma, it is important to assess ABC (airway, breathing and circulation) first.
• Open fractures increase the risk of infection.
• Immobilization has multi-system effects.
• For a child with a fracture, it is important to assess the five P’s of ischemia:
1. Pain and point of tenderness
2. Pulse - distal to the facture
3. Pallor
4. Paresthesia
5. Paralysis
• Children with structural defects/disorders require regular follow-up evaluation until they reach skeletal maturity.
• Children in casts or traction need to be monitored for alterations in skin integrity routinely.
• Children under one year of age generally do not experience fractures.
• Because children’s soft tissues are so resilient, dislocation and sprains are less common.