COMMON PEDIATRIC CASES

IN OPD

ANNA MURIELLE B. DUNGCA-BALDERAMA, MD

GENERAL PEDIATRICIAN

RESPIRATORY

COUGH

COUGH

ACUTE BRONCHITIS

ACUTE BRONCHITIS
Bronchitis refers to nonspecific bronchial

inflammation
Acute bronchitis is a syndrome, usually viral in

origin, with cough as a prominent feature.

ACUTE BRONCHITIS
First presents with nonspecific upper respiratory

infectious symptoms, such as rhinitis

3 to 4 days later, a frequent, dry, hacking cough

develops, which may or may not be productive

Sputum may become purulent, but does not

necessarily imply bacterial infection.

ACUTE BRONCHITIS
Clinical Manifestations

Absent or low-grade fever

Upper respiratory signs such as nasopharyngitis,

conjunctivitis, and rhinitis

Auscultation of the chest may be unremarkable initially

ACUTE BRONCHITIS

Breath sounds become coarse, with coarse and fine

crackles and scattered high-pitched wheezing.

Chest radiographs are normal or may have increased

bronchial markings.

ACUTE BRONCHITIS
The principal objective of the clinician is to exclude

pneumonia
Absence of abnormality of vital signs (tachycardia,

tachypnea, fever) and chest examination reduced the

likelihood of pneumonia

ACUTE BRONCHITIS
Treatment

Self-limited

Antibiotics, although frequently prescribed, do not hasten

improvement in uncomplicated acute bronchitis.

Supportive

ACUTE BRONCHITIS
Anti-pyretic:

Paracetamol

Dose: 10-15 mg/kg/dose Q4 prn

Preparation: 100mg/ml Drops, 120mg/ 5ml and 250mg/ 5ml Syrup
Sample Computation:
Wt: 10kg

Dose: 10mg/kg/dose

10kg X 10mkdose X 5ml

120mg

Prepn: 120mg/5ml
4.16 ml or

5ml

ACUTE BRONCHITIS
Expectorant:

Guafenesin

Dose (Empiric): 6mos - 2yo: tsp- tsp Q4-6

2yo 6 yo: tsp- 1 tsp Q4-6
6 yo 12 yo: 1 tsp 2 tsp Q4-6
Preparation: 100mg/ 5ml

ACUTE BRONCHITIS
Mucolytic:

Carbocisteine

Dose (Empiric) and Preparation:

40mg/ ml Infant Drops

1-2yo: 1.5ml Q8

200mg/5ml Susp:
2-3 yo: 2.5ml Q8
4-7 yo: 5ml Q8
8-12 yo: 7.5ml Q8

ACUTE BRONCHITIS
Mucolytic:

Ambroxol

Dose (Empiric) and Preparation:

6mg/ ml Infant Drops

<6 mos: 0.5ml BID
7-12 mos: 1ml BID
1-2yo: 1.25ml BID

15mg/5ml Susp:
2-5 yo: 2.5ml TID
6-11yo: 5ml TID

ACUTE BRONCHITIS
Bronchodilator + Expectorant:

Salbutamol + Guaifenesin

Dose (Empiric): 2-6yo:5-10 l TID

7-12yo: 10ml TID

Preparation: Guafenesin 50mg + Salbutamol 1mg/ 5ml

Salbutamol

Dose: 0.10-0.15 mg/kg/dose TID

Preparation: 2mg/5ml

ACUTE BRONCHITIS
Antihistamine:

Cetirizine

Dose:0.25mg/kg/dose, ODHS
Preparation: Infant Drops: 2.5mg/ ml
Syrup: 5mg/5ml

Decongestant:

Phenylpropanolamine/ Phenylephrine

Dose (Empiric) and Preparation:

Infant Drops
1-3mos: 0.25ml Q6
4-6 mos: 0.5ml Q6
7-12 mos: 0.75ml Q6
1-2 yo: 1ml Q6

ACUTE BRONCHITIS

Phenylpropanolamine/ Phenylephrine

Dose (Empiric) and Preparation:

Syrup:
2-6 yo: 2.5ml Q6
7-12yo: 5ml Q6

COUGH

PNEUMONIA

PNEUMONIA
Inflammation of the lungs usually caused by viral or

bacterial infections
Leading single cause of mortality in children aged

less than 5 yo

PNEUMONIA
Clinical Manifestations

Preceded by upper respiratory tract infection symptoms,

typically rhinitis and cough

In viral pneumonia, fever usually is present; however,

temperatures are generally lower than in bacterial
pneumonia.

Tachypnea is the most consistent clinical manifestation of

pneumonia.

PNEUMONIA
o Intercostal, subcostal, and suprasternal retractions, nasal

flaring, and use of accessory muscles is common

o Vomiting post-tussive
o Severe infection may be accompanied by cyanosis and

respiratory fatigue, especially in infants

o Crackles and wheezing

PNEUMONIA
Treatment
Anti-pyretic:

Paracetamol

Dose: 10-15 mg/kg/dose Q4 prn

Preparation: 100mg/ml Drops, 120mg/ 5ml and 250mg/ 5ml Syrup

Expectorant:

Guafenesin

Dose (Empiric): 6mos - 2yo: tsp- tsp Q4-6

2yo 6 yo: tsp- 1 tsp Q4-6
6 yo 12 yo: 1 tsp 2 tsp Q4-6
Preparation: 100mg/ 5ml

PNEUMONIA
Mucolytic:

Carbocisteine

Dose (Empiric) and Preparation:

40mg/ ml Infant Drops

1-2yo: 1.5ml Q8

200mg/5ml Susp:
2-3 yo: 2.5ml Q8
4-7 yo: 5ml Q8
8-12 yo: 7.5ml Q8

PNEUMONIA
Mucolytic:

Ambroxol

Dose (Empiric) and Preparation:

6mg/ ml Infant Drops

<6 mos: 0.5ml BID
7-12 mos: 1ml BID
1-2yo: 1.25ml BID

15mg/5ml Susp:
2-5 yo: 2.5ml TID
6-11yo: 5ml TID

PNEUMONIA
Bronchodilator + Expectorant:

Salbutamol + Guaifenesin

Dose (Empiric): 2-6yo:5-10 l TID

7-12yo: 10ml TID

Preparation: Guafenesin 50mg + Salbutamol 1mg/ 5ml

Salbutamol

Dose: 0.10-0.15 mg/kg/dose TID

Preparation: 2mg/5ml

PNEUMONIA
Antihistamine:

Cetirizine

Dose:0.25mg/kg/dose, ODHS
Preparation: Infant Drops: 2.5mg/ ml
Syrup: 5mg/5ml

Decongestant:

Phenylpropanolamine/ Phenylephrine

Dose (Empiric) and Preparation:

Infant Drops
1-3mos: 0.25ml Q6
4-6 mos: 0.5ml Q6
7-12 mos: 0.75ml Q6
1-2 yo: 1ml Q6

PNEUMONIA

Phenylpropanolamine/ Phenylephrine

Dose (Empiric) and Preparation:

Syrup:
2-6 yo: 2.5ml Q6
7-12yo: 5ml Q6

Zinc Supplement

Dose: <2 yo old: 10mg/ day

>2 yo old: 20mg/ day
Preparation: Infant Drops: 10mg/ml
Syrup: 20mg/5ml

PNEUMONIA
Antibiotics

Amoxicillin

Dose:40-50mg/kg/day, TID
Preparation: Infant Drops: 100mg/ ml
Syrup: 125mg/5ml, 250mg/5ml

Clarithromycin

Dose: 15mg/kg/day, BID

Preparation: Syrup: 125mg/5ml, 250mg/5ml

PNEUMONIA
Sample Computation for Amoxicillin:
Wt: 10kg

Dose: 40mg/kg/day

10kg X 40mkdose X 5ml

120mg

16.6
3

Prepn: 120mg/5ml

5.5 or

6ml

COUGH

BRONCHIAL ASTHMA

BRONCHIAL ASTHMA
Chronic inflammatory condition of the lung airways

resulting in episodic airflow obstruction

Histopathologic abnormalities of the airways:

epithelial damage
subepithelial collagen deposition with basement membrane
thickening
mucus gland and smooth muscle hypertrophy

BRONCHIAL ASTHMA
These pathologic changes, linked to persistent

airways inflammation and hyperresponsiveness,

form the chronic basis of this disease.

BRONCHIAL ASTHMA
Clinical Manifestations

Dry coughing, expiratory wheezing, chest tightness, and dyspnea

are commonly provoked by physical exertion and airways irritants
(e.g., cold and dry air, environmental tobacco smoke)

Asthma symptoms are generally reversible either spontaneously or

with treatment

Asthma exacerbations for prolonged periods are induced by

common respiratory viral infections and by inhalant allergen
exposure

BRONCHIAL ASTHMA
Clinical Manifestations

Exacerbations are characteristically worse at night

Can progress to severe airflow obstruction, shortness of breath,

and respiratory distress and insufficiency

Rarely, severe sequelae such as hypoxic seizures, respiratory

failure, and death can occur.

BRONCHIAL ASTHMA
Treatment:
Bronchodilator:

Salbutamol

Dose: 0.10-0.15 mg/kg/dose TID

Preparation: 2mg/5ml

Salbutamol + Guaifenesin

Dose (Empiric): 2-6yo:5-10 l TID

7-12yo: 10ml TID

Preparation: Guafenesin 50mg + Salbutamol 1mg/ 5ml

BRONCHIAL ASTHMA
Treatment:
Bronchodilator:

Salbutamol nebule

1 nebule x 3 doses Q15 mins apart

1 nebule Q4-Q8 or as PRN

Preparation: 2.5mg/2.5ml

Salbutamol + Ipratropium Br

1 nebule x 3 doses Q15 mins apart

1 nebule Q4-Q8 or as PRN

Preparation: Ipratropium Br 500mcg + Salbutamol 2.5mg/ 2.5ml

BRONCHIAL ASTHMA
Treatment:
Steroid:

Prednisone

Dose: 1-2 mg/kg/day BID- TID

Preparation: 5mg/5ml, 10mg/5ml

Prednisolone

Dose: 1-2 mg/kg/day BID- TID

Preparation: 15mg/5ml, 20mg/5ml

BRONCHIAL ASTHMA
Treatment:
Anti-Leukotriene:

Montelukast

Dose (Empiric) and Preparation:

2-5 yo: 4mg chewable tab/ sachet OD
6-14 yo: 5mg tab OD
> 15 yo: 10 mg tab OD

COUGH

TUBERCULOSIS

TUBERCULOSIS
Also called Primary Kochs Infection
A highly contagious infection and disease caused by

exposure to the virulent bacterium Mycobacterium

tuberculosis progressing from infection to disease,
when signs and symptoms manifest either form
pulmonary or extrapulmonary involvement

TUBERCULOSIS
Clinical Manifestations

Non-productive cough, mild dyspnea and cervical

lymphadenopathies are the most common manifestations in
young children

Difficulty in gaining weight and failure to thrive

TUBERCULOSIS
Diagnosis

(If 3 or more of the following criteria are present)

Exposure to an adult/ adolescent with active TB disease

Signs and symptoms suggestive of TB

Positive tuberculin (PPD) test

Abnormal Chest Xray finding suggestive of TB

Other laboratory findings suggestive of TB (histological, cytological,

biochemical, immunological)

TUBERCULOSIS
Treatment

Isoniazid

Rifampicin

Dose: 10-15 mg/kg/dose OD

Preparation: 200mg/5ml

Dose: 10-20 mg/kg/dose OD

Preparation: 200mg/5ml

Pyrazinamide

Dose: 30-40 mg/kg/dose OD

Preparation: 500mg/5ml

GASTROINTESTINAL

DIARRHEA

ACUTE GASTROENTERITIS
Caused by a wide variety of enteropathogens, including bacteria,

viruses, and parasites.

Clinical manifestations include watery diarrhea, bloody diarrhea,

chronic diarrhea, vomiting, abdominal pain

Laboratory studies are often not requirand some may ed because

most episodes are self-limited

Require fluid and electrolyte therapy
Few need other nonspecific support, benefit from antimicrobial

therapy

ACUTE GASTROENTERITIS
Assessment of Dehydration
A

Look at: Condition

Eyes
Thirst

Well, alert
Normal
Drinks normally,
not thirsty

Restless, irritable
Sunken
Thirsty, drinks
eagerly

Lethargic
Sunken
Drinks poorly, not
able to drink

Feel: Skin pinch

Goes back quickly

Goes back slowly

Goes back very

slowly

Assesment

No Signs of DHN

Some DHN

Severe DHN

ACUTE GASTROENTERITIS
PLAN A

AGE

ORS

<2yo
2-10 yo
> 10 yo

PLAN B

PLAN C

Weight (kg) x 75ml /kg

AGE
Infants
Children

50-100 ml
100-200 ml
As tolerated

Amount of ORS to give in the 1 st

4 hours

30ml/ kg
1 hour
30 mins

70ml/kg
5 hrs
2 hrs

ACUTE GASTROENTERITIS

<15kg

wt x 50cc/kg in 8 hrs

>15kg

wt x 30cc/ kg in 8 hrs

Holliday-Segar
0-10kg

wt x 100 cc

11-20kg

(wt x 50 cc) + + 1000 cc

>20kg

(wt x 20 cc) + + 1500 cc

ACUTE GASTROENTERITIS
Treatment
Antibiotics

Cefalexin

Dose:40-50mg/kg/day, TID
Preparation: Infant Drops: 100mg/ ml
Syrup: 125mg/5ml, 250mg/5ml

Cotrimoxazole

Dose:8-10mg/kg/day (TMP), BID

Preparation: Syrup: 200mg (SMX) 40mg (TMP)/5ml
400mg (SMX) 80mg (TMP)/5ml

ACUTE GASTROENTERITIS
Antibiotics

Metronidazole

Dose:30-50mg/kg/day, TID
Preparation: Syrup: 125mg/5ml

Zinc Supplement

Dose: <6 mos old: 10mg/ day

>6 mos old: 20mg/ day
Preparation: Infant Drops: 10mg/ml
Syrup: 20mg/5ml

ACUTE GASTROENTERITIS
Probiotics:

Erceflora vial OD-BID

Protexin sachet and tab OD

GASTROINTESTINAL

ABDOMINAL PAIN

ABDOMINAL PAIN

DYSPEPSIA

DYSPEPSIA
Periumbilical abdominal pain is the most common location

for children with Recurrent Abdominal Pain

Epigastric pain is frequently associated with symptoms of

early satiety, nausea, bloating, or belching

A negative evaluation and no response to acid-blocking

medication, is referred to as Nonulcer dyspepsia

DYSPEPSIA
Treatment
Dicycloverine

Dose (Empiric) and Preparation:

5mg/ ml Infant Drops

6mos -2 yo: 0.5ml- 1ml Q4-6 PRN

10mg/5ml Syr:
2-5 yo: 2.5ml - 5ml Q4-6 PRN
6-12yo: 5ml Q4-6 PRN

DYSPEPSIA
Treatment
Domperidone

Dose: 0.25 mg/kg/dose TID PRN

Preparation: Infant Drops: 5mg/ ml
Syrup: 5mg/5ml

ABDOMINAL PAIN

ACUTE GASTRITIS

ACUTE GASTRITIS
Gastric inflammation
Periumbilical abdominal pain, epigastric pain, early

satiety, nausea, bloating, or belching

Risk factors: Softdrinks, Coffee, Does not eat on time

ACUTE GASTRITIS
Treatment
Esomeprazole

Dose: 1-11 yo:

10-19kg: 10mg/ day
>20kg: 20mg/ day
Preparation: 10mg susp

Lansoprazole

Dose:

<30kg: 15mg/ day

>30kg: 30mg/ day
Preparation: 15mg/ tab, 30mg/ tab

ABDOMINAL PAIN

INTESTINAL PARASITISM

INTESTINAL PARASITISM

Abdominal pain, vomiting, diarrhea

Pallor
Anal pruritus
Malnutrition, failure to thrive

INTESTINAL PARASITISM
Deworming must not be done in:
Severe malnutrition
High-grade fever
Profuse diarrhea
Abdominal pain
Serious illness
Previous hypersensitivity to anti-helminthic drug

INTESTINAL PARASITISM
Treatment
Mebendazole

Dose (Empiric): >12 mos: 500mg single dose at bedtime every

6 mos
Preparation: 50mg/ ml

Albendazole

Dose (Empiric): >12 mos 24 mos: 200mg single dose at bedtime

every 6 mos
>24 mos: 400mg single dose

Preparation: 400mg/ chewable tab

NEPHROLOGY

URINARY TRACT
INFECTION

URINARY TRACT INFECTION

Infection of the bladder and the kidneys
E. coli is the most common cause
Occur in all age groups

URINARY TRACT INFECTION

Clinical Manifestations:
Urgency, frequency, dysuria
Abdominal or suprapubic pain with or without tenderness
May or may not have fever
Foul-smelling and cloudy urine

URINARY TRACT INFECTION

Treatment:
Antibiotics

Amoxicillin

Dose:40-50mg/kg/day, TID
Preparation: Infant Drops: 100mg/ ml
Syrup: 125mg/5ml, 250mg/5ml

Cefalexin

Dose:40-50mg/kg/day, TID
Preparation: Infant Drops: 100mg/ ml
Syrup: 125mg/5ml, 250mg/5ml

URINARY TRACT INFECTION

Cotrimoxazole

Dose:8-10mg/kg/day (TMP), BID

Preparation: Syrup: 200mg (SMX) 40mg (TMP)/5ml
400mg (SMX) 80mg (TMP)/5ml

Co-amoxiclav

Dose:40-50mg/kg/day (Amoxicillin)
Preparation: Syrup:
125mg (Amox) 31.25mg (CA) or 156.25mg/5ml TID
250mg (Amox) 62.5mg (CA) or 312.5mg/5ml TID
200mg (Amox) 28.5mg (CA) or 228.5mg/5ml BID
400mg (Amox) 57mg (CA) or 457mg/5ml BID

INFECTIOUS

SYSTEMIC VIRAL ILLNESS

SYSTEMIC VIRAL ILLNESS

Fever
No focus
General signs and symptoms: Body malaise, muscle pains,

vomiting, headache, dizziness, decreased appetite

SYSTEMIC VIRAL ILLNESS

Treatment

Self-limited

Supportive

INFECTIOUS

NON-SPECIFIC VIRAL
EXANTHEM

NON-SPECIFIC VIRAL EXANTHEM

Fever
Non-pruritic rashes
General signs and symptoms: Body malaise, muscle pains,

vomiting, headache, dizziness, decreased appetite

SYSTEMIC VIRAL ILLNESS

Treatment

Self-limited

Supportive

SYSTEMIC VIRAL ILLNESS

Paracetamol

Dose: 10-15 mg/kg/dose Q4 prn

Preparation: 100mg/ml Drops, 120mg/ 5ml and 250mg/ 5ml
Syrup

Cetirizine

Dose:0.25mg/kg/dose, ODHS
Preparation: Infant Drops: 2.5mg/ ml
Syrup: 5mg/5ml

INFECTIOUS

ROSEOLA
INFANTUM

ROSEOLA INFANTUM
A mild febrile, exanthematous illness occurring almost

exclusively during infancy.

More than 95% of roseola cases occur in children younger

than 3 yr, with a peak at 6-15 mo of age.

Transplacental antibodies likely protect most infants until 6

mo of age.

ROSEOLA INFANTUM
The prodromal period may include mild upper respiratory tract signs,

such as minimal rhinorrhea, slight pharyngeal inflammation, and mild

conjunctival redness
Mild cervical or, less frequently, occipital lymphadenopathy may be

noted
High temperature, usually ranging from 37.9 to 40C
Fever persists for 3-5 days, and then typically resolves rather abruptly
A rash appears within 12-24 hr of fever resolution.
After 1-3 days, the rash fades.

ROSEOLA INFANTUM
Treatment

Self-limited

Supportive

ROSEOLA INFANTUM

Paracetamol

Dose: 10-15 mg/kg/dose Q4 prn

Preparation: 100mg/ml Drops, 120mg/ 5ml and 250mg/ 5ml
Syrup

Cetirizine

Dose:0.25mg/kg/dose, ODHS
Preparation: Infant Drops: 2.5mg/ ml
Syrup: 5mg/5ml

INFECTIOUS

HAND-FOOT-AND-MOUTH
DISEASE

HAND-FOOT-AND-MOUTH DISEASE
A syndrome characterized by vesicular stomatitis and and

cutaneous lesions of the extremities

Predominant causes: Coxsackie A16 and Enterovirus 71
Commonly affected: <10 yo

HAND-FOOT-AND-MOUTH DISEASE
Clinical Manifestations:

Fever, sorethroat, decreased appetite

Enanthem appears 1-2 days after fever onset

Exanthem follows thereafter

HAND-FOOT-AND-MOUTH DISEASE
Treatment

Self-limited

Supportive

INFECTIOUS

MUMPS

MUMPS
A systemic disease characterized by inflammation of one or

more of the salivary glands, usually of the parotid

1-2 days prodromal period with fever, anorexia, headache,

vomiting
Parotid gland enlargement commences after prodromal period
Bilateral involvement seen in 70-80%
Associated parotid gland tenderness and ear pain

MUMPS
Treatment

Self-limited

Supportive

INFECTIOUS

LYMPHADENITIS

LYMPHADENITIS
Lymph node enlargement is caused by proliferation of normal

lymphoid elements or to infiltration by malignant or

phagocytic cells
Localized/ Regional adenopathy is most frequently the result

of infection in the involved node and/or its drainage area

Acutely infected nodes are usually tender. There may also be

erythema and warmth of the overlying skin

Caused by Streptococcus/ Staphylococcus

LYMPHADENITIS
Treatment:
Antibiotics

Co-amoxiclav

Dose:40-50mg/kg/day (Amoxicillin)
Preparation: Syrup:
125mg (Amox) 31.25mg (CA) or 156.25mg/5ml TID
250mg (Amox) 62.5mg (CA) or 312.5mg/5ml TID
200mg (Amox) 28.5mg (CA) or 228.5mg/5ml BID
400mg (Amox) 57mg (CA) or 457mg/5ml BID

Thank you!