#pediatrics
VERYSmooth Muscle
i♡histo
232 of 366
I’m gonna start rotating in the pediatric wards on Monday! I got assigned to Neurology subspecialty so here I am brushing up on some cases I might encounter. I also need to review on neuroanatomy really soon. Wish me luck!
ig:studyingdoc
222/366
I’m done with one month of OB and I’m starting my pediatrics rotation tomorrow!!! I’m honestly excited, scared, and anxious all at the same time. I loved pediatrics back in clerkship and I honestly hope I’ll feel the same way.
I have a lot of backlogs in my asks right now and I’ll be answering them one by one in a bit! Hehe
ig:studyingdoc
On my last shift, I had a pair of chonky 3-month-old twins come back to our department because one of them had suddenly developed rapidly worsening stridor; when they were seen initially, they both had fever, cough, and nasal congestion. Unsurprisingly, they were COVID+; unfortunately, this quickly evolved into croup for one of the chubby beans. He was crying and barking away while his twin slept completely unawares; he struggled to breathe and was so upset, making it harder for himself to breathe because of how upset he was… the classic moderate croup-er that was just too young to be soothed with words and distraction alone.
Of course, when the beans are this mad/anxious and working this hard to breathe, there’s no way you can get them to take any oral medications. My nursing colleague and I attempted to decrease his stridor in whatever ways did not require him to swallow–I put him face-down in my arms with his chubby little cheek smooshed against the lateral condyle of my elbow, rocking him and patting his little diapered butt. Eventually that calmed him enough to stop crying, and his stridor improved enough for my nursing colleague to get him to take a few puffs from an epinephrine MDI. His stridor got a bit better still and now could be heard faintly as the chunker dropped off to sleep, probably exhausted from crying and breathing so hard.
Unfortunately… we already knew this little guy would start screaming again if we moved him, and he was now too sleepy to actually swallow any oral meds… so we weighed the options with his caregiver and opted to give his steroid medication as an intramuscular injection, since then we could at least ensure he received the whole dose. Predictably, the little guy was NOT happy to be poked while he had finally nodded off, so I resumed rocking him and patting his little butt.
Maybe twenty minutes later, after all his medications were in, I arranged the little bean in his mother’s arms in the same prone position as he had been in mine; he protested stridorously for a few minutes before settling back to sleep. (During this transfer over to mom, we all became acutely aware of the string of drool from the beany bean’s face down my elbow and reaching literally all the way to the floor… I was honestly kind of impressed.)
Thankfully, the steroids kicked in as expected and when I checked back in the next few times our little chonk was fast asleep in his carseat with no stridor and no work of breathing. Eventually he and his brother were discharged with an anticipatory dose of oral steroids in case his brother developed similar symptoms, and instructions to come back if those symptoms returned or worsened. The babies’ poor caregiver looked so exhausted (but relieved).
Unsurprisingly, I woke up the next morning after this shift with very sore arms… I guess soothing chunky chunkers is actually good weight training…?
If there aren’t any kiddos in your life, you may not have realized this, but kiddos love pressing buttons. You know that visceral satisfaction you feel when you get to pop some good bubble wrap? For the little beans, every button, no matter how mundane it may seem to us, is like bubble wrap.
The other day I got on the elevator and a mom rushed on behind me, pushing her stroller with one hand and carrying her little bean in the other. I had my finger on the “door open” button to ensure they could get on, and I saw the kiddo’s wide, curious eyes trained on my hand at the button pad.
“Could you press the button for me?” I asked her, indicating with my finger which button I needed her to press. She nodded and squirmed excitedly in her mom’s arms until her mom brought her over. I stepped out of the way so she could press my floor button. She squealed with delight, giggling and beaming at me behind her tiny teddy-bear print mask. Her mother chuckled and showed her which button to press next for their destination, and she very excitedly mashed that button too.
The little peanut was just so happy by her opportunity to press buttons (and come to think of it, a lot of kiddos also just enjoy elevators for some reason) that she couldn’t stop grinning and wiggling in her mom’s arms. When we arrived at my floor I waved at her as I stepped out of the elevator, and she chirped, “Byeee!!!” and continued to wave at me until the elevator doors closed.
Children experience life and joy in a different way than adults; we are simply privileged that their experience is so willingly and enthusiastically shared.
Sudden infant death syndrome, or SIDS, usually happens when infants die in their sleep without any particular reason. Researchers in Australia say they’ve found why infants die from SIDS.
In the latest study, researchers found that infants who died from SIDS had lower levels of an enzyme known as Butyrylcholinesterase (BChE). This enzyme is thought by scientists to help regulate pathways in the brain which drive a person’s breathing, confirming what scientists had originally hypothesized.
The Approaches to Examining a Toddler: Tactical Tips for Toddlerology
- The “Parent First” or “Watch [Parent] Do It” Strategy: employing the philosophy of having a taster for monarchs because if [parent] does not die after you look in their mouth then it must be okay.
- The “Toy Checkup” Strategy: only useful if the kiddo brought their own toy, generally, but kind of fun to show them how you will listen to their chest or check their ROM or look in their ears… (can be combined with the “You Try” strategy–see below)
- The “You Try” Strategy: Hand over your stethoscope or your otoscope or reflex hammer or tongue depressor or whatever. Let them touch it and understand it’s not threatening. (WARNING: Toddlers are gross and indiscriminate with their bodily fluids, so be prepared for an unexpected goober/booger/vomit and ALWAYS, ALWAYS clean/dispose between patients!). If going for combo of “Toy Checkup” + “You Try” or “You Try” + “Parent First”, show the kiddo how to do the maneuver for their turn, then it is your turn to check on them, etc.
- The “Taking Advantage of DevelopmentalImagination” Strategy: Stethoscope = special heart, lung, and tummy telephone. Otoscope = lava checker/sucker; otoscopy = checking for [cute or silly thing] inside ears (I tend to accompany this with, “Hello? Are any [cute/silly thing(s)] home? Nope! No one is home. Maybe they’re on the other side?”). Abdo exam = “Did you eat [silly thing]? Maybe I can find it in your tummy!”, or “Did you know that your tummy is also a drum? Listen here! *proceed to percuss*”, or “Where are the [silly/cute thing(s)] hiding in your tummy? Let’s find them…”
- The “FOMO” Strategy: Younger kiddos often want what their older siblings have… if you’ve got a cooperative older sibling, examine them first with the little one watching. They usually want what their older siblings have, so they might even be eager for their turn to have their ears checked…
- The “Sound Effects” Strategy: Anything you need to palpate or make general contact with in the toddler’s sphere of personal space should have a sound effect. Personally, I’m a fan of “boop boop”. Other kids really likesinging and music…
- The “Kindasorta Bribing” Strategy: …this one I find is pretty hit-or-miss, but sometimes the thought of a reward will get a bit of cooperation. Always remember that our little friends lovestickers.
- The “Monkey See, Monkey Do” Strategy: Sometimes you kinda just walk in there, wave at the kiddo and make funny faces at them and get them to warm up to you, and then do the stuff you want them to do and they just… do it. I find it SUPER cute when I do this for MSK exams to check neurovascular status after an injury or for neuro exams, particularly finger-to-nose testing… it’s just so magical.
- The “Smoke and Mirrors [and Additional Screentime]” Strategy: I cannot stress enough how powerful distractionis…
- The “Yeah… You’re Just Not Having It So Let’s Get This Over With” Strategy: …you just do the thing and you do it as quickly as possible and GTFO. The kid’s already crying, screaming, and trying to get away from you by any means possible so you might as well make it short.
(Sometimes I have so much fun with these that I come home and tell my significant other all about these exams and re-enact them on him and he just sits through the whole thing and laughs at me but is also like, “Wait did you come up with that on the spot?”, to which the answer is usually “yes, and I love doing it” or “at some point but since then I just do the same thing depending on the kid” and he just laughs and then I realise that he doesn’t see a single beanerino during his workday and I am immediately sad for him because that is really sucky.)
100% GOLD
Sometimes you gotta make things work when you’ve been to 4 stores trying to find some simple loafers and when you finally find the right pair they have every size but yours. Oh, you know, the old thick socks and heat gun to add half a shoe size trick. Sometimes you have to laugh because your friend has the same color pants and a patient thought her tunic was a dress with no pants but you still OWN. IT.
Post link
Ventricular Septal Defect
Atrial Septal Defect
Patent Ductus Arteriosus
Mirror, Mirror on the …floor?
I think being a boy mom is going to involve a loooot of future urgent care visits. My oldest son is almost 4 with the body of a 6 year old, the impulse control of an 18 month old, and the coordination of a newborn foal on ice (yes, concerned followers, we are in ALL the therapies). It’s a recipe for disaster, and I’m honestly surprised that he hasn’t had a concussion or fracture yet.
So Sunday I was in his bathroom and noticed there was no TP, so I asked him to go to my bathroom to get a few rolls. He doesn’t know how to walk—running is his only speed. So he took off in socks, slid across the hardwood floor, and went straight through a 40+ lb floor mirror. The clash of the mirror shattering was jarring, and the subsequent blood curdling scream had me frantically calling out to big J asking if he was okay. He was screaming that the glass broke and he was bleeding. I have warned him probably a thousand times about running in the house AND I’ve specifically pointed out the danger of the mirror and a glass-top table we have that he’s tried to climb on before, but he’s 3 and warnings are useless. Of course at that point I was just worried he was seriously injured.
I expected to see arterial spray when I met up with J, but thankfully there were just a few trickles. If y’all had seen the shape this mirror ended up in you’d be shocked that all he ended up with was 3 stitches in his hand and a little superglue on another cut. Not even shards in his feet! I cleaned up the wounds and wrapped up his hand with paper towels (I couldn’t get to my actual kit with gauze because it was on the other side of the razor sharp shards of mirror). I called a neighbor and dropped off little J so I wouldn’t have to wrangle both kids at urgent care on a Sunday afternoon and we went on. Amazingly there were hardly any kids there so we got in quickly and got the stitches done with only a few minutes of screaming.
One would think such a scary experience would make big J wary of running in the house, but it hasn’t deterred him one bit. I anticipate many visits to urgent care for casts, splints, and stitches in the years to come.
Weighty Perspective
(In Peds rounds)
Resident: everybody lost weight overnight—
Wayfaring: —I didn’t!
Peds Attending: Me neither dammit!
Wayfaring: of course I’ve been practicing eating a lot longer than these babies have.
Peds Attending: well there’s that.
Does High Stress in a Home Cause Childhood Obesity?
In a recent study, published in Clinical Obesity, researchers at University of California San Diego School of Medicine found associations between adverse home environments and appetite hormones in children.
Researchers measured high stress factors (maternal depressive symptoms, family stress and socioeconomic disadvantage) in the households of 593 Chilean children at ages 10 and 16. At age 16, the participants provided fasting blood samples for assessment of adipokines and appetite hormones.
The study found high levels of stress during childhood and adolescence can reduce levels of adiponectin, the body’s fat burning hormone, which makes it difficult to lose weight and contributes to obesity.
Patricia East, PhD, senior author of the study in the Department of Pediatrics at UC San Diego, explains more and how the results from participants from Chile can be used for patients in the United States.
Question: What is the clinical significance of this study?
Answer: Our results show that not only are high levels of stress during childhood and adolescence contributing to the reduction in the body’s fat burning hormone, which makes it difficult to lose weight, but because fat-burning hormones reduce inflammation and help regulate the body’s glucose levels, lower levels of this hormone, adiponectin, may also be an early red flag for developing type 2 diabetes.
It may be advisable for physicians to screen for diabetes in children and teens who are exposed to high levels of stress and have a lot of abdominal fat (a waist circumference above the 90th percentile or approximately greater than 70 centimeters).
Like the United States, Chile is a developed, upper-middle income nation with a highly literate population and good access to health care. Prevalence of overweight/obesity is similar between the U.S. and Chile, at approximately 40 and 30 percent, respectively.
A recent National Chilean Health Survey found high but equivalent prevalence of risk factors, such as smoking, high cholesterol and hypertension, between Chile and the U.S. Thus, while cultural factors, such as diet and physical activity, likely play a role in risk for diabetes, disease prevalence and contributing risk factors are similar between the two countries.
Q: What types of health issues do children with obesity face?
A: Rates of pediatric type 2 diabetes are rapidly increasing and are occurring at younger ages. Risk factors for children and teens include being overweight, inactivity and having a family history of diabetes.
Many children develop type 2 diabetes in their early teens. Adolescent girls are more likely to develop type 2 diabetes than are adolescent boys.
Q: What are next steps now that you have results?
A: We are currently examining the associations between childhood adversity, appetite hormones and glucose and insulin levels at age 23 to determine if in fact early adversity and fat burning hormones link to type 2 diabetes in young adulthood.
— Michelle Brubaker
Post link
Researchers look at the use of intravenous immunoglobulin for treatment of Kawasaki disease and multisystem inflammatory syndrome in children, a rare reaction to SARS-CoV-2
Kawasaki disease (KD) is rare, with fewer than 6,000 diagnosed cases per year in the United States. It is most common in infants and young children and causes inflammation in the walls of some blood vessels in the body. KD is a common cause of acquired heart disease in children around the world, causing coronary artery aneurysms in a quarter of untreated children.
Multisystem inflammatory syndrome in children (MIS-C) is also rare, a life-threatening illness that follows exposure to severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2). MIS-C is characterized by the acute onset of fever and variable symptoms, including rash, cardiovascular complications, shock and gastrointestinal symptoms, including abdominal pain, diarrhea and vomiting.
KD and MIS-C share several clinical features and immune responses. Both conditions are treated with intravenous immunoglobulin (IVIG), a therapeutic containing antibodies purified from blood products. Antibodies in the blood protect us from a number of viral, bacterial and fungal pathogens, but when administered as IVIG, can also suppress excessive inflammation. How it does this is an ongoing area of research worldwide.
In a pair of new studies, published online October 26 and August 31, 2021, two collaborating teams of researchers at University of California San Diego School of Medicine examined the use of IVIG in two groups; one group used a second dose of IVIG in children with KD who do not respond to the first dose of the drug, and the other group used IVIG as an effective treatment for MIS-C.
“Our research teams looked further into KD to improve treatment, and then used what we know about that disease to advance science in another illness,” said senior author Jane C. Burns, MD, professor and director of the Kawasaki Disease Research Center at UC San Diego School of Medicine and Rady Children’s Hospital-San Diego.
“Same Treatment Tested for Kids with Kawasaki Disease and Rare COVID-19 Reaction”
The National Institutes of Health (NIH) has awarded researchers at University of California San Diego approximately $30 million over five years to expand and deepen longitudinal studies of the developing brain in children.
“This is a groundbreaking study of normal and atypical brain developmental trajectories from day 0 to 10 years of age in a large sample of about 8,000 families,” Christina Chambers, PhD, MPH, professor of pediatrics at UC San Diego School of Medicine and professor in the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego.
