Pediatrics

A

• ADHD in Children — Diagnosis & Treatment

  Use DSM‑5 criteria with impairment in ≥2 settings; combine behavioral therapy and school supports; stimulants are first‑line pharmacotherapy with careful monitoring and shared decision‑making.
• Autism Spectrum Disorder — Screening & Early Intervention

  Autism care begins with developmental surveillance at every well visit, standardized developmental screening at 9, 18, and 30 months, and autism-specific screening at 18 and 24 months. A positive screen is not the diagnosis, but it should trigger diagnostic evaluation, hearing and developmental assessment, and referral to early-intervention services without waiting for a definitive autism label.

B

• Bronchiolitis - Supportive Care and High Flow Nasal Cannula

  Bronchiolitis is a viral lower-respiratory illness of infancy diagnosed clinically from coryza followed by cough, tachypnea, wheeze or crackles, and increased work of breathing. Treatment is supportive: nasal suctioning, hydration, and oxygen for persistent hypoxemia. Bronchodilators, corticosteroids, antibiotics, and routine imaging are not recommended for typical disease; high-flow nasal cannula is reserved for selected infants with persistent respiratory distress or oxygen needs despite standard support.
• Button Battery Ingestion (Pediatrics) — Honey/Sucralfate, Urgent Removal, and Follow‑Up

  Esophageal button batteries cause caustic injury within hours. Administer honey or sucralfate en route/ED for children ≥1 year when safe, obtain immediate radiographs, and remove esophageal batteries emergently; follow a structured pathway for post‑removal evaluation and delayed complications.

C

• Child Maltreatment - Recognition, Documentation, and Safety

  Suspected child maltreatment requires immediate attention to medical stabilization, injury recognition, objective documentation, mandated reporting, and a safe disposition. The clinician's role is not to prove abuse beyond doubt but to recognize concerning patterns, obtain appropriate medical evaluation, preserve the child's history and physical findings accurately, and notify the designated child-protection authority when reasonable suspicion exists.
• Constipation in Children — Evaluation & Treatment

  Functional constipation is common; use Rome criteria and exclude red flags; treat with disimpaction, maintenance laxatives (PEG), and behavioral interventions.
• Croup - Dexamethasone and Nebulized Epinephrine

  Croup is an acute viral upper-airway illness characterized by barking cough, hoarseness, and inspiratory stridor. Give a corticosteroid to children with croup of any severity; add nebulized epinephrine for moderate to severe obstruction, reassess after its effect wanes, and escalate airway support early when fatigue, hypoxemia, or impending respiratory failure appears.
• Croup with Impending Respiratory Failure — Racemic Epinephrine and Steroids

  Severe laryngotracheitis with stridor at rest, retractions, and hypoxia. Provide humidified oxygen, nebulized racemic epinephrine with observation for rebound, and systemic corticosteroids; prepare for advanced airway if deteriorating.

E

• Early‑Onset Neonatal Sepsis — Evaluation & Management

  Early-onset neonatal sepsis requires rapid treatment of symptomatic or unstable newborns while avoiding unnecessary antibiotics in well-appearing infants. Use gestational age, maternal risk factors, infant examination, and a validated categorical, multivariate, or serial-examination strategy; obtain blood culture when treatment is indicated, start empiric ampicillin plus gentamicin in typical cases, and stop antibiotics when cultures remain negative and the clinical course does not support infection.

F

• Failure to Thrive — Evaluation & Nutrition

  FTT is inadequate growth from insufficient intake, malabsorption, or increased needs. Use detailed feeding history and growth charts; prioritize outpatient, family‑centered strategies and targeted labs.
• Febrile Infant 29 to 60 Days - ED Algorithm

  Well-appearing term infants 29 to 60 days old with documented fever of at least 38.0°C can be risk-stratified using the AAP febrile-infant pathway. Obtain urinalysis with urine culture strategy, blood culture, and inflammatory markers. Lumbar puncture and empiric parenteral antibiotics are guided by inflammatory-marker results, urinalysis, clinical judgment, and shared decision-making. Selected infants with reassuring evaluation and reliable follow-up can be managed at home with explicit 24-hour reassessme

H

• Hand‑Foot‑and‑Mouth Disease — Diagnosis & Care

  Viral exanthem (Coxsackie/enteroviruses) with oral ulcers and vesicular rash on hands/feet; supportive care with hydration and pain control; counsel on contagion and complications.

I

• Intussusception - Diagnosis and Air Enema Reduction

  Intussusception is telescoping of one bowel segment into another, most often ileocolic in young children. Suspect it with episodic severe abdominal pain, vomiting, lethargy, or bloody stool even when the classic triad is incomplete. Ultrasound is the preferred diagnostic test. In a stable child without perforation or peritonitis, pneumatic or hydrostatic enema reduction is both diagnostic and therapeutic; surgery is required when reduction fails or complications are present.
• Intussusception (Pediatrics) — Ultrasound Diagnosis and Pneumatic Enema Reduction

  Episodic colicky pain, vomiting, and currant‑jelly stools in infants/toddlers. Diagnose with ultrasound (target/doughnut sign) and reduce with air enema under fluoroscopy/US when no perforation; operate if peritonitis, perforation, or failed enema.

K

• Kawasaki Disease - Diagnosis, IVIG, and Aspirin

  Kawasaki disease is an acute childhood vasculitis that can cause coronary artery aneurysms. Diagnose complete or incomplete disease from persistent fever, mucocutaneous findings, inflammatory markers, and supportive laboratory or echocardiographic features. Treat promptly with IVIG plus aspirin; identify children at high risk for IVIG resistance or coronary complications who may benefit from additional anti-inflammatory therapy and ensure serial echocardiographic follow-up.

M

• Measles — Recognition, PEP, and Public Health

  Measles should be recognized as a febrile respiratory illness with cough, coryza, conjunctivitis, Koplik spots, and a descending morbilliform rash in an epidemiologically compatible patient. Immediately institute airborne precautions, notify public health, obtain recommended PCR/serology specimens, and coordinate post-exposure prophylaxis: MMR vaccine within 72 hours of exposure for eligible susceptible contacts or immune globulin within 6 days for selected high-risk contacts.
• Multisystem Inflammatory Syndrome in Children - Recognition and Initial Therapy

  MIS-C is a rare postinfectious inflammatory syndrome occurring weeks after SARS-CoV-2 infection, characterized by fever, systemic inflammation, and involvement of multiple organs. Admit suspected cases for multidisciplinary evaluation; assess shock and myocardial injury early, use IVIG plus glucocorticoid therapy for most hospitalized patients with significant disease, and individualize antiplatelet or anticoagulant therapy according to thrombosis and coronary risk.

N

• Neonatal Fever (≤60 Days) — AAP Risk-Stratified Sepsis Evaluation and Management

  Well-appearing febrile infants require age-based risk stratification per AAP (0–28 days vs 29–60 days) using inflammatory markers and urinalysis; obtain cultures as indicated. Admit and treat with IV antibiotics if high risk; consider outpatient management with close follow-up for low risk.
• Neonatal Fever 0 to 28 Days - Sepsis Evaluation and Management

  Fever of 38.0°C or higher in an infant 0 to 28 days old is a high-risk presentation because invasive bacterial infection can initially look subtle. The AAP well-appearing febrile-infant guideline begins at 8 days of age, so newborns 0 to 7 days require separate neonatal management. In general, neonates and young infants in this age range need prompt blood and catheterized urine cultures, age-appropriate CSF evaluation, empiric parenteral antibiotics, and hospital observation; evaluate and treat for neonata
• Neonatal Jaundice - Phototherapy Thresholds and Workup

  Neonatal jaundice requires interpretation of the total serum bilirubin by postnatal age in hours, gestational age, and neurotoxicity risk factors. Use the 2022 AAP treatment thresholds for infants at least 35 weeks gestation, confirm significant transcutaneous values with serum testing, identify hemolysis and feeding problems, and start intensive phototherapy when the age-specific threshold is reached. Escalate urgently when bilirubin approaches the exchange-transfusion threshold or neurologic signs appear.
• Neonatal Jaundice — Risk Stratification & Phototherapy

  Risk-stratify neonatal unconjugated hyperbilirubinemia by gestational age, postnatal age in hours, bilirubin trajectory, feeding, hemolysis, and neurotoxicity risk factors. Use the AAP hour-specific treatment thresholds for infants at least 35 weeks gestation, start intensive phototherapy when the treatment line is reached, escalate urgently near the exchange-transfusion threshold, and plan follow-up according to how close the bilirubin is to the treatment threshold.
• Nursemaid’s Elbow — Reduction & Counseling

  Radial head subluxation from axial traction; clinical diagnosis; treat with supination‑flexion or hyperpronation technique; counsel caregivers to avoid traction.

O

• Otitis Media with Effusion — Management

  Middle ear effusion without acute infection; watchful waiting and hearing evaluation; consider tympanostomy tubes for persistent bilateral OME with hearing loss or developmental risk.

P

• Pediatric Asthma Exacerbation - ED Management

  A pediatric asthma exacerbation is treated by rapidly reversing bronchospasm, suppressing airway inflammation, and identifying children at risk of respiratory failure. Give repeated inhaled short-acting beta-2 agonist therapy, add ipratropium for moderate to severe attacks, administer systemic corticosteroid early, and use oxygen, IV magnesium, and intensive respiratory support according to severity. Discharge requires sustained clinical improvement plus an asthma action plan and controller review.
• Pediatric Dehydration - Oral Rehydration and IV Fluids

  Most children with mild to moderate dehydration can be rehydrated safely with oral rehydration solution, given in small frequent volumes and replaced after ongoing losses. Severe dehydration, shock, altered mental status, or inability to tolerate enteral therapy requires isotonic IV resuscitation followed by deficit and maintenance replacement. Clinical reassessment, not a single laboratory value, determines whether rehydration is succeeding.
• Pediatric Diabetic Ketoacidosis - ICU Management of Fluids and Electrolytes

  Pediatric diabetic ketoacidosis requires controlled correction of dehydration, insulin deficiency, ketosis, and electrolyte deficits while monitoring closely for cerebral injury. Begin isotonic fluids, start low-dose IV insulin after initial fluid resuscitation, add potassium according to the measured level and urine output, and add dextrose before glucose normalizes so insulin can continue until ketoacidosis resolves. Neurologic deterioration is an emergency requiring immediate treatment for cerebral injur
• Pediatric Head Injury - PECARN Imaging Decision Rules

  The PECARN head-trauma rules identify children with minor blunt head injury who are at very low risk of clinically important traumatic brain injury and can often avoid CT. Apply the age-specific rule only to appropriate patients with GCS 14 to 15, then combine the risk category with observation, mechanism, age, symptoms, and caregiver reliability. CT is indicated for high-risk findings and should not be delayed when neurologic status is deteriorating.
• Pediatric Sepsis - Early Recognition, Fluids, and Vasoactive Support

  Pediatric sepsis is life-threatening organ dysfunction caused by infection and requires rapid recognition of abnormal perfusion, respiratory failure, neurologic change, and shock. Obtain cultures when this does not delay treatment, give appropriate antimicrobials promptly, use carefully reassessed crystalloid boluses when shock is present, and start epinephrine or norepinephrine early when perfusion remains inadequate or further fluid is unsafe.
• Pyloric Stenosis - Ultrasound Diagnosis and Preoperative Resuscitation

  Hypertrophic pyloric stenosis causes progressive nonbilious projectile vomiting in young infants and is diagnosed primarily by ultrasound. The emergency priority is not immediate surgery but correction of dehydration, chloride and potassium depletion, and metabolic alkalosis. Once volume and electrolytes are normalized, pyloromyotomy provides definitive treatment.