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What is the therapy for diaper rash?
- zinc oxide (Desitin, Balmex)
- Petrolatum/white petrolatum
- calamine, allantoin, mineral oil, lanolin, kaolin, cod liver oil, dimethicone, corn starch, glycerin, colloidal oatmeal, hard fat, zinc carbonate, zinc acetate (approved)
- Vitamin A+D, vitamin E, witch hazel, peruvian balsam, silicone, aluminum hydroxide, aluminum acetate, microporous cellulose, sodium bicarb, aloe vera, tea tree oil (unapproved)
What agents are generally not recommended for use in diaper rash?
- external analgesics/anesthetics
- external anti-inflammatory agents
Who should be referred to the physician for diaper rash?
- > 7d duration
- rash outside of diaper area
- skin erosion or pustules
- significant diarrhea present
- fever or behavioral changes
- atypical lesions
- other fungal infections present (thrush)
- severe or recurrent diaper rash
What is the nonpharmacologic tx for teething?
- gum massage
- chewing devices
- cold, wet washcloth
- teething biscuits/crackers or teething toys
- vaseline if drooling significant
What are the drugs used for teething relief?
- benzocaine (don't use this)
What sx are not attributed to teething?
- nasal congestion
Who should be referred to a physician for pediatric gastroenteritis?
- under 6mo old
- chronic conditions
- fever over 38-39C
- bloody stools
- frequent and substantial volumes of diarrhea
- persistent vomiting
- sx of dehydration
- mental status changes
- poor response to oral rehydration tx
What is the initial therapy for dehydration?
Oral rehydration solution
What is the treatment for patients with diarrhea who are not dehydrated?
- continue age-appropriate diet
- complex carbs, lean meat, yogurt, fruits, and vegetables may be better tolerated than fatty foods or foods high in simple sugar
What is the treatment for mild dehydration?
- 50 mL/kg ORS plus replacement of continuing losses over a 4h period
- Reevaluate and replace losses at least every 2h
What is the treatment for moderate dehydration?
- 100 mL/kg ORS plus replacement of continuing losses over a 4h period
- Reevaluate and replace losses every hour
How much fluid should be replaced for each stool in dehydrated patients?
How much fluid should be replaced for each emesis in dehydrated patients?
How do you give oral therapy to children who are vomiting?
- frequent small sips of 1-2tsp q 1-2 min
- gradually increase amount as tolerated
What is the tx for severe dehydration?
- Normal saline or Lactated Ringer's 20 mL/kg IV
- Reassess and repeat if needed
- Switch to ORS when stable and mental status has improved
Why shouldn't cola, ginger ale, apple juice, chicken broth, or tea be used for rehydration in young children?
- too many carbs w/high osmolality increases diarrhea and dehydration
- kids are less able to equilibrate electrolyte imbalances
- broth has too much sodium also, possibility of hypernatremia
- tea has no sodium, possibility of hyponatremia
- Kids 5 and up can have sports drinks w/additional sodium if mildly dehydrated and refuse ORS
What role do probiotics play in diarrhea?
- some utility for viral-induced GE
- can reduce duration of diarrhea by 1/2 to 1 day
- reduce frequency of stools by 1-2 stools/d by day 2 of tx
What are the nonpharmacologic tx for constipation in kids?
- increase fluids and bulk content
- regular toilet habits
- prompt response to urge
- don't rush child in bathroom
What is DOC for constipation in kids?
What is the tx for constipation in kids?
- PEG 3350
- Saline laxatives (avoid rectal in < 2yo, and oral in < 5yo)
- Mineral oil (never in < 6yo)
- Emollients in 6 and up
- Bulk laxatives in 6 and up
What is the tx for impaction in kids?
- Glycerin or enema for < 1yo
- Bisacodyl, Mg citrate, PEG, enemas in > 1yo
- Caution with electrolyte abnormalities with saline agents
What is the maintenance tx for constipation in < 5yo?
- glycerin suppositories
- barley malt extract
- avoid stimulants and phosphate enemas
What is the maintenance tx for constipation in 5 and up?
- Milk of magnesia
- PEG 3350
- avoid stimulants and excessive enemas