Common Illnesses of Infants and Children Part 1

1. Common Illnesses of Infants and Children Part 1 P.Naina Mohamed Pharmacologist

2. Introduction • Common Illnesses of Infants and Children • Neonatal Hyperbilirubinemia (Physiologic Jaundice) • Colic • Common cold and flu • Ear Infection • Fever • Nausea and Vomiting • Spitting up in babies • Diarrhea • Diaper rash • Oral thrush • Shortness of Breath • Mouth Problems • Feeding Problems • Elimination Problems • Cradle cap

3. Introduction Illnesses discussed in this presentation: • Neonatal Hyperbilirubinemia (Physiologic Jaundice) • Colic • Common cold and flu • Cough • Sore Throat • Ear Infection • Fever

4. Neonatal Hyperbilirubinemia • Neonatal Hyperbilirubinemia (total serum bilirubin level above 5 mg per dL (86 μmol per L) is one of the most common problems encountered in newborns. • Newborns produce bilirubin at a rate of approximately 6 to 8 mg per kg per day. • Newborns produce twice the rate of adults due to increased red blood cell turnover in neonates. • Bilirubin production typically declines to the adult level within 10 to 14 days after birth. • The average full-term newborn will have a peak bilirubin level of 6mg/dl on the third or fourth day of life. • Levels usually go down to about 2-3mg/dl by the end of the first week, gradually reaching the adult value of 1mg/dl by the end of the second week. • Phototherapy should be initiated when the total serum bilirubin level is at or above 15 mg per dL (257 mol per L) in infants 25 to 48 hours old, 18 mg per dL (308 mol per L) in infants 49 to 72 hours old, and 20 mg per dL (342 mol per L) in infants older than 72 hours. • Jaundice typically results from the deposition of unconjugated bilirubin pigment in the skin and mucus membranes.

5. Pathophysiology Babies in womb need higher Hb (RBCs) to get oxygen from mother’s blood After birth, fetal hemoglobin (Hb) broken down Bilirubin is the final product of degradation of heme of these extra red blood cells (RBCs) Excess bilirubin is removed from the bloodstream by the liver and excreted in the stool The newborn’s immature liver may not excrete the bilirubin fast enough in the first days after birth Hyperbilirubinemia (Physiological Jaundice) (especially common in premature and low birth weight infants and Babies who don’t feed and stool often enough during the early days )

6. Treatment • Feed the baby early and often. • colostrum acts as a laxative, and frequent stooling lowers bilirubin levels. • Keep track of urine and stool output • Avoid water supplements. Only 2%of the bilirubin is excreted in the urine, and 98% in the stools. Colostrum and milk contain fat, which stimulates bowel movements, and water can just fill the baby up so that he is less interested in nursing. • Encourage the baby to stay awake and to feed at least every two hours. Jaundice makes the baby sleepy. • Supplement with the expressed milk. If the baby is sleepy at the breast, and is having fewer than three large bowel movements in 24 hours, consider expressing the milk after feedings and give it to him (preferably not with a bottle at this stage – he may become confused by rubber nipples if he is only a few days old). Use a dropper, syringe, cup, or tube-feeding device if possible. • Expose the baby to indirect sunlight. Undress him down to his diaper and put him in a room that gets a lot of light. His skin is very sensitive, so never put him in direct sunlight. • Avoid medications such as aspirin and sulfa drugs.

7. Colic • Colic is defined as a crying lasts for more than 3 hours a day, 3 days per week for more than 3 weeks. • Colicky babies usually get fussy toward the end of the day, but colic can happen at any time. • Colic affects as many as 25 percent of babies. Colic usually starts a few weeks after birth and often improves by age 3 months. By ages 4 to 5 months, the majority of babies with colic have improved.

8. Possible Mechanisms of Development Infants swallow air Mothers’ diet Infants have During feeding containing gas immature and crying producing foods digestive cabbage, boroccoli, system and cauliflower, volatile lack of probiotics chemicals, allergens, etc Increase gas and Trace elements Indigestion Bloating passed to the baby through the breast milk Gas & Bloating COLIC

9. Colic Symptoms • Predictable crying episodes. A baby who has colic often cries about the same time every day, usually in the late afternoon or evening. The crying usually begins suddenly and for no clear reason. The baby may have a bowel movement or pass gas near the end of the colic episode. • Intense or inconsolable crying. Colic crying is intense and often high pitched. The baby's face may flush, and he or she is extremely difficult to comfort. • Posture changes. Curled up legs, clenched fists and tensed abdominal muscles are common during colic episodes.

10. Colic Causes • The cause of colic is unknown. Researchers have explored a number of possibilities, including allergies, lactose intolerance, an immature digestive system, maternal anxiety, and differences in the way a baby is fed or comforted. Yet it's still unclear why some babies have colic and others don't. Risk factors • Infants of mothers who smoke during pregnancy or after delivery have a greater risk of developing colic. • Colic doesn't occur more often among firstborns or formula-fed babies. Complications • Colic doesn't cause any lasting medical consequences. Babies who have colic grow and develop normally.

11. Colic Treatment Drugs • Colic improves on its own, often by age 3 months. • Some physicians prescribe medications, like… • Simethicone is probably the only harmless medication, but it has not been shown to provide significant benefit compared with placebo. • Dicyclomine hydrochloride (Bentyl) was previously widely used but was later found to be associated with apnea, coma, and death. • Hyoscyamine sulfate (Levsin) may cause anticholinergic toxicity. • Diphenhydramine (Benadryl) causes sedation but may cause paradoxical agitation and should not be used in children younger than 1 year old. • Other drugs that are no longer recommended for colic include phenobarbital and paregoric, mainly because of the dangerous side effect of oversedation. • Some research suggests that treatment with probiotics (substances that help maintain the natural balance of "good" bacteria in the digestive tract) can soothe colic. More research is needed to determine the effects of probiotics on colic.

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