Kidney Problems in Kids: Nephrotic Syndrome
- This is a kidney problem where a lot of protein leaks into the urine.
- Signs:
- A lot of protein in the urine (more than 3.5 grams a day).
- Swelling, especially around the eyes.
- Low protein in the blood.
- High fat in the blood.
- Causes:
- Most common in children is “Minimal change disease”.
- Other causes include “Focal segmental glomerulosclerosis” and “Membranous nephropathy”.
- Symptoms: Swelling around the eyes, weight gain, poor nutrition.
- Tests: Urine tests, blood tests (like kidney and liver function tests).
- Treatment: Medicine called prednisolone.
- Problems it can cause: Infections, poor growth, blood clots, and acute kidney injury (AKI).
Breathing Problems in Babies: NRDS (Hyaline Membrane Disease)
- This happens when babies have trouble breathing because they don’t have enough “surfactant” in their lungs.
- What is surfactant? It’s a special oily substance that helps keep the lungs from collapsing. It’s made by cells called pneumocytes.
- Causes:
- Not enough surfactant.
- Being born too early (premature birth).
- Not enough oxygen (hypoxia).
- Being born by C-section.
- Testing for surfactant: Doctors can check the amount of surfactant in the fluid around the baby before birth. If the ratio is low, there’s a risk of NRDS.
- Symptoms: Fast breathing, grunting sounds, nose flaring, pulling in of skin between ribs when breathing.
- Tests: Oxygen levels, chest X-ray (shows a “ground glass” look).
- Treatment: Give oxygen, give surfactant, keep the baby stable.
- Prevention: Mothers at risk can get a steroid shot (betamethasone) to help the baby’s lungs develop.
Stomach Problem in Babies: Hypertrophic Pyloric Stenosis
- This is when the tube leaving the stomach gets too narrow, making it hard for food to pass through.
- Symptoms (usually in babies 3-5 weeks old):
- Forceful, non-green (non-bilious) vomiting.
- Poor growth and weight gain.
- Not getting enough nutrients.
- Signs a doctor might find: Swollen belly, a non-tender lump (like an olive) in the belly.
- Tests:
- Blood tests might show a chemical imbalance.
- Ultrasound can show a swollen stomach.
- A special X-ray with barium might show a “string sign”.
- Treatment: Stop feeding by mouth, fix any chemical imbalances, and then surgery to widen the tube.
Heart Problems in Babies: Congenital Heart Disease (Born with it)
- These are heart problems that babies have from birth.
- Types:
- Acyanotic (baby usually looks pink): ASD (hole between top heart chambers), VSD (hole between bottom heart chambers), PDA (open blood vessel that should close after birth).
- Cyanotic (baby might look blue): Transposition of Great Vessels, TOF (Tetralogy of Fallot), Truncus Arteriosus, Tricuspid Atresia.
- Common Findings:
- VSD: Causes a loud heart sound (holosystolic murmur).
- TOF: X-rays might show a “boot-shaped heart”.
- Transposition of Great Vessels: Can be seen in babies of diabetic mothers, X-ray might show “egg shell shape”.
- PDA: Can be seen after a mother had Rubella infection.
- ASD: Causes a specific heart sound (wide fixed splitting).
- Best test to diagnose: Echocardiogram (Echo).
- Treatment:
- Small holes might close on their own.
- Larger holes often need surgery.
- Surgery is done for large holes that cause symptoms or if a child is older than 1 year with lung pressure.
Yellow Skin in Babies: Neonatal Jaundice
- This is when a baby’s skin and eyes look yellow because of too much bilirubin (a yellow substance) in the blood.
- Physiological Jaundice (Normal):
- Shows up after 24 hours of birth.
- Bilirubin levels usually don’t go higher than 15 mg/dl.
- Usually goes away in less than 2 weeks.
- Pathological Jaundice (Problematic):
- Shows up within the first 24 hours of birth.
- Bilirubin levels increase more than 15 mg/dl.
- Lasts longer than 2 weeks.
- How Bilirubin is processed: An enzyme helps change bilirubin from a bad form to a good form that the body can get rid of.
- Problems with bilirubin processing:
- Crigler-Najjar Syndrome: This enzyme is completely missing.
- Gilbert Syndrome: This enzyme is partially missing.
- Dubin-Johnson Syndrome: Problems with how bilirubin is moved out of the liver (completely missing).
- Rotor Syndrome: Problems with how bilirubin is moved out of the liver (partially missing).
Diarrhea in Children (History questions)
- Is it acute (less than 14 days) or chronic (more than 14 days)?
- How often is the child having watery stools?
- Does the child have fever or vomiting?
- If yes, check for dehydration. This could be gastroenteritis.
- Is the child allergic to any food?
- Test with a skin prick test. Treatment is rehydration.
- Does the child have belly pain with diarrhea after drinking milk?
- This could be lactose intolerance. Test with a hydrogen breath test. Treatment is a lactose-free diet.
- Does the child have trouble gaining weight or blood in their stool with breathing problems and cough?
- This could be cystic fibrosis. Test with a sweat chloride test. Treatment is enzyme replacement and vitamins.
- Does the child have belly pain and blood in their stool with tiredness?
- This could be Inflammatory Bowel Disease (IBD). Test with a fecal calprotectin test. Treatment is steroids or mesalamine.
- Does the child have watery, bloody, or mucus-filled stools?
- This could be enterocolitis. Test with stool culture and sensitivity. Treatment is fluid replacement and antibiotics.
Fever with Seizures (Febrile Fits) – Questions to ask
- Has the child had seizures with fever?
- How high was the fever?
- How long did the seizure last?
- Does the child have ear pain or pus coming from the ear?
- Does the child have burning or pus when they pee?
- Is the child’s neck stiff or are they throwing up?
- How many seizures have they had in a day?
- Has anyone else in the family had seizures with fever at this age?
- Are they awake and alert after the seizure?
- Simple seizures: No brain damage, low chance of happening again.
- Complex seizures: More than 15 minutes, multiple attacks in 24 hours, not fully awake after. Higher chance of happening again and possible brain damage.
History of Fever – More Questions
- When did the fever start?
- Have you checked the fever with a thermometer?
- Does the child have a runny nose or sneezes?
- Does the child have a cough or sore throat?
- Does the child have vomiting or diarrhea with the fever?
- Does the child have a stiff neck and seizures with the fever?
Pregnancy History (Ante Natal History)
- Did you have regular doctor check-ups during pregnancy?
- Did you have problems like sugar or high blood pressure?
- Did you take any medicines during pregnancy?
Birth History (Delivery)
- Where was the baby born?
- Was it a normal birth or C-section?
After Birth History (Post Natal History)
- How long after birth did the baby cry?
- How much did the baby weigh?
Feeding History
- What kind of milk do you give the baby?
- If cow’s milk, how is it prepared?
Vaccination History
- Has the child received all their vaccinations?
- Do you have the vaccination card?
Growth Milestones
- 3 months: Neck holding.
- 6 months: Sits with support.
- 9 months: Stands with support.
- 12 months: Crawls, walks with support.
- 15 months: Walks without support.
- 3 years: Rides a tricycle.
APGAR Score (Baby’s health at birth)
- 8-10: Good health.
- 4-7: May need help breathing.
- 0-3: Needs emergency help.
Dehydration Assessment
- No dehydration (Plan A):
- Alert, normal tears, wet mouth, drinks normally, skin pinch goes back quickly.
- Treatment: Home treatment, zinc, continue feeding, follow up if not improving in 5 days or worsening in 2 days.
- Some dehydration (Plan B):
- Restless, sunken eyes, skin pinch goes back slowly, drinks eagerly, dry mouth, irritable.
- Treatment: ORS (oral rehydration solution), fluids, zinc.
- Severe dehydration (Plan C):
- Floppy, skin pinch goes back very slowly, refuses to drink, dry tongue.
- Treatment: Give ORS by mouth or IV fluids (Ringer’s Lactate and Dextrose), antibiotics (for cholera if older than 2), continue breastfeeding.