Childhood Diseases and Disorders

1. Childhood Diseases and Disorders Pathophysiology

2. InfectiousDiseases • Viruses • Bacterial • Fungal • Parasitic

3. Viral Diseases

4. Measles, Mumps, and Rubella (MMR) • Measles (Rubeola) • Highly contagious (incubation period is 7-14 days) • Symptoms include fever, inflammation of respiratory mucous membranes, rash, and spots in mouth called Koplik’s spots • Treatment is fluids, fever reducer, and rest • May cause encephalitis or meningitis or ear infections and conjunctivitis (pink eye) • Mumps • Affects parotid glands (one of the three salivary glands) • Spread by saliva with incubation period 16-18 but may be as long as 25 days • Blood test determines presence and symptoms are chills, swelling of glands, fever • Treatment is to treat symptoms • May cause orchitis (inflammation of testis) or nerve conduction deafness • Rubella (German Measles or three day measles) • Incubation period of 14-21 days • Symptoms like rubeola but lighter in color; also joint pain and lymph node involvement • Diagnosis through a blood test • May cause fetal problems or birth defects is pregnant women are exposed (80% chance in first 3 mos)

5. MMR

6. Varicella (ChickenPox)/ Poliomyelitis • Varicella • Incubation of 10-21 days; caused by varicella-zoster • May have shingles as an adult • Symptoms include classic dew drop rose petal macular rash (vesicles) • Poliomyelitis • Incubation of 3-6 days for milder form, 7-21 for severe form • Spread through oral fecal routes • Headache, sore throat and then paralysis • Stool sample or throat cultures confirms diagnosis • Treatment is only supportive; physical therapy or respiratory ventilation may be needed

7. Chicken Pox Polio

8. Influenza/ Common Cold • Influenza • Symptoms are fever, headache, joint pain, runny nose, etc • No treatment except rest, hydration, nasal sprays • Common Cold (rhinovirus) • Symptoms are rhinitis • No treatment except rest, hydration, nasal sprays

9. Mononucleosis • Caused by Epstein-Barr virus • Spread through saliva • Symptoms happen 4-7 days after exposure • Diagnosis through blood test showing rise in WBC • Takes 3-4 weeks to recover and sports should be avoided for one month after to protect the spleen

10. Acquired Immunodeficiency Syndrome (AIDS) • Caused by HIV virus • In 1980’s most children with the disease got it from infected blood because they were hemophiliacs and received transfusions. Today most get it from perinatal transmission • Some sexually active teens have the disease • 2.1 million live with HIV • Time between HIV infection and AIDS is shorter in children and infants

11. Bacterial Diseases

12. Diphtheria / Pertussis • Diphtheria • Once had a fatality rate of 20% in 1920’s • Caused by Corynebacteriumdiphtheriae • Produces a membranous coating of pharynx, nose, and sometimes tracheobronchial tree called exudate with proteins and WBC that seep from tissue • Diagnosis is gray membrane covering throat and positive culture • Treatment is antibiotic and diphtheria antitoxin • Pertussis (whooping cough) • Caused by Bordetella pertussis • Incubation is 6-10 days but can be as long as 21 days • Symptoms are • Catarrhal- increase in inflammation of mucous membranes • Paroxysmal-spasm or convulsion with violent coughing, cyanosis, vomiting • Convalescent stage-gradually reduced coughing • Treatment is with antibiotics and supportive therapy but pneumonia can be a problem

13. Tuberculosis (TB) • Affects respiratory system • Currently on the rise • Caused by Mycobacterium tuberculosis • Also found in GI system and the bones, brain, and lymph nodes • Incubation period is 4-12 weeks • Symptoms include bloody sputum, fever, cough, lymph node enlargement • Disease in children often stays dormant • Diagnosis is by positive skin test, sputum culture and chest x-rays • Treatment is rest, drug therapy • There is a TB vaccine, bacilleCalmette-Guesnn (BCG) for places with infection greater than 1% per year

14. Tularemia (Rabbit fever or deer fly fever) • Caused by Francisellatularensis • Symptoms include headaches, lymph node swelling, chills, vomiting • Diagnosis is with blood test or chest x-ray to rule our pneumonia • Treatment is with antibiotics • Prevention is protection from ticks

15. Impetigo / Acute Tonsillitis / Otitis Media • Impetigo • Caused by pyoderma commonly found on face and hands of children • Caused by Staphylococcus aureus • Acute Tonsillitis • Infection of palatine tonsils caused by beta-hemolytic streptococci • Symptoms are sore throat, cough, fever, trouble swallowing • Diagnosis with throat culture • Treatment is tonsillectomy • Otitis Media • Bacterial infection of middle ear • If persistent, myringotomy with tympanopathy tubes might be treatment

16. Fungal Diseases

17. Candidiasis/ Tinea • Candidiasis • Also known as thrush, oral fungal infection • Caused by Candida albicans • White plaques on mucous membranes and tongue • Treatment of choice is usually swabbing mouth with oral nystatin • Tinea • Also known as ringworm • Usually affect scalp and between toes • Males also get it in the groin area

18. Parasitic Diseases

19. Giardiasis / Pediculosis • Giardiasis • Infection with protozoa called giardia • Caused by the Giardia lambliaand affects the digestive system • Symptoms include watery diarrhea , nausea, flatulence • Stool will float and be shiny • May take many samples to identify parasite • Treatment is furazolidone or similar drugs; clear fluids to prevent dehydration • Pediculosis • Lice acceptance • Adult females produce 6 eggs/ 24 hours • Nits (eggs) can be seen in hair • Treated with permethrin 1% crème rinse

20. Pinworms/ Roundworms • Pinworms (seatworms or threadworms) are nematodes that infect intestines and rectum • No harmful, just itchy • Caused by Enterobiusvermicularis • Eggs can survive for 2-3 weeks; females lay 10,000-20,000 eggs at anus • Symptoms are anal itching and look like white threads • Diagnosis is by microscopic exam of stool • Treatment is OTC or prescription drug therapy; may need to repeat in 2 weeks • Roundworms • Ascarislumbricoidesfound in soil • Symptoms are abdominal pain, excessive gas, weight loss, vomiting • Diagnosis is through stool sample • Treatment is same as for pinworms

21. RespiratoryDiseases • SIDS • Croup • Adenopid Hyperplasia • Asthma • Pneumonia

22. Respiratory Illness

23. Sudden Infant Death Syndrome (SIDS) / Croup • SIDS • Unexplainable death of an infant under age one; also known as crib death • Cause unknown but suggested that infants be put in supine rather than prone position • Only diagnosis is autopsy • Croup • Also known as laryngotracheobronchitis (URI) • Caused by parainfluenza 1 and 2 viruses in children from 3 mos- 3 yrs old • Symptoms are inspiratory stridor, difficulty breathing at night • Diagnosis is physical exam • Treatment is usually high humidity, fluids, rest, racemic epinephrine • https://www.youtube.com/watch?v=Qbn1Zw5CTbA

24. Adenoid Hyperplasia/ Asthma • Adenoid Hyperplasia • Enlargement of the pharyngeal tonsils • Symptoms are blockage of Eustachian tubes causing otitis media; difficulty breathing • Diagnosis is exam/ throat culture • Treatment is antibiotic therapy or adenoidectomy • Asthma • More than 5 million children under age 18 diagnosed (I out of every 4) • #1 reason for school absences • Cause unknown • Symptoms are respiratory distress • Diagnosis is by chest x-rays, allergy test, pulmonary function tests, physical exam • Treatment is with medications like a bronchodilator and anti-inflammatory drugs • Monitored with peak flow meter • Prevention is knowing triggers • https://www.youtube.com/watch?v=VA9C_aCH7F0

25. Pneumonia • Infection of the lung parenchyma • Can be viral or bacterial; alveolar air spaces become filled with fluid • Symptoms are wheezing, coughing, fever, malaise • Diagnosis is by chest x-ray and auscultation of the chest • Treatment varies (antibiotics if bacterial)

26. Digestive Diseases / Cardiovascular Diseases • Digestive • Colic- in babies • Fluid Imbalances • Food Allergies • Eating Disorders • Cardiovascular • Most are related to genetic or developmental disorders

27. Fluid Imbalances / Food Allergies/ Eating Disorders • Fluid Imbalance • Children have higher exchange of fluids so diarrhea or vomiting can be serious • Dehydration serious • Treatment includes rehydration and electrolyte replacement • Food Allergies • Overreaction of immune system to a particular food • Reaction may take seconds or even hours • More common in children especially under age 1 • After age three, if one develops it stays for adult life • Testing can be done • http://health.usnews.com/health-news/health-wellness/articles/2014/04/17/how-to-cope-with-food-allergies • Eating Disorders • Problem during adolescence • Anorexia and bulimia most common

28. Musculoskeletal Diseases / Blood Diseases • Musculoskeletal • Legg-Calve-Perthes (LCP) • Ewing’s Sarcoma • Blood Diseases • Leukemia

29. Musculoskeletal diseases • Legg-Calve-Perthes (LCP) • Avascular necrosis of the upper end of the femur • Blood flow is reduced to the head of the femur • Most common in boys age 4-8 • Only symptom is pain when walking • Cause unknown • Diagnosis with x-ray • Treatment is maintain position of femur, rest, ROM exercises, traction, etc. • Ewing’s Sarcoma • More common in males; found in long bones like femur • Cause unknown • Diagnosis with x-ray, CT scan, MRI • Treatment is chemotherapy or amputation

30. NeurologicDiseases / Eye and EarDiseases • Neurologic • Reye’s Syndrome • Eye and Ear • Strabismus • Deafness

31. Neurologic Diseases • Reyes Syndrome • Acute encephalopathy seen in children under age 15 • Cause unknown but relationship with use of aspirin • Symptoms are nausea and vomiting, liver enlargement, seizures • Diagnosis should be suspected in a child who had a recent viral illness; blood testing of liver enzymes and lumbar puncture (spinal tap) • Treatment is in ICU

32. Eye and Ear Diseases • Strabismus • Lazy eye or crossed • Should not be present after age 4 mos • Deafness • Ranges from mild to complete • Cause unknown but may be from trauma, infections, or exposure to ototoxic drugs • Audiometric testing is needed for accurate diagnosis • Treatment depends on extent of deafness • Cochlear implants are now inserted surgically to stimulate 8th cranial nerve

33. Blood Diseases • Leukemia • Malignancy of the blood-forming cells located in bone marrow • Most common cancer in children • Cause is unknown • Most common type in children is ALL (Acute Lymphoblastic Leukemia) • Symptoms are pale skin, easy bleeding, bruising, abdominal pain, fever • Diagnosed with blood tests and bone marrow biopsy • Treatment is chemotherapy or radiation in some cases

34. Trauma • Child Abuse • Suicide • Drug Abuse • Poisoning

35. Child Abuse • More common than any other pediatric illness • Neglect vs. abuse • Neglect is failing to provide basic needs • Abuse is causing harm • Diagnosed with physical exam and interview of child and care providers • Cigarette and hands most common items of abuse • Shaking Baby Syndrome common • Types of abuse • Sexual • Physical • Emotional • Verbal

36. Suicide • 3rd leading cause of death (15-24 years) • Firearms used in 57% of male suicides • Depression, alcohol and drug use are contributing factors • Highest in incarcerated youths, gay or bisexual, and sexually abused • Girls attempt more but males are more successful in suicide attempts

37. Poisoning • Among top five causes of death under age 10; 75% under age 6 • Household items and medications are common forms of poisoning • Lead poisoning is chronic and blood can be tested to diagnose; caused neurological disorders • Treatment MAY be medication to induce vomiting