Questions:
1. Which essential questions will you ask a pediatric patient or their caregiver when the presenting complaint is bloody diarrhea? Will these questions vary depending upon the child’s age? Why or why not?
2. How do the common causes of vomiting differ in infants, children, and adolescents? What clinical or historical findings will indicate the need for diagnostic studies and why? Which diagnostic studies will you initially order and why?
3. What are the various ways in which UTIs manifest in pediatric patients? How are UTIs managed differently, depending on the age of the patients? Which diagnostic studies would you recommend considering the age of a patient and why? When would you recommend prophylactic antibiotics to pediatric patients and why?
Answers:
- Questions to be asked to a paediatric patient or their caregiver when the presenting complaint is bloody diarrhea are:
-What is the duration of the appearance of symptoms?
-What is the number of bowel movements per day and how this is different from the infant/child’s usual pattern?
-Details about the child’s dietary intake before the diarrhea.
-Are any solid stools are passed between the loose movements?
-How is the stool consistency?
-Is there a presence of blood in the stool?
-Are the stools foul smelling?
-Was cow’s milk fed to the infant for the first time?
-Does the child have fever?
-How much is the urine output of the child?
-Has the child vomited? If yes, how often?
-Has the child travelled recently?
Some questions will vary depending on the child’s age. Particularly if the child is an infant allergic colitis due to ingestion of cow’s milk is possible. In older children inflammatory bowel disease could be a possibility (Murphy, 2008).
2. Causes of vomiting in infants differ from those in children and adolescents. Among infants vomiting should not be confused with reflux, particularly if in some infants the reflux is forceful. Causes of vomiting in infants could be – blockage, intestinal obstruction or pyloric stenosis. Intestinal infections can also cause vomiting among infants. In older infants or children vomiting can be caused by food poisoning, gastroenteritis or peptic ulcer, obstruction and respiratory/urinary tract infections. The vomiting may be associated with abdominal pain in some cases. In children obstruction and vomiting could also be caused by swallowing of a coin. A concussion could also cause vomiting and can be diagnosed with a brain CT scan (/nausea-and-vomiting-in-infants-and-children-beyond-the-basics, 2016).
Among adolescents infectious gastroenteritis is the main cause of nausea and vomiting. Vomiting can also occur due to appendicitis, induced vomiting in case of bulimia, pancreatitis, ulcers, overdose of toxins, and inflammatory bowel disease or pregnancy. A clinical examination can diagnose most conditions but tests may be needed in others. Pyloric stenosis can be diagnosed with an ultrasound, and a urine pregnancy test in case of pregnancy.
3. Urinary tract infections in infants and children may occur due to bacterial infection of the bladder- cystitis or the kidney/s- pyelonephritis. The infection may cause fever in infants and children. Children may also complain of pain during urination and at times of burning. The bacteria infect through the urethral opening and the infection may at times even affect the kidney/s. Among infants UTI is more common among boys but in older children UTI is seen more commonly among girls due to a short urethral opening.
Sample of urine may be collected through a catheter or aspiration. Microscopic examination of urine can help in detection of pyuria or bateriuria. Confirmation of UTI is done through a culture test may be followed by a dose of antibiotic therapy. Delay in diagnosis can cause the infection to travel up through the ureters to the kidneys. Symptoms can then include pain in the sides or lower back and general malaise (Weinberg).
References:
/nausea-and-vomiting-in-infants-and-children-beyond-the-basics. (2016). Retrieved February 17, 2016, from http://www.uptodate.com: http://www.uptodate.com/contents/nausea-and-vomiting-in-infants-and-children-beyond-the-basics
Murphy, M. S. (2008). Management of bloody diarrhoea in children in primary care. BMJ : British Medical Journal , 336(7651):1010-1015.
Weinberg, G. (n.d.). urinary-tract-infection-in-children-(uti). Retrieved February 17, 2016, from http://www.msdmanuals.com: http://www.msdmanuals.com/home/children’s-health-issues/miscellaneous-bacterial-infections-in-infants-and-children/urinary-tract-infection-in-children-(uti)
