Chapter 19 Evaluation and Care of the Pediatric Patient

Common Pediatric Diseases and Disorders

There are many diseases and disorders seen in a pediatric practice. The following table lists some
of the more common ones along with their symptoms and usual treatment.
Disease
Asthma

Description
Lung disease in
which the airways
become inflamed
and obstructed as a
response to various
stimuli, including
allergens

Signs and Symptoms

Usual Treatment

Airway
obstruction,
wheezing,
coughing,

Bronchodilators

inability to speak,

Theophylline

Beta agonists
Corticosteroids

fatigue and
cyanosis,
which may result
in
severe distress

Diaper
dermatitis

A rash anywhere in
the groin region or
gluteal folds of the
buttocks which may
become infected
with bacteria or yeast

Patches of
reddened skin that
may contain fluid
and pustules

Frequent diaper
changes

Skin inflammation
resulting from
allergies and
irritatants

Vesicles, redness,
oozing, crusting,
scaling and itching

Removal of
offending agent,
astringents,
antihistamines,
corticosteroids

Gastroenteritis A syndrome of
vomiting and
diarrhea that may
cause dehydration
and electrolyte
imbalance

Diarrhea, vomiting,
dehydration,
lethargy, anorexia,
weight loss, fever
and decreased
urination

Give fluids

Impetigo

Superficial skin
infection
characterized by
vesicles and pustules

Lesions on the
skin, exudate,
crusting, and
itching

Systemic and
topical antibiotics

Otitis media

Bacterial or viral
infection of the
middle ear

Severe earache,
fever, nausea and
vomiting, and
diarrhea

Antibiotic therapy

Pinworms

Small worms that

Irritation of the

Oral medication for

Eczema

Application of
protective barrier
ointments

Antibiotics if
caused by a
bacterial infection

(Enterobius
vermicularis)

infest the large

intestine

anal region,
allergic skin
reaction, intense
itching, and
secondary infection

the entire family,

thorough cleansing
of the house,
bedding, and
sleepware, topical
medication for
irritation

Scabies

Contagious skin
infestation caused by
the itch mite

Severe itchy rash

characterized by
fine wavy dark
lines.

5% permethrin
cream

Lesions may occur

between the
fingers, at the wrist
or elbow, in the
axilla, and on the
trunk or
extremities
Strep throat

Severe throat
infection caused by
the Streptococcus
genus of bacteria

Red, sore throat,

pustules, and high
fever

Antibiotics

Urinary tract
infection

An infection of the
kidneys, ureters, or
bladder caused by
microorganisms

Painful and
frequent urination,
foul-smelling
urine, and
hematuria

Antibiotics

Other Pediatric Conditions

In todays society, we hear a lot about issues that can have a profound effect on the pediatric
patients learning abilities and social interactions. Conditions such as ADHD, autism, Downs
syndrome, cerebral palsy and childhood obesity are more prevalent now and need to be dealt
with in a professional but helpful manner.

Attention-Deficit Hyperactivity Disorder (ADHD)

Although first described in 1845, this condition appears to be on the increase in current years. It
may first be apparent in preschool, while others cases are diagnosed in late adolescence and even
adulthood. The most classic symptoms of ADHD are:

Being overly impulsive

Unable to maintain attention during important tasks

Hyperactivity

Usually the child is viewed as one who is disruptive and highly active. Another child with
ADHD might be a day dreamer. Poor concentration is a term often used to describe the patient.
This condition is difficult to diagnose as these symptoms may also be an indication of other
physical or emotional problems. If diagnosed, the patient can be treated with medication and
support by the health care team.

Autism
Autism is a brain disorder that hinders a persons ability to communicate or relate to others. It is
thought to be a genetic disorder, as it often runs in families. This disorder can also affect how a
child understands and processes information that is sensory in nature.
Autism is usually diagnosed by the time a child reaches the age of three; however, some
cases are not diagnosed until later. Typically parents are the first to notice the signs and seek the
advice of their pediatrician. There are diagnostic guidelines that have been established by the
American Academy of Child and Adolescent Psychiatry (AACAP) which the clinician will use to
determine if the child has the core symptoms of autism. Signs and symptoms may include:

Toddlers who do not begin to talk or do not interact like other children do

Little or no eye contact with others

Plays alone

Delayed language development

Repetitive patterns of behavior such as, rocking, keeping to a certain routine or ritual, and
resistance to any change

There is no mold that all persons with autism fit into. Some need help with the simplest
aspects of daily living, while others are able to function at a level high enough that permits them
to attend school in a regular class and participate in sports and other activities.
Treatment methods include: behavioral, speech, and occupational therapy, parent
education, and sometimes medications. Since each child with autism is different, treatment
methods are usually individualized. Collectively, most children with autism need to be in a
structured and specialized educational program in order to achieve their highest potential.

Down Syndrome
Down syndrome is a common birth defect that occurs in approximately one in every 800 to 1,000
newborns. This syndrome includes mild to moderate mental retardation and other health
problems such as cardiac valvular disease, along with specific physical characteristics which
include a sloping forehead, low-set ears, and short, broad hands.
The most common form of Down syndrome, trisomy 21, is caused by the presence of an
extra 21st chromosome. The cause of the occurrence of this extra chromosome is unknown but
appears to be related to the age of the mother and usually occurs in women over the age of 40.

Cerebral Palsy
Cerebral palsy is a term that is used to describe a range of disorders that impairs control of
movement due to damage to the brain during its developmental stage. It is one of the most
common causes of disability in children. While CP is not a progressive disease, symptoms may
get better for a time only to worsen later on. The exact cause of CP is unknown but is thought to
be related to the oxygen levels in the brain before, during, and after birth, infections, and injuries
occurring during the birth process. Children with CP not only have physical disabilities, but may
also have some level of retardation, learning disabilities, and vision, speech, hearing, and
language problems.

Patient Tutor
Parents, especially first-time parents, and caregivers may need to be
provided with educational information on infant and child safety
issues, including car seats, cribs, animals/pets, etc. Brochures and
pamphlets are useful tools along with information about community
resources available to assist the parent with these issues.

Pediatric Disorders Related to Abnormal Vital Signs and

Measurements
The following table identifies some possible medical conditions related to abnormal
measurements. The medical assistant should be familiar with pathology related to pediatric
patients. Familiarity with common diseases and disorders helps to increase communication
opportunities with patients and family members, thus enabling better patient education and
patient compliance.
Abnormal Vital Sign

Possible Pediatric Pathology

Low Weight (less than 5th

percentile)

GI disease, neurological disorder, environmental

influences, failure to thrive

Low Height, Short Stature

Endocrine disorder, growth hormone deficiency,

Inflammatory bowel disease, renal disease, celiac disease
(disorder of the immune system that damages lining of
the small intestine if foods are consumed that contain
gluten)

Small Head Circumference

Premature suture closure, chromosomal abnormalities,

infection, maternal metabolic disorder

Large Head Circumference

Hydrocephalus, subdural hematoma, brain tumor, benign

brain growth

Elevated Blood Pressure

Renal artery disease, coarctation (stricture) of the aorta,

primary hypertension, drugs

High Pulse Rate

(Tachycardia)

Supraventricular tachycardia

Low Pulse Rate

(Bradycardia)

Hypoxia, intracranial disorders, heart block, drug

ingestion, anorexia

Rapid, Shallow Respirations

Cardiac disease, metabolic acidosis, bronchiolitis,

pneumonia

Fever

Infections, anxiety, dressing the infant too warmly