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 Description Signs and Symptoms Usual Treatment

Asthma Lung disease in which Airway obstruction, Bronchodilators
the airways become wheezing, coughing, Beta agonists
inflamed and inability to speak,
obstructed as a Corticosteroids
response to various fatigue and cyanosis, Theophylline
stimuli, including which may result in
allergens
severe distress
Diaper A rash anywhere in Patches of reddened Frequent diaper
dermatitis the groin region or skin that may contain changes
gluteal folds of the fluid and pustules Application of
buttocks which may protective
become infected with barrier
bacteria or yeast ointments
Eczema Skin inflammation Vesicles, redness, Removal of
resulting from oozing, crusting, offending
allergies and irritatants scaling and itching agent,
astringents,
antihistamines,
corticosteroids
Gastroenteritis A syndrome of Diarrhea, vomiting, Give fluids
vomiting and diarrhea dehydration, Antibiotics if
that may cause lethargy, anorexia, caused by a
dehydration and weight loss, fever bacterial
electrolyte imbalance and decreased infection
urination
Impetigo Superficial skin Lesions on the skin, Systemic and
infection characterized exudate, crusting, topical
by vesicles and and itching antibiotics
pustules
Otitis media Bacterial or viral Severe earache, Antibiotic
infection of the middle fever, nausea and therapy
ear vomiting, and
diarrhea
Pinworms Small worms that Irritation of the anal Oral medication
infest the large region, allergic skin for the entire
(Enterobius
intestine reaction, intense family,
vermicularis)
 itching, and thorough
secondary infection cleansing of the
house, bedding,
and sleepware,
topical
medication for
irritation

Scabies Contagious skin Severe itchy rash 5% permethrin

infestation caused by characterized by fine cream
the itch mite wavy dark lines.
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 Red, sore throat, Antibiotics
caused by the pustules, and high
Streptococcus genus fever
of bacteria
Urinary tract An infection of the Painful and frequent Antibiotics
infection kidneys, ureters, or urination, foul-
bladder caused by smelling urine, and
microorganisms hematuria

Other Pediatric Conditions

In today’s society, we hear a lot about issues that can have a profound effect on the pediatric
patient’s learning abilities and social interactions. Conditions such as ADHD, autism, Down’s
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 person’s 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)
Low Height, Short Stature
Small Head Circumference
Large Head Circumference
Elevated Blood Pressure
High Pulse Rate
(Tachycardia)
GI disease, neurological disorder, environmental
influences, failure to thrive
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)
Premature suture closure, chromosomal abnormalities,
infection, maternal metabolic disorder
Hydrocephalus, subdural hematoma, brain tumor, benign
brain growth
Renal artery disease, coarctation (stricture) of the aorta,
primary hypertension, drugs
Supraventricular tachycardia
Low Pulse Rate Hypoxia, intracranial disorders, heart block, drug
(Bradycardia) ingestion, anorexia
Cardiac disease, metabolic acidosis, bronchiolitis,
Rapid, Shallow Respirations
pneumonia
Fever Infections, anxiety, dressing the infant too warmly