Normal Growth Pattern
0-1 year: double birth weight by 4 months, triple by 1 year; increase length 50% and occipital frontal circumference 40% by 1 year
2-6 years: slow but steady growth; gain ~2-3 kg/year and 5-8 cm/year
7-10 years: continued steady growth; girls increase in
Occipital Frontal Circumference
Microcephaly -> OFC > 2 SD below mean for age and sex
Macrocephaly -> OFC > 2 SD above mean for age and sex
Age Based Milestones
Holding head upright: 3 months
Sitting upright: 6 months
Walking: 12 months
Running: 18 months
Jumping: 24 months
Breastmilk
At least for the first 6 months
Documented medical and neurodevelopmental advantages
Breastfeeding Benefits to Mom
Increased calorie utilization
Decreased uterus size
Decreased breast cancer risk
Convenient
$$$
Improved maternal-infant bond
Breastfeeding Benefits to Baby
Faster GI emptying
Decreased GI diseases and/or adverse effects
Immunoprotective
Decreased allergies: food and atopic dermatitis
Improved maternal-infant bonding
Formula
Main source of nutrition
Supplmentation of breastfed babies
Variety of formulas
Supplements
Preterm: iron and multivitamin
Breastfed: vitamin D and iron
Formula fed: vitamin D
Gastroesophageal Reflux (GER)
Retrograde movement of gastric contents across the lower esophageal sphincter into the esophagus
GER: treatment
Once proven to have GERD
Symptomatic + poor weight gain
Non-pharm -> H2RA -> PPI for shortest duration
Dosing
Individualized weight based or body surface area dosing:
mg/kg/dose, mg/kg, day, mg/m2
Body Surface Area (BSA):
less accurate in infants, larger BSA per kg compared to adults
Adult does at ~40 kg
Filling Prescriptions
Calculate the dose independently:
Ask parent for weight
Call physician's office for weight
Formulations: Liquid
Use metric dosing with mL
Never use kitchen spoons
Infants: administer with head upright
Child: administer sitting up
Spitting/vomiting dose: partial dose if >15 minutes
Formulations: Chewable Tablets
~2 years and older
Advantages:
Palatability
Stability
Precise dosing
Portability
Ease of administration
Formulations: Tablets and Capsules
Usually > 5 y.o.
Choking hazard
Verify if tablet/capsule can be crushed or opened
Disease states may require learning to swallow tablets and capsules earlier: cystic fibrosis
Oral Syringe
Ideal for infants who cannot drink from cup
Deliver to side of mouth to avoid taste buds
Can pre-measure for caregivers/babysitters (with cap)
Allows delivery of viscous liquids
Mark syringe for dose and demonstrate how to use
Droppers
Useful in infants unable to drink from a cup
Deliver to side of mouth to avoid taste buds
Droppers come with many medications: use only with designated medication
Medicine Spoon
Convenient for children who can drink from a cup but likely to spill
Easy to hold
Has both mL and tsp (should use mL when educating)
Medicine Cup
Convenient for older children
Not graduated for infant doses
Many OTC medications come with a cup
Guidelines by Volume
< 1 mL: dropper or 1 mL syringe
1-5 mL: 1-5 mL syringe or spoon
> or = 5 mL: 10-20 mL syring, spoon, or cup
EpiPen
Indicated for severe allergic reactions (anaphylaxis)
Two EpiPen products available based on patients weight: 15-29 kg give 0.15 mg or > or = 30 kg give 0.3 mg
Each EpiPen product contains a single dose of medication
Auvi-Q
Provides voice instructions and has an auto-retractable needle
ISMP Warning
Increased errors reported with homemade kits:
Given IV instead of IM
Gave whole 1 mg contained in vial/ampule
Subcutaneous Injections
Insulin pens most common
Avoid in neonates
Insulin syringes used for non-insulin products: enoxaparin, desmopressin, injections with small volumes (< 1 mL)
Enoxaparin
Comes as a 100 mg/mL solution or prefilled syringe
Smallest prefilled syringe is 30 mg
Enoxaparin Education to Parents
General technique (swab vial, new syringe each time, etc...)
Draw up to 15 units on insulin syringe
Consider marking 1 syringe for reference
Proper disposal of used syringes
FDA Pregnancy Categories
A: no risk in human studies
B: no risk in animal studies but no human studies done; or animal studies show risk but none demonstrated in human studiese
C: risk in animal studies but no human studies done. Benefits may outweigh risks
D: human studies demon
Transfer into Breastmilk
Small size
Weak base
Low binding
Lipid soluble
Prolactin
Promotes synthesis of milk
Oxytocin
Promotes ejection of milk
Dopamine
Inhibits prolactin release
Decreases Milk Supply
Dopaminergic agents (ergots, levodopa): inhibit prolactin release
Hormones (estrogen, androgen): block prolactin effect
Vasoconstrictors: decrease blood flow to breast
Increases Milk Supply
Dopamine antagonists (metoclopramide, neuroleptics): inhibit dopamine secretion
Methyldopa: false dopamine precursor
H2RA, fenfluramine, tryptophan: increase serotonergic transmission