Acute and Chronic Illness Management
Pediatric twists on ABCs
Asthma is managed stepwise: a short-acting beta agonist for rescue, inhaled corticosteroids for persistent symptoms, a spacer for children, and a written action plan with school access to medication. Bronchiolitis is supportive: suction, hydration, oxygen as needed; routine bronchodilators, steroids, and antibiotics are not recommended. Croup gets dexamethasone at any severity; moderate to severe disease with stridor at rest also gets nebulized epinephrine plus observation for 2-4 hours.
Fluids and metabolic crises
Estimate dehydration from weight loss and clinical signs, then use oral rehydration solution (about 50 mL/kg for mild, 100 mL/kg for moderate, replaced over 3-4 hours with ongoing losses). In diabetic ketoacidosis, fluids and insulin are given cautiously with frequent neurologic checks because rapid correction risks cerebral edema. In sickle cell disease, fever is an emergency: obtain cultures and start antibiotics promptly.
Chronic conditions
Cystic fibrosis: pancreatic enzymes with every meal and snack, airway clearance, and nutrition for growth. Type 1 diabetes: sick-day rules, and never stop basal insulin. Ductal-dependent congenital heart lesions need prostaglandin E1; recognize hypercyanotic spells in tetralogy of Fallot (knee-chest position, oxygen, morphine per protocol).
Medication safety traps
Dose by weight in kilograms every time. Never give aspirin during a viral illness (Reye syndrome). Avoid over-the-counter cough and cold products under 4 years and codeine under 12. Recheck calculations and dispense with an oral syringe, not a kitchen spoon.
Rule of thumb
For most pediatric respiratory infections the answer is supportive care plus reassessment, so question any option that adds routine antibiotics, steroids, or albuterol to a wheezing infant with bronchiolitis.