Acute and Chronic Illness Management in Children
Acute and chronic illness items test protocol-driven management and early recognition of deterioration. Know the first-line treatment, what not to give, and the monitoring that catches complications.
Common acute conditions
- Bronchiolitis: supportive care - suction, hydration, oxygen if SpO2 <90%. No routine bronchodilators, steroids, or antibiotics.
- Croup: single dose dexamethasone 0.15–0.6 mg/kg; nebulized epinephrine 1:1000, 0.5 mL/kg (max 5 mL) for moderate-severe stridor at rest.
- Asthma: albuterol by MDI with spacer is preferred; add ipratropium and systemic steroids in moderate-severe exacerbations.
- Dehydration: oral rehydration 50 mL/kg over 3–4 h (mild) or 100 mL/kg (moderate); ondansetron reduces vomiting.
- DKA: isotonic fluid bolus, then insulin infusion 0.05–0.1 units/kg/h. Watch for cerebral edema - headache, bradycardia, hypertension, falling consciousness - and treat with mannitol or hypertonic saline.
Chronic conditions
- Sickle cell vaso-occlusive crisis: hydration, timely opioids, oxygen only if hypoxic. Fever in a child with sickle cell is an emergency because of sepsis risk.
- Cystic fibrosis: airway clearance, pancreatic enzymes with meals, infection prevention, growth monitoring.
- Congenital heart disease: watch feeding, growth, and cyanosis; endocarditis prophylaxis only for specific lesions.
- Transition planning to adult care begins in early adolescence.
Worked example
A 4-year-old with asthma has retractions, speaks in phrases, and has SpO2 91%. This is a moderate-severe exacerbation: albuterol with spacer, add ipratropium and oral dexamethasone, oxygen to keep SpO2 at 92–94%, and reassess after each treatment. Escalate if there is no improvement.
Traps
- Antibiotics for bronchiolitis.
- Aspirin in a febrile child (Reye syndrome).
- Cough and cold preparations under 4 years.
- Rehydrating DKA too rapidly.