OMSB Pediatrics (OEPEDS) cheat sheet

WHO/CDC growth: weight-for-age, length/height-for-age, weight-for-length or BMI-for-age, and head circumference-for-age (<2 y) plotted on the correct chart; a fall across ≥2 major percentile lines warrants evaluation for failure to thrive.

Developmental milestones: social smile 6 wk; head control 3 mo; sits unsupported 6-8 mo; pincer grasp 9-10 mo; walks independently 12-15 mo; 2-word phrases 18-24 mo; 3-word sentences and 50+ words by 3 y.

Red flags for developmental delay: loss of previously acquired skills, persistent primitive reflexes (Moro beyond 4-6 mo, asymmetric tonic neck beyond 6 mo), hand preference before 18 mo, no babbling by 9 mo.

Vaccination timing (EPI/expanded programme): BCG and hepatitis B at birth; OPV/IPV and pentavalent at 2, 4, 6 mo; measles-containing vaccine at 9 and 15-18 mo; booster doses at 18 mo and 4-6 y.

Failure to thrive workup: calculate mid-parental height, plot BMI, screen CBC, celiac serology, TSH, urinalysis, and electrolytes; organic causes suggested by dysmorphism, organomegaly, or abnormal growth velocity.

Lead poisoning: CDC blood lead reference value 3.5 µg/dL; levels ≥45 µg/dL require chelation; iron deficiency increases lead absorption.

Iron deficiency anemia: microcytic hypochromic with low ferritin and high TIBC; universal screening at 12 mo; treatment is 3 mg/kg/day elemental iron for 3 months after hemoglobin normalizes.

Normal vital signs (awake): infant HR 100-160/min, RR 30-60/min; toddler HR 90-150/min, RR 24-40/min; school-age HR 70-120/min, RR 18-30/min; hypotension is a late sign of shock in children.

APGAR scored at 1 and 5 min: Appearance, Pulse (<100 = 1, ≥100 = 2), Grimace, Activity, Respiration; score ≤3 at 5 min mandates continued resuscitation and reassessment every 5 min to 20 min.

Neonatal resuscitation: initial steps (warm, dry, stimulate, position airway) for 30 s; positive pressure ventilation at 21-30% O2 for ≥35 weeks' gestation and 21-30% for preterm, titrated to preductal SpO2 targets; chest compressions if HR <60/min after effective ventilation.

Surfactant deficiency in respiratory distress syndrome: grunting, retractions, nasal flaring, ground-glass lungs with air bronchograms; antenatal corticosteroids at 24-34 weeks reduce incidence and severity.

Physiologic jaundice appears after 24 h and peaks at 3-5 days (term); jaundice within 24 h, direct hyperbilirubinemia, or a rapidly rising bilirubin is pathologic. Treat with phototherapy or exchange transfusion per hour-specific nomogram.

Kernicterus risk rises with total bilirubin >25 mg/dL, hemolysis, prematurity, sepsis, and acidosis; acute signs include lethargy, poor feeding, hypertonia, and retrocollis.

Sepsis risk: group B Streptococcus and E. coli dominate early-onset disease; empiric ampicillin plus gentamicin covers early-onset; add cefotaxime for meningitis.

Hypoglycemia defined as glucose <45 mg/dL in the first 48 h; screen infants of diabetic mothers, small or large for gestational age, and preterm infants; treat with feeding or IV dextrose 10% bolus.

Necrotizing enterocolitis: feeding intolerance, bloody stools, abdominal distension, pneumatosis intestinalis on radiograph; manage with bowel rest, decompression, and antibiotics; surgery for perforation.

Acyanotic lesions with left-to-right shunt: VSD (most common congenital defect), ASD, PDA, AV septal defect; physiology is pulmonary overcirculation with failure to thrive and recurrent infections.

Cyanotic lesions with decreased pulmonary flow: tetralogy of Fallot (VSD, overriding aorta, pulmonary stenosis, right ventricular hypertrophy), tricuspid atresia; increased flow: transposition of the great arteries.

Duct-dependent lesions: prostaglandin E1 maintains patency in transposition, critical pulmonary stenosis, interrupted aortic arch, and severe coarctation; watch for apnea and hypotension.

Hypercyanotic (tet) spell: knee-chest position, supplemental oxygen, morphine, IV fluid bolus, phenylephrine or beta-blocker; avoid dehydration and crying.

Kawasaki disease: fever ≥5 days plus ≥4 of conjunctivitis, oral mucosal changes, cervical lymphadenopathy, rash, and extremity changes; treat with IVIG 2 g/kg and aspirin; coronary artery aneurysm is the major complication.

Murmurs: innocent murmurs are systolic, soft (grade 1-2), and vary with position; a pansystolic murmur suggests VSD, a continuous murmur suggests PDA, and an ejection click with systolic murmur suggests aortic or pulmonary stenosis.

Ductal-dependent coarctation: upper-limb hypertension with lower-limb hypotension, weak femoral pulses, radio-femoral delay; associated with bicuspid aortic valve and Turner syndrome.

Congestive heart failure in infants: tachypnea, poor feeding, sweating with feeds, hepatomegaly; treat with diuretics, ACE inhibitors, and digoxin in selected cases.

Asthma diagnosis in children ≥6 y: compatible symptoms plus demonstrated variable expiratory airflow limitation (FEV1/FVC <0.90 or reversibility ≥12% in FEV1 after bronchodilator).

Acute asthma severity: mild-moderate uses accessory muscles with normal speech; severe has inability to complete sentences, SpO2 <90%, and silent chest suggests life-threatening obstruction. Acute treatment: oxygen, repeated inhaled salbutamol, ipratropium, and systemic corticosteroids.

Cystic fibrosis: autosomal recessive CFTR defect; diagnose with sweat chloride ≥60 mmol/L on two occasions or two disease-causing mutations; newborn screening uses immunoreactive trypsinogen.

Cystic fibrosis complications: pancreatic insufficiency (steatorrhea, fat-soluble vitamin deficiency), meconium ileus, bronchiectasis with Pseudomonas aeruginosa, and CF-related diabetes; treat with airway clearance, dornase alfa, and pancreatic enzymes.

Croup: barking cough, inspiratory stridor, hoarseness; treat with a single dose of dexamethasone 0.15-0.6 mg/kg; nebulized epinephrine for moderate-severe stridor.

Epiglottitis: sudden high fever, drooling, tripod positioning, muffled voice; do not inspect the throat or agitate; secure the airway in a controlled setting with anesthesia present.

Foreign body aspiration: sudden choking with unilateral wheeze and decreased breath sounds; radiograph may show air trapping; rigid bronchoscopy is the definitive treatment.

Bronchiolitis: most commonly respiratory syncytial virus in infants <2 y; wheeze, crackles, and tachypnea; supportive care with oxygen and hydration; bronchodilators and corticosteroids are not routinely recommended.

Gastroesophageal reflux in infants: physiologic regurgitation peaks at 4 months and resolves by 12 months; avoid routine acid suppression in uncomplicated cases; alarm signs include bilious vomiting, failure to thrive, and hematemesis.

Pyloric stenosis: first-born male, 3-6 weeks of age, non-bilious projectile vomiting, visible peristalsis, olive-shaped mass; diagnosis by ultrasound showing pyloric thickness ≥3 mm and length ≥15 mm; correct hypochloremic hypokalemic metabolic alkalosis before surgery.

Bilious vomiting in a neonate is a surgical emergency until malrotation with volvulus is excluded; perform urgent upper GI contrast study.

Intussusception: 6-36 months, colicky pain, drawing up legs, red currant jelly stool, sausage-shaped mass; ultrasound shows target sign; treat with air or contrast enema if no perforation or peritonitis.

Celiac disease: tissue transglutaminase IgA plus total IgA; duodenal biopsy showing villous atrophy and crypt hyperplasia; strictly gluten-free diet; associated with type 1 diabetes and IgA deficiency.

Acute gastroenteritis: oral rehydration solution 50 mL/kg over 4 h for mild dehydration and 100 mL/kg over 4 h for moderate; zinc supplementation for 10-14 days reduces diarrhea duration in children.

Neonatal cholestasis: conjugated bilirubin >1 mg/dL or >20% of total; causes include biliary atresia, choledochal cyst, metabolic disease, and infection; biliary atresia requires Kasai portoenterostomy ideally before 60 days of life.

Hepatitis B: perinatal transmission risk highest with HBeAg-positive mothers; administer hepatitis B vaccine and immunoglobulin within 12 h of birth; test for surface antigen at 9-12 months.

Febrile seizure: age 6 months to 5 years, fever ≥38°C, no CNS infection; simple is generalized, lasts <15 min, and occurs once in 24 h; complex has focal features, lasts >15 min, or recurs within 24 h.

Status epilepticus: seizure lasting >5 min or repeated seizures without recovery; first-line is a benzodiazepine (midazolam, lorazepam, or diazepam), then a second benzodiazepine, then a second-line agent such as levetiracetam, fosphenytoin, or valproate.

Bacterial meningitis in infants: ampicillin plus cefotaxime (or ceftriaxone) plus vancomycin; add dexamethasone before or with the first antibiotic dose in suspected pneumococcal meningitis.

Head trauma: Glasgow Coma Scale ≤13, focal deficit, or suspected skull fracture warrants CT; observe children with minor head injury per validated rules; suspect non-accidental trauma with inconsistent history or retinal hemorrhage.

Cerebral palsy: non-progressive motor impairment from early brain injury; risk factors include prematurity, hypoxic-ischemic encephalopathy, and intraventricular hemorrhage; associated with epilepsy, visual and hearing deficits, and feeding difficulty.

Migraine in children: headache lasting 1-72 h, often bilateral frontal or temporal, associated with nausea, photophobia, and phonophobia; treat acute attacks with ibuprofen or acetaminophen and rest.

Guillain-Barré syndrome: ascending symmetric weakness with areflexia, albuminocytologic dissociation in CSF, and nerve conduction slowing; monitor vital capacity for respiratory failure; treat with IVIG or plasma exchange.

Neonatal hypotonia: central causes include hypoxic-ischemic encephalopathy, chromosomal disorders, and metabolic disease; peripheral causes include spinal muscular atrophy and congenital myopathies; check creatine kinase and consider genetic testing.

Short stature: height below -2 SD or growth velocity below 25th percentile for age; screen with bone age, CBC, celiac serology, TSH, IGF-1, and karyotype in girls for Turner syndrome.

Growth hormone deficiency: low IGF-1 and insufficient GH response to provocation; treat with recombinant GH; monitor for intracranial hypertension and slipped capital femoral epiphysis.

Type 1 diabetes: most common pediatric endocrine disease; presentation with polyuria, polydipsia, weight loss, and ketoacidosis; diagnose with glucose ≥200 mg/dL with symptoms or HbA1c ≥6.5%.

Diabetic ketoacidosis: glucose >200 mg/dL, venous pH <7.3 or bicarbonate <15 mmol/L, ketonemia; manage with isotonic fluid, insulin infusion after initial fluid bolus, and frequent electrolyte monitoring; cerebral edema is the leading cause of death.

Congenital hypothyroidism: newborn screening with TSH; treat with levothyroxine 10-15 µg/kg/day started within 2 weeks to prevent intellectual disability; reassess thyroid function after 3 years.

Congenital adrenal hyperplasia: 21-hydroxylase deficiency most common; virilization in girls, salt wasting with hyponatremia and hyperkalemia in the severe form; treat with hydrocortisone and fludrocortisone.

Precocious puberty: breast or pubic hair before 8 y in girls and 9 y in boys; GnRH stimulation test distinguishes central from peripheral; central precocious puberty treated with GnRH agonist.

Obesity: BMI ≥95th percentile for age and sex; screen for hypertension, dyslipidemia, and type 2 diabetes; recommend family-based lifestyle intervention and screen for depression.

Fever without a source in infants <3 months: full sepsis evaluation including blood, urine, and CSF cultures; empiric antibiotics with ampicillin and gentamicin or cefotaxime; admit infants <28 days.

Kawasaki disease, MIS-C, and toxic shock syndrome share fever and mucocutaneous findings; toxic shock syndrome is associated with Staphylococcus aureus or Streptococcus pyogenes and requires aggressive fluid resuscitation and clindamycin plus antistaphylococcal therapy.

Measles: Koplik spots, coryza, cough, conjunctivitis, and descending maculopapular rash; isolate with airborne precautions; administer vitamin A to children with measles.

Tuberculosis in children: diagnose with history of contact, tuberculin skin test or interferon-gamma release assay, and chest radiograph; treat latent infection with isoniazid for 6-9 months; active disease with a 4-drug regimen.

Hand, foot, and mouth disease: coxsackievirus A16 or enterovirus A71; vesicles on palms, soles, and oral mucosa; A71 can cause brainstem encephalitis and cardiopulmonary failure.

Malaria in children: fever, anemia, and hepatosplenomegaly after travel to endemic areas; thick and thin smears or rapid diagnostic test; severe malaria treated with IV artesunate.

HIV in children: vertical transmission prevented with maternal antiretroviral therapy, infant prophylaxis, and avoidance of breastfeeding when safe replacement feeding is feasible; diagnose infants with virologic testing at 4-6 weeks.

Vaccine contraindications: live vaccines are contraindicated in severe immunodeficiency and pregnancy; anaphylaxis to a vaccine component is an absolute contraindication; mild illness is not a reason to defer vaccination.

Pediatric assessment triangle: appearance, work of breathing, and circulation to skin; abnormal findings trigger immediate primary survey and resuscitation.

Weight estimation for resuscitation: length-based tape or age-based formula (weight in kg = 2 × age in years + 8 for children 1-10 y); use actual weight when available.

Fluid resuscitation: 20 mL/kg isotonic crystalloid bolus for shock, reassess after each bolus; in septic shock give 10-20 mL/kg and reassess for fluid overload; use 10 mL/kg in cardiogenic shock and DKA.

Cardiopulmonary arrest: compressions at 100-120/min with a depth of one-third of the anteroposterior chest diameter; compression-to-ventilation ratio 30:2 for one rescuer and 15:2 for two rescuers in children.

Epinephrine in pediatric cardiac arrest: 0.01 mg/kg IV/IO of 0.1 mg/mL (0.1 mL/kg) every 3-5 min; defibrillate at 2 J/kg for ventricular fibrillation or pulseless ventricular tachycardia, escalating to 4 J/kg.

Anaphylaxis: intramuscular epinephrine 0.01 mg/kg of 1 mg/mL (maximum 0.5 mg) into the anterolateral thigh; repeat every 5-15 min; adjuncts include oxygen, fluids, and antihistamines, but epinephrine is first-line.

Trauma: primary survey with catastrophic hemorrhage control first; give tranexamic acid within 3 h of injury in significant hemorrhage; avoid excessive crystalloid and use blood products early.

Drowning and hypoxic injury: prioritize rescue breathing and oxygenation; cervical spine immobilization is not routine unless mechanism suggests trauma; rewarm and monitor for arrhythmia and pulmonary edema.