Answers from the Pediatrician
12 Sep, 2012
Editor’s Note: Dr. Psota will write for Her View From Home once a month. If you have a question you would like her to answer, simply leave a comment on this post or send an e-mail to firstname.lastname@example.org and we’ll make sure she answers your question!
These questions come from a previous post on Her View From Home:
1. When to start solids and in what order?
The American Academy of Pediatrics recommends breast feeding or formula exclusively till somewhere between 4 and 6 months of age. If there are no prior feeding or formula problems, we start the solids in the following order: cereal–vegetables–fruits–and finally meats. We recommend going thru all 4 food groups of baby foods before starting table foods.
If the child has any feeding problems requiring a special formula or concerns regarding the need for increased calories, they should discuss this with their physician at the 4 month health care visit.
2. When to take the child to the doctor?
This is very age dependent, as the younger child is more worrisome than an older child and gets sicker faster than an older child.
0 to 2 months of age: Any temperature rectally greater than 100.5, needs to be seen day or night. Also if not feeding well or not having wet or dirty diapers.
2 to 12 months of age and has had 1st set of immunizations: If temperature greater than 101, the child should be seen within 12-24 hours. Also if difficulty breathing or wheezing, greater than 8-10 stools per day, blood in stools, or no wet diaper in past 8-12 hours, the child should be seen that day.
12 to 24 months: If temperature above 101 and not associated with any other symptoms, or the child doesn’t act normal when the temperature has returned to normal with fever reducers. If you can’t get the temperature down with appropriate doses of fever reducer, difficulty breathing or wheezing, persistent vomiting beyond 12-24 hours, child not alert and responsive to family and unable to get the child to drink–these children need to be seen.
24 months of older: Temperature lasting longer than 48-72 hrs. or doesn’t return to normal with adequate doses of fever reducer. Also if severe abdominal pain, vomiting longer than 24 hours, altered mental state, difficulty breathing and wheezing, bloody diarrhea, rash that is purplish and doesn’t appear to be bug bites, ear ache or sore throat or the child that is not improving in 24 to 48 hours.
The parents should always call their pediatrician or family physician’s office if they are unsure if they need to be seen or not.
3. What is sepsis?
Sepsis is a clinical spectrum that begins with a systemic infection, caused by a bacteria, a fungus, or a virus. The infection can be the result of spread from a localized infection of the lungs, kidney, skin, meninges, or the gastrointestinal tract. The infection or sepsis can progress to severe sepsis (this includes organ dysfunction along with the infection), then to septic shock which means low blood pressure and poor tissue perfusion of the organs, and ultimately death.
Children at risk for sepsis include infants, those with serious injuries, those on chronic antibiotics, malnourished children, and those with chronic medical conditions. Also those who are immune suppressed are at an increased risk for infection, therefore increased chance of sepsis and septic shock.
It is important to distinguish between the infection and the host response to the infection, or the inflammatory response. If the host’s immune response produces an inflammatory cascade of toxic substances, and this cascade is uncontrolled, it leads to a systemic inflammatory response syndrome (SIRS). This leads to cellular and organ dysfunction and eventual death.
Initial signs and symptoms of sepsis include temperature instability (either high or low), tachycardia (fast heart rate), and tachypnea (fast respiratory rate). The child usually appears very ill and becomes sick quickly. Vital signs, physical examination and laboratory results are used to make the diagnosis.
Treatment includes intravenous antibiotics, admission to an intensive care unit with continuous close monitoring. Despite early diagnosis and treatment, severe sepsis has a mortality rate of approximately 10%.
The best means of prevention include: obtaining all the recommended immunizations, cleaning all cuts and wounds adequately and observing for signs of infection and close monitoring when child is ill.
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