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The most common pediatric infectious disease; otherwise known as the "common cold"

Acute Viral Rhinitis


Signs and symptoms of Acute Viral Rhinitis

Sudden onset of CLEAR or mucoid rhinorrhea, nasal congestion, and fever. May present with a sore throat, cough, and red TM for u[ to 14 days.


Common pathogens for Acute Bacterial Rhinosinusitis

S pneumoniae, H influenzae, M catarrhalis, and B-hemolytic streptococci


Signs and symptoms of Acute Bacterial Rhinosinusitis

Nasal congestion, PURULENT nasal discharge, facial pain/pressure, cough, headache, fever for less than 30 days


When to diagnose and treat Acute Bacterial Rhinosinusitis with antibiotics

1. If s/sx last for more than 10 days
2. worsening of symptoms within 10 days after initial improvement in s/sx
3. s/sx of FOCAL signs. i.e., periorbital edema, severe sinus tenderness, or severe headache.


Treatment considerations for Acute Bacterial Rhinosinusitis

1. Pediatrics - 7 days after symptoms resolves
2. Adults - 7-10 days, may be longer to prevent relapses
3. Daycare status, recent antibiotic use, allergies, and age.
4. NSAIDS/Tylenol for pain and fever control
5. Nasal decongestants for < 3 days
6. OTC ORAL deongestants, antihistamines, cough/cold preps are not receommended for children < 4 years old
7. Intranasal corticosteroid sprays are RECOMMENDED in ALL adults and may be useful for CHILDREN WITH ALLERGIC SINUSITIS


Successive episodes of bacterial infections of the sinuses, each lasting less than 30 days & SEPARATED intervals of at least 10 days

Recurrent sinusitis


Episodes of inflammation of the paranasal sinuses lasting more than 90 days

Chronic sinusitis


Antibiotic treatment difference between acute sinusitis and chronic/recurrent sinusitis

Duration of chronic/recurrent sinusitis treatment is 3 - 4 weeks


Differential diagnosis for chronic/recurrent sinusitis

1. Anatomical problems (septal deviation, polyp, or foreign body)
2. Cystic fibrosis or immunodeficient
3. Reflux esophagitis
4. Anaerobic and Staph organisms


Triad of children with Allergic rhinitis or "hay fever"

1. Allergic rhinitis
2. Asthma
3. Eczema

More common in red-haired children


Signs and symptoms of Allergic Rhinitis

1. Rubbing of nose (Allergic Salute sign)
2. Allergic shiners (Dark circles and swelliing under the eyes)
3. Clear nasal drainage with pale, swollen and boggy nasal turbinates
4. Conjunctival injection, tearing, and redness of eyes
5. Enlarged tonsils


Treatment of Allergic Rhinitis

1. Avoidance of allergic triggers
2. Nasal irrigations
3. Non-sedating Antihistamines (Loratidine, Cetirizine)
4. Intranasal corticosteroids
5. Mast-cell stabilizers (Cromolyn sodium, Montelukast)


Common causes of Epistaxis

1. Dry nose
2. Nose rubbing
3. Picking
4. Vigorous blowing


Rare cause of Epistaxis

1. Bleeding disorders such as Von Willebrand (Clotting factor VWF deficient)


When to do a full work-up for Epistaxis

1. Family hx of bleeding disorder
2. Medical hx of easy bleeding
3. Spontaneous bleeding at any site
4. Bleeding lasting for over 30 min. or blood that will not clot with direct pressure
5. Onset before 2 yrs of age
6. A drop in Hematocrit due to epistaxis


Treatment for Epistaxis

1. Patient up, lean forward and pinch SOFT part of the nose for 5 - 15 minutes
2. ONE time oxymetazoline spray (Afrin) or Phenylephrine
3. Application of polysporin to prevent recurrence until all crusting is healed
4. No NSAIDS or Aspirins


90% of Sorethroat and fever are caused by what?

1. Viral infections.
2. Only 5-15% is caused by Bacterial infections. (No Antibiotics)
3. Viral infections most commonly presents with cough and rhinorrhea


Different Viral infections of the Throat

1. Infectious Mononucleosis
2. Herpangina
3. Pharyngoconjuctival fever
4. Hand, Foot, & Mouth Disease


Large exudative tonsillitis, Generalized POSTERIOR cervical adenitis, fever, palpable SPLEEN or axillary adenopathy

Inf. Mononucleosis. Palpate for the SPLEEN!


2-3 mm ulcers on the anterior pillars and soft palate and uvula and is caused by Coxsackie virus



If presenting with exudative tonsillitis, CONJUCTIVITIS, lymphadenopathy and fever.

Pharyngoconjuctival fever. Consider viral infections of negative for Rapid Strep such as Adenovirus


Ulcers on the tongue and oral mucosa; vesicles, pustules, & papules on the palms, soles, interdigital areas, and buttocks and is caused by enteroviruses

Hand, Foot, & Mouth Disease


What is the most common bacterial cause of Acute Bacterial Pharyngitis

Group A Beta-Hemolytic Streptococcus (GABHS)


Centor Criteria

1. Fever
2. Lack of Cough
3. Exudates on Tonsills
4. Adenopathy of ANTERIOR Cervical

2 out of 4; do rapid strep
3 out of 4 has a sensitivity of 90% for GABHS (Empiric)

Do C&S if sending home patient without Antibiotics


Treatment for Acute Bacterial Pharyngitis

1. Oral Penicillin V or IM Penicillin if compliance issues
2. Amoxicillin
3. If allergic to PCNs then Erythromycin / Azithromycin or Cephalosporins


Complications of Tonsillitis

1. Peritonsillar Cellulitis or Abscess - UNILATERAL with high fever and soft palate and uvula DISPLACED
2. Retropharyngeal Abscess - GABHS with Respiratory symptoms AND neck hyperextension, dysphagia, drooling, dyspnea, and gurgling respirations


Most common pathogens of Acute Otitis Media (AOM)

1. Strep Pneumoniae
2. HIB - not the bacteria in HIB vaccine (unencapsulated and non-typeable)
3. Moraxella Catarrhalis


Signs and Symptoms of AOM

1. Fever, Otalgia, Insomnia, Anorexia
2. EFFUSION (OEM or SOM) for up to 3 months. If longer than 3 months, refer for hearing tests and consider PE tubes
3. Erythematous, retracted (early) or BULGING (late), immobile/decreased mobility of TM and decreased light reflex
4. Loss of bony landmarks and light reflex (cone of light) on otoscopic examination
5. Purulent discharge for perforated TM


What kind of hearing loss is present with OEM?

Conductive hearing loss (Hearing loss over 20 decibels after 3 months is considered significant)


When should you refer an AOM?

1. If patient is less than 3 months
2. If OEM for more than 3 months


What should be assessed and possible complications for AOM with or without fever?

1. Nucchal rigidity - Meningitis (Common the younger the child is)
2. Pneumonia
3. Mastoiditis - Palpate behind the ear
4. Tympanosclerosis - scarring of TM and middle ear stuctures resultin into conductive hearing loss
5. Perforation of TM - drainage of ear
6. Cholesteatoma - granulation tissue develops near perforation - refer for surgery


Flat tympanogram



Flat tympanogram with negative peak pressure

Obstructed Eustachian tube


Helpful in identifying ear pathogen

Nasal swab


First line treatment for AOM

1. Amoxicillin 90mg/kg/day up to 4g/day for:
- 5-7 days in children > 2 yrs
- 10 days in children < 2 yrs


Antibiotic treatment for AOM if patient developed a RASH from PCN

1. Cephalosphorin
- Cefuroxime (Ceftin)
- Cefpodoxime (Vantin)
- cefdinir (Omnicef)


Antibiotic treatment for AOM if patient developed an URTICARIA / HIVES or OTHER SERIOUS ALLERGIC REACTION from PCN

1. Trimethoprim-sulfamethoxazole (Bactim)
2. Azithromycin (Zithromax)


If unable to take orally or compliance issues with antibiotic treatment, what should be considered?

1. single IM Ceftriaxone (Rocephin)


Second line treatment for AOM and used when no improvement after 48-72 hours after Amxocillin or has had antibiotics in the past month

1. Amoxicillin-clavulanate (Augmentin) - Dose so that Amoxicillin is dosed at 90mg/kg/day


Augmentin is effective for what organisms?

1. Drug-resistant Strep. Pneumoniae (DRSP)
2. Beta-lactamase positive strains of M. Cat and H.Flu

Alternatives are Cefuroxime or IM Ceftriaxone


What Antibiotics should not be given for H. Flu and S. pneumoniae?

1. Macrolides (Azithromycin)


What can be given to penicillin allergic children?

1. Erythromycin
2. Clarithromycin
3. Azithromycin


Pain management for Otalgia?

1. Tylenol or Motrin
2. Topical anesthetic drops (Auralgan) - Only if TM is intact


Discuss observation of AOM for 6 years and older

Allow 6 years older patients to go home and observe s/sx for 48 hours and instruct parents to fill safety net antibiotic prescription (SNAP) if symptoms does not improve in 48 hours or if it worsens


What are the risk factors and how to prevent AOM

1. Second hand smoke (inflames eustachian tibes and impedes drainage)
2. Pacifier use or Bottle feeding - Avoid use after 6 months pacifier
3. Daycare
4. Promote breast feeding
5. Immunizations (Pneumococcal / HIB )
6. Eustachian tube dysfunction common in infants (shorter, wider, floppier and more horizontal)
7. Craniofacial disorders such as down's syndrome
8. Winter months
9. Immunocompromised


Extreme case of OME

Glue ear - Immobile TM even with positive or negative pressure


What causes OME

1. Allergies causing swelling and inflammation of Eustachian tube
2. AOM and residual for up to 16 weeks


Signs and symptoms of OME

1. Usually asymptomatic
2. Feeling of fullness in the ear
3. Popping with swallowing
4. Air travel complaints
5. Air-fluid line / bubbles
6. Dullness and interrupted light reflex with protrusion of incus d/t negative pressure behind TM


How is OME diagnosed?

Pneumatic Otoscopy


Infection / Cellulitis of the ear canal with bacteria or fungus?

Otitis Externa


Risk Factors for Otitis Externa

1. Overzealous removal of ear wax
2. Water stasis in the ear canal
3. Trauma to external canal (Hearing aids, Q-tips, etc.)


Signs and symptoms of Otitis Externa

1. Pain / Itching in the ear
2. Swelling of ear canal
3. Minimal thick (Purulent) drainage
4. Tenderness on tragus and pinna
5. Unable to visualize TM
6. Possible pre-auricular or cervical lymphadenpathy


Treatment of Otitis Externa

1. Topical Antibiotics (Flouroquinolone drops) with steroid (Ciprodex)
2. If TM can't be visualized, assume perforated TM and use only drops safe for the middle ear and do NOT irrigate.
3. Pope ear wick (insert dry wick then instill drops) to ensure drops entering into the canal


What to assess in eye newborn assessment

1. Clarity of Cornea
2. Presence of red reflex (Indicates intactness not vision)
3. Drainage


What medication causes chemical conjunctivitis with horrible drainage

prophylactic silver nitrate (Also not effective against chlamydia; leading cause of opthalmia neonatorum)


Partial nasolacrimal duct obstruction with continuous tearing and yellowish discharge and swelling



Treatment for Acute Dacryocystitis

1. Massage lacrimal sac 6 times a day for chronic dacryocystitis
2. If infected; use oral Augmentin
3. Topical Antibiotics
4. IV antibiotics for severe infection or evidence of periorbital cellulitis


What treatment of eye disorders do NP never prescribe?

Steroid eye drops!


Patient has dacryocystitis that persisted for 8 months now with inflammation of lacrimal sac

Refer to ophthalmology


What are used for assessing the alignment of eyes and diagnosis of strabismus?

1. Hirschberg test
2. Corneal light reflex
3. Cover test


Treatment for Strabismus

Refer to ophthalmologist for possible patching or surgery


Up to what month is brief periods of strabismus normal for newborn? Unless strabismus is very obvious and persistent

6 months


1. Esotropia
2. Exotropia
3. Hypotropia
4. Hypertrpia

1. Inward turn of eyes
2. Outward turn of eyes
3. Downward turn of eyes
4. Upward turn of eyes


Caused by brain trying to suppress the off center image and can result in permanent blindness; considered the most common and serious complication of strabismus



How to check visual acuity in newborn?

1. Newborns are able to BRIEFLY visually track mother’s face or brightly colored object within an hour after birth (fixation reflex not developed for several weeks so fixation is brief)
2. Don’t talk to baby when assessing vision – he may look toward sound rather than visual stimulus
3. Older babies should show increased body motion or reach when interesting object (like bottle, pacifier or toy) is presented
4. Children who can talk can be given eye charts with pictures to identify
5. Snellen E chart or blackbird chart may be used if child can talk and follow directions


Visual Acuity development in children

Newborn - 20/200 to 20/400
6 months - 20/60 to 20/100
1st grader (5-6 yo) - 20/20 to 20/25


How often to check vision for children

Every 1 to 2 years


Patient has 20/40 in Left eye and 20/100 on Right eye. What is the next plan of action?

Refer! One is for less than 20/40 in either eye and the other is a difference of more than 1 line in acuity between eyes


Visual Acuity is almost always done first in all eye conditions except for what?

1. Chemical injury
2. Foreign body

Irrigate affected eye profusely first. Refer if decreased acuity.


Itchy, red, watery eyes with WHITISH AND STRINGY discharge with usual history of allergies

Allergic "Vernal" conjuctivitis


Treatment of Allergic conjunctivitis

1. Mast cell stabilzers (Cromolyn sodium (Opticrom)
2. H2 receptor antagonist such as Levocabastine (Livostin)
3. Non-steroidal anti-inflammatories such as Ketorolac tromethamine (Acular)
4. Combination drops such as Olopatadine (Patanol) with mast cell stabilizer and H2 receptor antagonist
5. AVOID steroid eye drops: risk of glaucoma and cataracts, refer to ophthalmologist for those.
6. Systemic antihistamines such as Benadryl are helpful


Signs and symptoms of Viral conjunctivitis

1. Redness, watery eyes with CLEAR discharge usually
2. Preauricular lymph node often enlarged


Organism causing Viral conjunctivitis

3. Associated with pharyngitis caused by Adenovirus
2. Herpes Simplex Virus
3. Measles virus.


Treatment for Viral conjunctivitis

1. Self-limiting / resolving
2. Prophylaxis antibiotic eyedrops to avoid secondary bacterial infections
3. Very contagious so practice good hand hygiene
4. Children should stay out of school until redness and tearing resolves


Treatment for HSV-related eye disorders

Refer to opthalmologist!


Signs and symptoms of Bacterial conjunctivitis

1. Redness
2. PURULENT discharge
3. May have symptoms of URI
4. Usually NO adenopathy


Organisms causing Bacterial Conjunctivitis

1. Haemophilus Influanzae, 2. Strep pneumoniae
3. Moxarella catarrhalis
4. Straph Aureus


Treatment for Bacterial Conjunctivitis

1. Warm compress
2. Hand washing and no sharing of towels
3. Refer if no improvement in 48-72 hours
4. Antibiotics


Antibiotics for Bacterial Conjunctivitis. Drops if concerned about vision. Ointment if concerned about prolonged contact with ocular surface and soothing effect

1. Erythromycin ophthalmic ointment: Apply 0.5-in ribbon QID for 5-7d
2. Polymyxin-trimethoprim ophthalmic solution: Instill 1-2 drops QID for 5-7d
3. Sulfacetamide ophthalmic solution: Instill 1-2 drops QID for 5-7d
4. Azithromycin ophthalmic solution: Instill 1-2 drops BID for 2d, then 1 drop for 5d
5. Ciprofloxacin ophthalmic solution: Instill 1-2 drops every 2h while awake for 2d, then 1 or 2 drops every 4h while awake for the next 5d
6. Levofloxacin ophthalmic solution: Instill 1-2 drops in affected eye(s) every 2h while awake (up to 8 times daily) on days 1-2; instill 1-2 drops in affected eye(s) every 4h while awake (up to 4 times daily) on days 3-7
7. Ofloxacin ophthalmic solution: Instill 1-2 drops in affected eye(s) every 2-4h on days 1-2; instill 1-2 drops QID on days 3-7


When to give systemic (Oral/parenteral) antibiotics for bacterial conjunctivitis?

1. If caused by Chlamydia trachomatis
2. N. Gonorrhea (Ophtalmia neonatorum)


A teenager presents to the clinic with possible bacterial conjunctivitis. What is the next plan of action?

Culture eyes in sexually active teenagers to rule out STD


Patient presents to the clinic with Eye pain. What is the next plan of action?

1. Visual Acuity (except for foreign body and chemical substance: Irrigation first)
2. Pupillary reaction
3. Anesthetic drops prior examination or removal of foreign body

Refer immediately if abnormal or presence of imbedded objects


Patient presents with sudden severe unilateral eye pain with tearing and redness. What do you suspect?

1. Corneal abrasion


How to diagnose and examine a possible corneal abrasion?

Flourescein dye and woods or cobalt blue lamp

Corneal abrasion will appear as bright yellow / greenish collection of dye on surface of eye


Treatment for corneal abrasion

1. Antibiotic drops or ointment
2. Patching is not recommended
3. No contact lenses until healed
4. No anesthetic eye drops for home use
5. Topical cyclopegic drops (Atropine opthalmic)
6. NSAID / Tylenol or narcotics for pain management
7. Follow-up in 24 hours


Signs and symptoms of Blepharitis

1. Redness and irritation of eyelid margins
2. May present with dry eyes and conjunctivitis
3. Crusting


Redness and irritation of eyelid often caused by bacterial overgrowth (Staph Aureus) and meibomian gland obstruction



Treatment for Blepharitis, Hordeolum and Chalazion

1. Eyelid scrubs with baby shampoo
2. Warm compress
3. Topical antibiotic ointment (Polysporin or Sulamyd ointment)
4. I & D for Chalazion if slow to resolve


Redness and localized eyelid NODULE / GRANULOMA often caused by obstruction of meibomian glands



Redness, swelling, warm and PAPULE on eyelid specifically in the glands of Zeis usually by Staph Aureus

Hordeolum "Stye"


Redness and swelling of both eyelids with pain and FEVER usually caused by staph aureus and strep pyogenes

Periorbital Cellulitis


Treatment for Periorbital cellulitis

Refer for hospitalization and systemic antibiotics


Most common intraocular malignancy of childhood, usually presenting before age of 3



Patient presents to the clinic with sign of Leukocoria (white reflex in pupil), strabismus, red eye, and glaucoma. What is the next course of action?

Perform Red reflex (Buckner test) to consider Retinoblastoma - Positive Bruckner test is a difference in the quality of the red reflex between eyes. Refer if positive!


Risk factors of Acute Closed-angle Glaucoma (ACAG)

1. Age
2. Farsightedness
3. Family History
4. Medications


Signs and symptoms of ACAG

1. Rapid onset of severe unilateral eye pain
2. Blurred vision WITH halos around lights
3. Nausea / Abdominal pain
4. Redness and cloudy appearing cornea
5. Dilated, non-reactive pupil
6. Eye feels har don palpation


Treatment for ACAG

Refer urgently to opthalmologist


Common etiology of Keratitis

1. Bacterial (Pseudomonas Aeruginosa, M. Cat, Gram-negative bacilli, staph)
2. Viral ( HSV)
3. Contact lense left overnight
4. Corneal trauma (Surgery)


Signs and symptoms of Keratitis

1. Blurred vision from Hazy cornea, may have central ulcer
2. HYPOPYON (pus in the anterior chamber)
3. Diffuse erythema
4. Eye pain
5. Photophobia
6. Grittiness
(foreign body sensation)


Treatment for Keratitis

Refer to an Opthalmologist


Signs and symptoms of Uveitis

1. Unilateral eye pain
2. Photophobia
3. Blurred Vision from cloudy cornea
4. PERILIMAL ERYTHEMA (Redness at border of cornea and sclera)
5. Reactive and small pupil


Treatment for Uveitis

Referral to an ophthalmologist


Common organisms causing Otitis Externa

1. Pseudomonas Aeruginosa - Foul-smell
2. Staphylococcus Aureus
3. Aspergillus or other fungi - Common in Diabetics


Differential Diagnosis for Otitis Externa

1. Furunculosis of the ear canal
2. Mastoiditis
3. AOM with TM perforation
4. Patent PE tubes (Draining)


First line treatment for Otitis Externa

1. Flouroquinolone drops (Covers Pseudomonas and Staph)
- Ciprofloxacin/dexamethasone (Ciprodex) 4ggts BID for 7 days (Can be used even if TM is perforated or with PE tubes (safe)
- Neomycine/Polymixin B/Hydrocortisone (Cortisporin otic) 3-4 gtts TID_QID for 7-10 days (NOT SAFE for use with perforated TM or PE tubes - CAN CAUSE HEARING LOSS)


Prevention of Otitis Externa

1. Avoid vigorous ear cleaning
2. Avoid Q-tips
3. After swimming, use 2-3 gtts of 1:1 sol'n of vinegar and ethyl alcohol, or swim ear drops.


When should you always treat with antibiotic therapy for AOM?

less than 6 months and severe AOM WITH otorrhea


When can you suggest observation for AOM?

more than 6 months for unilateral AOM WITHOUT otorrhea or more than 2 years for bilateral AOM WITHOUT otorrhea


First line treatment for children with tympanostomy tubes and otorrhea but no systemic symptoms (pain, fever)?

Flouroquinolone otic drops (cipro otic) 4 gtts BID x 7 days


Child presents to clinic with history of AOM for more than 4 weeks. What is next plan of action?

Likely a new pathogen, start with Amoxicillin or other first line treatments


What are some reasons for antibiotic failure?

1. Drug-resistant pathogen (Macrolides for H. Flu and Strep Pneumoniae for Amxocillin failure)
2. Non-compliance - IM Ceftriaxone
3. Vomiting of medications - improve with flavoring


Fluid remains in ear after AOM for how many weeks?

1. 2 weeks - 60-70% for OME
2. 4 weeks - 40% for OME
3. 3 months - 10-25% for OME


Treatment for OME

1. Have child come back after 4 weeks for evaluation
2. Refer for Audiology evaluation if present for more than 3 months
3. Refer to ENT for hearing loss for possible tympanostomy (PE) tube placement


Preschoolers get an average of how many febrile illness per year?

6 to 8


Core (rectal) temperature of more than 38 C or 100.4 F



Most accurate temperature measurement

Rectal Temperature


When not to use a tympanic temperature?

1. Children under 3 months
2. Ear wax / Cerumen impaction - blocking ear canal


Most common cause of fever

Viral infections


Mom of patient asks if teething causes fever?

No it does not


What is the main challenge in diagnosing fever?

Differentiate viral and serious bacterial infections (SBI)


Risk factors for Serious bacterial illness

1. Less than 3 months old
2. History of prematurity
3. Previous hospitalizations
4. Immunodeficient (Asplenia)
5. Daycare or household contact
6. Not fully immunized infants


Signs of serious illness

1. Fever of more than 40 C / 105 F
2. Nuchal rigidity
3. Petechial skin rash
4. Seizures
5. Respiratory problems
6. AOM / Mastoiditis
7. Murmurs
8. Abdominal distension / tenderness
9. Joint issues


Diagnostic testing for Fever

1. CBC with differential - WBC >15,000 or <5,000
2. UA/C&S - poss. UTI
3. CXR - poss. Pneumonia
4. Lumbar puncture - poss. Meningitis
5. Blood cultures: poss. Bacteremia
6. Stools for C&S - poss. infectious diarrhea


A 4-week old infant presents to the clinic for fever. What is the next plan of action?

1. Refer for hospitalization, full septic work-up and IV antibiotics pending culture


Plan of action for NON-TOXIC looking, no risk factors of SBI with fever for 4 weeks to 3 months

1. Full septic work-up
2. Treatment for underlying conditions
3. Empiric antibiotics after cultures
4. ROCEPHIN 50mg/kg/day
5. Reliable caregiver with phone and transportation
6. Close follow-up in 24 hours


Plan of action for TOXIC looking OR WITH risk factors of SBI with fever for 4 weeks to 3 months

1. Refer
2. Hospitalizations
3. Full septic work-up
4. IV antibiotics pending culture results


Plan of action for NON-TOXIC looking with fever for more than 3 months to pre-school

1. Diagnostic testing guided by underlying conditions. (UA for all girls less than 2 years old and all males less than 6 months, uncircumcised < 12 months)
2. Antipyretics
3. Fever of LESS THAN 39 C (102 F) - Close follow-up by visit or phone
4. Fever of MORE THAN 39 c (102 F) - Consider empiric antibiotics with close follow-up


Plan of action for TOXIC looking with fever for more than 3 months to pre-school

1. Septic work-up
2. Consider hospitalization
3. IV antibiotics if no focal source of fever


When can aspirin be used for children?

NEVER! causes Reye's syndrome


Dosing of Acetaminophen (used for patients more than 2 months)

15 mg / kg every 4-6 hours NTE 5 doses in 24 hours


Dosing of Motrin / Advil (used for patients more than 6 months)

10 mg / kg every 6-8 hours NTE 40 mg/kg/day total dose


Home instructions for parents with children with fever

1. Increase OFI
2. Light clothing
3. TSB
4. No alcohol or cold water baths
5. Monitor temp, activity level, oral intake, change in condition every 4 hours
6. Follow-up in 24 hours by visit or phone