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cleft lip and palate

• Failure of development in first trimester of gestation
• Prevented by folic acid
• Can be lip or palate or both
• Usually occurs in isolation w/o any other problems
• Etiology: can be caused by smking, alcohol, anticonvulsants, phenytoin, steroids


cleft lip and palate treatment

• Special feeders, keep upright after and during feedings, burp more frequently
• Repair lip in 6 months and palate in 18 months
• Post op – airway management, maintain suture line, nutrition
• Long term needs – dental care, orthodontia, speech/hearing, plastic surgery, self image


Tracheo-Esophageal Fistula / TEF

• Esophagus ends and trachea is attached to stomach
• Malformation that happens in week 4 or 5 of gestation
• Triad S/S – drooling/choking, cyanosis and cough
• High aspiration risk. Surgical emergency – close fistula of trachea and esophagus, insert G tube and reattach esophagus


TEF Preop

Suction any secretions, maintenance IV fluids, monitor VS


TEF Postop

Measure gastrostomy drainage, IV fluids and antibiotics. TPN may be needed. Feedings introduced slowly and in small amounts. Assess for respiratory difficulty



part of intestine prolapses into another (small intestine into large). abrupt onset, pain, vomiting and currant jelly stools (bright red, mix of mucus and blood). can cause bowel ischemia, perforation and periodontitis
tx: enemas or surgery. then watch for return of normal brown stools



abnormal rotation of intestine into abdominal cavity during development


pyloric stenosis

• Overgrowth of pyloric muscle
• Obstruction in passage of stomach and duodenum
• Causes projective vomiting, dehydration, irritability and hunger, hard mass abdomen w/ visible peristalsis, scrawny baby


Hirschsprung Disease

• Congenital
• Lack proper innervation of colon
• Lack peristalsis, may have constipation
• Tx: remove effected part of the bowel


imperforate anus

anus is not fully developed. repair surgically. risk for fibrosis or scarring of tissue during surgery (so they have less control or feeling there). may need anal dilation



protrusion of an organ through the muscle wall of the cavity that normally contains it. Inguinal and umbilical hernias are common in children



• Most common cause of emergency abdominal surgery in children
• Inflammation of appendix
• S/S – vomiting, fever, localized pain
• If they suddenly feel better it likely means they ruptured
• Tx – surgical removal


short bowel/gut syndrome

decreased capacity to absorb/digest food due to loss of intestine (can be from many different causes/conditions). may need TPN, may recover. goal is to get to enteral and oral feedings



• Paroxysmal abdominal pain in young infants
• Onset is 2 to 6 weeks and resolves by 3 months
• Baby cries a lot
• Tx - Need to support families, rocking baby rhythmically, white noise, swaddling, pacifier


Gastroesphageal reflux

• Most common cause of organic failure to thrive
• Backflow of gastric contents into esophagus bc sphincter is inappropriately relaxed
• Common < 3 months of age
• Tx – depends on severity. Positioning (on left side), meds (Zantac, PPI), smaller feedings with food that digests quicker


G tube indications

Indications: difficulty swallowing, inadequate nutrition, difficulty gaining weight



inflammation of stomach and intestines. 2nd leading cause of death worldwide in children under 5. very common, dehydration, vomiting, diarrhea. wash hands to prevent spread.



• Difficulty passing stool or hard stool
• ¼ of all GI referrals
• Managed with diet, fluids, meds (stool softener or enema) and toileting routine
• Encopresis – hold BM so long that it builds up in gut


clubfoot / talipes equinovarus

• Genetic component and more common in males, may be secondary to abnormal uterine positioning, may be neuromuscular or vascular problems
• Foot folded up against leg, muscles in lower limbs atrophied, smaller foot
• Tx: surgery is last resort. Serial casting – regular and aggressive stretching of soft tissue until foot is in more of a natural position


Developmental dysplasia of the hip

4 types
• S/S – no pain in infancy, not always apparent at birth. Less mobility/flexibility on one side. Painless limp in toddler, waddling duck-like gait in older child. Overtime untreated will cause limp and pain
• Treatment – observation, pavlik harness (to keep kid flexed and abducted), Seattle seat, surgery, Spica cast


Hip dislocation

type of developmental dysplasia of the hip. femoral head is dislocated from acetabulum


Dislocatable hip

type of developmental dysplasia of the hip. femoral head is in acetabulum but may be dislocated fully when stressed


Subluxable hip

type of developmental dysplasia of the hip. femoral head moves partly out of acetabulum


Acetabular dysplasia

type of developmental dysplasia of the hip. Acetabulum is shallow and lost its cup shape



hip joint loses circulation, atrophies and becomes necrotic. Self limiting. Lasts several months to a year. Dead bone is resorbed and replaced in 1-3 yrs.
S/S - pain worse with activity, limp, "stiff hip"



Lateral curvature of spine more than 10 degrees


Scoliosis treatment

observation (up to 30 degrees), bracing, surgery if > 40 degrees, cosmesis, sitting balance, pressure sore prevention. If 100 degrees then surgery to prevent cardiopulmonary compromise


Muscular Dystrophy

• Muscle fibers replaced by disease, fatty, cartilage tissues. Progressive to entire musculature and terminal.
• S/S – muscle weakness, unusual gait, progressives to otheries systems (scoliosis, respiratory difficulty, cardiomyopathy), die in 20s


Muscular Dystrophy treatment

supportive care, prednisone and deflazacort, surgery for deformities, respiratory therapy, mental health support


Slipped capital femoral epiphysis

femoral head falls off. caused by growth spurt, trauma, sports injury, overweight, endocrine disorder