PEDIATRIC CONDITIONS: DIAGNOSTIC TESTS, TREATMENT, AND POSSIBLE PRESENTATION

1. Asthma

• Possible Presentation (Symptoms):
  • Wheezing (a whistling sound when breathing out)
  • Coughing (may be worse at night or with exercise)
  • Shortness of breath
  • Chest tightness or pain
  • Rapid breathing
  • Use of accessory muscles to breathe (neck and chest muscles pulling in)
  • Fatigue
• Diagnostic Tests:
  • Clinical history and physical examination: Doctor will ask about symptoms, triggers, and family history.
  • Spirometry: Measures how much air a child can breathe out and how quickly. Often done in older children who can cooperate.
  • Bronchoprovocation testing: Involves inhaling substances that may trigger asthma to see if lung function changes.
  • Allergy testing: To identify potential triggers (skin prick tests or blood tests).
  • Chest X-ray: May be done to rule out other conditions.
• Treatment:
  • Quick-relief medications (bronchodilators): Like salbutamol (albuterol), used to quickly open airways during an asthma attack. Usually given via inhaler with a spacer.
  • Long-term control medications (anti-inflammatory): Like inhaled corticosteroids (e.g., budesonide, fluticasone), leukotriene modifiers (e.g., montelukast), and long-acting beta-agonists (LABAs) (often combined with inhaled corticosteroids). Taken daily to prevent symptoms.
  • Asthma action plan: A written plan outlining daily management, recognizing worsening symptoms, and when to seek emergency care.
  • Trigger avoidance: Identifying and avoiding known asthma triggers (e.g., allergens, irritants, exercise-induced asthma management).

2. Bronchiolitis

• Possible Presentation (Symptoms):
  • Runny nose (often clear initially)
  • Cough (initially mild, progressing to more persistent)
  • Fever (usually low-grade)
  • Wheezing
  • Rapid breathing
  • Difficulty feeding
  • Irritability
  • Apnea (pauses in breathing) in severe cases
  • Nasal flaring and chest retractions (signs of increased work of breathing)
• Diagnostic Tests:
  • Clinical history and physical examination: Doctor will assess symptoms and breathing patterns.
  • Pulse oximetry: Measures oxygen saturation levels.
  • Nasal swab or aspirate: To test for respiratory syncytial virus (RSV) or other viruses.
  • Chest X-ray: May be done to rule out pneumonia.
• Treatment:
  • Supportive care is the mainstay:
    • Adequate hydration: Frequent small feeds of breast milk or formula, or oral rehydration solutions. Intravenous fluids may be needed in severe cases.
    • Nasal suctioning: To clear nasal passages, especially before feeding.
    • Oxygen therapy: If oxygen saturation levels are low.
    • Bronchodilators (e.g., salbutamol): May be tried, but often not consistently effective for bronchiolitis.
    • Corticosteroids: Generally not recommended for routine bronchiolitis.
    • High-flow nasal cannula: May be used in more severe cases.
    • Mechanical ventilation: Rarely needed in very severe cases.

3. Chickenpox (Varicella)

• Possible Presentation (Symptoms):
  • Mild fever
  • Fatigue
  • Loss of appetite
  • Itchy rash that goes through stages:
    • Small, raised bumps (papules)
    • Fluid-filled blisters (vesicles)
    • Scabs
  • The rash typically starts on the face, scalp, and trunk and spreads to the limbs.
  • Lesions appear in crops, so different stages of the rash may be present at the same time.
• Diagnostic Tests:
  • Clinical history and physical examination: The characteristic rash is usually sufficient for diagnosis.
  • Tzanck smear: Scraping of a blister to look for characteristic cells (less commonly done).
  • Viral culture or PCR: Can be done to confirm the diagnosis, especially in atypical cases.
• Treatment:
  • Supportive care:
    • Rest
    • Plenty of fluids
    • Calamine lotion or cool compresses: To relieve itching.
    • Avoid scratching: To prevent secondary bacterial infections and scarring. Keep fingernails short.
    • Acetaminophen (paracetamol): For fever and pain (avoid aspirin due to the risk of Reye’s syndrome).
  • Antiviral medications (e.g., acyclovir): May be prescribed for individuals at higher risk of complications (e.g., adolescents, adults, immunocompromised individuals), ideally started within 24-48 hours of rash onset.

4. Cold (Common Cold, Viral Upper Respiratory Infection)

• Possible Presentation (Symptoms):
  • Runny nose (initially clear, may become thicker and discolored)
  • Nasal congestion (stuffy nose)
  • Sneezing
  • Sore throat
  • Cough (may be dry or productive)
  • Low-grade fever (more common in younger children)
  • Headache
  • Body aches
  • Fatigue
  • Decreased appetite
• Diagnostic Tests:
  • Clinical history and physical examination: Usually sufficient for diagnosis.
  • Rapid viral tests (e.g., for influenza, RSV): May be done if symptoms are suggestive or during outbreaks.
• Treatment:
  • Supportive care is the mainstay:
    • Rest
    • Plenty of fluids
    • Nasal saline drops or sprays: To help clear nasal congestion.
    • Humidifier: To moisten the air.
    • Acetaminophen (paracetamol) or ibuprofen: For fever and pain.
    • Avoid over-the-counter cough and cold medications in young children: Due to potential side effects and lack of proven benefit.
    • Honey for cough (in children older than 1 year): May provide some relief.

5. Cough

• Possible Presentation (Symptom):
  • A forceful expulsion of air from the lungs.
  • Can be dry or productive (with phlegm).
  • May be associated with other symptoms depending on the underlying cause (e.g., fever, runny nose, sore throat, wheezing).
• Diagnostic Tests:
  • Clinical history and physical examination: Doctor will ask about the nature of the cough, associated symptoms, and duration.
  • Chest X-ray: May be done to rule out pneumonia or other lung conditions.
  • Sputum culture: If a productive cough is present and bacterial infection is suspected.
  • Viral testing (nasal swab): To identify viral causes like influenza or RSV.
  • Allergy testing: If allergies are suspected as a trigger.
  • Spirometry: If asthma is suspected.
• Treatment:
  • Treatment depends on the underlying cause:
    • Viral infections: Supportive care (rest, fluids, honey for cough in older children).
    • Bacterial infections: Antibiotics.
    • Asthma: Bronchodilators and long-term control medications.
    • Allergies: Antihistamines and trigger avoidance.
    • Croup: Corticosteroids and sometimes nebulized epinephrine.
    • Whooping cough: Antibiotics (macrolides).
    • Avoid cough suppressants in young children: Unless specifically advised by a doctor.