Pediatrics

FRICHMOND ADMIT
Fluids/ Feeding Admit
Respiratory Diet, Fluids
Infectious M onitor
Cardiac Intervention
Hematologic Therapeutics
Metabolic
Output
Neurologic
Drugs

EMERGENCY PEDIATRICS
PALS:
General Pediatric Assessment: (CBC)
Consciousness
Breathing
Color
Primary Assessment: (ABCDE)
Airway
Breathing
Circulation
Disability
Exposure
Secondary Assessment: (SAMPLE)
Signs/Symptoms
Allergy
Medications
Past medical history
Last meal
Events leading to
Head to Toe Physical Examination
Tertiary Assessment: Diagnostics
Asystole:
High quality CPR
Epinephrine
Bradycardia: (HR <60)
High quality CPR
Epinephrine, Atropine
Supraventricular Tachycardia (SVT):
Stable:
o Vagal maneuvers: ice
o Adenosine
Unstable: synchronized cardioversion

Blood Pressure (BP): (p5)

<28 days <60
1-12 months <70
1-10 years <70 + (age in years x 2)
> 10 years <90

ET SIZE A N D DEPTH:
ET size(uncuffed) = (age in years /4) + 4
ET size (cuffed) = (age in years/4) + 3.5
ET depth = age in years /2 + 12 or 3 x ET size
Neonates:
ET Size Weight (g) AOG (weeks)
2.5 < 1000 <28
3.0 1000-2000 28-34
3.5 2000-3000 34-38
3.5-4.0 >3000 >38
ET depth (neonates) = wt in kg + 6

IVF resuscitation: NSS @ 20 ml/kg [25% of est. blood vol (80)]

Commonly Used Emergency Drugs:

Adenosine: SVT
0.1 mg/kg IV/iO rapid bolus, may repeat at 0.2 mg/kg
Max l 5t dose: 6 mg, max subsequent dose: 12 mg
Amiodarone: Vtach/ Vfib
5 mg/kg IV/IO push if no pulse; give over 15-20 mins if w/
pulse, monitor for hypotension
Atropine: Bradycardia
0.02 mg/kg IV/IO (min dose 0.1 mg, max single dose child
0.5 mg, adolescent 1 mg), may repeat q5min to max dose
of 1 mg child, 2mg adolescent
Dextrose: hypoglycemia
5-10 ml/kg 10% dextrose for <2 mo
2-4 mlAg 25% dextrose for 2 mo- 2 yr
1-2 ml/kg 50% dextrose for >2 yr
Diazepam: Seizures
Neonate: 0.3-0.75 mg/kg/dose IV q 15-30 mins x 2-3
doses (max total dose: 2 mg)
Child: >1 mo: 0.2-0.5 mg/kg/dose IV q 15-30 mins (max
total dose <5 yr: 5 mg; >5-10 yr: 10 mg) May repeat
dosing in 2-4 hours as needed
Adult: 5-10 mg/dose IV q 10-15 mins (max total dose: 30
mg in an 8-hr period) May repeat dosing In 2-4 hrs as
needed
Rectal dose (using IV dosage form): 0.5 mg/kg/dose
followed by 0.25 mg/kg/dose in 10 min pm
Epinephrine:
Asystole
0.01 mg/kg (0.1 ml/kg) 1:10,000 IV/IO q 3-5 mins (max 1
mg); 0.1 mg/kg (0.1 mg/kg) 1:1000 ET q 3-5 mins
*1:10,000 prepared as follows: 0.1 ml 1:1000 + 0.9 ml NSS
Anaphylaxis
0.01 mg/kg (O.OlmL/kg) 1:1000 IM in thigh q 15 mins pm
(max single dose 0.3 mg)
 Asthm a
0,01 mg/kg (0.01 mL/kg) 1:1000 SQ q 15 mins (max
0.3mg)
Croup (as alternative to racemic epi)
0.5 mL/kg of 1:1000 sol'n diluted in 3 mL NS (max dose:
<4 yr: 2.5 mL/dose; >4 yr: 5 mL/dose
M idazolam : Sedation
6 mo-5 yr: 0.05-0.1 mg/kg/dose over 2-3 min. May repeat
dose prn in 2-3 min intervals up to max total dose of 6 mg
6-12 yr: 0.025-0.05 mg/kg/dose. (max total dose: 10 mg)
> 12 yr: 0.5-2 mg/dose. (max total dose: 10 mg)
Naloxone: Opioid overdose
<5 yr or <20 kg: 0.1 mg/kg IV/iO/IM/SC
>5 y r or >20 kg: 2 mg IV/IO/IM/SC
Phenobarbital: Status epilepticus
LD: 15-20 mg/kg/dose. May give additional 5 mg/kg doses
ql5-30 mins to a max total dose of 40 mg/kg
MD: 4-6 mg/kg/day OD or BID
IV push not to exceed 1 mg/kg/min
Phenytoin: Status epilepticus
LD: 15-20 mg/kg IV (max dose: 1500 mg/24 hours)
MD: 5-8 mg/kg/24 hours
IV push not to exceed 1 mg/kg/min
Sodium Bicarbonate: Metabolic acidosis half correction
HC03 (meq) = 0.3 x wt (kg) x base deficit (@1 meq/kg/hr)
O r HC03 = 0.3 x (desired - actual HC03) x wt (kg)
Mix # of meqs HC03 w/ equal amount of sterile water
Half given for 30m in-lhr followed by infusion over 4-6hr$

Infusion Drugs:
Dopamine Premix (ml/hr) = wt x dose / preparation
Prep: single dose -13.3; double dose - 26.6
Dobutamine Premix (ml/hr) = wt x dose / preparation
Prep: single dose -1 6 .6 ; double dose - 33.2
Aminophylline:
LD: 5-6 mg/kg x w t (kg) 25 mg/ml,__ml + __ ml NSS/
D5W to make 25 ml solution to run for 20 mins
MD: Img/kg/hr x w t (kg) x (4) hrs; -> 25 m g/ml,__ml +
_ml NS5/D5W to make 100 ml solution to run for (4)
hours a t __ml/hr
Furosemide drip: (ml) = [0.05 mg/kg/hr x w t (kg) x 24] / 10
Furosemide 20mg/2ml,__mL + __mL SW to make a total
solution of 24 m l to run at 1 mL/hr
Magnesium sulfate:
LD: 200 mg/kg; MD: 30 mg/kg/hr
MgS04 250 mg/mL L D :__mL + equal am out of SW to be
given per IV infusion over 1 hour the start M D :__mL +
__mL SW to make 12 mL to run at 0.5 mL/hr
Midazolam drip: (mg) = [wt (kg) x 6 x 1] / 4
Midazolam 5 m g/ m L,__mL + SW/D5W to make 25 ml
solution to run at 1 ml/hr
Nicardipine drip (ml/hr) =[dose (mcg/kg/min) x wt(kg) x60mins] / 100
Dose: 0.5-5 mcg/kg/min
Nicardipine 1 mg/mL vial, dilute 10 mg in 90 mL NSS to
make a 100 mcg/mL solution to run a t __mL/hr

Rule of 6: _ mg d r u g _ = 6 x desired dose (mcg/kg/min) x w t (kg)

100 ml fluid desired rate (ml/hr)
Medication Dose Diiution in IV Infusion Rate
(mcg/kg/min) 100 ml D5W
Amiodarone 5-10 6 mg/kg lml/hr=lmcg/kg/min
Dopamine 2-20 6 mg/kg lml/hr=lmcg/kg/min
Dobutamine 2.5-15 6 mg/kg lml/hr=lmcg/kg/min
Epmephrine 0.1-1 0.6 mg/kg lml/hr=0.1mcg/kg/min
lidocaine 20-50 6 mg/kg lml/hr=lmcg/kg/min
Phenylephrine 0.05-4 0.3 mg/kg lml/hr=0.05mcg/kg/min
Prostaglandin E l 0.05-0.1 0.3 mg/kg lml/hr=0.05mcg/kg/min
Terbutaline 0.1-0.4 0.6 mg/kg lml/hr= lmcg/kg/min
Vasopressin D.5-2mUnits/kg/min 6 mUnits/k.g lmi/hr=lmUnit/kg/min
■ .. - ■ —— I■
.1 .1
-fh ..
(Source: The Harriet Lane Handbook 18 ed)
NRP:
Birth
i V
Term ? -» Routine care:
Am niotic fluid clear? - provide warmth
Breathing or crying? *clear airway
G ood muscle tone? - dry
- assess color
Provide warm th
Position, clear airway
Dry, stimulate, reposition

Evaluate HR, RR, color observe if breathing,

HR>100, pink
Apneic OR Breathing, HR>100
HR <100 but cyanotic

Give supplementary 02
i .
m Persistent cyanosis

Provide Positive pressure ventilation (PPV)* -> if HR>100, pink **

post-

It
resuscitative care
HR <60 HR>60

PPV & Chest compressions*

HR <60
V
Administer epinephrine and/or volume*

•Endotracheal intubation may be done

GROWTH AND DEVELOPMENT
Weight:
BW: 2.5-3.5 kg
BW regained by 2 weeks
2 x - 4 months
3 x -ly e a r
4x - 2 years
Formulas (kg):
0- 6 mo: age in mo x 600 + BW
6- 12 mo: age in mo x 500 + BW
3-12 mo: (age in mo + 9) / 2
1- 6 yrs: age in years x 2 + 8
7- 12 yrs: (age in years x 7 - 5) / 2
Length/Height:
BL: 48-53 cm (50 cm)
Increase 50% by 1 year (75 cm)
2 x - 4 years
3x -1 3 years
Formula (cm): 2-12 years: age in years x 6 + 77
Head Circumference:
At birth: 33-38 cm (35 cm)

Age Approx W t Growth in G row th in RDA

Gain (g/day) Lt/Ht HC (cm/mo) (kcal/kg/day)
(cm/mo)
0-3 mo 30 3.5 2.0 115
3-6 mo 20 2.0 1.0 110
6-9 mo 15 1.5 0.5 100
9-12 mo 12 1.2 0.5 100
1-3 yr 8 1.0 0.25 100
4-6 yr 6 3 cm/yr 1 cm/yr 90-100
No. of teeth (1 year) = age in m o - 6
Mid-parental height:
Boys: [(maternal ht in cm +13) + paternal ht in cm] / 2
Girls: [maternal ht in cm + (paternal ht in cm - 13)] / 2
*if will use height in inches, m ay replace the factor 13 with 5
 DEVELOPMENTAL MILESTONES:
Vlotor Adaptive l.anguage >ocia!
1st 4 wks Senerally flexed, 'Doll's-eye', -rying /isual preference
urns head fr side yioro reflex or human face
o side, head sags
Dn ventral
suspension
1 mo Holds head up Watches person, Merts, 3ody movements
momentarily, :ixates on object at rhroaty, gurgling n cadence w/
Head lags when nidline, ounds /oice of other in
pulled to sitting Hands closed >ocial contact,
Heflex smile
2 mo Head sustained in :ollows moving Cloos Social smile,
plane of body on abject 180 degrees .istens to voice
ventral suspension
Head lags when
oulled to sitting
3 mo Head above plane typical Moro >ays 'aah, ngah' >ustained social
of body on vertical 'esponse has not :ontact,
suspension, persisted, makes .istens to music
Reaches toward defensive movements
and misses object, Dr selective
Waves at toy. withdrawal reactions
Early head control
w/ bobbing,
Back rounded
4 mo Lifts head and Sees pellet, but Laughs out loud,
chest, w/ head in makes no m ove to M ay show
approx vertical reach for it displeasure if
axis, legs extended social contact is
Symmetric proken,
posture Excited at sight of
Hands in midline, Food
Reaches and
grasps obj and
brings to mouth,
No head lag when
pulled to sitting
 1— Motor adaptive Language 5ocial
7 mo Roils over, Pivots, Reaches out for and Forms Prefers mother,
Crawls or creep- grasps large object, polysyllabic Babbles,
:rawls, Lifts head, Transfers objects vowel sounds Enjoys mirror.
Rolls over,Squirms From hand to hand. Responds to
Sits briefly, w/ Grasp uses radial changes in
support of pelvis, oalm emotional content
Leans forward on Rakes at pellet of social contact
lands,
3ounces actively
10 mo Sits up alone and Grasps objects w/ Repetitive Responds to
^definitely w/o thumb and forefinger, constant sounds sound of name,
support, Pokes at things w/ 'mama', 'dada' Plays peek-a-boo
Back straight, Forefinger, or pat-a-cake,
Pulls to stand, Picks up pellet w/ Waves bye-bye
Cruises or walks assisted pincer,
lolding on to Uncovers hidden toy,
furniture Attempts to retrieve
dropped object,
Releases object
grasped by others
12 mo Walks w / 1 hand Picks up pellet w/ Says a few words Plays simple ball
held, unassisted pincer, oesides 'mama' game,
Rises indep., Releases object on and 'papa' Makes postural
Fakes several 'equest adjustment to
steps dressing
15 mo Walks alone, Makes tow er of 3 jargon, ndicates some
Crawls upstairs tubes, :ollows simple desires or needs
Makes a line with commands, oy pointing,
trayon, May nam e a Hugs parents
1nserts raisin in bottle amiliar object,
Responds to
name
18 mo tuns stiffly, 7!akes tow er of 4 10 words Feeds self,
its on small chair, ubes, average), Seeks help when
Walks up stairs 1imitates scribbling Slames pictures, n trouble,
vith 1 hand held, and vertical stroke, dentifies one or M ay complain
Explores drawers C)umps raisin from more body parts when w et or
and wastebaskets >ottle soiled,
Kisses w / pucker
 Motor adaptive (Language Social
24 mo Runs well, Jumps, Makes tower of 7 Puts 3 words Handles spoon
Walks up and cubes, together well, Often tells
down stairs one Circular scribbling. (subject, verb, about immediate
step at a time. Imitates horizontal object) experiences,
Opens doors, stroke, Helps to undress
Climbs on Folds paper once Listens to stories
Furniture mitatively w/ pictures
30 mo Goes up stairs onMakes tower of 9 Refers to self by Helps put things
alternating feet cubes, Makes vertical pronoun Y , away,
and horizontal Knows full name Pretends play,
strokes. Imitates Handles spoon
circular stroke well
3 years Rides tricycle, Makes tower of 10 Knows age and Plays simple
Stand cubes. sex, Counts 3 games, Helps in
Handed­ momentarily on Imitates construction objects correctly, dressing, Washes
ness one foot of 'bridge' of 3 cubes, Repeats 3 lands
Copies circle. Imitates numbers ora
20 cross sentence of 6
primary syllables,
teeth Most of speech
ntelligible to
strangers
4 years Hops on one foot, Copies bridge, Counts 4 pennies Plays w/ several
Throws ball mitates construction accurately, :hildren, w/
Visual overhead. of 'gate' of 5 cubes, fells story, aeginning of social
acuity Uses scissors to Copies cross and Dast tense, nteraction and
20/20 cut out pictures, square, Draws man Sing songs from •ole-playing,
Climbs well w/ 2-4 parts besides memory Goes to toilet
lead, Identifies alone
onger of 2 lines
5 years Skips Copies triangle, Mames 4 colors. Dresses and
umps over low Mames heavier of 2 Repeat sentence jndresses,
obstacles weights jf 10 syllables, <^sks questions
'ie shoe laces Counts 10 about meaning of
jennies correctly words,
:uture tense Role-playing
6 years Copies diamonds Repeats 5 digits,
(nows right from
1eft hand ______________
Fontanel closure:
Anterior fontanel: 9-18 months
Posterior fontanel: 6-8 weeks

Tooth eruption (3-16 mo):

No. of teeth (1st year) = age in mo - 6
5- 7 mo - 1st tooth to appear; lower central incisor
3 years - 20 primary teeth
6- 8 years - 32 secondary teeth
6 years - eruption of 1st molars and loss of deciduous
teeth
9 years - 8 permanent incisor and 4 permanent molars
11-12 years - premolars erupt
Delayed tooth eruption: no teeth by 13 mo

Crying phase:
at 6 weeks: 3 hours/day
By 3 months: decrease to <1 hour
Colic: > 3 hours/day > 3 days/week

Toilet training:
daytime bladder control preceeds bowel control
girls preceed boys
bedwetting is normal up to 4 years in girls and 5 years in
boys

Temper tantrums:
appear by end of 1 year and peak between 2-4 years
problem if > 15mins or > 3x/day

Visual acuity:
- 20/30 by 3 years
20/20 by 4 years
RED FLAGS OF DEVELOPMENT:
(From Preventive Health Care Handbook, PPS, 2012)

Motor Delay:
Poor head control by 3months
Hand still fisted by 4 months
Unable to hold object by 7months
Does not sit independently by lOm onths
Cannot stand on one leg by 3years

Language Delay:
Does not turn to sound by 6months
Does not babble or use gestures by 12months
No single word utterance by 16months
No 2 word phrases by 2years
No 3 w ord sentences by 3years

Psychosocial Delay:
No social smile by 3months
Not laughing in playful situation by 6months
Hard to console, stiffens when approached by lye a r
In constant motion, resists discipline
Does not play with other children at 3years

Cognitive Delay:
2months - not alert to mother
6months - not searching for dropped object
12months - no object permanence
18months - no interest in cause and effect games
2years - does not categorize similarities
3years - does not know full name
4 Vi years - cannot count sequentially
5years - does not know letters/colors
5 Vi years - does not know own birthday or address
School Age Children:
Slow to rem em ber facts
Slow to learn new skills, relies heavily on m em o riza tion
Poor coordination, unaware of physical surroundings and p ro n e to
accidents
M ay be awkward and clumsy, and has troub le w ith fine m o to r skills

Reading Skills (For school age children):

Slow in learning connection betw een letters and sounds
Confuse basic words
Repeats, omits or adds w ords
Does not read fluently
Does not like reading at all
Avoids reading aloud
Uses fingers to follow a line of print w hen reading
Makes consistent reading errors:
Letter reversals: b-d, p-q
Letter inversion: m -w
Transpositions: felt-m elt
W ord reversals: was-saw
Num ber reversals: 14-41

Draw a Person Test: 1 point/ part

Age = (# of points x 3 + 36) /12

HEADS/SF/FIRST
Home Family/ Friends
Education/ School Image
Abuse Recreation
Drugs Spirituality and
Safety Connectedness
Sexuality/ Sexual Identity Threats and Violence
SEXUAL MATURITY RATING (SMR):
Girls:
SMR Pubic hair Breasts
1 Preadolescent Preadolescent
2 Sparse, lightly pigmented, Breast and papilla elevated as
straight, medial border of labia small mound, areola increase in
diameter
3 Darker, beginning to curl, Breast and areola enlarged, no
increase in amount contour separation
4 Coarse, curly, abundant but Areola and papilla form
less than in adult secondary mound
5 Adult feminine triangle, spread Mature nipple projects, areola
to medial surface of the thigh part of the general contour
Boys:
SMR Pubic hair Penis Testes
1 None Preadolescent Preadolescent
2 Scanty, long, Slight enlargement Enlarged scrotum,
slightly pigmented pink, texture altered
3 Darker, starts to Larger Larger
curl, small amount
4 Resemble adult but Larger, glans and Larger, scrotum
less, course, curly breadth increase in dark
size
5 Adult distribution, Adult size Adult size
spread to medial
thigh

IMMUNIZATIONS
BCG
- ID
- within 1st 2 months
DTP
- IM
- 6,10,14 weeks ( 4 weeks apart)
- 4th dose - may be given as early as 12 months provided with
6 months interval from the 3rd dose
- 5th dose - 4yrs - may not be given if 4th dose given at >4 yrs
 Hepatitis B
- IM
- 1st dose - within 12 hours of life
- Subsequent doses at least 4 weeks apart
- 3rd dose preferable not earlier than 24 weeks
- 4th dose if: 3rd dose given < 24 weeks old, if patient used EPI
schedule of 0, 6,14 weeks, if preterm < 2kg with 1st dose
given at birth
- If born to a HBsAg + mother, give HBI6 within 12 hours of life
- If born to a mother of unknown status, then turned out to be
HBsAg +, may give HBIG no later than 7 days of life
Hib
- IM
- 6,10,14 weeks (4 weeks apart)
- If 1st dose given before 7-11 months - 2nd dose should be
given at least 4 weeks later and 3rd dose at least 8 weeks
from the 2nd dose
* Booster -12-15 months - with interval of 6 months from the
3rd dose
- 1 dose if with no vaccination in > 5 years old with sickle cell,
leukemia, HIV, splenectomy
Measles
- SC
- 9 months, may be given as early as 6 months
- If given < 12 months, should give 2 additional doses (MMR)
beginning at 12-15 months separated by at least 4 weeks
MMR
- SC
- 12-15 months
- 2nd dose - 4-6 years old with interval of at least 4 weeks
Polio
- OPV (per orem), IPV (IM)
- 6,10,14 weeks (4 weeks apart)
- 4th dose - 1 year old
- 5th dose - 4 years old - at least 6 months after previous dose
 - Final dose should be on or after the 4th birthday and at least
6 months from the previous dose.
- If given >4 doses prior to 4 years old, an additional dose
should be given at age 4 to 6 years
Rotavirus
- Per orem
- Monovalent (Rotarix)
o 2 doses: 1st dose - 6weeks; 2nd dose not later than
-

24weeks
- Pentavalent(Rotateq)
o 3 doses: 1st dose - 6-14 weeks; 3rd dose - not later than
32 weeks; at least 4 weeks interval
Hepatitis A
- IM
- 12 months
- 2nd dose - 6-12 months after the 1st dose
HPV
- IM
- Females 10-18 years, males 9-18 years (quadrivalent)
- Bivalent (HPV2): 0,1, 6 months
- Quadrivalent (HPV4): 0, 2, 6 months
- At least 1 month interval between 1st and 2nd dose and at
least 3 months interval between the 2nd and 3rd dose
Influenza
- IM/SC
- 6 months-8 years receiving vaccine for the 1st time - 2 doses,
4 weeks apart then yearly
Pneumococcal
- IM
- PCV - Pneumococcal Conjugate Vaccine - 6 weeks old
o 6,10,14 weeks, 4 weeks interval, plus a booster at 6
months after the 3rd dose
o Healthy children 2-5years old with no previous PCV -
may give 1 dose PCV13 or 2 doses PCV 10 at least 8
weeks apart
 o Routine PCV not recommended for healthy children
£5years old
- PPV - Pneumococcal Polysaccharide vaccine - 2 years old
o High risk children £2years old - recommended after
completing the PCV series
o Healthy children - no additional doses needed if PCV
series is completed
- PPV should be given at least 8 weeks after PCV
- For children >2years with high risk medical conditions*:
o W/o any pneumococcal vaccination: 1 dose PCV13
followed by 1 dose PPV at least 8 weeks later
o W/ previous PCV, w/o PPV vaccination: 1 dose PPV at
least 8 weeks after the most recent dose of PCV
o W/ previous PPV, w/o PCV: 1 dose PCV13 at least 8
weeks after the most recent dose of PPV
o A single revaccination with PPV should be administered
5 years after the first dose to children with high risk
medical conditions*

•High risk medical conditions:

o Chronic heart disease-
cyanotic congenital heart
disease and cardiac failure
o Chronic lung disease -
include asthma if treated
with high-dose oral
corticosteroid
o DM
o GSFleak
o Cochlear implant
o Sickle cell disease and
other hemoglobinopathies
o Anatomic or functional
asplenia
o HIV
o Chronic renal failure
o Nephritic syndrome
o Treatment with
immunosuppressive drugs
or radiation therapy
including malignant
neoplasms, leukemias,
lymphomas, Hodgkin's
disease
o Solid organ
transplantation
o Congenital
immunodeficiency
 Varicella
- SC
- 1st dose -1 2 -1 5 months, 2nd dose 4-6 years
- Interval of at least 3 months
- 2nd dose recom m ended for children, adolescents and adults
w ho previously received only one dose of vaccine
- If > 13 years old without vaccine - 2 doses, 4 weeks apart
Tetanus and diphtheria toxoid (Tdap/Td)
- IM
- Td b o o s te r-e v e ry 10 years
- 7-18 years not fully immunized - single dose Tdap
- 7-18 years never immunized - 3 doses at 0,1, 6 months
preferably Tdap as 1st dose then Td
Typhoid
- IM
- 2 years old then every 2-3 years
Meningococcal
- 2 years old x 2 doses, 2 months apart
Rabies
- IM/ID
- Post-exposure prophylaxis: days 0, 7,21,28
VERORA8 (inactivated purified rabies vaccine prepared on vero cell line)
Precaution: allergy to neomycin

Pre-exposure 0.5ml on Day 0,7,28, booster after ly r

then every 5 yrs
Post-exposure
-in subjects unvaccinated against rabies 0.5ml IM on Day 0,3,7,14,28
-in subjects with pre-exposure prophylaxis 0.5ml IM on Day 0,3 |
RABIPUR (purified chick em bryo cell)
-recommended single dose: 1ml IM (adult/children), deitoid/thigh, N O T
gluteal
-intradermal: 1 dose of 0.1ml reconstituted vaccine
Nonvaccinated 2 injections of 0.1ml each at 2 sites on upper arms over L
and R deltoid on Day 0,3,7 and 28 (or 30), 90
Fully vaccinated Immediate booster of 0.1ml on Day 0,3
 Guide to Tetanus Prophylaxis in Routine W ound Management in
Children 7 years of age and older and adolescents
History of absorbed Clean, minor wounds All other wounds*
tetanus toxoid (doses)
wTd orTdap TIG Td orTdap TIG
Less than 3 or Yes No Yes Yes
unknown
3 or more *No No ~No No
+Such os, but not limited to wounds contaminated with dirt, feces, and saliva;
puncture wounds; avulsions; wounds resulting from missiles, crushing, burns, and
frostbite; and wounds extending into muscle.
*For children <7 yr, DTaP or DTP is preferred to tetanus toxoid alone if <3 doses of
DTaP/DTP hove been previously given; if pertussis vaccine is contraindicated, DT
is given. For persons > 7 yr, Td is preferred to tetanus toxoid alone.
*ye$, if >10 yrs since the last dose
■“yes, if >5 yrs since the last dose

Combination vaccines: (source: vaccine inserts)

VACCINE 3RAND NAMES MIN DOSING SCHEDULE DOSE
AGE
DTaP*IPV/Hib 5-in-l) 2 mo Primary vaccination: 3 injections at 15ml
•Pentaxim 3n interval of 1-2 months from the
*lnfanrix-IPV- age of 2 months, followed by one
-fib Dooster injection within the 2nd year
Df life
DTaP-IPV- (6-in-l) 2 mo Primary vaccination: 3 doses such as 3.5ml
HepB/Hib Mnfanrix hexa 2,3,4 months; 3,4,5 months; 2,4,6
months; or 2 doses such as 3,5
months. There should be an interval
of at least 1 month between doses,
rhe EPI schedule (6,10,14 weeks)
may only be used if a dose of Hep B
vaccine has been given at birth.
Booster: after a vaccination with 2
doses of Infanrix hexa, a booster dose
must be given at least 6 months after
the last priming dose, preferably
oetween 11 and 13 months
After a vaccination with 3 doses,
 a booster dose m ay be given at least
5 months after the last priming dose
and preferably before 18 months of
age
Flu *Fluarix 5 mo Vearly, preferably before the start of 5-36 mo:
*Vaxigrip the flu season, Feb to June 3.25ml
*lnfluvac For children below, 9 yrs, 2 doses >3yrs:
4weeks apart, then yearly 3.5ml
Typhoid *Typhim 2 yrs Single injection ensures protection. 3.5ml
*Typherix Revaccination should be performed
every 3 years if the risk of exposure
continues.
Hepatitis A *Avaxim 12mo One primary vaccination dose, then 3.5ml
*Havrix Dooster injection 6-18 months later.
Hepatitis A - *Twinrix Jr. (for Primary vaccination: 0,1, 6 months >16yrs:
Hepatitis B 1-15 yrs) Lml
*Twinrix Adult L-15yrs:
(>15yrs) ).5ml
Rotavirus *RotaTeq 6 wks totaTeq: 2omes
vaccine (pentavalent) l “ dose: 6-12 weeks, subsequent na
*Rotarix doses should be administered at a eady-
monovalent) minimum interval of 4 weeks to-use
aetween each dose. squeeza
Should not be given beyond 32 t le
weeks. Flastic
tube
Pneumococcal *Prevenar 13 5 wks :or infants and children 6 weeks 2,5ml
13-valent through 5 years
conjugate 3rimary immunization: 3 doses at
vaccine (PCV- approximately 2 month-intervals,
13) ollowed by a fourth dose at 12-15
months.
rhe customary dose for the 1st dose is
2 months, but it can be given as
/oung as 6 weeks.
the recommended dosing interval is
4-8 weeks. The 4th (booster) dose
should be administered at approx.
12-15 months, at least 2 months after
the 3'd dose.
 For previously unvaccinated children:
7-11 months: total of 3 doses. 2
doses at least 4 weeks apart, then 3r<!
dose after the 1st bday, separated
From the 2nd dose by at least 2
months
12-23 months: total of 2 doses. 2
doses at least 2 months apart
>24 months through 5 years (prior to
6th bday): 1 dose
Pneumococcal *Pneumo 23 2 yrs Primary vaccination: one dose 0.5ml
polysaccharide *Pneumovax Revaccination every 5 years
vaccine
Quadrivalent *Garda$il 3 yrs For girls/women aged 9-45 yrs 0.5mi
HPV (types 1st dose: at elected date
6,11,16,18) 2nd dose: 2months after the 1st
3rd dose: 6months after the 1st
For boys 9-26 years for the
prevention of external genital lesions
and infection caused by HPV types
5,11,16,18
jVaricelia *Vz-Vax 12 mo ,sl dose: 12-15 months; 2nd dose: 4-6 0.5ml
vaccine *Varilrix rrs but m ay be administered at an
*Okavax ■arlier age provided the interval
letween the 1st and 2nd dose is at
l<=ast 3 months
Jl individuals aged 13 years and
3bove and w ithout previous evidence
0f im m unity should receive 2 doses at
€>ast 4 weeks apart.
__________ L
OTHER VACCINES (source: PPD 2012-2013)
Vaccine Brand name Age Schedule Dose/Route
Tdap Adacel (Sanofi 4-64yrs 0.5ml IM single inj
pasteur)
DTap Boostrix (GSK) >4yrs D.5ml IM single inj

Hepa B Engerix (GSK) 0,1,6 for <19yrs OR 0,1,2, >20yrs: 20mcg/dose

booster at 12th m onth ■cl9yrs: lOmcg/dose
 Hepa B Euvax (Sanofi (protective antibody >16yrs: 1ml 20mcg
pasteur) titer: >10 IU/L) <15yrs: 0.5ml lOmcg
Hepa A Havrix (GSK) >19yrs: 1ml
l-18yrs: 0.5ml
PPV + Synflorix (GSK) 5 wks *6wks-6mos 3 doses 0.5ml IM
nontypable at least 1 month apart,
H.influenzae booster at least 6mos
protein D after the last dose
conjugate *7-llmos, previously
vaccine, unvaccinated -> 2 doses
adsorbed 1 mo apart, booster at 2
yrs, at least 2 mos after
the last dose
*12-23mos, previously
unvaccinated -> 2 doses
at least 2 mos apart
*24mo$-5yrs 2 doses
at least 2mos apart

i FLUIDS AND ELECTROLYTES

Urine Output (UO) (ml/kg/hr) = UO (ml) / # of hours / wt (kg)
i Fluid balance = input - output
; Output = UO (ml) + IWL

j Insensible Water Loss (IWL):

| IWL = BSA x 400
BSA = V[(wtxht)/3600]
j IWL in febrile = BSA x 500-600
1 IWL in term: 20ml/kg
IWL in premature infants in incu bators (mlj^kg/day)
Age(d)/ BW 0.5-0.75 0.75-1.0 1-1.25 1.25-1.5 1.5-1.75 1.75-2
0-7 100 65 55 40 20 15
7-14 80 60 50 40 30 20
, (Source: Avery)
i
Plasma osmolality = 2 x Na + glucose (mg/dL)/18 + BUN (mg/dL)/ 2.8
NV: 285-295 mosm/kg
' Effective osmolality = 2 x Na + giucose(mg/dL)/18

(
I.

)
. IV FLUIDS COMPOSITION:
IVF Na+ cr K* Ca Lactate
0.9% NaCI 154 154 —
0.45%NaCI 77 77
0.3%NaC! 51 51
LRS 130 109 4 3 28
D5NR 140 98 5
D5NM 40 40 13
'D5IMB 25 22 20
D5 - 1 7 calories/lOOml
If only on IVF - lose 0.5-1%/day
Fever -1 0 -1 5 % inc in maintenance water needs/ 1°C inc in T>38°C

WHO ORS Composition:

Glucose Na Cl K Citrate Osmolality
75 75 65 20 10 245

Maintenance fluids:
Body Weight Fluids/ day Hourly rate
0-10 kg lOOml/kg 4ml/kg/hr
11-20 kg 1000ml + 50ml/kg >10kg 40ml/hr + 2ml/kg/hr x (wt-lOkg)
>20 kg 1500ml + 20ml/kg >20kg 60ml/hr + lml/kg/hr x (wt-20kg)
Maximum fluids 2400ml/ day 100m l/hr

Replacement fluids:
Diarrhea composition: Na SSmeq/L, K 25meqfl, HC03‘ 15meq/L,
metabolic acidosis
- Ds0.2NS + 20meq/L Na HC03‘ + 20meq/L KCI
Gastric fluid:Na60meq/L, K lOmeq/L, Cl 90meq/L, metabolic alkalosis
- NS + lOmeq/L KCI
Altered renal output:
- Replacement o f insensible fluid losses (25-40% maintenance)
- Replace with half normal saline
- If w/ polyuria - measure urine electrolytes and replace based
on that
Third space loss - replace with isotonic fluids
 Deficit therapy:
Severity of Dehydration <15kg/ <2 years old >15kg/ >2 years old
Mild 50 ml/kg 30 ml/kg
Moderate 100 mL/kg 60 ml/kg
Severe 150 mL/kg 90 mL/kg
Fluid deficit (L) = pre-illness weight (kg) - illness weight (kg)
% Dehydration = (pre-illness wt - illness wt) / pre-illness wt x 100%

Fluid management of dehydration:

Restore intravascular volume: NS 20ml/kg x 20mins; may repeat as
needed
Rapid volume replacement: 20ml/kg NS/LRS (max of 1L) over 2 hours
Calculate 24 hour fluid needs: maintenance + deficit
Subtract isotonic fluid already administered from the 24 hour fluid needs
Administer remaining volume over 24 hours using Ds0.45% NaCI +
20meqs/L KCI
Replace ongoing losses

Hyponatremia:
Factitious etiologies:
- Hyperlipidemia: Na decreased by 0.002 x lipid (mg/dL)
- Hyperproteinemia: Na decreased by 0.25 x [protein (g/dL)-8]
- Hyperglycemia: Na decreased 1.6 meq/L for each lOOmg/dL
rise in glucose
Corrected Na =measured Na+1.6 x(glucose -100mg/dl)/100

For severe symptomatic hyponatremia:

May give3% NaCI: (0.5 meqs/L)
Dose 4-5 mL/kg over 15-30 mins
NaCI (mL) = [3 x vol of prep needed (mL)] / 14.6
_m LN a C I+ __m l SW to make 1L
OR calculate sodium deficit as follows and give over 4 hours:
Na deficit = wt (kg) x 0.6 x (desired Na - actual Na)
+ Na maintenance = wt (kg) x 2
 The estimated effect of 1 L of any infusate on s. Na can be calculated by
Androgue-Madias equation: change in s.Na = (infusate N a -s.N a) /
(total body water + 1)
Total body water in children = 0.6 x BW

NaCI: 1 gm contains 18 mmol Na

5.85% NaCI: 1 mL contains 1 mmol NaCI

Hypernatremia:
Total Uosm excretion = [U osmo (mOsm/kg) x 24 hours urine volume]
If >1000 mOsm/day is excreted - consistent w/ osmotic dieresis
(glycosuria, diuretics, high protein diet)

If Euvolemic, calculate water replacement required for tonicity change:

Vol of water req to lower Na
= [(measured plasma Na x TBW) / desired plasma Na] - TBW

Hypematremic Dehydration: (Nelson's)

Restore intravascular volume: NS 20 mL/kg over 20 mins
Determine time of correction on basis of initial Na concentration:
145-157 m eq/L- 24 hours
158-170 meq/L - 48 hours
171-183 meq/L-7 2 hours
184-196 meq/L - 84 huers
Administer fluid at constant rate over time of correction: D5 half­
normal saline (+20 meq/L KCI); typical rate: 1.25-1.5 x maintenance
Follow serum sodium - should be <12 meq/L/24 hours

(Harriet) Free Water Deficit (FWD) (L): 4 mL/kg needed to decrease s.Na
by 1 meq/L or 3 mL/kg if Na >170 because less FW is required to
decrease s.Na at higher concentrations
Therefore:
FWD = (4mL/kg or 3mL/kg)xwt(kg)x(conc.Na present - conc.Na desired)

(Chiu-Yap) FWD = [(measured Na x BW x 0.6) / desired Na] - (0.6 x BW)

 Hypokalemia:
Potassium supplement should be given per orem whenever possible
- 1 kalium durule = 10 meqs K - will increase s. K by 0.1
- 1 medium latundan = 10 meqs K
- 1 gm KCI grain = 13.3 meqs K
For patient on IVF, add KCI 40 mmol to each L of IVF
Potassium Infusion Rate (KIR) = meqs/ml potassium x rate / wt (kg)

Hyperkalemia:
ECG, Limit exogenous K
Therapy w/ immediate onset of action:
- 10% Ca gluconate 0.5 ml/kg IV over 3-5 min w/ ECG monitoring
(aims to stabilize cell membrane and opposes the negative
inotropic effect of hyperkalemia)
Therapy w/ rapid onset of action:
- Correct acidosis w/ NaHC03 2 mmol/kg IV over 30 min (aims to
drive potassium into cells)
- Glucose and insulin drip: 5ml/kg D10 + O.lunit/kg over 30-
60mins (Aims to drive potassium into cells)
- Salbutamol administration at 1-5 mcg/kg/min IV or nebulized
at 10-20mg over 15 min (aims to drive K into cells)
Therapy with longer onset of action:
- Kayexalate (Na polystyrene sulfonate resin) - 0.5-1 gm/kg p.o
or per rectum, 4-6 hours. A single dose of lg/kg can decrease
s.K by 1 meq/L. (aims to decrease potassium absorption
- Acute dialysis

Burns:
1st 24 hours:
- Parkland formula: 4ml LRS/kg/%BSA burned
- + maintenance fluids
- half to be given over the 1st 8 hours from the onset of injury;
half to be given at an even rate over the next 16 hours
2nd 24 hours:
- use half of 1st day's fluid requirement as D5LRS
ACID-BASE
Henderson-Hasselbach equation: [H+] = 24 x PC02/ [HC03]

NV pH: 7.35-7.45
PC02: 35-45 mmHg
HC03': 20-28 meq/L

Arterial vs Venous blood:

02 saturation >88% - arterial
02 saturation <88% - venous/mixed/pulmonary disease

To predict arterial values from venous values:

Arterial pH = 1.004 x venous pH
Arterial pC02 = 0.873 x venous pC02
Arterial HC03 = 0.951 x venous HC03

Appropriate compensation:
- Metabolic acidosis: PC02= 1.5 x [HC03'] +8 + 2
- Metabolic alkalosis: PC02increase by 7 mmHg for each 10
meq/L increase in s. HC03'
- Respiratory acidosis:
o Acute:HC03‘ increase by 1 for each 10mmHg inc in PC02
o Chronic: HC03‘ increase by 3.5 for each 10 mmHg inc in PC02
- Respiratory alkalosis:
o Acute: HC03'decrease by 2 for each 10 mmHg dec in PC02
o Chronic: HC03'decrea$e by 4 for each 10 mmHg dec in PC02

Anion gap = Na* - (Cf + HC03) NV: 12 meq/L ± 2

Gl/ NUTRITION:
Gastric capacity (oz) = age in months + 2
Gastric emptying time = 2-3 hours
BREASTFEEDING:
Ten steps In successful breastfeeding:
1. Have a written breastfeeding policy that is routinely
communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this
policy.
3. Inform all pregnant women about the benefits and management
of breastfeeding.
4. Help mothers initiate breastfeeding within half hour after birth.
5. Show mothers how to breastfeed & maintain lactation, even if
they should be separated from their infants.
6. Give newborn infants no food or drink other than breastmilk,
unless medically indicated.
7. Practice rooming in - allow mothers & infants to remain together
24 hours a day.
8. Encourage Breastfeeding on Demand.
9. Give NO artificial teats or pacifiers (dummies or soothers) to
breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and
refer mothers to them on discharge from the clinic or hospital.

Correct breastfeeding technique:

Support the baby's head and entire body throughout the
feeding; the head, back and hips should be facing the breast
and aligned in straight manner
Maintain the position of the baby in such a way he is 'face to
face', 'chest to chest', 'tummy to tummy' with the mother
Support the breast with the hand of the opposite arm in a C-
hold position; thumb above 4 fingers under the breast
Stimulate the infant to open the mouth wide by stroking the
corner of the baby's lips; check that the chin touches the
breast and the lower lip is turned outward
Ensure that the baby grasps the entire nipple plus the one
inch of the surrounding areola
 Allow the baby to suck 15-30 mins per breast to extract both
foremilk and hindmilk
Empty breast around 8-12x/day to ensure adequate milk
secretion

Breastmilk Storage:
Room Tem perature > 25°C - 1 hour
Room Tem parature < 2 5 ° C -4 hours
Refrigerator 4°C - 8 days
Freezer 1 door - 2 weeks
Freezer 2 door - 3 months
Deep Freezer -20°C - 6 months

MILK FORMULAS: (*Note: Breastmilk is still best for babies)

Starter infant formula - 0-6 mo
Follow-on formula - 6-12 mo
Growing-up formula
INFANT NUTRITIONAL PRODUCTS
Milk M anufacturer Age Dilution
Aiacta Bibo Trio Mead Johnson 3-6 mos. 1
Alactami! Bibo Trio Mead Johnson 5-12 mos. 1 __
Bonna W yeth 3-6 mos. 12
Bonamil W yeth >6 mos. 12
Enfamil A + O ne Mead Johnson 3-6 mos. 11
Enfamil A+ Tw o Mead Johnson 5-12 mos. 11 __ _
Frisolac One Alaska M ilkCorp 3-6 mos. 11 ___
Frisoiac Tw o Alaska Milk Corp 5-12 mos. 11
Gain Arivanrp Plus Abbott >6 mos. 1 2 _____
Nan O ptiproO ne Nestle 3-6 mos. 1 1________
Nan Optipro Tw o Nestle 6-12 mos. 1 i — — --------
Nestle 0-6 mos. 1 1 ______
Npstoppn Tw n Nestle 6-12 mos. 1 1 ______
Npstnapn Thrpp Nestle 10-24 mos. 1 1 ______
W yeth 6-12 mos. 1 ____— -----
Promil (Fe)
Promil Gold (Fe+DHA+AA) W yeth 6-12 mos. 1 ______— -
W yeth 3-6 mos. 1 2_-------.------
S26
1 2__ _____ _
S26 Gold (Fe+DHA+AA) W yeth_________ __ 3-6 mos.
 S26 HA Gold Wyeth 3-12 mos. 1:2
Similac infant formula Abbott 3-6 mos. 1:2
Similac plus advance Abbott 3-6 mos. 1:2
Similac Tw o Abbott 5-12 mos. 1:2
LACTOSE-FREE
Enfalac A+ lactose free Mead Johnson 3-6 mos. 1:1
Enfapro A+ lactose free Mead Johnson 6-12 mos. 1:1
Enfagrow A+ lactose free Mead Johnson 1-3 yrs.
NAN AL 110 Nestle 1:1
Promil lactose free Wyeth 5-12 mos. 1:2
S26 lactose free Gold Wyeth 3-6 mos. 1:2
Similac LF plus j Abbott 3-12 mos. 1:2
SOY-BASED
Isomil Advance One Abbott 0-6mos. 1:2
Isomil Advance Two Abbott 6mos-3yrs. 1:2
Isomil Advance Three Abbott >3yrs. 4scoops:240ml
526 soy Gold Wyeth 0-12 mos. 1:2
GOAT MILK
DG Infant Formula Pacific Healthcare 0-6 mos. 1:1
DG Milk Supplement Pacific Healthcare 6mos. -3yrs 1:1
EXTENSIVELY HYDROLYZED
Nutramigen A+ Mead Johnson 1:1
PARTIALLY HYDROLYZED
NAN HW One Nestle 0-6 mos. 1:1
NAN HW Two Nestle 6-12 mos. 1:1
NAN HW Three Nestle 12-36 mos. 1:1
Similac HW Plus Abbott 0-12 mos. 1:2
PARTIALLY HYDROLYZED AND 80% REDUCED LACTOSE
NAN Sensitive Nestle 1:1
Enfalac Gentlease Mead Johnson 0-12 mos. 1:1
PREMATURE MILK FORMULA
Enfalac A+ Pre-mature Mead Johnson L:1 (24kcal/oz)
Pre-NAN Nestle 1:1
Similac Neosure Abbott 1:2
CHILD MILK FORMULAS
Anchor 1+ Fonterra brands lscoops:200ml
Anchor 3+ Fonterra brands Itbsp: 1 cup
Anchor fortified Fonterra brands tbsp:l cup
WljjwtG'V
Aqiva W yeth >4 yrs. >scoops:175ml
Bonakid W yeth 1-3 yrs. >$coops:210ml
Bonakid preschool W yeth >4 yrs. >scoops:210ml
Enervon bright Unilab 1-3 yrs. i tbsp:200ml
Enfagrow A+Three Mead Johnson 1-3 yrs. *scoops: 196ml
Enfagrow A+ Four Mead Johnson >3 yrs. 3 tbsp: 210ml
Friso Three Alaska M ilkCorp 1-3 yrs. 5scoops:180ml
Friso Four Alaska Milk Corp >3yrs. 5$coops:180mi
Gain plus advance Abbott 1-3 yrs. 1:2
Gain school advance Abbott >3 yrs. 3scoops:175ml
Grow Milk Supplement l-3yrs Abbott 1-3 yrs. 3scoops:175ml
Grow Powdered Milk Drink Abbott >3yrs. 3scoops:175ml
Vanilla 3+
Nan Optipro Three Nestle 12-36 mos. 1:1
NANKID Optipro Four Nestle >3 yrs.
Nido 3+ Nestle >3 yrs. 3 tbsp:225ml
Nido 5+ Nestle >5 yrs. 3 tbsp:225ml
Nido Jr. Nestle 1-3 yrs. 7scoops:225ml
Alactagrow Bibo Trio Mead Johnson 1-3 yrs. 3 tbsp: 210ml
Nido fortified Nestle 3 tbsp:180ml
Pediasure Complete Abbott 1-3 yrs. 5scoops:190ml
Pediasure Plus Abbott >3 yrs. to make 225ml
(lkcal/ml)
Progress Gold W yeth 1-3 yrs. 7scoops:210ml
Progress Pre-school Gold W yeth >4 yrs. 4 tbsp:210ml
Promil Kid W yeth 1-3 yrs. 5scoops:210ml
Promil Pre-school W yeth >4 yrs. 4 tbsp:210mi
Similac GainPlus Abbott l-3yrs 3scoops:175ml
Similac GainSchool Abbott >3yrs 3scoops:175ml
Vitaminized Lactum 1-3 Mead Johnson >1 yrs. 4 tbsp:220ml
Vitaminized Lactum 3+ Mead Johnson >3 yrs. 4 tbsp:200ml
Vitaminized Lactum 6+ Mead Johnson >6 yrs. 4 tbsp:200ml
Vitaminized Lactum RD Mead Johnson >1 yr.
(Source: MIMS 2015)
 COMPLEMENTARY FEEDING:
Begin with one new food at a time to be given for 3 days
Start with lugaw or cereals, fruits and vegetables in any
order, giving 1-2 teaspoons a day
6 months - pureed foods
8 months - finger foods
10 months - lumpy or chopped foods
12 months - table foods
Frequency: 6-8 months: 2-3x/day, 9-24 months: 3-4x/day;
Give nutritious snacks once or twice a day
Offer a variety of foods to improve the quality of food intake
Avoid drinks w/ low nutrient value (iced tea, commercial
fruit juice)
Fruit juice -100% juice - 4-6 oz/day for 1-6 years; 8-12
oz/day for 7-18 years
Do not add salt to the infant's diet before one year of age
Give no more than 24 oz/day of cow's milk

RECOMMENDED ENERGY INTAKE:

Population Energy Protein Population Energy Protein
group Kcal G group kcal G
Infants(mo)
Birth-<6mo 560 9
6-<12mo 720 14
Children(yr)
1-3 1070 28
4-6 1410 38
7-9 1600 43
Males (yr) Females(yr)
10-12 2140 54 10-12 1920 49
13-15 2800 71 13-15 2250 63
16-18 2840 73 16-18 2050 59
Preenant w om en (trimester) Lactating women
First 66 T 6 mo +500
Second +300 66 2 6 mo +500
Third +300 66
DIETARY PRESCRIPTION:
TCR(kcal)=CHO (g) + CHON (g) + Fats (g)-rounded off to the nearest 5
Use RENI from the table, then use either of the 2 methods:
Method 1: Subtract recommended protein intake from RENI, then
divide the remainder into 60% CHO and 40% fats
Method 2: 60% CHO, 10% CHON, 30% fats
CHO (g) = TCR x 0.6/4
CHON (g) = TCR x 0.1 / 4
Fats (g) = TCR x 0.3 / 9

Total Parenteral Nutrition (TPN):

TFR: Preterm - 70-80 ml/kg/day; Term - 60-70 mi/kg/day
Day 0-1 of life - D10W
D2 of life-+Na
D3 of life- +K

Computation:
Total volume (TV) = TFR (mL/kg) x wt (kg)
*May use Total Volume for Computation (TVC) instead of TV by
multiplying TV by 1.1 for the tubings

Na = given x wt (kg) / 2.5

K = given x wt 9kg) / 2
Ca = given x wt (kg) /100
6% aminosteryl (aa) = [given x wt (kg) x 100] / 6
*For the electrolytes and aa, if with tubings, multiply by 1.1
(Elec+aa) = (Na + K + Ca) + aa
D50W (ml) = (TV x desired dextrosity) - {[TVC - (elec+aa)] x 5} / 45
D5W (mL) = TV - [D50W + (elec+aa)]
To check Dextrosity = [(vol D50W x 50) + (vol D5W x 5)] / T V
20% Intralipid (IL) (mL) = [given x wt (kg) x 100] / 20
GIR = [rate (mL/hr) x dextrosity x 0.167] / w t (kg) NV: 4-6

Carbohydrate (kcal/kg/day)= [(ratexdextrosity x 24 x 4 kcal)/100] / w t

Protein (kcal/kg/day) = (gram aa x wt (kg) x 4 kcal) / wt
Fats (kcal/kg/day) = (gram fats x wt (kg) x 9 kcal) / wt
Non-protein/protein ratio = kcal (fats x carbohydrate) / wt(kg) x aa
NV Cal/g = 150-200
NPN = (total carbohydrate + fat) /g protein x 0.16
Non-protein calorie to nitrogen ratio = (kcal/day) / (gram N/day)
gram N/day = (g of protein/day) / 6.25

TREATMENT OF SEVERE MALNUTRITION:

3 Phases:
1. Stabilization phase - days 1-7
2. Rehabilitation phase - week 2-6
3. Follow-up phase - week 7-26

10 Steps in management of a child with malnutrition:

1. Treat/prevent hypoglycemia
2. Treat/ prevent hypothermia
3. Treat/ prevent dehydration
4. Correct electrolyte imbalance
5. Treat infection
6. Correct micronutrient deficiencies
7. Begin feeding
8. Increase feeding to recover lost weight/ 'Catch-up Growth'
9. Stimulate emotional and sensorial development
10. Prepare for discharge

RESPIRATORY

Oxygenation Indices:
Desired Fi02 = [(Pa02/ a/A ratio) + (HCO3/0.8)] / 713
Or = (desired Pa02 x actual Fi02) / actual Pa02
Desired RR = (pC02 x RR)/desired pC02
l:E ratio = [(60/actual RR) - IT) / IT
pA02 (alveolar) = 713 (Fi02) - (pC02/0.8)
 Arterial/ alveolar P02 ratio (a/A) = pa02/pA02
NV>0.8 -young
<0.4 - shunt
>0.4 - V/Q mismatch
0.7 - elderly
Fi02 (%):
Nasal cannula (max 4Lpm) = TFR x 4 + 21
02 mask (5-8Lpm) = (TFR-1) x 10
02 mask w/NRM (6-10Lpm) = TFR x 10
02 hood = TFR x 10
Expected P02 = TFR x 5 (NV 80-100)
Room air = 21% x 5 = 100%
Mild hypoxemia - 61-75
Moderate hypoxemia - 41-60
Severe hypoxemia - <40
Alveolar-Arterial 02 gradient (AaD02) = PA02 - Pa02
NV<20 (on room air); 20-65 (on 100% 02)
>25 - pulmonary shunt
<25 - extrapulmonary shunt
>30-A R D S
P/F = Pa02/Fi02
NV 400-500

Differentiation of Pleural Fluid:

) Transudate Exudate
Appearance Clear Cloudy/purulent
Cell count (mm3) <1000 >50,000
Cell type Lympho, mono PMN
LDH (u/L) <200 >1000
PF /serum LDH ratio <0.6 >0.6
Protein > 3g Unusual Common
PF/ serum protein ratio <0.5 >0.5
Glucose Normal Low {<40 mg/dL)
pH Normal (7.4-7.6) <7.10
Gram Stain Negative Occ +
 Predicted Normal PEFR (6-17 years)
Males = (ht in cm - 100) x 5 + 175
Females = (ht in cm - 100) x 5 + 170

Predicted Average Peak Expiratory Flow Rates for Normal Children;

Height PERF Height PERF
In Cm L/min In cm L/min
43 109 147 56 142 320
44 112 160 57 145 334
45 114 173 58 147 347
46 117 187 59 150 360
47 119 200 60 152 373
48 122 214 61 155 387
49 124 227 62 157 400
50 127 240 63 160 413
51 130 254 64 163 427
52 132 267 65 165 440
53 135 280 66 168 454
54 137 293 67 170 467
_______ | 140 307

% Predicted = actual PEF/expected PEF x 100

PF Variability:
- Get 3 determination in AM and 3 determinations at night
- Get the highest determination and the lowest determination of
the day
- = [(day's highest - day's lowest)/mean of the day's highest and
lowest] x 100 (GINA 2014)

Bronchodilator Reversibility = [(post-bronchodilator-pre-

bronchodilator)/pre-bronchodilator] x 100
* Positive if with increase in FEV1 of >12% predicted 10-15
minutes after salbutamol
NOMOGRAM Qf NORMAL CHILDREN (BOYS & GIRLS) ASEO 5 TO 18 YEARS

MEAN
JTAK fuow RATE

fcomofTSiBm twx fwn origin*! da*«

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 Predicted Normal PEFR (6-17 years)
Males = (ht in cm -100) x 5 + 175
Females = (ht in cm -100) x 5 + 170

Predicted Average Peak Expiratory Flow Rates for Normal Children:

Height PERF Height PERF
In Cm L/min In cm L/min
43 109 147 56 142 320
44 112 160 57 145 334
45 114 173 | 58 ™ ..... 347
46 117 187 59 150 360
47 119 200 60 152 373
48 122 214 61 155 387
49 124 227 62 157 400
50 127 240 63 160 413
51 130 254 64 163 427
52 132 267 65 165 440
53 135 280 66 168 454
54 137 293 67 170 467
55 140 307

% Predicted = actual PEF/expected PEF x 100

PF Variability:
- Get 3 determination in AM and 3 determinations at night
- Get the highest determination and the lowest determination of
the day
- = [(day's highest - day's lowest)/mean of the day's highest and
lowest] x 100 (GINA 2014)

Bronchodilator Reversibility = [(post-bronchodilator - pre-

bronchodilator)/pre-bronchodilator] x 100
- Positive if with increase in FEV1 of >12% predicted 10-15
minutes after salbutamol
IMMUNOLOGY

fV r r r y y V v ’y ' * » V y ? ' < y % jw c h < y# r o^-d to S p y * ?/A * » ‘ -Ar t •’v y r ' j r + r i r i * » * ^ . « r * * , <y
O r t ■' ■*'.'< V •'■* • b • •..-»> 5 0 0 ir-'V^r* V<* C|K k V*i o -.»» 7 S i »f > * « ?- , * y y f I'TT v jr & iU < < W «i
K you or Kvmww* you Vnov* b o#e<tod by V o or more of *fy» foflow>ng Warning S>yv tpcolr
to o phytKLtarj about tHo pos >»h^ p'evrfX * of on or.cicrfymg Pnnviry ImmJnodcfcMncy.
NOMOGRAM OF NORMAL CHILDREN (BOYS & GIRLS) AGED 5 TO IS YEARS'

MEAN
N EPH RO LO GY
Significant colony count in urine specim en:
M d stream dean catch - 100,000 CFU/ml
Cathetenzed - 50,000 CFU/ml
Suprapubic aspiration - any num ber as long as single colony

Estimated Creatinine Clearance/ GFR (ml/min/1.73m2)

Schwartz form ula = k x ht (cm) j s. crea (mg/dl)
K; 0.33 - LBW < lye a r
0.45 - term < lye a r
0 55 - children and adolescent girls
0.70 - adolescent boys

Norma! Values of GFR:

| Age G^R (Range) Age GPR 1Range)
mL/min/1.73m2 r Unvr./1.73m2
Neonates <34 wk Neonates >34 wk
gestattonal age gestational age
2-3 days 11-15 2-8 days 17-60
j <2-28 d3ys 15 28 4-28 days h 26-68
3C 90 days 4C £5 30-90 days 30 86
1 6 mo 35-114
6 12 rro 49 157
12-13 mo 62-191
! 2yr- adult 89-165
(Source: The Harriet Lane Handbook Is ed)

Creatinine clearance (g/24hours)

= [u. crea (mg/dL) x (vol (ml)/ 1440 mm / s. crea)] *
s. crea (mg/dl) = s. crea (mmol/L) / 88.4

B/C ratio = BUN/Creatimne

NV 10-15 mg/dL
>20:1 - pre-renal
<10:1-renal
UPr:UCr ratio = UPr (mg/dL) / UCr (mg/dl)
N V : < 0 .5 - < 2 years, < 0.2 - > 2 years
>2 - nephrotic range proteinuria

Mean bladder capacity= <2y/o = w t x 7 (mL) o r age x 2 + 2 (oz)

>2y/o = age in yrs + 2 x 30 (m l) or age/2 + 6 (oz)
Residual urine = postvoid/ prevoid x 100% NV: <10%

Fluid limitation = 400-600mi/m2/24 hours x BSA + UO in 24 hours

Na limitation (mg/day) = 2-3 x d ry weight x 23
W h e re in 2-3 is Na m aintenance; 23 is atomic w t of Na

ACUTE RENAL FAILURE (PRIFLE CRITERIA):

Criteria Estimated CCI UO
Risk eCCI decrease by 25% < 0.5 ml/kg/hr x 8 hours
Injury eCCI decrease by 50% < 0.5 ml/kg/hr x 16 hours
Failure eCCI decrease by 75% or < 0.3 ml/kg/hr x 24 hours or
eCCI <35ml/min/1.73m2 Anuricx 12 hours
Loss Persistent failure > 4weeks
End stage Persistent failure > 3months

Pre-renal vs Intrinsic ARF:

Pre-renal ARF Intrinsic ARF
Specific gravity >1.020 <1.010
Urine osmolality (mosm/kg) >500 <350
Urine sodium (meq/L) <20 >40
FeNa <1% >2%

Stages of Chronic Kidney Disease:

Stage GFR (m!/min/1.73m2)
1 Kidney damage with normal/ >90
increase in 6FR
2 Kidney damage with mild 60-89
decrease in GFR
3 Moderate decrease in GFR 30-59
4 Severe decrease in GFR H 15-29
5 Kidney failure <15 or in dialysis
 HEMATOLOGY
Age-Specific Blood Cell Indices:
Age Hb (g/dL) Hct (%) Retie WBC(xlOVpL) Pit (107|iL)
Mean(-2SD) Mean(-2SD Mean(±2SD) Mean(±2SD)
Term 16.5(13.5) 51 (42) 3-7 18.1 (9-30) 290
l-3d 18.5 (14.5) 56 (45) 1.8-4.6 18.9 (9.4-34) 192
2 wk 16.6(13.4) 53 (41) 11.4(5-20) 252
1 mo 13.9(10.7) 44 (33) 0.1-1.7 10.8 (4-19.5)
2 mo 11.2 (9.4) 35 (28)
6 mo 12.6(11.1) 36 (31) 0.7-2.3 11.9(6-17.5)
6m-2y 12.0(10.5) 36 (33) 10.6 (6-17) (150-350)
2-6y 12.5(11.5) 37 (34) 0.5-1.0 . 8.5(5-15.5) (150-350)
6-12y 13.5(11.5) 40 (35) 0.5-1.0 8.1 (4.5-13.5) (150-350)
12-18y
Male 14.5 (13) 43(36) 0.5-1.0 7.8 (4.5-13.5) (150-350)
Female 14.0(12) 41(37) 0.5-1.0 7.8 (4.5-13.5) (150-350)
Adult
Male 1 15.5 (13.5) 47 (41) 0.8-2.5 7.4 (4.5-11) (150-350)
Female | 14.0(12) 1 41 (36) 0.8-4.1 7.4 (4.5-11) (150-350)

Mentzer index = MCV / RBC

>13.5 - IDA (inc RDW, dec RBC)
<11.5 - Thalassemia (dec ROW, inc RBC)

Corrected Reticulocyte Count (CRC)

= (% reticulocytes x Actual Hct) / Normal Hct

l:T ratio (band.neutrophil ratio) = bands / neutrophils

NV <0.2

Absolute neutrophilic count (ANC) = WBC x neutrophils x 1000

NV >1500
- 1000-1500 - mild neutropenia
500-1000 - moderate neutropenia
< 500 - severe neutropenia
Absolute lymphocytic count (ALC) = WBC x % lymphocytes x 1000
NV >2500

Absolute eosinophil count = WBC x % eosinophils x 1000

500-1500 - mild eosinophilia
1500-5000 - moderate eosinophilia
>5000 - severe eosinophilia

Blood transfusion:
packed RBC - 10-15 ml/kg over 4-6 hours
FFP -10 -15 ml/kg
Platelet concentrate - 1 unit/10 kg
1 unit pRBC will increase Hgb by 1, Hct by 3g/dL
1 unit platelet concentrate will increase platelet count by
40-50

RBC transfusion guidelines in neonates:

Well with Hct <20% and low retie
02 dependent infant w / Hct <30-35%
Significant cardiac disease, respiratory disease, ECMO -
Hct<40-45%
Modifying criteria:
o Tachycardia >180 bpm x 24 hours
o Tachypnea
o Apnea
Poor weight gain in a preterm

Cut-off of Hematocrit for blood transfusion in relation to 02

requirement:
0.25 - non-02 requiring
0.35 - on CPAP (nasal/ET)
0.40-0.45 - on high M V set-up
CARDIOLOGY
ECG READING:
Axis:

Rhythm:
Asses the P wave with respect to whether P wave is likely to
arise from the sinus node or elsewhere
Sinus rhythm is where P wave is positive in I, II, and aVF

Rate:
1500 / R-R interval {# of small O ) ;
1 small □ = 0.04 s; 1 big □ = 0.20 s
Tachycardia >120, Bradycardia <60
SVT: £220 infants, £180 children

Intervals:
PR interval = # of small □ x 0.04
Measured from the beginning of the P wave to the
beginning of the QRS complex
NV: <0.2s in older children and adolescents
 Q T interval = # of small □ x 0.04
Measured from the beginning of the QRS complex to the
end of the T wave
Bazett's Formula: Q Jc = Q T / V(R-R x 0.04)
Long QTc: >440 msecs, Short QTc: 250-320 msecs

Hypertrophy:
RAE - peaked, tall P waves; upper limit of normal for P wave
amplitude is 3 mm from 0-6 months and 2.5 mm for >6 mos
LAE - broad, notched P wave in lead II or a deep, slurred
biphasic P wave in V I
RVH - Tall R in V I, Deep S in V6, qR in V I, RSR' in V I, Right
axis deviation, Upright T wave in V I after 7 days old
LVH - Tall R in V6, deep S in V I, Tall R in aVF, Inverted T
waves in II, 111, aVF and V5-V6, lateral Q waves
Biventricular hypertrophy: criteria for both LVH and RVH are
present; Katz-Wachtel criterion - total voltage (R+S) in V4 is
>60mm

Arrhythmias:
First degree AV Block - all the atrial impulses reach the
ventricles; PR interval is abnormally long (>0.2s; >0.16s in
infants and young children)
Type I Second degree AV Block - PR interval lengthens
progressively until a ventricular beat is dropped; also known
as Wenchebach phenomenon
Type II Second degree AV Block - not all atrial impulses are
conducted to the ventricles; PR interval is unchanged
Third degree AV Block - conduction from the atria to
ventricles is completely interrupted; ventricles beat at a
lower rate independent of the atria
Atrial flutter usually has a rate of 200-350/min
Saw tooth appearance is due to atrial contractions
Atrial fibrillation is characterized by irregular, rapid and
disorganized discharges, rates range from 300-500/min
O ther ECG findings:
Hyperkalemia - tall peaked T waves (1st manifestation),
prolongation of QRS complexes, ventricular arrhythmias may
develop, the fibers eventually become unexcitable and the
heart stops in diastole
Hypokalem ia - prom inent U waves, late T wave inversion,
narrow Q.RS com plex

HYPERTENSION
SBP o r DBP Frequency of BP Therapeutic Pharmacologic
Percentile m easurem ent Lifestyle Change Therapy
N orm al <90tn Recheck at next Encourage
scheduled PE healthy diet,
sleep and
physical activity
P re -H TN 90w -<95,h or if Recheck in 6 W eight None unless
BP exceeds m onths management, compelling indications
120/80mmHg physical activity such as CKD, DM,
even if 90th and diet heart failure or LVH
upto <95,h
Stage 1 95,n- 99m + Recheck in 1- W eight Initiate therapy based
H TN 5m m H g 2wks or sooner i management, on indications:
the patient is physical activity symptomatic,
symptomatic; and diet secondary HTN,
elevated on 2 hypertensive target-
additional organ damage, DM,
occasions, persistent HTN despite
evaluate or refer non-pharmacologic
w/in lm o measures
Stage 2 >99tri percentih Evaluate or refer W eight Initiate therapy
H TN + Sm m Hg w/in lw k or management,
im m ediately if physical activity
sym ptom atic and diet
 NEUROLOGY
Glasgow Coma Scale for Infants and Children:
Score Child Infant
Eye 4 Spontaneous Spontaneous
Opening 3 To speech To speech
2 To pain To pain
1 No response No response
Verbal 5 Oriented, appropriate Coos and babbles
4 Confused Irritable cries
3 Inappropriate words Cries to pain
2 Incomprehensible Moans to pain
1 No response No response
Motor 6 Obeys commands Moves spontaneously and purposefully
5 Localizes pain Withdraws to touch
4 Withdraws to pain Withdraws to pain
3 Flexion to pain Abnormal flexion
2 Extension to pain Abnormal extension
1 No response No response

CSF Analysis:
Pressure WBC Protein Glucose
Normal 50-80 <5; >75% lympho 20-45 >50 (75% s. glue)
Bacterial Inc (100-300) 100-10,000; PMN 100-500 Dec, <40
Viral N/sIt'T 80-150 Rarely >1000, Lympho N/sItt 50-200 Wdec
TB Increased 10-500, 100-3000 t50
Early-PMNs;Late-lympho
In traum atic taps:
For e ve ry 700 RBC = 1 W BC
Tru e CSF W BC = (CSF WBC - s.WBC) x CSF RBC / s. RBC
1 mg/dL protein per 1000/mm3 RBC

CSF Analysis:
Test tube #1: protein, sugar
Test tube #2: cell count, diff count
Test tube #3: gram stain, culture and sensitivity
Test tube #4: save specimen for possible Phadebac (Strep.
sp, Hib, S. pneum o, N. meningitidis, E. coli) or HSV IgG/IgM

1
r
NEONATOLOGY
APGAR Score:
Sign 0 1 2
Heart Rate Absent <100/ min >100/min
Respiration Absent Slow, irregular Good, crying
Muscle Tone Limp Some flexion Active motion
Response No response Grimace Cough/sneeze
Color Blue, pale Body pink, Completely pink
extremities blue

EINC (Essential Intrapartum and Newborn Care):

1. Immediate and thorough drying
2. Early skin-to-skin contact
3. Properly timed cord clamping
4. Non-separation of newborn from mother for early
breastfeeding

Newborn Screening: 24-72 hours after birth

1. Congenital Adrenal Hyperplasia (CAH)
2. Congenital Hypothyroidism (CH)
3. Galactosemia (GAL)
4. Glucose-6-phosphate dehydrogenase deficiency (G6PD)
5. Phenylketonuria (PKU)
6. Maple Syrup Urine Disease (MSUD)
If done in < 24 hours, may result in:
o False (+) CH and CAH
o False (-) GAL and PKU
Repeat at 2 weeks of age
If post-BT(pRBC)
->repeat after 48 h rs-C A H , PKU, MSUD
repeat after 2 weeks - CH
-> repeat after 120 days - G6PD
If positive result retest/ confirmatory test
Hearing Screening:
Screening ABR
If abnormal bilateral -> repeat after 2 weeks
If abnormal unilateral repeat after 3 months

Feeding:
Trophic feeding -1 0 ml/kg/day
Start feeding -10-20 ml/kg/day (wt x 5)
Term - 15-20 ml in the 1st 24 hours
Increase of feeding -10-30 ml/kg/day
Full feeds: Term: 100 ml/kg; Pre-term: 150 ml/kg
Maximum TFR for preterms:
if with OGT: 150-160 ml/kg/day
If per orem: 150-200 ml/kg/day
Calories needed to maintain weight:
Term: 60-80 kcal/kg/day
Preterm: 80-100 kcal/kg/day
Calories needed to gain weight:
Term: 100-120 kcal/kg/day
Preterm: 110-140 kcal/kg/day
Breastmilk and milk formula: 20 kcal/ oz
Preterm milk formula: 24 kcal/ oz

Hypoglycemia:
Monitor blood sugar on the following:
SG A -1 , 3,6,12, 24,36 HOL
LGA -1 , 3, 6 HOL
Infants of diabetic mothers -1 , 3, 6,12 HOL
<2.5 kg and >3.8 kg
Management:
If >45mg/dL -> feed
If 26-44mg/dL, asymptomatic -Meed and reassess after lhr,
if persistently 24-44 mg/dL for 3x-> start D10W@80 ml/kg
If 26-44mg/dL, symptomatic or <20-25 mg/dL -> D10W @
2mL/kg bolus and D10W @ 80 mL/kg
 - Maintain blood glucose 560 mg/dL
Start weaning 24 hours after stable glucose is established
Every after 2 normal blood glucose level, decrease IVF by 10
mL/kg until 60 ml/kg then discontinue IVF. After 2 normal
blood glucose level off IVF, discontinue Hgt monitoring

Preterms:
Corrected age = postnatal age (wks)-(40wks -gestational age in wks)
Or = (day of life / 7 days) + gestational age
32 weeks - non-nutritive sucking
34 weeks/1.3 kg - fractionated feeding
1.6 kg - out of incubator
1.8 kg-discharge

When to discontinue pulse oximeter?

On full cup feeding
Weight 1.8-2 kg
3-5 days off theophylline (1/2 life up to 30-100hrs)
34 weeks old

Cranial ultrasound:
For all <1.5kg to detect PVH-IVH
l sl- 3-7 days, 2nd- 28-30 days/ before discharge
ROP screening:
BW <1500 g or
Gestational age <32 weeks or
BW >1500g with unstable clinical course
1st exam: 4-6 weeks from birth or within 31st-33rd week post-
conceptual age whichever come later

Laboratories:
BUN, crea - screening should be >48 hours (falsely elevated if earlier)
Ca, P04 - screening for osteopenia of prematurity
FeS04 - should be given to preterms by 2 months/ when BW is doubled
 NCPAP:
Compressed air = ((100 - desired Fi02) / 79] x 02 FR (5)
02 = 5 - compressed air
Fi02 60% 54 50 47 45 40 35 34 32 30 28 25
CA 2.5 2.9 3.2 3.4 3.5 3.8 4.1 4.2 4.3 4.4 4.6 4.7
02 2.5 2.1 1.8 1.6 1.5 1.2 0.9 0.8 0.7 0.6 0.4 0.3

Significant blood count in neonates:

Bands: >5
Eos: >5
Reticulocyte count: >7 (>10 if with hemolysis-ABO)

Exchange transfusion:
EBV for exchange = wt x 2 x 80 ml (full exchange) or x 40 ml
(half exchange)
Vol. per aliquote for exchange = wt x 80 x 0.05
# of exchanges = EBV for exchange / vol per aliquote per
exchange

Discharge orders:
Exclusive breastfeeding q 2-3 hours for 15-30 mins/breast,
burp midway and after feeding
Expose to sunlight between 7-9AM for 10-15 mins
Daily cord care
Daily bath with mild soap and lukewarm water
Start multivitamins on 2 weeks of life
Follow-up on 2 weeks of life

Other drugs used in nursery:

Ibuprofen: PDA (<10 day old) - Dose: 10-5-5
Surfactant: RDS
Dose: 4 mL/kg divided in aliquots per ET
Prophylactic: $ 32 weeks
Therapeutic: Early rescue: within 4-6 HOL
Late rescue: > 4-6 HOL
Aminophylline: Apnea
LD: 8 mg/kg, MD: 1.5-3 (2) mg/kg/dose
Dilute 1 ml of aminophylline 25 mg/mL with 4 mL NSS to
make a concentration of 5 mg/mL. From this solution,
aspirate_mL and give per IV infusion over 30 mins as LD,
then give maintenance dose at _ mL q 12 hours (may inc to
q 8 hours) to start 12 hours after the LD

COMMON SKIN DISORDERS and Management

ATOPIC DERMATITIS
-acute exacerbations: topical steroids of the appropriate strength
depending on body area
-anti-histamines
-topical/systemic antibiotics if with secondary bacterial infection
-antiviral for eczema herpeticum
-wet dressings for oozing, excoriation and crusting
-adequate hydration with lubricant creams and ointments
General instructions for long-term management of AD:
-daily bath with mild soap and lukewarm water
-keep skin lubricated ->
• hydrophilic petrolatum (Vaseline/Lander) apply over
affected areas after bath and 2-3x/day
• aquaphor
• cetylalcohol cream (Cetaphil)
• (Physiogel Al cream) apply after bath BID
-keep fingernails trimmed short
-avoid overheating of skin
-always use a soap substitute
CONTACT DERMATITIS
♦irritant dermatitis (diaper dermatitis)
-zinc oxide and petrolatum-based formulations, apply on affected 1
areas every after diaper change
-candidal infection: topical antifungal (imidazole, nystatin) |
♦allergic contact dermatitis - topical steroids ***■

i;

,
 FURUNCULOSIS/CARBUNCLE/ABSCESS
- antibiotics: oxacillin, cephalexin
- if entertaining MRSA: clindamycin, cotrimoxazole, fucidic acid
MACULOPAPULAR (MORBILIFORM) DRUG ERUPTIONS
- occur 7-21 days after onset of the offending medication
- last 7-14 days
NUMMULAR ECZEMA - topical steroids
PAPULAR URTICARIA (insect bite reactions) - antihistamines, topical
steroids; insect repellant
SCABIES - permethrin; treat family members, boil linens and towels
SEBORRHEIC DERMATITIS
- low potency steroids for 1-2 wks
- topical ketoconazole cream and shampoos
- ciclopirox olamine shampoo (Stieprox) 1:1 dil, apply onto scalp,
lather then rinse, re-apply, leave for 5 mins then rinse. Use
daily. Reassess after 1 week
URTICARIA - antihistamines, prednisone for severe, refractory cases
VIRAL EXANTHEMS - often lasts 2 weeks; reassurance ______
Incubation infectivity PEP
period
MEASLES 8-12 days 3 days before rash up to 4-6 days after Vaccine within
72hrs;
IG up to 6 days
MUMPS 16-18 days 1-2 days before to 5 days after parotid
swelling
♦Peak swelling: 3 days, subside by 7days
RUBELLA 14-21 days 5 days before to 6 days after rash Vaccine within
♦isolate for 7 days after onset of rash 72hrs
VARICELLA 10-21 days 24-48hrs before rash and until vesicles are Vaccine within 3-5
crusted, usu 3-7 days after onset of rash days after exposure
Neonatal; 5 days before to 2 days after Varizlg within 4 days
delivery
ROSEOLA 10 days 3eak age: 6-15 months
VIC symptom: fever and fussiness
 PEDIATRIC SURGERY

Pediatric Pre-operative Risk Assessment:

PS 1 - no underlying physical or metabolic disturbance
PS 2 - mild to moderate disturbances that do not interfere with daily
routines
PS 3 - severe disturbances that interfere with daily ordinary activities
PS 4 - severe disturbances that are constant threat to life
PS 5 - moribund condition in patient likely to succumb within 24 hours
whether or not operation is undertaken
PS 6 - organ donor

ASA Classification:
Class I - a normally healthy patient
Class II - a patient with mild systemic disease (eg. Controlled reactive
airway disease)
Class III - a patient with severe systemic disease (eg. A child who is
actively wheezing)
Class IV - a patient with severe systemic disease that is a constant
threat to life (eg. An asthmatic child with severe uncontrolled
asthma)
Class V - A moribund patient who is not expected to survive without
the operation (eg. A patient with severe cardiomyopathy requiring
heart transplant)

PAPP Operative Risk Classification:

Low operative-risk: children w ho are in ASA classes I and II
High operative-risk: children in ASA class III and IV, children with special
needs, and those with anatomic airway abnormalities or extreme
tonsillar hypertrophy present issues that require additional and
individual consideration. These children will need further cardiac or
pulmonary risk stratification and evaluation by a specialist.

Allowable blood loss = wt (kg) x 80 x 10%

 DRUGS
ml = mkd x wt (kg) x prep (ml/mg)
mkd = ml x prep (mg/ml) / wt (kg)
COMMONLY USED OPD DRUGS
DRUG DOSE
ANTI-PYRETIC/ANALGESIC
Paracetamol 10-15mkdose PO/PR q4-6,
max: 90mkday
Ibuprofen 5-10mkdo$e q6-8, max 40mkday
JRA: 30-50mkday q6,
max 2400mg/day
Naproxen >2yr: 5-7mkdose q8-12, max
1250mg/day
Dysmenorrhea: 500mg D l, then
250mg q6-8, max 1250mg/day
ANTIMICROBIALS
Acyclovir Varicella: 80mkday PO QID x 5 days, 200mg, 400mg, 800mg tab
max: 3200mg/day
Zoster: 4000mg/day div 5x/day x
5-7days for >12yrs old
Amoxicillin Std dose: 25-50mkday PO q8-12
High dose: 80-90mkday PO q8-12 lOOmg/ml (10ml drops)
Co-amoxiclav TID dosing: 20-40mkday
BID dosing: 25-45mkday
AOM: 80-90mkday (amox content; 125mg davulanate)
use BID formulations)
PREPARATION
PO:32$mg, 500mg tab
120mg/5ml, 125mg/5ml,
250mg/5ml (60ml syrup)
60mg/0.6ml (15ml drops)
®R: 125mg, 250mg supp
200mg, 400mg tab
100mg/5ml (60ml suspension)
250mg, 500mgtab
750mg tab (sustained release)
275mg, 550mg tab (as sodium
salt)
250mg, 500mg
Tabs:
TID dosing: 250mg, 500mg
BID dosing: 875mg (125mg
davulanate); Augmentin XR: lg
amox (62.5mg davulanate)
Oral suspension;
HD dosing: 125, 250mg
amox/Sml (31.25 and
32.5mg/5ml davulanate)
3ID dosing: 200,400mg
amox/5ml (28.5 and 57mg/5ml
davulanate)
\ Azithrom ycin Otitis media (>6mo) 200mg/5ml (15ml and 30ml
5 day regimen: lOmg/kg D1 (max suspension)
500mg), then 5mkday QD (max 250mg cap
250mg/day) on D2-5 500mg film coated tab
3 day regimen: lOmkday QD (max
500mg/day)
1 day regimen: 30mkday (max
1500mg/day)
CAP (>6mo): use AOM 5day
regimen
Pharyngitis/tonsillitis (2-15yrs):
12mkday QDx5d max500mg/day)
Pharyngitis, tonsillitis, skin/soft
tissue inf (adolescent): 500mg D l,
then 250mg/day D2-5
Cefaclor Child (>lmo): 20-40mkday q8,max 250mg, 500mg cap
2g/day 125mg/5ml, 250mg/5ml susp
"on empty stomach 50mg/mi drops
Cefixime Infant (>6mo) and child: 8mkday lOOmg, 200mg cap
ql2-24, max 400mg/day 100mg/5ml suspension
Acute UTI: 16m kdayql2 D l, then 20mg/ml drops
kmkday q24 x 13 days, max
400mg/day
Adolescent: 400mg/day ql2-24
Cefuroxime Child (3mo-12yr) 250mg, 500mg tab
5haryngitis/tonsillitis: 20mkday 125mg/5ml, 250mg/5ml
Jl2,max500mg/day; 12mg tab q l2 suspension
Otitis media, impetigo, sinusitis:
Omkday ql2, max lg/day; 250mg
tab ql2
Cephalexin 25-100mkday q6, max 4g/day JSOmg, 500mg cap
rvon empty stomach
L25mg/5ml, 250mg/5ml susp,
00mg/ml drops
Chloramphenicol 5O-lOOmkday q6 5OOmg cap, 125mg/5ml susp
Ciprofloxacin **use with caution in <18yrs 250mg, 500mg tab
20-30mkday ql2, max 1.5g/day
Complicated UTI: 20-40mkday ql2,
rrlax 1.5g/day
Clarithromycin 15m kdayql2 250mg, 500mg tab
125mg/5ml, (250mg/5ml) susp
mm

Clindamycin 10-30mkday q6-8 150mg, 300mg cap

Cloxaciilin 50-lOOmkday q6 jOOmg cap, 125mg/5ml
Co-trimoxazole Minor/moderate infections: Adult tab:400mg SMX/80mg
(based on Child: 8-12mkday BID TMP
TMP) >40kg: 160mg/dose BID Forte tab:800mg SMZ/I60mg
Severe infections: TMP
Child and adult: 20mkday q6-8 200mgSMZ/40mgTMP/5ml
UTI prophylaxis: 2-4mkday QD
Erythromycin Neonate(chlamydial conjunctivitis & 250mg, 500mg tab
pneumonia): 50mkday q6 xl4 days 200mg/5ml suspension
Child:30-50mkday q6-8,max 2g/day Hosone liquid: 125mg/5ml
Hosone drops: lOOmg/ml
Metronidazole Amebiasis: 35-50mkday TID xlOdays SOOmg tab
Anaerobic infection: 125mg/5m! suspension
30mkday q6, max 4g/day
Other parasitic infections:
15-30mkday q8
Bacterial vaginosis:
500mg PO BID x 7 days or 2g x 1
dose; vaginal 5g BID x 5 days
Mupirocin >3mo: small amt TID x 5-14 days 1% cream, ointm ent
Ointment may be used in >2mo
ntranasal: 2-4x/d x5-14 days
Nitrofurantoin >lmo: SOmg, lOOmg cap
fx: 5-7mkday q6, max 400mg/day
JTI prophylaxis: l-2mkdose ODHS,
■nax lOOmg/day
>12yr:
Vlacrocrystals: 50-100mg/dose q6
Dual release: lOOmg/dose q l2
JTI prophylaxis (macrocrystals):
iO-lOOmg/dose ODHS
Permethrin Head lice: wet hair, apply shampoo E Omg/mi lotion (30ml, 60ml)
ind leave on for 10-15 mins then : Omg/ml shampoo (30ml,
inse thoroughly QD for 7 days. E>0ml)
Eomb w/ fine bristles
>cabies: apply 5% cream form neck
o toe (head to toe in infants and
oddlers). Wash off w/water in 8-
I4hrs. May rpt in 7 days.
 Tetracycline ** do not use in <8yr 250mg, 500mg cap
25-50mkday q6, max 3g/day
TB DRUGS Single daily dose 3x weekly
Isoniazid 3.Omg/kg (10-15mg/kg) 20-30mg/kg 200mg/5ml
rnax 300mg/day max 900mg
Rifampicin ].5mg/kg (10-20mg/kg) 10-20mg/kg 200mg/5ml
rnax 600mg/day max 600mg
Pyrazinamide 3lOmg/kg (20-40mg/kg) 50mg/kg 250mg/5ml
rnax 2g max 2g
Ethambutol \>Omg/kg (15-25mg/kg) 30-50mg/kg 400mg tab
nax 1.2g max 2.5g
Streptomycin >0-40mg/kg, max lg lg vial (dissolve in
2m! sterile water)
Antl-TB drug combinations:
Kidz Kit 2 (INF, Rif), Kidz Kit 3 (INF, Rif, PZA); Refam duo (INH, Rif); Refam pedia kit
(INH, Rif) - doses as above
Myrin (Ethambutol300mg, INH75mg, Rif ISOmg); Myrin-P forte (Eth 275mg, Rif 150mg,
INH75mg, PZA400mg) ~[>71kg 5 tabs/day, 55-70kg 4 tabs/day, 40-54kg 3 tabs/day]
Bifix (INH75mg, Rifl50mg)~[>71kg 5tabs, 55-70kg 4tabs, 38-54kg 3tabs, 30-37kg 2tabs)
~ali doses to be taken 30mins before or 2 hours after meals

ASTHMA/ALLERGY DRUGS
Cetirizine Drops: 6-12m: 1ml QD 2.5mg/ml oral drops (Alnix)
12m-<2yr: 1m! QD or BID 5mg/5ml oral solution
2-5yr: 2ml QD or 1ml BID lOmg tab
Syrup: 2-5yr: 5mi QD or 2.5ml BID
5-12yr: 10ml QD or 5ml BID
Tab: 6-12yr: 'A tab BID or Itab QD
>12yr and adult: ltab QD
>12yr: 20gtts QD lOmg/ml oral drops (Zyrtec)
5-12yr: 20gtts QD/ 10 gtts BID
2-6yr: 5gtts BID
Desioratadine 5 -llm : 2ml QD 5mg tab
l-5yrs: 2.5ml QD 2.5mg/5m! syrup
5 -llyrs: 5ml QD
>12yrs - adult: ltab or 10ml QD
Diphenhydramine 5mkday q6 PO/IM/IV, max 25mg, 50mg cap
300mg/day 12.5mg/5m! (60ml, 120ml
syrup)
Salmeterol + >12yr: 2 inhalations 25/50 OR 25/125 yiDI: Salmeterol +
Fluticasone DR 25/250 BID luticasone 25/50mcg;
>4yr: 2 inhalations 25/50 BID ?5/125mcg; 25/250mcg
Budesonide + >12yr: 1-2 inhalation QD-BID 1Judesonide 160mcg +
Formoterol Max daily MD: 4 inhalations 1ormoterol 4.5mcg
>4 yr: 1 inhalation BID Symbicort) turbuhaler 60
Max daily MD: 2 inhalations loses
Hydroxyzine 2mkday q6-8 PRN LOmg, 25mgtab
Alternative dosing by age: >mg/mi (60ml syrup)
<6yr: 50mg/day q6-8
>6yr: 50-100mg/day q6-8
Levocetirizine 2-6yr: 1.25mg BID (2.5ml solution or :CT 5mg
5drops BID) Oral drops 5mg/5mi
>6yr: 5mg QD Oral solution 500mcg/ml
Loratadine 2-5yr: 5mg QD LOmg tab
>6yr: lOmg QD Lmg/ml (30ml syrup)
Methyl- Asthma exacerbation 4mg tab, 16mg tab
Prednisolone <12yr: lm kday ql2, max60mg/day or
ligher alt regimen lmkdose q6x48hrs
then l-2mkday ql2, max 60mg/day
>12yr: 40-80mg/day ql2-24 or higher
alt regimen 120-180mg/day q6-8 x
48hrs then 60-80mg/day ql2
Outpatient asthma exacerbation
3urst therapy:
cl2yr: l-2mkday ql2-24, max
50m/day x 3-10 days
>12yr: 40-60mg/day ql2-24x5-10d
Montelukast Asthma and seasonal AR 4mg, 5mg chewable tab
Smo-5yr: 4mg oral granules or lOm gtab
chewable tab PO ODHS
S-14yr: 5mg PO ODHS
>14yr: lOmg PO ODHS
Prednisone Asthma exacerbation 5mg, 20mg tab
<12yr: lm kday ql2, max 60mgday Pred-10/Prolix: 10mg/5ml
>12yr: 40-80mg/day ql2 to 24
Asthma exacerabation burst Prednisolone
cl2yr: l-2mkday ql2-24, Liquipred:15mg/5ml
max60mg/day Optipred: 20mg/5ml
>12yr: 40-60mg/day ql2-24x5-10d
 Salbutamol O.lmkdose q6-8 (max 2mg/dose) 2mg/5ml; 2mg/tab
1-2 puffs/inhalation q4-6 or PRN 2.5mg/2.5ml nebules
Img/ml nebulizing solution
lOOmcg/actuation x 400
Terbutaline Oral 2.5mg tab
<12yr: initial 0.05mkdose q8, increas<j 5 mg XR tab
as needed, max 0.15mkdose q8 or 1.5mg/5ml syrup
total 5mg/day 5mg/2ml nebulizing
>12yr: 2.5-5mg/dose q6-8 solution
Max dose: 12-15yr: 7.5mg/day;
>15yr: 15mg/day
Mebulization
<2yr: 0.5mg in 2.5ml NS q4-6
2-9yr: lm g in 2.5ml NS q4-6
>9yr: 1.5-2.5mg in 2.5ml NS q4-6
Gl DRUGS
Esomeprazole clOyr: lOmg PO BID, may increase 20mg, 40mg tab
dose by 50% at 4-wk intervals up to a [Nexium lOmg sachet)
max 20mg BID
10-12yr: 20mg PO BID, may increase
dose by 50% at 4-wk intervals up to a
max 40mg BID
12-17yr: 20-40mg QD up to 8 wks
Lansoprazole GERD: <10kg: 7.5mg QD 15mg, 30mg cap
ll-30kg: 15mg QD-BID, may increase 15mg, 30mg FDT
up to 30mg BID after >2wks of
nonresponse
>30kg: 30mg QD-BID
>12yr: 15mg QD for up to 8 wks
Omeprazole lm kd PO QD-BID lOmg, 20mg cap
Alternative dosing for pxs >2yr
<20kg: lOmg PO QD
>20kg: 20mg PO QD
OTHERS
Ascorbic acid Scurvy: 100-300mg/day div QD-BID OOmg, 250mg, 500mg tab
For at least 2 wks 00mg/5ml (60,120, 250ml
5 yrup)
1 OOmg/ml (15, 30, 60ml
d rops)
50mg/0.6ml (15ml drops)
 Aspirin Analgesic/antipyretic: 10-15mkdose 30mg, lOOmg, 325mg tab 1
50/PR q4-6, max: 60-80mkday
Anti-inflam: 60-100mkday q6-8
<awasaki: 80-100mkday QID during
Febrile phase until defervescence;
then 3-5mkday QD am for at least 8
Lvks or until both pit and ESR normal
Bacillus clausii k vial BID x 5 days
(Erceflora)
Domperidone Dyspepsia lOmg tab
Adult: 1 tab or 2 tsp TID lmg/ml suspension
Child: 2.5ml/10kg BW TID
Mausea and vomiting
Adult: 2 tabs or 4 tsp TID-QID
Child: 5ml/10kg BW TID-QID
all doses should be given before meal
Iron (based on DA 4s recommended by DOH:
elemental Fe) Preterm: 2-4mkday QD-BID, max .BW: 0.3ml QD to start at 2
15mg/day mos until 6mos
Child: 3-6mkday QD-TID 15mg/0.6ml drops)
Adult: 60-100mg BID up to 60mg QID 5-llm os: 0.6ml QD for 3
Prophylaxis mos (15mg/0.6ml drops)
^reterm: 2mkday, max 15mg/day L-5yrs: 5ml QD for 3 mos OR
rerm: l-2mkday, max 15mg/day 3ml once a week for 6 mos
\dult: 60-100mg/day QD to BID 30mg/5ml)
'with or after meals 0-19yrs: 1 tab QD (tablet
ontaining 60mg elemental
e with 400mcg folic acid)
Kamillosan oral 2 puff TID 15ml spray solution
Lactulose C'hronic constipation 3.3g/5ml
Cihild: 7.5ml/day PO after breakfast
akdult: 15-30ml/day QD, max
GOml/day
C)R 0.5ml/kg to 3ml/kg BID
Mebendazole >2yr and adult 5Omg/ml, 10ml (single dose)
Pinworm: lOOmg PO x 1 dose, may 5OOmg chewable tab
1at in 2 wks if not cured
Hookworm, roundworm, whipworm:
1OOmg PO BID x 3 days, may rpt in 3-
4 wks OR 500mg x 1
 Deworming: 12 months and above: '
500mg, single dose every 6 months 1
!
Multivitamins c6mos: 0.3ml -0 .5 m l
NB:Clusivol 0.3ml, the rest 0.5ml)
5m o-lyr: 0.5ml; >1 yr: 1ml; 2-6 yr:
2.5ml-5ml; 6-12yr: 5-10ml
Nystatin Preterm: 0.5ml (50,00011) to each 100.000 units/ml 1
side of mouth QID suspension
Term: 1ml (100,00011) to each side of 500.000 units per tab
I1
mouth QID
Child: 4-5ml (400,000-600,OOOU) 1
swish and swallow QID 1
"400,000-800,000 units/d div q4-6
Polycresulin Cauterizing solution
Cone. Sol'n
(Albothyl)
Racecadotril Adult lOOmg q8 lOmg sachet -in fan t
(Hidrasec) Powder for children and infants 30mg sachet-child
1.5mg/kg/dose with 1 initial dose and
3 daily divided doses
Tobramycin Eye drops: 1-2 drops q4
Vitamin A Supplementation in measles (6mo- 50,000 IU gel cap
2yr)
5mo-lyr: 100,000 lU/dose QD PO x 2
days, rpt 1 dose at 4 wk
1

Zinc
1-2 yr: 200,000 lU/dose QD PO x 2
days, rpt 1 dose at 4 wk
<6mo: lOmg OD x 14 days lOmg/ml drops
|1
(elemental Zn) >6mo: 20mg OD x 14 days 20mg/5ml syrup

Compress to be used on affected areas for 15 mins TID

- NSS Compress: Dissolve 4 tsp of rock salt in 1 L water !
- KMN04 compress: Dissolve crystals to make a It. pink solution I
Magic mouthwash: for mouth sores I
- Mix AlMgOH (Maalox) 5 mL + sucralfate lg/tab J4 tab pulverized +
diphenhydramine 12.5mg/dmL 5ml, paint over ulcerated areas q6 j
Tranexamic acid gargle: mucosal bleeding j
- Tranexamic acid 250 mg/cap + 250 mL water gargle TID

!
 Topical steroids for use in AD:
Class Potency
1 Ultra high Clobetasol propionate 0.05%
II High Betamethasone dipropionate 0.05%
III Medium to high Betamethasone dipropionate 0.05%
IV and V Medium Mometasone furoate 0.1%
Hydrocortisone butyrate 0.1% ointment
VI Low Hydrocortisone butyrate 0.1% cream
Desonide 0.05%
VII Least potent Hydrocortisone 1% and 2.5%

Other Drugs (for infusion):

Albumin: Hypoaibuminemia
- Prep: 20% - 200mg/mL, 25% - 250mg/mL; 50 mL vial
- Dose: 0.5 g/kg/dose to infuse over 4-6 hours
Mannitol 20%: Dose: 0.5 mg/kg/dose
- mL mannitol = dose (mg/kg/dose) x wt (kg) x 100/20
IVIG Infusion: Kawasaki: Dose: 2g/kg
- Premedications: hydrocortisone and diphenhydramine 30 mins prior
- Give IVIG_mg as follows: (__vials o f __ g/vial prep) infuse starting rate
of O.Olml/kg/min for the 1st 30 mins, double rate q 15-30 mins until
max rate of 0.08ml/kg/min is reached. If well-tolerated, maintain rate
until completion of infusion for 12 hours.
- Hold main line during infusion and Monitor VS ql5m in then q30min then
qlhr, Refer if w/vomiting, chills, fever, flushing, HA, hypotension

Foods and Drinks to be avoided in Drugs and Chemicals to be avoided in

G6PD Deficiency G6PD Deficiency*
Fava beans (Dingdong mixed nuts®, Antibacterial Drugs
Mr. Bean®) Nalidixic acid
Red wine Nitrofuran
Legumes (abitsuelas, garbanzos, Nitrofurantoin
kadyos, monggo) Furazolidone (Macrodantin, Diafuran,
Blueberry Diapectolin, Furoxone)
Soya-based food (taho, tokwa, soy Nitrofurazone/Nitrofural (Furacin)
sauce) P-aminosalicylic acid
Tonic water
Bitter melon/ampalaya Analgesics/Antipyretics
Acetanilid
Antihelminthic Dimercaprol
B-naphthol Futamide
Niridazole Isobutyl nitrate
Stibophan Mepacrine
Phenazopyridine (Azomir)
Sulfonamides and Sulphones Probenecid
Dapsone (Lepravir) Thiazolesulfone
Glucasulphone sodium Urate oxidase/Rasburicase
Glyburide/Glibenclamide (Eugiucon,
Gluban, Lodulce, Orabetic) Chemicals
Mafenide acetate Methylene blue
Salicylaazosulphapyridine/Sulfasalazine Arsine
Stibophen (2-(2-Oxido-3,5- Phenylhydrazine
Disulphonatophenoxy)- Toluidine blue
l,3,2,Benzodioxastibole-4-6- Trinitrotoluene
Disulphonate) Aniline dyes
Suiphacetamide/Sulfacetamide
Sutphadimidine Others
Sulfafurazone Menthol (Alaxan gel, Ben-gay,
Sulphamethazole/Sulfamethoxazole Efficascent oil, Listerine mouthwash,
(Bacidal, Bactille Forte, Bactrim, Mentopas
Bacxal, medicated plaster, Omega pain killer)
DU Co-trimoxazole, Forteprim, Camphor
Globaxol, Pharex Co-trimoxazole, Naphthalene (moth balls)
Ritemed Henna
Co-trimoxazole, Septrin, Trim S) Herbs (cattle gallstone bezoar,
Sulphanilamide/Sulfanilamide honeysuckle flower, 100% pearl
Sulphapyridine powder,
Sulphoxonel/Sulfoxone figwortflower, acalypha indica)
Sulfasalazine, Salazosulfapyridine
(salazopyrin)
* Items in italics are not available in the
Antimalarials Philippines
Chloroquine (Aralen, Chlorofoz)
Pamaquine
Primaquine (Source; Chiong MA, et al. Basic
Pentaquine Inform ation for Physicians. N ewborn
Screening Reference Center
Miscellaneous National Institutes of Health)
Acetylphenylhydrazine
 03
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Growth indicators

co-E a<2> rQ •p
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JQ O 43 o o o
JQ E 43
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00 00 00
 Weight-for-age GIRLS | W o rld Health
f O rg a n iza tio n
Birth to 2 years (z-scores)

17 17

16 16

15 15

14 14

13 13

12 12

11 11
W e ig h t (kg)

10 10

9 9

8 8

7 7

6 6

5 5

4 4

3 3

2 2

Months 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11
Birth 1 year 2 years
A g e (com pleted m onths and years)
W H O Child G ro w th Standards
 Weight-for-age GIRLS | W o rld Health
f O rg a n iza tio n
2 to 5 years (z-scores)

30

29

28

27

26

25

24

23

22

21
W e ig h t (kg)

20

19

18

17

16

15

14

13

12

11

10

7
Months

A g e (com pleted m onths and years)

W H O Child G ro w th Standards
 Length-for-age GIRLS | W o rld Health
f O rg a n iza tio n
Birth to 2 years (z-scores)

95

90

85

80

75
Length (cm)

70

65

60

55

50

45

Months

A g e (com pleted m onths and years)

W H O Child G ro w th Standards
 Height-for-age GIRLS | W o rld Health
f O rg a n iza tio n
2 to 5 years (z-scores)

125 125
x — 3
_ x x X --
xX-^* x " ’"^
^x*X ^
120 120

—
__ X -'"

rs
X ^ X X -"
’■ 'X ^ x x X x"’
x X ’-
X x -^ ^ X -
^ X xX*
115 xx^^ 115
X ^
X "^ xX~
x --^ x^
x ^
x x "^
_ x -- X* - A -
110 110
|__X - x * ^ X -^ 0
___ _ x - ^ ^xX X X -
X ^ ____ " ____ -
^ 0 x x -^ _X -^ ____ -
____ ____-* „____ x - - ^
105 xx" ^ __ - — '*
105
H eight (cm)

xx ^ — ^ x X -
^___ X ----- - X "
_____ ___X X X *
XX X'*"’* xX "
100 . J )
4 _ 100
_X ^ x '— <x X -^ ^ x X -- ------ -
X X __^ ^ x -x > ^ ^ x -x — "
X "X X *
X X ’
X X -X " ,x X - — X "
✓ _x^
95
/
—
0__ X
,^ -X x x ^
„____- X -"
— -■—
- -3 - 95
^ x --' ^ X — 'X X - x -x -
1<<<X X - X ’ „__ —■x X "
^ x - x x ”-^ ____ X - " ^ - — xx*^1
____ _ _.X - * -
_ _____ _
90 ^xx* _^ ___ X l ^ - x —- 90
X'X '* ■ x x -^ l^ — X
XXX —
^ x 1
✓ X --X ~ ___ - — "

85
^ x _ [JB, - X - - ’
85
X X *" „____ -X '
— ^ x x - x x -^
.x x x XXX"
— 1
_____ - ~__ -**■'
80 ,-------- r xx ^ 80
x x -x
x x - ’*'
—
Months 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10
2 years 3 years 4 years 5 years
A g e (com pleted m onths and years)
W H O Child G ro w th Standards
 Weight-for-length GIRLS | W o rld Health
f O rg a n iza tio n
Birth to 2 years (percentiles)

zz
22 97th 22

y z
y/ y 85th
20 y z 20

yz
z
Z
z Z

y
y
y 50th
18
/
y y /
z
y
/
z 18

Z _y 15th
Z y
/ / z
16 / /
16
y / y 3r
y 3rd
u
/ y 7
y y s ' y
/ / / /
y / / y
14 y
I- /
/
y y
s '
y
14
W e ig h t (kg)

/
y y y
y y
/ y y y
y y y
y y
12 y y y 12
y
y y
y y
y
y y y y y y

y y
y
10 y y y y y
y
10
y y y y
y
y y

y y y y
y y y
y

y y y — _y
__
y y
y
y ',,' y y
8
y
>K
»
y
y
y
ffH*y
y
y
y y ' 8
y y y y
y
/y y y y
y
y
y
y y
y y y-
6 //
s '
y
y y
y
y
y 6
y^ y y
/ y
/
>
/ s ' s*
s 'y
s '
y

s*
4 y y —■
y y* >-
y y

2 — 2
■ ■■ ■■ ■
45 50 55 60 65 70 75 80 85 90 95 100 105 110

Length (cm)
W H O Child G ro w th Standards
 Weight-for-Height GIRLS | W o rld Health
f O rg a n iza tio n
2 to 5 years (z-scores)

32
/ 3
z
y 30
r
7
y
>/
/ - 2 - 28
7 z
7r 7
7 7
/7 y 0

7 /7 26
7 /7 z7
_ _ 1

/ 7y 7y
/_
/
7 7 y 7y 24
7 7 7y
7^
7 7 z00 / 0

7 7y 7 22
7 7
/ 7 7 Z
7 7 7Z 7 - 1
7 00
W e ig h t (kg)

7 7
00
7 00 20
7^ 7
/ / 7 7z
/ ,7 7 z - 2

/ *7 z .7 7
00*
7 7 z 7^ 18
7 7 >z -3
7* ,7*00* 7 z 00^ ,7
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|(*7 _ 0* 16
t 7 7
7 ^ 00 000*
7 00* 7. 7^
7*"1
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t*'"' ,
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7-- T-^ _■ ~~+,0000 ^7 7 +0000**" ^+*00*
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~~tL+000 ~~+ ---- 0000 ~_, ,000 0000 7 00000*
12
77 T-** * ^ ^7 7--'
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0*0* — — —— ———————————————————
— — — — — — —

— __—’ — __— — _. —— — — — — — — — — — — — — — — — — — — — — —— — — — — — — — — — — —
T-'' *”1.7—T _77- 8
7""* 7—* — = in —-
— -—
-
7--■SSP’ ,77 5^***
— — 6

100 110 120

H eight (cm)
W H O Child G ro w th Standards
 BMI-for-age GIRLS | W o rld Health
f O rg a n iza tio n
2 to 5 years (percentiles)

19

18

17
BMI (kg/m2)

16

14

13

12
Months

A g e (com pleted m onths and years)

W H O Child G ro w th Standards
BMI-for-age GIRLS | W o rld Health
f O rg a n iza tio n
Birth to 5 years (z-scores)

22

21

20

19

18

17

16

15

14

13

12

11

10

A g e (com pleted m onths and years)

W H O Child G ro w th Standards
 BMI-for-age GIRLS W o r ld H e a lth
W i p f O r g a n iz a t io n
5 to 19 years (z-scores)
BMI (kg/m2)

2007 WHO Reference

 Head circumference-for-age GIRLS , W o rld H ea lth
i p g w O rg a n iz a tio n
Head circumference (cm) Birth to 2 years (z-scores)

W H O Child Growth Standards

 Weight-for-Height GIRLS | W o rld Health
f O rg a n iza tio n
2 to 5 years (z-scores)

32
/ 3
z
y 30
r
7
y
>/
/ - 2 - 28
7 z
7r 7
7 7
0
/7 y
7 /7 26
7 /7 z7
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/ 7y 7y
/_
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7 7 y
7y 24
y
7 7 7
7^
7 7 z00 / 0

7 7y 7 22
7 7
/ 7 7 Z
7 Z
7 77 00 7 - 1
W e ig h t (kg)

7 7
00
7 00 20
7^ 7
/ / 7 7z
/ ,7 7 z - 2

/ *7 7 z .7 7
00*
7 z 7^ 18
7 7 >z -3
7* 7 00^ ,7
/
,7*00* +000 t ' 7 z
|(*7 16
t_
_0* 7 7
7 ^ 00 000*
7 000 00*
00* 7. 7^
7*"1 t " 7 7 00* ,t7
^00 0000" t*
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' 7'*' 7-^** 7.
,«
f* 14
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,—0* 0000* 7000* 770 * 7
00** ^00 ** " 7.000* 0** .7^*
T*-0* ,,0000* __
_00* ^70000* 7*.000* "+00*00* 0000'
7-- T- ^_
_■ ~~+,0000 ^7 7+0000**" ^+*00*
^7* * ^ ~ ~ tL+000 ~~+ ------- ~
__,0000 ,000 0000 700000* 12
77 T-** * ^ ^77--' 000* ~000*‘
iip
,,,- 77 __700**
0** 000* 7-7-—' T-'-' ^
__.0000 0000*** 700000*
^7 ^7»7—■
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T5 * 00** +00»00** _
_.___0*** 777-' 10
7^— — — _
__' — 77 — — 77-0*0*— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —
— _ _— ’
_ — _ _
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T-'' T
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— ■SSP’
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100 110 120

H eight (cm)
W H O Child G ro w th Standards
 Weight-for-age BOYS \W o rld Health
0 O rg a n iza tio n
Birth to 2 years (percentiles)
W eight (kg)

W H O Child G ro w th Standards
 Weight-for-age BOYS | W o rld Health
f O rg a n iza tio n
2 to 5 years (percentiles)

24

23

22

21

20

19

18
W eight (kg)

17

16

15

14

13

12

11

10

Months

Age (completed months and years)

W H O Child G ro w th Standards
 Height-for-age BOYS | W o rld Health
f O rg a n iza tio n
2 to 5 years (percentiles)

120 120

115 115

110 110

105 105
Height (cm)

100 100

95 95

90 90

85 85

80
Months 80 2 4 6 8 10 2 4 6 8 10 2 4 6 8 10
2 years 3 years 4 years 5 years
Age (completed months and years)
W H O Child G ro w th Standards
 We ig ht-for-length BOYS | W o rld Health
f O rg a n iza tio n
Birth to 2 years (percentiles)

22 22

20 20

18 18

16 16

14 14
W eight (kg)

12 12

10 10

8 8

6 6

2 2

45 50 55 60 65 70 75 80 85 90 95 100 105 110

Length (cm)
W H O Child G ro w th Standards
 Weight-for-height BOYS | W o rld Health
f O rg a n iza tio n
2 to 5 years (z-scores)

30 30

28 28

26 26

24 24

22 22

20 20
W eight (kg)

18 18

16 16

14 14

12 12

10 10

8 8

6 6

65 70 75 80 85 90 95 100 105 110 115 120

Height (cm)
W H O Child G ro w th Standards
 BMI-for-age BOYS | W o rld Health
f O rg a n iza tio n
Birth to 5 years (z-scores)

22

21

20

19

18
BMI (kg/m2)

17

16

15

14

13

12

11

10

Months

Age (completed months and years)

W H O Child G ro w th Standards
 BMI-for-age BOYS W o r ld H e a lth
W i p f O r g a n iz a t io n
5 to 19 years (z-scores)
BMI (kg/m2)

2007 WHO Reference

 Head circumference-for-age BOYS , W o rld H ea lth
i p g w O rg a n iz a tio n
Birth to 5 years (z-scores)

54

52
33
33 3333*
3A
50 ~ 3^*
3A A3,33
____
—~
r >A

48 r Zz .
^33*3
Head circumference (cm)

Z: z 3"_
z
A 3 z /A
____
33*33
46 r ^3 ”
/7 /
/ y Z A4. z Z _ —'
____

3 z —
a; 33A-"
44 7 // 33 3^
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n z 3^ A ---
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42 // zn A
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40 f
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itrtm m
ui’i z
/// / Z
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y
36
/Af

34 //
TT11
\tf
IJ
32 I
I
1
Months 2
Birth

W H O Child Growth Standards

 Birth to 36 months: Boys N AM E
Length-for-age and Weight-for-age percentiles R E C O R D # __

Birth 3 6 9 12 15 18 21 24 27 30 33 36

L
E
N
G
T
H

L
E
N
G
T
H

E
I
G
H
T

W
E
I
G
H
T
 Birth to 36 months: Girls N AM E
Length-for-age and Weight-for-age percentiles R E C O R D # __

Birth 3 6 9 12 15 18 21 24 27 30 33 36

L
E
N
G
T
H

L
E
N
G
T
H

E
I
G
H
T

W
E
I
G
H
T
 Birth to 36 months: Boys
Head circumference-for-age and N AM E
Weight-for-length percentiles R E C O R D # __

Birth 3 6 9 12 15 18 21 24 27 30 33 36
I
HI < Q
o — OCODSU-LUOCLIJZOLU

http://www.cdc.gov/growthcharts S A F E R * H EALTH IER* P E O P L E "

 Birth to 36 months: Girls
Head circumference-for-age and N AM E
Weight-for-length percentiles R E C O R D # __

Birth 3 6 9 12 15 18 21 24 27 30 33 36
I
HI < Q
o — OCODSU-LUOCLIJZOLU

Published May 30, 2000 (modified 10/16/00).

SO U R C E: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts S A F E R • H E A L T H IE R ' P E O P L E "
 2 to 20 years: Boys N A M E ______________________
Stature-for-age and Weight-for-age percentiles R E C O R D # __

12 13 14 15 16 17 18 19 20

S
T
A
T
U
R
E

S
T
A
T
U
R
E

W
E
I
G
H
T

W
E
I
G
H
T

http://www.cdc.gov/growthcharts safer • h e a l t h i e r - p e o p l e 1"

2 to 20 years: Girls N A M E ______________________
Stature-for-age and Weight-for-age percentiles R E C O R D # __

12 13 14 15 16 17 18 19 20

S
T
A
T
U
R
E

W
E
I
G
H
T

http://www.cdc.gov/growthcharts safer • h e a l t h i e r *p e o p l e "

2 to 20 years: Boys n a m e ________________
Body mass index-for-age percentiles record #

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Published May 30, 2000 (modified 10/16/00).

SO U R C E: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts S A F E R * H E A L T H IE R * P E O P L E "
2 to 20 years: Girls n a m e ________________
Body mass index-for-age percentiles record #

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Published May 30, 2000 (modified 10/16/00).

SO U R C E: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts S A F E R * H E A L T H I E R * PE O P L E ™
 N A M E __________________
Weight-for-stature percentiles: Boys record #

Published May 30, 2000 (modified 10/16/00).

SO U R C E: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts S A F E R * H E A L T H IE R * PE O P LE ™
 N A M E __________________
Weight-for-stature percentiles: Girls record #

Published May 30, 2000 (modified 10/16/00).

SO U R C E: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts s a f e r * h e a l t h ie r * p e o p l e "
 Blood Pressure Levels for Boys by Age and Height Percentile
SlftoUc BP (mmHal_____________ _____________ d w o m T E F T , , ^ . ^

AO* «■ till* of B «g M + 4 " P*ic*flNi« of Htlght •*

SO! 10th 25th 50th 75th 90th 95th 5th 10th 25th 50th 75th 90th 95th
i vm •0 81 83 85 87 38 89 34 35 36 37 38 39 39
9om 94 95 97 99 100 102 101 49 50 51 52 53 53 54
95m 99 99 101 103 104 106 106 54 54 55 56 57 58 58
«* h 109 106 108 110 112 113 114 61 52 83 $4 65 M 66
2 5om 94 85 87 68 90 92 92 39 40 41 42 43 44 44
9osn 97 99 100 102 104 105 106 54 55 56 57 58 58 59
95tft 101 102 104 106 108 109 110 59 59 60 81 62 63 61
Wh 109 110 111 113 115 117 117 66 67 68 69 70 71 71
3 «W i 86 87 89 91 93 94 95 44 44 45 48 47 48 48
601ft 100 101 103 105 107 108 109 59 59 60 61 62 63 63
95th 104 105 107 109 110 112 113 63 63 64 65 66 67 67
990. 111 112 114 116 118 119 120 71 71 72 73 74 75 75
4 50th 88 eo 91 93 95 96 97 47 48 49 50 51 51 52
9Cth 102 103 105 107 109 110 111 62 63 64 65 66 66 67
951ft 106 107 109 111 112 114 115 66 67 68 69 70 71 71
99tft 113 114 116 118 120 121 122 74 75 76 77 78 78 79
5 501ft 90 91 93 96 96 98 98 SO 51 52 53 54 55 55
«m 104 105 106 108 110 111 112 65 66 67 68 69 69 70
951ft 108 109 110 112 114 115 116 69 70 71 72 73 74 74
wm 115 118 118 120 121 123 123 77 78 79 80 81 81 82
6 50m 91 92 94 96 96 99 100 53 53 54 55 56 57 57
90th 105 106 100 110 111 113 113 68 68 69 70 71 72 72
95tti 109 110 112 114 115 117 117 72 72 73 74 75 76 76
991ft 116 117 119 121 123 124 125 80 80 81 82 83 84 84
7 501ft 92 94 96 97 99 100 101 55 55 56 57 58 59 59
90th 108 107 109 111 113 114 115 70 70 71 72 73 74 74
95»ft 110 111 113 115 117 118 119 74 74 75 76 77 78 78
9901 117 118 120 122 124 125 126 82 82 83 84 85 08 88
8 50Oi 94 95 97 99 100 102 102 56 57 58 59 60 M 61
90th 107 109 110 112 114 115 116 71 72 72 73 74 75 76
950i 111 112 114 116 118 119 120 75 76 77 78 79 79 80
99lh 119 120 122 123 125 127 127 83 84 85 86 07 87 88
9 5001 95 96 98 100 102 103 104 57 58 59 60 81 61 62
900) 109 110 112 114 115 117 118 72 73 74 75 78 76 77
9501 113 114 116 118 119 121 121 76 77 78 79 60 81 81
9901 120 121 123 125 127 128 129 84 65 86 87 88 86 89
10 5001 97 98 100 102 103 105 106 58 59 60 61 81 62 63
9001 111 112 114 115 117 119 119 73 73 74 75 76 77 78
9501 115 116 117 119 121 122 123 77 78 79 80 81 81 (2
990i 122 123 125 127 128 130 130 85 88 86 88 88 89 90
 Blood Pressure Levels for Boys by Age and Height Percentile (Continued)
Systoic BP O r * D U s t o h c BP (mmHfl)

Percentile 4 - Percentile of He*gW + 4 " Percentile of Height

Age
(YeeO ♦ 5th 10th 25th 50lh 75tf» 90th 95*11 5th 10th 25th 50th 75th 90th 95th
11 50th 99 100 102 104 105 107 107 59 59 60 61 62 63 63
90th 113 114 115 117 119 120 121 74 74 75 76 77 78 78
85th 117 118 119 121 123 124 125 78 78 79 80 81 82 62
99th 124 125 127 129 130 132 132 86 86 97 88 89 90 90
" 12 50th 101 1Q2 104 100 108 109 110 59 60 61 62 63 63 64
90th 115 116 118 120 121 123 123 74 75 75 78 77 78 79
95lh 119 120 122 123 125 127 127 78 79 80 81 82 62 63
99(h 128 127 129 131 133 134 135 86 87 88 89 90 90 91
13 50th 104 105 108 108 110 111 112 60 60 61 62 63 64 64
90th 117 118 120 122 128 125 126 75 75 78 77 78 79 79
95th 121 122 124 126 128 129 130 79 79 80 81 82 83 83
99th 128 130 131 133 135 138 137 87 87 88 89 90 91 91
14 50th 106 107 109 111 113 114 115 60 81 62 63 84 65 05
90th 120 121 123 125 126 128 128 75 76 77 78 79 79 80
95lh 124 125 127 128 130 132 132 ao 80 81 02 63 84 84
991h 131 132 134 136 138 139 140 87 88 89 90 91 92 92
15 50th 109 110 112 113 115 117 117 61 62 63 (4 65 66 66
90th 122 124 125 127 129 130 131 78 77 78 79 80 80 61
95th 128 127 129 131 133 134 135 61 81 82 83 84 85 85
99th 134 135 138 138 140 142 142 66 89 90 91 92 93 93
16 50U» 111 112 114 118 118 119 120 63 63 64 65 66 07 67
90th 125 126 128 130 131 133 134 78 78 79 60 61 82 82
95th 129 130 132 134 135 137 137 82 83 83 84 85 M 87
99tn 136 137 130 141 143 144 145 90 90 91 92 93 94 94
17 50th 114 115 116 118 120 121 122 65 66 66 67 66 69 70
90th 127 128 130 132 134 135 138 80 60 81 82 63 64 64
95th 131 132 134 136 138 139 140 84 85 86 87 87 68 89
99th 139 140 141 143 145 146 147 92 93 93 94 95 96 97

BP. blood pressure

•The 90fi percent* it 128 80. 95<h percent)* » 1645 SO. and the M«h percent* ■ 2 328 SO over the mean
For research purposes, the standard dewrtons n Appendix Tat* 8-1 » * * one to compute BP Z scores and percent** tor boys
w<h heignt percentiles given n Tat* 3 (I e the 5t». 10th. 25th. 50th. 75m. ;***• PafaK****
must be converted to height Z-scores gnen by 15% = •l 645 10% * -1 26 76% le V h ^ e *
05% = 1 645) and then computed accorded to the methodology * ^ 2-4 desertoed si Appendix B For crtfdren with height
percentiles other than these, tote* steps 1-4 as described n Appendix 8
 Blood Pressure Levels for Girls by Age and Height Percentile
Systolic BP (mmHg) Diastolic BP (mmllQ!
BP
PetcinisJe <t* Petcomii* ol Height ■#► «• PereentiMs ot Height - 3
* «•
(Y M rt 5th 10th 25lh 50th 75th 90th 95th 5th 10th 25th 50th 75ttl 90th 95th
1 50lft 03 84 85 86 88 89 90 38 39 39 40 41 41 42
90th 97 97 98 100 101 102 103 S2 53 53 54 55 55 56
95th 100 101 102 104 105 106 107 56 57 57 58 59 59 60
99th 108 108 109 111 112 113 114 64 64 65 65 m 67 67
2 50tn 85 85 87 88 89 91 91 43 44 44 45 46 46 47
90th 99 99 ioo 101 103 104 105 57 58 58 59 60 61 61
95th 102 103 104 105 107 108 109 61 62 62 63 64 65 65
99th 109 110 111 112 114 115 116 69 69 70 70 71 72 72
3 50th 86 87 88 89 91 92 93 47 48 48 49 50 50 51
90th 100 100 102 103 104 106 106 61 62 62 63 64 64 65
95th 104 104 105 107 108 109 110 65 66 66 67 68 68 69
99th 111 111 113 114 115 116 117 73 73 74 74 75 76 76
4 50th 88 88 90 91 92 94 94 50 50 51 52 52 53 54
90th 101 102 103 104 106 107 108 64 64 65 66 67 67 68
95th 105 106 107 108 110 111 112 68 68 69 70 71 71 72
99th 112 113 114 115 117 118 119 76 76 76 77 78 79 79
5 50th 39 90 91 93 94 95 96 52 53 53 54 55 55 58
90th 103 103 105 106 107 109 109 66 67 67 68 69 69 70
95th 107 107 108 110 111 112 113 70 71 71 72 73 73 74
99th 114 114 116 117 118 120 120 78 78 79 79 80 81 81
6 50th 91 92 93 94 96 97 98 54 54 65 56 56 57 58
90th 104 105 106 108 109 110 111 68 68 69 70 70 71 72
95th 108 109 110 111 113 114 115 72 72 73 74 74 75 76
99th 115 116 117 119 120 121 122 80 60 80 B1 82 83 83
7 50th 93 93 95 96 97 99 99 55 56 56 57 58 58 59
901h 106 107 108 109 111 112 113 69 70 70 71 72 72 73
95th 110 111 112 113 115 116 116 73 74 74 75 76 76 77
99th 117 118 119 120 122 123 124 81 81 82 82 S3 84 84
B 50th 95 95 96 98 99 100 101 57 57 57 58 59 60 60
90th 108 109 110 111 113 114 114 71 71 71 72 73 74 74
95th 112 112 114 115 116 118 118 75 75 75 76 77 78 78
99th 119 12Gl 121 122 123 125 125 82 82 83 83 84 85 86
50th 96 97 98 100 101 102 103 58 58 58 59 60 61 61
90th 110 110 112 113 114 116 116 72 T2 72 73 74 75 75
95th 114 114 115 117 118 119 120 76 76 78 77 78 79 79
99th 121 121 123 124 125 127 127 83 83 84 64 87
85 86
50th 98 99 100 102 103 104 105 59 59 59 60 62
61 62
90th 112 112 114 115 116 118 118 73 73 73 74 75 76
76
95th 116 116 117 119 120 121 122 77 77 77 78 79 80 80
 Blood Pressure Levels for Girls by Age and Height Percentile (Continued)
Systolic BP (mmHg) Diastolic BP

Ana Percentile * entile of Height 4* Percentile of Height

00 *
—— ------m — r r - ------- ----------- rr*------ r-----------:— — --------------------------------- - ... -■—
< Y e «> 5 th 1 0 th 2 5 th 5 0 th 7 5 th 9 0 th 9 5 th 5 th 1 0 th 2 5 th 5 0 th 7 5 th 9 0 th 9 5 th

11 5 0 th 100 101 102 103 105 106 1Q7 60 60 60 61 62 63 63

9 0 th 114 114 116 117 118 119 120 74 74 74 75 76 77 77

9 5 th 118 118 119 121 122 123 124 78 78 78 79 80 81 81

99m 125 125 126 128 129 130 131 85 85 86 87 87 88 89

12 5om 102 103 104 105 107 108 109 61 61 61 64 64

62 63

g o th 116 116 117 119 120 121 122 75 75 75 76 77 78 78

9 5 m 119 120 121 123 124 125 126 79 79 79 80 81 82 82

9 9 tn 127 127 128 130 131 132 133 86 86 87 88 90
88 89

13 5om 104 105 106 107 109 110 110 62 62 62 63 64 65 65

9 0 th 117 118 119 121 122 123 124 78 77
76 76 78 79 79

9 5 th 121 122 123 124 126 127 128 80 80 80 81 82 83 83

9 9 th 128 129 130 132 133 134 135 87 87 88 89 89 90 91

14 5 0 th 106 106 107 109 110 111 112 63 63 63 64 65 66 66

9 0 th 119 120 121 122 124 125 125 77 77 77 78 79 80 80
95m 123 123 125 126 127 129 129 81 61 81 82 63 84 84
9 9 th 130 131 132 133 135 136 136 88 88 89 90 90 91 92
15 5 0 th 107 108 109 110 111 113 113 64 64 64 65 66 67 67

9 0 th 120 121 122 123 125 126 127 78 78 78 79 80 81 81

9 5 m 124 125 126 127 129 130 131 82 82 82 83 84 85 85

9 9 th 131 132 133 134 136 137 138 89 89 90 91 91 92 93

16 5 0 th 108 106 110 111 112 114 114 6 i 64 65 66 66 67 68

90m 121 122 123 124 127 78 78 79 60 81 81 82

126 128
9 5 m 125 126 127 128 130 131 132 82 82 83 84 85 85 86
99m 132 133 134 137 90 90 90 91 92 93 93
135 138 139

17 5 0 th 1GS 109 110 111 64 65 65 66 67 67 68

113 114 115

S O th 122 122 123 125 126 127 128 78 79 79 80 81 81 82

9 5 th 125 126 127 129 130 131 132 82 S3 83 84 85 85 86

9 9 th 133 133 134 136 137 138 139 90 90 91 91 92 93 93

BP, Wood pressor*

* The 90th percentile « 1 28 SO, 95th percenWe is 1 645 SO, and the 99th percentSe is 2 326 SO over me mean

For research purposes, me standard deviation* in Appendu Table B -t aiovr one to compute BP Z-scores and percent*** tor girt*
with height percentiles given *i Table 4 (I e . tot 5th 10th. 25th. 50th. 75tfi. 90th. and 95th percentiles) These height percentiles
must be converted to height Z-scores given by (5 % = -1 845. 10% - -128. 25% = -0 58. 50% = ft 75% - 0 68. 90% = 1 28%,
95% = 1 645) and then computed according to me methodology *> steps 2 -4 described m Appendix 0 For children with he^ht
percentiles other than these. foSow steps 1-4 as described in Appenda B
 Blood Pressure Levels for Girls by Age and Height Percentile (Continued)

Systolic BP (mmHg) Diastolic BP tmmHfl)

BP --------------- ---------------------------------------------- ------------------------------------------ -
Age Percentile + Percentile of Heigh! Percentile o f Height
(Year) * 5th 10th 25th 50th 75th 90th 95th Sth 10th 25th 50th 75th 90th 95th
11 5om 100 101 102 103 105 106 107 60 60 60 61 62 63 63
90th 114 114 118 117 118 119 120 74 74 74 75 76 77 77
95th 118 118 119 121 122 123 124 78 78 78 79 80 81 81
99th 125 125 126 128 129 130 131 85 85 86 87 87 88 89
12 50th 102 103 104 105 107 108 109 61 61 61 62 63 64 64
90th 116 116 117 119 120 121 122 75 75 75 76 77 78 78
95th 119 120 121 123 124 125 126 79 79 79 80 81 82 82
99th 127 127 128 130 131 132 133 86 86 87 88 88 89 90
13 50th 104 105 106 107 109 110 110 62 62 62 63 64 65 65
90th 117 118 119 121 122 123 124 78 76 76 77 78 79 79
95th 121 122 123 124 126 127 128 80 80 80 81 82 83 83
99th 128 129 130 132 133 134 135 87 87 68 89 89 90 91
14 50th 106 106 107 109 110 111 112 63 63 63 64 65 66 66
90th 119 120 121 122 124 125 125 77 77 77 78 79 80 SO
95th 123 123 125 126 127 129 129 81 81 81 82 83 84 84
99th 130 131 132 133 135 136 136 88 88 89 90 90 91 92
15 50th 107 108 109 110 111 113 113 64 64 64 65 86 67 67
90th 120 121 122 123 125 126 127 78 78 78 79 80 81 81
95th 124 125 126 127 129 130 131 82 82 82 83 84 85 65
99th 131 132 133 134 136 137 138 89 89 90 91 91 92 93
16 50th 108 108 110 111 112 114 114 64 64 65 66 86 67 68
90th 121 122 123 124 126 127 128 78 78 79 80 81 81 82
95th 125 126 127 128 130 131 132 82 82 83 64 85 85 86
99th 132 133 134 136 137 138 139 90 90 90 91 92 93 93
17 50th 108 109 110 111 113 114 115 64 65 65 66 67 67 68
90th 122 122 123 125 126 127 128 78 79 79 60 81 61 82
95th 125 126 127 129 130 131 132 82 83 83 94 65 85 86
99th 133 133 134 136 137 138 139 90 90 91 91 92 93 93
BP, btood pressure
* The 90th percentile is 1 28 SO. 95th percentile is 1 645 SD, and the 99th percent*® is 2 326 SO over the mean
For research purposes, the standard ctevabon* mAppendix Table B~1 aflowone to compute BP 2-scores and percent*^ for girts
with height percentiles given mTable 4 (ie , the 5th, 10th, 25th. 50lh. 751h, 90th. and &5th percentrfes; These height percentiles
must be converted to height Z scores given by (5% = -1 545, 10% = -128,25% = -0.68, 50% = 0. 75% = 0.68, 90% = 126%,
95% = 1 645) and then computed according to the methodology tosteps 2-4 described mAppendix B. For children *«h height
percentiles other than these. Mow steps 1-4 as described in Appendix B
R e fe re n c e s :
A k c a n -A rik a n A, et at. M o d ified RIFLE Criteria in Critically III Children with Acute
K id n e y In ju ry
C h io n g M A , et al. Basic In fo rm a tion fo r Physicians. N ew b orn Screening Reference
C e n te r, N a tio n a l Institutes o f Health
C hiu M C , Y a p HK. Practical Paediatric N ep hrology: An Update of Current
Practices. M e d c o m Lim ited, 2005
C u s te r J a nd Rau R; T h e H arriet Lane Handbook, 18!h edition
G lo b a l S tra te g y fo r A sth m a M anagem ent and Prevention 2014
G o d f r e y et al B ritJ.D is.C h e st, 6 -4 ,1 5 (1970)
J e ffre y M o d e ll F o u n d a tio n , N e w York. 10 W arning Signs of Prim ary
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