Pediatrics and Psychiatry
Astra Clinical Library
Pediatrics
Practical pediatrics guides for clinical decisions, with cited evidence, testing strategies, and actionable next steps.
45 guides
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Pediatric endocrinology and emergency medicine
Pediatric Diabetic Ketoacidosis
Pediatric diabetic ketoacidosis requires rapid confirmation of hyperglycemia, ketonemia, and acidosis; protocolized isotonic fluid resuscitation, potassium replacement, and delayed low-dose intravenous insulin; and intensive neurologic surveillance for cerebral edema while treating the precipitant and preventing recurrence.[21]Neonatology
Neonatal Sepsis
Neonatal sepsis requires immediate culture-directed evaluation and empiric treatment when illness is plausible, while structured early-onset risk assessment, serial examination, and timely culture review prevent avoidable antibiotic exposure in uninfected infants.Pediatrics
Child Abuse and Neglect
Child abuse and neglect require prompt recognition, meticulous medical assessment, protection-focused communication, and reporting under applicable law. Clinicians should distinguish medical mimics from concerning injury patterns while avoiding delay in safeguarding, multidisciplinary evaluation, and referral for ongoing physical and mental health needs.Neonatology
Neonatal Respiratory Distress Syndrome
Neonatal respiratory distress syndrome is surfactant-deficiency respiratory failure in premature infants. Early recognition, noninvasive respiratory support, selective surfactant delivery, and avoidance of injurious ventilation are central decisions while infection, transient tachypnea, and air-leak disorders remain in the differential.Neonatology and Pediatric Infectious Diseases
Neonatal Meningitis
Neonatal meningitis requires prompt cerebrospinal fluid evaluation and hospital-based empiric antimicrobial therapy because clinical findings are nonspecific, culture sensitivity falls after antibiotics, and delayed recognition risks death and neurodevelopmental disability.Pediatrics
Acute Otitis Media
Acute otitis media requires confirmation of middle-ear effusion with compatible tympanic-membrane inflammation, not symptoms or erythema alone. Management hinges on analgesia, selective antibiotic use, reassessment of nonresponse, and recognition of uncommon suppurative or intracranial complications.Pediatrics
Kawasaki Disease
Kawasaki disease requires prompt clinical recognition and coronary surveillance because no confirmatory test exists, incomplete presentations remain at risk for coronary aneurysm, and treatment should not be deferred for a negative early echocardiogram or rigid completion of fever-duration criteria.Neonatology
Neonatal Hypoglycemia
Neonatal hypoglycemia requires risk-based screening, time-sensitive operational thresholds, prompt feeding or dextrose therapy, and escalation for symptomatic, severe, recurrent, or persistent low glucose values while recognizing that universally validated neuroprotective thresholds remain unavailable.Pediatric Infectious Disease
Tuberculosis in Children
A practical approach to pediatric tuberculosis centers on separating exposure, infection, and disease; obtaining microbiologic confirmation whenever feasible; identifying CNS and disseminated disease urgently; and matching treatment to disease severity, susceptibility, age, and the likely source-case resistance pattern.Pediatrics
Febrile Seizure
Classify the event promptly, treat ongoing convulsions as status at 5 minutes, and direct testing toward meningitis or another cause of fever. A neurologically normal child with a simple febrile seizure generally needs fever-focused evaluation rather than EEG, imaging, or antiseizure prophylaxis.Pediatrics
Croup
Manage croup by recognizing impending upper-airway failure, separating viral disease from epiglottitis, bacterial tracheitis, and foreign body, then using corticosteroids for symptomatic disease and nebulized epinephrine for clinically important obstruction with repeated bedside reassessment.Pediatrics
Infantile Hypertrophic Pyloric Stenosis
In an infant with progressive nonbilious projectile emesis, rapidly distinguish pyloric obstruction from bilious or systemic emergencies, confirm suspected hypertrophic pyloric stenosis with ultrasound when needed, correct dehydration and metabolic alkalosis before anesthesia, then proceed to pyloromyotomy.Pediatrics
Pediatric Asthma
Confirm variable airflow limitation when feasible, treat exacerbations promptly with bronchodilation and early corticosteroids, and adjust long-term therapy according to current control, exacerbation risk, adherence, inhaler technique, and age-specific treatment options.Pediatric Endocrinology
Congenital Hypothyroidism
Manage an abnormal newborn screen as a time-critical thyroid hormone deficiency: confirm with serum testing, begin levothyroxine promptly, monitor free T4 and TSH intensively, and use thyroid imaging to clarify permanence without delaying treatment.Pediatrics
Severe Acute Malnutrition
Recognize severe acute malnutrition by anthropometry or nutritional edema, distinguish marasmus from kwashiorkor, triage complications requiring inpatient stabilization, and transition feeding deliberately to avoid metabolic and fluid-related deterioration.Neonatology
Neonatal Jaundice
Manage neonatal jaundice with age-specific bilirubin assessment, prompt identification of hemolysis and other high-risk patterns, guideline-based phototherapy, and urgent escalation for bilirubin encephalopathy or exchange-level hyperbilirubinemia.Pediatrics
Pediatric Pneumonia
Manage pediatric pneumonia by first identifying hypoxemia, respiratory distress, sepsis, and pleural complications; use selective imaging and microbiology; avoid biomarkers as stand-alone bacterial tests; and reassess nonresponse early for complications, resistant pathogens, or an alternative diagnosis.Pediatrics
Failure to Thrive
Failure to thrive is a growth pattern requiring confirmation on serial, correctly plotted measurements, structured feeding assessment, and targeted testing for medical, developmental, and social contributors. Most children can begin outpatient nutritional and behavioral intervention; acute illness, severe undernutrition, or tube-feeding need changes disposition.Pediatric endocrinology
Androgen Insensitivity Syndrome
Diagnose androgen insensitivity syndrome by confirming a 46,XY DSD, excluding impaired testosterone synthesis, and identifying androgen receptor dysfunction. Management requires phenotype-specific counseling, coordinated DSD expertise, individualized gonadal decision-making, hormone planning, and lifelong attention to bone, sexual, reproductive, and psychosocial health.Pediatric Orthopedics
Legg-Calvé-Perthes Disease
Legg-Calvé-Perthes disease requires early recognition of femoral-head ischemia, radiographic staging, and age- and severity-based containment decisions to preserve hip congruence. Management hinges on range of motion, lateral pillar involvement, extrusion, and timely pediatric orthopedic referral.Sports Medicine and Pediatrics
Osgood-Schlatter Disease
Diagnose Osgood-Schlatter disease clinically in adolescents with load-provoked tibial tubercle pain, while using radiographs selectively for unilateral, severe, persistent, or traumatic presentations that may indicate another proximal tibial lesion or avulsion injury.Developmental-Behavioral Pediatrics
Down Syndrome
Clinical care in Down syndrome requires structured surveillance for congenital heart disease and evolving multisystem complications, plus a deliberate adult-life transition plan that recognizes the high risk of Alzheimer disease and changing care needs.Developmental-Behavioral Pediatrics
Fetal Alcohol Syndrome
Fetal alcohol syndrome is the severe phenotypic end of prenatal alcohol exposure, recognized by characteristic facial dysmorphology, growth impairment, and central nervous system dysfunction. Identification should trigger multidisciplinary neurodevelopmental assessment and needs-based intervention rather than reliance on facial findings alone.Pediatric Gastroenterology and Pediatric Surgery
Hirschsprung Disease
Suspect Hirschsprung disease in neonatal distal bowel obstruction or refractory constipation with delayed meconium. Stabilize enterocolitis and obstruction first, establish aganglionosis by rectal pathology, define disease extent for pull-through planning, and systematically evaluate postoperative obstruction, soiling, and recurrent enterocolitis.Pediatrics
Sudden Infant Death Syndrome
SIDS is a postmortem diagnosis of exclusion. Prevention hinges on repeated counseling for a supine, uncluttered infant sleep environment, while every sudden unexpected infant death requires coordinated history review, scene investigation, complete autopsy, and ancillary testing to distinguish unexplained death from suffocation, disease, trauma, or neglect.Pediatrics and Infectious Disease
Hand, Foot, and Mouth Disease
Hand, foot, and mouth disease is usually diagnosed clinically and managed with hydration-focused supportive care. The key physician task is to recognize dehydration, neurologic or cardiopulmonary complications, and mimics requiring lesion PCR, cerebrospinal fluid evaluation, or alternate treatment.Developmental-Behavioral Pediatrics and Psychiatry
Attention-Deficit/Hyperactivity Disorder
Diagnose ADHD through DSM-5 criteria, cross-setting impairment, collateral history, and active exclusion of competing conditions. Match treatment intensity to age, impairment, comorbidity, cardiovascular risk, adverse effects, and patient preference; monitor functional response rather than symptom scores alone.Developmental-Behavioral Pediatrics
Autism Spectrum Disorder
Use developmental surveillance and validated screening to trigger a comprehensive diagnostic assessment, then initiate individualized behavioral, communication, educational, and co-occurring-condition management without waiting for a single test to define care.Child and Adolescent Psychiatry
Conduct Disorder
Conduct disorder requires behavior-specific assessment, careful differentiation from trauma, mood, neurodevelopmental, and substance-related conditions, and treatment that targets family, school, peer, and comorbid drivers rather than aggression alone.Child and Adolescent Psychiatry
Oppositional Defiant Disorder
Evaluate persistent defiance by confirming clinically significant impairment, separating oppositional behavior from conduct disorder and chronic irritability syndromes, identifying ADHD and other comorbidity, and initiating parent-focused behavioral treatment while treating coexisting disorders with diagnosis-specific care.Pediatric Hematology, Immunology, and Transplantation
Wiskott-Aldrich Syndrome
Suspect Wiskott-Aldrich syndrome in boys with persistent microthrombocytopenia, eczema, infections, autoimmunity, or lymphoid malignancy; confirm the WAS variant and expedite curative therapy planning, because hematopoietic transplantation outcomes decline with older age and severe pretransplant infection.Pediatrics
Bronchiolitis Oxygen and Admission Criteria
Use respiratory effort, feeding safety, apnea history, risk factors, and persistent hypoxemia—not an isolated pulse-oximeter value—to determine disposition. For typical U.S. practice, initiate oxygen below 90%, reassess clinically after stabilization, and discontinue continuous monitoring once oxygen needs and work of breathing improve.Pediatric Emergency Medicine
Pediatric Croup Treatment
Treat croup severity at the bedside: give single-dose dexamethasone for children seeking care, add nebulized epinephrine for stridor at rest or increased work of breathing, observe after epinephrine, and escalate promptly when hypoxemia, exhaustion, or poor response suggests impending airway failure.Pediatric Emergency Medicine and Critical Care
Pediatric Asthma Escalation
Escalate pediatric asthma care according to response to initial bronchodilation, oxygenation, work of breathing, and trajectory. This guide defines practical triggers for intravenous magnesium, continuous albuterol, noninvasive support, PICU transfer, intubation planning, and avoidance of low-value rescue therapies.Pediatrics
Pediatric UTI Testing
Diagnose pediatric urinary tract infection by pairing an appropriately collected urine culture with urinalysis evidence of inflammation, while using collection method, age, illness severity, and imaging triggers to avoid contamination-driven treatment and identify obstructive or recurrent disease.Neonatology
Neonatal Jaundice Phototherapy Thresholds
For infants born at 35 weeks’ gestation or later, initiate phototherapy using the 2022 AAP hour-specific total serum bilirubin threshold matched to gestational age and bilirubin neurotoxicity risk factors, then use the bilirubin-to-threshold difference to determine discharge follow-up and escalation.Pediatric Emergency Medicine
Febrile Infant Workup
Evaluate well-appearing febrile infants by age, urinalysis, blood culture, and inflammatory markers; reserve lumbar puncture, empiric antibiotics, and hospitalization for higher-risk profiles while preserving reliable follow-up for selected older low-risk infants.Pediatrics
Pediatric Dehydration Rehydration
Select oral rehydration for most children with mild-to-moderate dehydration, use nasogastric ORS when drinking fails, and reserve isotonic intravenous fluid for shock, deterioration, altered mental status, ileus, or failed enteral therapy.Neonatology, Pediatric Cardiology, Adult Congenital Heart Disease
Patent Ductus Arteriosus
Manage PDA by separating preterm ductal patency from a clinically consequential shunt and from persistent congenital PDA in older patients. Echocardiography establishes anatomy and physiology; treatment is reserved for hemodynamic consequences, with transcatheter closure increasingly favored when definitive intervention is required.Pediatric Cardiology and Adult Congenital Heart Disease
Transposition of the Great Arteries
D-transposition requires rapid confirmation of anatomy, maintenance of effective intracardiac mixing, and neonatal anatomic repair; lifelong surveillance after arterial switch focuses on coronary obstruction, neo-aortic disease, ventricular function, and pulmonary arterial lesions.Dermatology and Pediatrics
Tinea Capitis
Confirm suspected scalp dermatophyte infection with hair and scale microscopy or culture when feasible, begin systemic therapy because topical agents do not reach the follicular infection, identify inflammatory kerion promptly to limit permanent alopecia, and interrupt household transmission with contact assessment and sporicidal shampoo.Pediatric Endocrinology
Delayed Puberty
Evaluate delayed puberty by separating constitutional and functional delay from central hypogonadism and primary gonadal failure. Growth trajectory, bone age, pubertal examination, LH/FSH, and sex steroids direct targeted evaluation, timed observation, puberty induction, and long-term replacement planning.Pediatric Endocrinology
Precocious Puberty
Evaluate early pubertal signs by separating transient or isolated variants from progressive hypothalamic-pituitary-gonadal activation and gonadotropin-independent disease. Age, tempo, growth, bone maturation, gonadotropin testing, and targeted imaging determine who needs observation, etiologic investigation, or GnRH-agonist suppression.Pediatrics