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1. Pediatric GI Physiology & Fluid Balance

• Assessment: Evaluate hydration status via fontanels (sunken = dehydration), skin turgor, mucous membranes, and urine output.

• Management:

◦ Mild/Moderate Dehydration: First-line treatment is Oral Rehydration Solution (ORS) (e.g., Pedialyte) in small, frequent amounts.

◦ Severe Dehydration: Requires isotonic IV fluids (e.g., normal saline).

2. Structural Anomalies

These congenital defects require immediate protection of the airway or defect and surgical intervention.

• Cleft Lip/Palate: Major concerns are feeding difficulties and aspiration. Use specialty bottles (e.g., Haberman) and keep the infant upright. Post-op: Protect the suture line (no pacifiers, use elbow restraints).

• Esophageal Atresia (EA) & Tracheoesophageal Fistula (TEF): Watch for the "Three C’s": Coughing, Choking, and Cyanosis during feeding. Management includes immediate NPO status, elevating the head, and surgical repair.

• Abdominal Wall Defects:

◦ Omphalocele: Organs in a sac.

◦ Gastroschisis: Herniated bowel without a sac.

◦ Care: Prevent hypothermia and cover the defect with a sterile, non-adherent, moist dressing immediately after birth.

• Anorectal Malformations: Assess for failure to pass meconium in the first 24 hours (imperforate anus).

3. Acute & Obstructive Disorders

These conditions often present as emergencies requiring rapid recognition of specific symptoms.

• Hypertrophic Pyloric Stenosis: Characterized by projectile, non-bilious vomiting and a palpable "olive-shaped" mass in the RUQ. Treated via pyloromyotomy.

• Intussusception: The telescoping of the bowel causing edema and obstruction. Classic signs are "currant jelly" stools (blood/mucus) and a sausage-shaped abdominal mass. Treatment is often a pneumatic (air) enema.

• Appendicitis: Inflammation causing RLQ pain (McBurney’s point). Warning: A sudden relief of pain may indicate rupture and peritonitis.

4. Chronic & Inflammatory Disorders

Management focuses on diet, medication, and preventing growth failure.

• Hirschsprung Disease (Megacolon): Absence of ganglion cells in the colon leads to obstruction. Signs include failure to pass meconium and ribbon-like stools. Surgical removal of the aganglionic section is required.

• Gastroesophageal Reflux (GERD): Common in infants. Management includes thickening feeds with rice cereal, keeping the infant upright for 30 minutes post-feed, and medications (PPIs). Severe cases may need a Nissen fundoplication.

• Celiac Disease: Immunological reaction to gluten damaging small intestine villi. Symptoms include steatorrhea (fatty stools) and failure to thrive. Strict lifelong avoidance of wheat, barley, rye, and oats is the only cure.

• Biliary Atresia: Bile duct obstruction leading to liver failure. Presents with jaundice and pale stools. The Kasai procedure is the primary treatment, though liver transplant is often eventually needed