Measles (Rubeola)
Cough, Coryza, Conjunctivitis + Koplik spots (white buccal lesions); maculopapular rash begins at hairline and spreads downward.
Kawasaki Disease
Fever >= 5 days + 4 of 5 CRASH criteria: Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hands/feet erythema; IVIG + high-dose Aspirin.
The 5 Cyanotic 'Ts'
1. Truncus arteriosus, 2. Transposition of great arteries, 3. Tricuspid atresia, 4. Tetralogy of Fallot, 5. Total anomalous pulmonary venous return.
Neonatal Jaundice
Pathologic if within first 24 hours of life, rate of rise > 5 mg/dL/day, or direct (conjugated) bilirubin > 2 mg/dL; risk of kernicterus.
The Classic Pediatric Exanthems Master Guide
| Exanthem | Etiology | Prodrome & Pathognomonic Signs | Rash Evolution |
|---|---|---|---|
| Measles (Rubeola) | Paramyxovirus | High fever, 3 Cs (Cough, Coryza, Conjunctivitis), Koplik spots | Confluent maculopapular rash begins at hairline and descends; stains coppery-brown |
| Rubella (German Measles) | Togavirus | Low fever, suboccipital & postauricular lymphadenopathy, Forchheimer spots | Maculopapular rash begins on face and descends; resolves much faster without staining |
| Roseola Infantum (Exanthem Subitum) | HHV-6 | Very high fever (3-5 days), child appears well; risk of febrile seizures | Fever abruptly breaks, immediately followed by macular rash on trunk that spreads to limbs |
| Erythema Infectiosum (Fifth Disease) | Parvovirus B19 | Mild fever, URI symptoms; aplastic crisis in sickle cell disease; hydrops fetalis in pregnancy | Erythematous 'slapped-cheek' appearance, followed by lace-like reticular rash on extremities |
| Scarlet Fever | Group A Strep (Pyrogenic exotoxin) | Fever, pharyngitis, strawberry tongue, Pastia lines in skin creases | Sandpaper-texture erythematous rash, circumoral pallor; followed by desquamation |
Pediatric Upper Airway Obstruction: Croup vs. Epiglottitis
| Feature | Laryngotracheobronchitis (Croup) | Acute Epiglottitis |
|---|---|---|
| Etiology | Parainfluenza virus (Types 1 and 2) | Haemophilus influenzae type b (Hib), Strep/Staph |
| Clinical Presentation | Gradual onset, barking 'seal-like' cough, inspiratory stridor, hoarseness | Sudden onset high fever, toxic appearance, 3 Ds: Drooling, Dysphagia, Distress |
| Patient Posture | Comfortable sitting or supine | Tripod positioning (sitting forward, neck extended, jaw thrust) |
| Neck Radiograph | AP neck: Steeple sign (subglottic tracheal narrowing) | Lateral neck: Thumbprint sign (swollen, enlarged epiglottis) |
| Management | Dexamethasone (oral/IM) ± Racemic epinephrine nebulizer | Airway emergency: Transfer to OR for intubation; IV Ceftriaxone |
OMM Board Correlate: Pediatric Cranial & Condylar Decompression
- Condylar Compression: Intrauterine constraint or birth trauma compresses the occipital condyles against the lateral masses of atlas (C1). This compresses the hypoglossal canal (CN XII), resulting in poor suckling, difficulty latching, and tongue dyspraxia.
- Jugular Foramen Compression: Compression between temporal and occipital bones irritates CN IX (glossopharyngeal), CN X (vagus), and CN XI (accessory), contributing to infantile colic, regurgitation, and torticollis.
- Condylar Decompression Technique: Gentle cephalad and lateral traction applied by physician finger pads over the occiput relieves somatic compression and normalizes suck reflex.
Board Traps & Common Distractors
- In a child presenting with suspected acute epiglottitis (drooling, tripoding, stridor), NEVER inspect the pharynx with a tongue depressor or agitate the child; reflex laryngospasm can cause immediate, irreversible complete airway obstruction.
- Kawasaki disease untreated with IVIG carries a 25% risk of coronary artery aneurysms, leading to myocardial infarction in young children; always obtain baseline echocardiography.
- In neonatal jaundice occurring within the first 24 hours of life, consider hemolysis (Rh or ABO incompatibility) or sepsis; unconjugated hyperbilirubinemia crossing the blood-brain barrier precipitates kernicterus (basal ganglia staining and choreoathetosis).