varying degrees of cognitive affect

brain/head is small

no cognitive deficiency 

mishaped head

usually flat head slanted to one side

very common

second hand smoke correlated with incidence

incidence less in breast fed babies

irritability 

pulling at ear

fever

postauricular and cervical lymph node enlargement

pain with sucking, chewing

rupture- purulent drainage

Antibiotic therapy if warranted

Antipyretics/Analgesics

Follow up necessary

encourage breast feeding

discourage smoking

feeding positioning

prevent recurrent infections to avoid tubes

prevent hearing loss because of scarring of tympanic membrane

can get meningitis from untreated OM

infection of external ear canal

overgrowth of normal flora/pathogens

prompted by wetness in ear

antibiotics

corticosteroid drops

keep ear dry

avoid removing cerumen

dry ears after swimming

fluid or infecion

aided with treatment or hearing aids

damage to hair cells or nerve cells

cochlear implants

lack of startle reflex

lack of response to noise

unable to localize sounds by 6 months

minimal verbalizations

use of gestures in older children

monotone speech

yelling

placement: size, alignment, spacing

puffiness

allergic shiners

conjunctiva

sclera

presence of redness, sweling or drainage

PERRLA

EOM

common childhood disorder

can be allergic or bacterial

severe itching

drainage common

agressive antibiotic treatment

WMC for comfort

assess for neurologic symptoms

lean forward

apply pressure/ice to bridge of nose

packing of naris if necessary

if frequent/persistent may indicate a bleeding disorder

purulent, foul smelling drainage 

may require sedation to remove

results from incomplete fusion of embryonic structures

associated with development of nasal structures

Syndromes that have cleft lip and or cleft palate as features

or factors that cause

chromosomal abnormalities

teratogens (drugs- anticonvulsants, Dioxin)

Maternal nutrition

maternal smoking

speech problems are the norm- require speech therapy

feeding challenges

long term problems with social acceptance, malposition of teeth 

numerous surgeries in stages may be needed

help parents work through emotions

special feeding devices-Haberman feeder

parent education

frequent burping needed

supine positioning

restraints required

meticulous care of suture line

observe for bleeding, excessive swelling at site

Viral

herpez zoster

canker sores

chemo induced

painful

affects eating

gentle mouth care

analgesics

inflammation of lymphoid tissue

abscess formation

OM

asses- Fluids, Airway, Pain

post op