Chinese+Medical+Pediatrics

General development:
2 months: head movement 4 months: arm movement 6 months: roll over 7 months: sit up 8 months: crawling 9 months: holding and standing 12-15 months: walking

Main Characteristics - physiology:
Zang Fu not fully formed, they are "Tender and delicate and the Qi is not yet full" Children have pure Yang constitutions

Main Characteristics - pathology:
a. Children are easily susceptible to disease, this transmits and changes rapidly. The Lung, Spleen and Kidneys are the three main Zang affected in pediatric diseases - these create most pediatric illness. b. Children's Zang Qi is "clear and effective, therefore they quickly return to health" c. Major pathological factors: wind, cold, heat, dry, summer heat, dampness, lingering pathogens and improper diet; - also external toxins, immunizations, food - too little or too much, irregular feeding, unsuitable milk, early weaning, inappropriate foods, overstrain, genetics and birth This is really important - it is the underlying cause - can resolve issues for possibly a person's life. Stagnation due to accumulation of excesses You'll see: red cheeks from heat rising from the Stomach, LI or SI channels. -Irritability -Insomnia When Fluids stagnate and dry up, leading to phlegm, you'll see nasal discharge, slippery pulse and possibly cough. When this continues for a period of time, the Liver function is said to be taxed, and the Qi flow is disrupted. This creates irritability and green around the mouth. Babies will often regurgitate curdled milk, milky appearing mouth, swollen abdomen, irritability smelly sour stools..

Underlying Causes of Illness:
Toxins: 40% of water unusable Food - 1.2 billion pounds of pesticides a year PLUS toxic additives. Aflatoxin and cancer - high whey protein diets - The China Study Air Mercury: radiation, houses Infections - Semmelweis and spooks (hand washing and fetal death) HPV, H. Pylori, EBV (lymphoma), measles (leukemia), Lyme's Allergies?/ mold? Food quality, Omega 6 fatty acids, trans-fat, sugar, maternal nutrient density increasing incidence of children getting cancer... Diet - Parent exposure, child exposure Antibiotics - 50% of antibiotics used for viral infections - antibiotics create dampness and Qi xu

Newborn Checkup
Skin to Skin contact is essential

Feeding and Diet
-breast feeding reduces newborn's pain -hearing loss screening should be down for newborns -normal urination: 6x/day -normal elimination: 1 per feeding up to every 5 days -breast fed babies may be explosive loose stools

Hygiene
-Tub bathing is preferred over sponge bathing -natural cord drying is preferred -foreskin should not be manipulated -avoid clorhexidine (chemical antiseptic) with babies

Home Visits (nurses, assistants)
-within first two years of life, affects child's well-being and reduce child abuse

Palpation
-Communicate with the parents -Palpate feet -Examine eyes

Looking
Face: red, pale, yellow, green-blue (cold/pain) Tongue: Flaws: body, coat, cracks Ears: smelly, foul discharge, dark brown d/c, low small ear, tip of ear below Eyes: inflamed, blue sclera, yellow sclera, black spots in sclera, whites of eyes show while sleeping, red and dry skin between the eyebrows, puffy bags under eyes Nose: watery d/c, thick white, thick yellow, thick green, green-blue d/c, alar flare, dry/irritated, crusty, lingering cheek boil Mouth: inflammation, spots, tonsils, throat, dribbling, mouth hangs open, lips deep red with white facem lips pale, lower lips protrudes, gums red and swollen, breathing from the mouth Two Yin: yellow, diaper rash even with hygiene, sore and irritated anus, anal itching, worse at night Skin: small papular, vesicular, macular Stools: yellow, soft, not dry or oily; green, thin water flecked with white, white masses in the stool, watery and yellow with bad smell, smells like soy sauce with occasional crying, irregular stools, missing days and then diarrhea, dry and pieces of stool, itching anus, undigested food in stool, shiny stools Urine: dark yellow and painful, turbid as though containing milk, red, dark yellow Finger Diagnosis: observe vein at the palmar side of index finger (children 2-3 yrs) Red- cold; purple- heat; blue- dry; black- stagnation???? First joint on the index finger is: ‘Gate of Wind.’ Second joint is: ‘Gate of Qi.’ Third joint is: ‘Gate of Life.’

Rub finger towards the body - if veins appear only beyond the ‘gate of wind’ (mild, exterior invasion) wide-excess. Narrow-deficient -if veins appear beyond the ‘gate of Qi’ (internal, more serious) -if veins appear beyond the ‘gate of life’ (serious life threatening disease) - blue veins (Cold) - red veins (Heat) Heat: irritable, clingy, restless, insomnia, red, focus difficult, crossed eyes Cold: grumpy, whiney, colicky, wakes up with tummy pains and sweats, pale, poor appetite, loose stools, vacant eyes -Chronic tonsillitis, otitis, tickly cough, worse tired, chronic cystitis -dampness avoid cow’s milk, cheese, sugar, bananas, oranges, peanuts, wheat, etc. -antibiotics: injures qi, causes dampness Stages of pathogenic disease: 1. Shivering and phlegm 2. Fever and sweats 3. Qi xu, phlegm, possibly heat, possible yin xu

**Listening and Smelling**
Strong voice Weak voice Shouting Voice low in pitch by school age Hoarseness Gurgling Loss of voice Incessant talking, but intelligible Incoherent babbling Poor grammar, forgets words, late development Gurgling Sniffling, snoring Mouth breathing Breath like bad eggs Burping gas like bad eggs Bad apple breath
 * Voice:**
 * Speech:**
 * Breathing:**
 * Smells:**

**Questioning: 10 Questions**
-hot/cold -perspiration -head -food and drink -chest and abdomen -hearing -family illness -sleep -pregnancy, birth, postnatal menses -family circumstances

Treatment options:
a. Acupuncture and Moxa b. Chinese Herbs c. Pediatric Tui Na d. Gua sha and Cupping e. Food Therapy f. Toxin training

Children's Physiology

 * Body height:** http://www.kidsgrowth.com/res4

Posterior fontanel: within 2-4 months (sometimes already closed at birth Anterior fontanel: between 12 and 18 months
 * Closure of fontanels:**


 * Number of Teeth**

1-3 mo – 45-40 / minute 4-6 mo - 40-35 /min 6-12 mo -35-30 /min 1-3 yo – 30-25
 * Respiration rate:**

Newborns - 1 year – 120-160/min 1-3yo – 100-120/min 3-5yo – 90-110/min 5-7yo – 60-100/min 7-12yo – 70-90/min
 * Pulse rate:**

Systolic: age (y) x 2 +80mm/hg Diastolic: ½-2/3 systolic pressure
 * Blood pressure** – need special cuff

Herb Dosage
1 month – 1/6 dose, 1-12mo – 1/3-1/2 adult dose, 1-7 yo – 2/3 adult dose 7 and above – adult dose

Herb Dosage Charts
Age 1/adult dose 0-1 mo 1/18-1/14 1-6 mo 1/14-1/7 6-12 mo 1/7 –1/5 1-2 yr 1/5- ¼ 2-4 yr ¼-1/3 4-6 yr 1/3-2/5 6-9 yr 2/5-1/2 9-14 yr ½- 2/3