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Deep partial-thickness: These burns extend into the deeper dermis, damaging nerve endings and blood vessels. Because they affect significant tissue layers and fluid balance, they are included in TBSA calculations.

Full-thickness: Full-thickness burns destroy the entire dermis and epidermis, often requiring grafting for healing. They significantly affect fluid shifts and metabolic needs, so they are always counted in TBSA.

Superficial partial-thickness: These burns extend into the upper dermis and cause blistering and pain. Since they involve more than just the epidermis, they are included in TBSA calculations to guide fluid resuscitation.

Keep infant upright for 20–30 minutes after feeds: Maintaining an upright position after feeding uses gravity to limit reflux and reduce regurgitation episodes. This intervention helps decrease irritability and supports better feeding tolerance.

Monitor weight closely: Infants with GERD are at risk for poor growth and failure to thrive due to calorie loss from frequent vomiting. Regular weight monitoring ensures nutritional status is maintained and identifies the need for adjustments in care.

Thicken feeds with rice cereal: Thickening formula with rice cereal can reduce the frequency of regurgitation by making feeds heavier and less likely to reflux. This intervention is often recommended under healthcare provider guidance to promote weight gain and reduce symptoms.

Hyponatremia: Salt-wasting CAH leads to aldosterone deficiency, impairing sodium reabsorption in the kidneys. This results in excessive sodium loss in urine, causing hyponatremia, which contributes to dehydration and weakness.

Hyperkalemia: Without sufficient aldosterone, potassium excretion is reduced, leading to potassium retention. This electrolyte imbalance can progress to life-threatening arrhythmias if not promptly corrected.

Hypotension: The combination of sodium loss, water depletion, and low cortisol contributes to hypovolemia. This decreases blood pressure, leading to hypotension, which is a key clinical feature of adrenal crisis.

Provide frequent burping: Infants with cleft lip swallow more air while feeding due to difficulty maintaining suction. Frequent burping helps reduce discomfort, spitting up, and risk of aspiration.

Continue breastfeeding or chest-feeding as possible: Many infants with cleft lip can still breastfeed effectively. The breast tissue helps fill the cleft and allows adequate suction, supporting bonding and nutrition.

Use a specialty bottle such as a Pigeon or Haberman feeder: These feeders are designed to compensate for poor suction by allowing milk flow with gentle compression. They ensure adequate nutrition while reducing feeding fatigue.

Position the infant semi-upright during feed: A semi-upright position uses gravity to prevent milk from entering the nasal cavity and reduces aspiration risk. It also improves comfort and efficiency during feeding.

Straining or crying with urination: Painful urination is a hallmark of UTI in young children. Irritability, crying, or straining while voiding indicates bladder or urethral irritation from infection.

Cloudy urine with foul odor: Cloudy, malodorous urine suggests bacterial overgrowth and pyuria. This is a classic finding that supports a UTI diagnosis, especially with fever and vomiting.

Frequent urination: Increased urinary frequency results from bladder mucosa irritation caused by infection. It is a typical symptom in pediatric UTI and adds further evidence to the diagnosis.