Peds Immune, pg 1 of 10
Which statement[s] is/are true?
• At birth the immune system is non-functional (it is partially functional at birth)
• For the first 2 months of life infants are completely protected by Antibodies from the mother. (partially protected)
• The immune system of a child is not fully functional until 6-8 years of age.
Immunity: Review
• Innate/Natural Immunity
• Intact Skin (very important in the immune response!)
• Mucous membranes
• Body pH (not as acidic as it will eventually become)
• Passive
• Placental transmission
• Breast feeding (IgG)
• Adaptive/Active (these develop over time)
• Inflammatory and phagocytic properties; born with phagocytic intact, takes a while for inflammatory response
to kick in
• Humoral-antibody mediated
• Cell mediated
Humoral Immunity
• Largely responsible for fighting bacterial infections; first time someone is exposed to a specific antigen, the body
stimulates a response to produce an antigen for that; specific antibody; the first time this happens, it takes about 72
hours to get an ample anti-body response
• B-lymphocytes
• Produced in bone marrow
• Antigen-Antibody response
• Primary immune response – 1st exposure time frame 3 days
• Subsequent <24 hours due to memory cells “remembering” the antigen
• At birth – IgG from mother – others increase through exposure during early childhood; this usually diminishes at
around 6 months of age, then slowly increases up through age 6 or 7.
Cellular Immunity
• Largely functional at birth
• T-lymphocytes
• Produced/mature in the thymus; if a baby is born without a thymus or thymus is disrupted d/t surgeries then we
really worry about an alteration in T-lymphocytes
• Responsibility in fighting viruses, fungi, slowly-developing bacterial invasions
• Beyond neonatal period they are mostly functional
Complement Activation (don’t worry if you don’t understand this!)
• Cascade that is responsible for the inflammatory response
• Inflammatory response brings stuff to the site of infection...shows us nurses indicators of infection (redness,
swelling, warmth)
• Important in inflammatory reaction; kills foreign cells
• Complement system is decreased in newborn period (1st 2 months) ; it develops after birth at different times for
different babies...baby may not be able to give us signs of WHERE the infection is, can’t wall-off the infection either
• Delays and hampers inflammatory response
Key Points!
• At birth and during the newborn period, the inflammatory response is not reliably present
• Under 6 years of age children do not have a full compliment of immunoglobulins
• Response to initial exposure to bacterial antigens takes 3 days, increasing the risk for sepsis due to difficulty
localizing and fighting bacterial infections
, Peds Immune, pg 2 of 10
Chain of Infection
• Agent to reservoir to exit to transmission to entry to host to agent…
• Agent
• Reservoir is where it lives
• Exit is how it gets out
• Transmission: airborne, contact, droplet
• Entry is how it gets into another person
• Host must be susceptible (children are MORE susceptible)
• Host becomes the agent
Measles
• Airborne (few things are truly airborne…..measles and chicken pox are); this is VERY contagious...MORE SO than
droplet! Will be on respiratory isolation; most contagious BEFORE the rash develops up to 4 days after rash shows
• Child is quite ill...symptoms are three Cs (choriza/runny nose, cough, conjunctivitis)
• Symptoms: cough, very high fever around 104-105, red eyes, rash hairline to feet, Koplik’s spots (these spots are
diagnostic for measles...bluish white spots in mouth)
• Complications: pneumonia (fairly common, can lead to ARDS), encephalitis, death
• Treat supportively
• Pain: tylenol
• Rash: keep clean and dry to reduce itchiness, Benadryl
• Eyes: warm compresses
Mumps (a happier situation than measles)
• Droplet transmission; contagious 7 days prior to swelling and stays contagious until 9 days after
• Symptoms: earache, swollen cheeks/jaw, fever, HA
• Complications: encephalitis (most common one, so need to teach parents signs of meningeal irritation), deafness
(child needs a follow-up hearing exam), testicular swelling
• No airway problems even though it looks like
• Problems with eating/drinking b/c it hurts to move jaw
• Kids are managed at home via comfort measures and fluids.
• Warm or cold compresses help
• Tylenol for pain
• Soft foods
• Hydration
Diphtheria
• A bacteria that produces an endotoxin that produces the symptoms
• Direct contact/ droplet transmission; can also get via unpasteurized milk
• Symptoms (wide-ranging): asymptomatic all the way up to “can’t breathe”, sore throat, fever, difficulty swallowing
• Complications: suffocation, paralysis (Guillian Barre), death, endocarditis (from endotoxin attacking heart),
neuropathy (from endotoxin)
• Treatment: antitoxin and abx + supportive care.
• Diphtheria has a high mortality rate in places where there is not a pediatric ICU...child needs to have airway
maintained via careful intubation.
Tetanus
• A spore that lives in dirt, gets into the body through some opening in the skin and causes production of an
endotoxin that attacks the CNS.
• Direct contact with non-intact skin; a huge cause world-wide is cutting the umbilical cord with something dirty
• Symptoms: muscle rigidity
• Complications: Respiratory, broken bones (because the muscles in young kids are stronger than the bones), death
• Treatment: antispasmodics (boat-load of Valium), so need to be careful for respiratory so be prepared for that, IV
abx, Immunoglobulin asap, Tetanus toxoid at a different site than the Immunoglobulin)
• Tetanus has a 30% mortality (even with ICU care)
Which statement[s] is/are true?
• At birth the immune system is non-functional (it is partially functional at birth)
• For the first 2 months of life infants are completely protected by Antibodies from the mother. (partially protected)
• The immune system of a child is not fully functional until 6-8 years of age.
Immunity: Review
• Innate/Natural Immunity
• Intact Skin (very important in the immune response!)
• Mucous membranes
• Body pH (not as acidic as it will eventually become)
• Passive
• Placental transmission
• Breast feeding (IgG)
• Adaptive/Active (these develop over time)
• Inflammatory and phagocytic properties; born with phagocytic intact, takes a while for inflammatory response
to kick in
• Humoral-antibody mediated
• Cell mediated
Humoral Immunity
• Largely responsible for fighting bacterial infections; first time someone is exposed to a specific antigen, the body
stimulates a response to produce an antigen for that; specific antibody; the first time this happens, it takes about 72
hours to get an ample anti-body response
• B-lymphocytes
• Produced in bone marrow
• Antigen-Antibody response
• Primary immune response – 1st exposure time frame 3 days
• Subsequent <24 hours due to memory cells “remembering” the antigen
• At birth – IgG from mother – others increase through exposure during early childhood; this usually diminishes at
around 6 months of age, then slowly increases up through age 6 or 7.
Cellular Immunity
• Largely functional at birth
• T-lymphocytes
• Produced/mature in the thymus; if a baby is born without a thymus or thymus is disrupted d/t surgeries then we
really worry about an alteration in T-lymphocytes
• Responsibility in fighting viruses, fungi, slowly-developing bacterial invasions
• Beyond neonatal period they are mostly functional
Complement Activation (don’t worry if you don’t understand this!)
• Cascade that is responsible for the inflammatory response
• Inflammatory response brings stuff to the site of infection...shows us nurses indicators of infection (redness,
swelling, warmth)
• Important in inflammatory reaction; kills foreign cells
• Complement system is decreased in newborn period (1st 2 months) ; it develops after birth at different times for
different babies...baby may not be able to give us signs of WHERE the infection is, can’t wall-off the infection either
• Delays and hampers inflammatory response
Key Points!
• At birth and during the newborn period, the inflammatory response is not reliably present
• Under 6 years of age children do not have a full compliment of immunoglobulins
• Response to initial exposure to bacterial antigens takes 3 days, increasing the risk for sepsis due to difficulty
localizing and fighting bacterial infections
, Peds Immune, pg 2 of 10
Chain of Infection
• Agent to reservoir to exit to transmission to entry to host to agent…
• Agent
• Reservoir is where it lives
• Exit is how it gets out
• Transmission: airborne, contact, droplet
• Entry is how it gets into another person
• Host must be susceptible (children are MORE susceptible)
• Host becomes the agent
Measles
• Airborne (few things are truly airborne…..measles and chicken pox are); this is VERY contagious...MORE SO than
droplet! Will be on respiratory isolation; most contagious BEFORE the rash develops up to 4 days after rash shows
• Child is quite ill...symptoms are three Cs (choriza/runny nose, cough, conjunctivitis)
• Symptoms: cough, very high fever around 104-105, red eyes, rash hairline to feet, Koplik’s spots (these spots are
diagnostic for measles...bluish white spots in mouth)
• Complications: pneumonia (fairly common, can lead to ARDS), encephalitis, death
• Treat supportively
• Pain: tylenol
• Rash: keep clean and dry to reduce itchiness, Benadryl
• Eyes: warm compresses
Mumps (a happier situation than measles)
• Droplet transmission; contagious 7 days prior to swelling and stays contagious until 9 days after
• Symptoms: earache, swollen cheeks/jaw, fever, HA
• Complications: encephalitis (most common one, so need to teach parents signs of meningeal irritation), deafness
(child needs a follow-up hearing exam), testicular swelling
• No airway problems even though it looks like
• Problems with eating/drinking b/c it hurts to move jaw
• Kids are managed at home via comfort measures and fluids.
• Warm or cold compresses help
• Tylenol for pain
• Soft foods
• Hydration
Diphtheria
• A bacteria that produces an endotoxin that produces the symptoms
• Direct contact/ droplet transmission; can also get via unpasteurized milk
• Symptoms (wide-ranging): asymptomatic all the way up to “can’t breathe”, sore throat, fever, difficulty swallowing
• Complications: suffocation, paralysis (Guillian Barre), death, endocarditis (from endotoxin attacking heart),
neuropathy (from endotoxin)
• Treatment: antitoxin and abx + supportive care.
• Diphtheria has a high mortality rate in places where there is not a pediatric ICU...child needs to have airway
maintained via careful intubation.
Tetanus
• A spore that lives in dirt, gets into the body through some opening in the skin and causes production of an
endotoxin that attacks the CNS.
• Direct contact with non-intact skin; a huge cause world-wide is cutting the umbilical cord with something dirty
• Symptoms: muscle rigidity
• Complications: Respiratory, broken bones (because the muscles in young kids are stronger than the bones), death
• Treatment: antispasmodics (boat-load of Valium), so need to be careful for respiratory so be prepared for that, IV
abx, Immunoglobulin asap, Tetanus toxoid at a different site than the Immunoglobulin)
• Tetanus has a 30% mortality (even with ICU care)
