Mnemonics: Pediatrics in the Developing World

Six Killer Diseases of Children (EPI Targets)

What needs to be memorized: The six diseases targeted by the Expanded Programme on Immunization - Tuberculosis, Diphtheria, Pertussis, Tetanus, Poliomyelitis, Measles

Mnemonic: "Thanda Dosa Pehle, Thoda Pyaaz Mila"

(Cold dosa first, mixed with some onion)

🔗 The Breakdown:

• Thanda → Tuberculosis
• Dosa → Diphtheria
• Pehle → Pertussis (Whooping cough)
• Thoda → Tetanus
• Pyaaz → Poliomyelitis
• Mila → Measles

Top Causes of Under-5 Mortality in Developing Countries

What needs to be memorized: The five leading causes of death in children under 5 years - Pneumonia, Diarrhea, Malaria, Neonatal conditions, Malnutrition

Mnemonic: "Papa Deta Malai Nahi, Mummy"

(Papa doesn't give cream, Mummy does)

🔗 The Breakdown:

• Papa → Pneumonia (leading cause)
• Deta → Diarrhea
• Malai → Malaria
• Nahi → Neonatal conditions
• Mummy → Malnutrition

Danger Signs in Severe Acute Malnutrition (SAM)

What needs to be memorized: Six danger signs requiring immediate admission - Lethargy, Not able to drink/breastfeed, Persistent vomiting, Convulsions, Hypothermia, Hypoglycemia

Mnemonic: "Le Nahi, Vomit Convulsion - Hypo-Hypo"

(Won't take feed, vomiting, convulsions, and double hypo problems)

🔗 The Breakdown:

• Le (nahi) → Lethargy + Not able to drink
• Nahi → Not able to drink or breastfeed
• Vomit → Persistent Vomiting (vomits everything)
• Convulsion → Convulsions
• Hypo → Hypothermia
• Hypo → Hypoglycemia

IMNCI Danger Signs in Sick Child (2 months to 5 years)

What needs to be memorized: Four danger signs requiring urgent referral - Not able to drink/breastfeed, Vomits everything, Convulsions, Lethargic/unconscious

Mnemonic: "Nahi Vomit - Convulsion Leti"

(Won't eat, vomits, gets convulsions, lies lethargic)

🔗 The Breakdown:

• Nahi → Not able to drink or breastfeed
• Vomit → Vomits everything
• Convulsion → Convulsions
• Leti → Lethargic or unconscious

Kwashiorkor vs Marasmus - Quick Identification

What needs to be memorized: Key distinguishing features of the two types of severe malnutrition

Mnemonic:
"KWASHI = Kid With A Swollen body, Hair changes, Irritable (Edema present)"
"MARASMUS = MARA (wasted) + SOOKHA (dried up - No edema, just skin and bones)"

🔗 Key Points:

• Kwashiorkor → Edema present (swollen), moon face, skin changes, irritable child
• Marasmus → No edema, severe wasting, old man face, alert child
• Marasmic-Kwashiorkor → Both edema AND severe wasting (worst form)

Vitamin A Deficiency - Progression of Ocular Signs

What needs to be memorized: Sequential progression from early to late stages - Night blindness → Conjunctival xerosis → Bitot's spots → Corneal xerosis → Keratomalacia → Corneal scar

Mnemonic Story: "Night me dekho: Conjunctiva dry, Bitot spots dikhte, Cornea bhi dry, phir Melt hota, Scar rehta"

(At night look: Conjunctiva dries, Bitot spots appear, Cornea also dries, then melts, scar remains)

🔗 The Progression:

• Night → Night blindness (earliest sign, reversible)
• Conjunctiva dry → Conjunctival xerosis
• Bitot spots → Bitot's spots (foamy triangular spots)
• Cornea dry → Corneal xerosis
• Melt → Keratomalacia (cornea melts - irreversible)
• Scar → Corneal scar (permanent blindness)

WHO ORS Composition (Low Osmolarity ORS)

What needs to be memorized: Key electrolyte concentrations in mmol/L - Sodium: 75, Glucose: 75, Chloride: 65, Potassium: 20, Citrate: 10

Mnemonic: "Sachin-Sachin ki TWIN 75 (Na + Glucose), Kohli ka 65 (Cl), Dhoni ka 20 (K), aur 10 extras (Citrate)"

(Using cricket scores to remember concentrations)

🔗 The Numbers:

• TWIN 75s → Sodium = 75 mmol/L AND Glucose = 75 mmol/L (same!)
• 65 → Chloride = 65 mmol/L (slightly less than Na)
• 20 → Potassium = 20 mmol/L
• 10 → Citrate = 10 mmol/L (least)

💡 Quick tip: The two main ingredients (Na & Glucose) have the same concentration of 75!

APGAR Score Components

What needs to be memorized: Five parameters assessed at birth - Appearance, Pulse, Grimace, Activity, Respiration

Mnemonic: The word APGAR itself is the mnemonic!

🔗 The Breakdown:

• A → Appearance (skin color - pink vs blue/pale)
• P → Pulse (heart rate - >100 vs <100 vs="">
• G → Grimace (reflex irritability/response to stimulation)
• A → Activity (muscle tone - active vs some flexion vs limp)
• R → Respiration (breathing - good cry vs weak vs absent)

💡 Remember: Scored at 1 minute and 5 minutes. Score of 7-10 is normal.

WHO Breastfeeding Recommendations

What needs to be memorized: Exclusive breastfeeding for 6 months, start complementary feeding at 6 months, continue breastfeeding till 2 years or beyond

Mnemonic: "6-6-24 Rule" or "Half-Half-Double Year"

🔗 The Timeline:

• 6 months → Exclusive breastfeeding ONLY (no water, no other food)
• 6 months onwards → START complementary feeding (while continuing breastfeeding)
• 24 months (2 years) → Continue breastfeeding till 2 years or beyond

💡 Think: First half year exclusive, from half year add food, total double year (2 years)

Gross Motor Milestones - The 3-Month Rule

What needs to be memorized: Key gross motor milestones occur every 3 months in the first year - 3 months: Head control, 6 months: Sits, 9 months: Stands with support, 12 months: Walks

Mnemonic: "Har 3 mahine mein kuch naya - HEAD, SIT, STAND, WALK"

(Every 3 months something new)

🔗 The Progression:

• 3 months → HEAD control (holds head steady)
• 6 months → SITS without support
• 9 months → STANDS with support
• 12 months → WALKS alone

💡 Bonus: Social smile at 6 weeks, Runs at 18 months

Dehydration Classification - "Some" vs "Severe"

What needs to be memorized: Signs of Some Dehydration (Restless, Eyes sunken, Drinks eagerly, Skin pinch slow) vs Severe Dehydration (Lethargic, Eyes sunken, Not drinking, Skin pinch very slow)

Mnemonic:
"SOME dehydration = REDS"
"SEVERE dehydration = LENS"

🔗 SOME Dehydration (REDS):

• R → Restless/irritable child
• E → Eyes sunken
• D → Drinks eagerly (thirsty!)
• S → Skin pinch goes back slowly

🔗 SEVERE Dehydration (LENS):

• L → Lethargic or unconscious
• E → Eyes sunken
• N → Not able to drink (or drinks poorly)
• S → Skin pinch goes back VERY slowly (>2 seconds)

💡 Need 2 or more signs to classify! Eyes sunken is common to both.

Top Causes of Neonatal Mortality in Developing Countries

What needs to be memorized: Birth asphyxia, Prematurity/Low birth weight, Neonatal sepsis, Hypothermia, Neonatal jaundice

Mnemonic Story: "Naya janam liya bachche ne: Pehle ASPHYXIA hui, phir PREMATURE nikla, SEPSIS ho gaya, THANDA (Hypothermia) ho gaya, aur YELLOW (Jaundice) bhi dikha"

(Baby is born: First gets asphyxiated, is premature, develops sepsis, becomes cold, and turns yellow)

🔗 The Five Major Causes:

• ASPHYXIA → Birth asphyxia (failure to breathe at birth)
• PREMATURE → Prematurity & Low birth weight complications
• SEPSIS → Neonatal sepsis (infections)
• THANDA/COLD → Hypothermia (newborn getting cold)
• YELLOW → Neonatal jaundice (severe hyperbilirubinemia)

Vitamin A Supplementation Schedule (India)

What needs to be memorized: 9 months: 1 lakh IU (with measles vaccine), 18 months: 2 lakh IU, then 2 lakh IU every 6 months till 5 years

Mnemonic: "Cricket Scoring - 9 pe Single (1), 18 pe Double (2), phir har 6 mahine Double-Double (2-2)"

🔗 The Schedule:

• 9 months → 1 lakh IU (100,000 IU) - given with measles vaccine
• 18 months → 2 lakh IU (200,000 IU) - doubled dose
• 2-5 years → 2 lakh IU every 6 months (continues the higher dose)

💡 Remember: First dose is 1 lakh at 9 months, all subsequent doses are 2 lakh each!