Although part of the Millennial Generation, I am by no means a “techie.” For example, I do not own a smartphone. I do not have accounts on Facebook, Twitter, or Pinterest. I am not a computer whiz kid or computer science savant. But I find my iPad as essential as my vision, and rarely leave home without it. To help the tech-savvy and tech-simple alike, I have compiled a list of 10 useful apps for general pediatricians.
I used certain criteria for inclusion. First, the app must be user friendly. Second, the app must be inexpensive, ie, less than $5 (I am on a resident’s budget, after all!). And third, the app must be of practical value to a general pediatrician’s practice.
1. Google Translate (free). In a busy pediatrics office without access to a translator, this app can be a lifesaver. This app translates English into 57 languages — and back. Speaking into the microphone, you can record your questions or instructions of up to 30 seconds into the voice recognition system. Results are then displayed in text in both English and the other language. This allows you to know immediately whether your device recorded your words exactly. If not, the app has a function that allows you to edit or make any corrections. Then, by pressing your phone’s speaker button, the app will verbalize your translation to the patient. You can also do the process in reverse. Have your patient speak into the microphone, and the app will translate the patient’s words into written and verbal English text.
Although not perfect, using the app for specific medical terms such as “pancreatitis” or “febrile seizure” is probably better than using a 7-year-old sibling as a translator. Of course, having a live adult translator or a translating phone subscription remains the gold standard medico-legally.
Drawbacks: It does a poor job at translating measurements using “teaspoons.” Instead, I found saying “milliliters” worked better. Translating specific antibiotics was also limited, but this easily can be overcome by free texting (ie, typing the word rather than dictating). Also, the audio function is not available for all 57 languages. Obtaining an entire history and physical using the app could take a while, but probably would work better than resorting to your acting skills for things like “vomiting” and “diarrhea.”
2. Epocrates (free). A survey of favorite apps among my fellow pediatric residents and pediatric attendings resulted in an overwhelming majority recommending Epocrates. This app allows you to easily look up any medication regarding dosing, formulas, adverse effects, etc. The app also can evaluate interactions between several drugs. Medications also can be assessed for safety indications in pregnancy and breast-feeding.
Drawbacks: The “monitoring” category was limited for specific guidelines. For example, when searching “risperidone,” Epocrates lists several laboratory evaluations to follow, without the specific timing and frequency.
3. Pedi QuikCalc (free). This app is perfect for those who prefer a less-detailed version of Epocrates, but who desire calculations done instantly. Several features are quite helpful. First, by entering the child’s weight and selecting the medication, the app will automatically calculate the correct dose. The app displays how it arrived at this dose in mg/kg and lists all of the available concentrations.
This app will also list whether or not the drug is approved for use in pregnancy and breast-feeding, or if adjustments must be made for renal impairment. The drug list itself is not nearly as all-inclusive as in Epocrates, but is sufficient for most circumstances.
The “more” category at the bottom of the app is particularly useful for its calculator tools, including a BMI calculator, mid-parental height calculator, body surface area calculator, and blood pressure percentiles calculator. A link for a bilirubin calculator provides phototherapy guidelines based on age.
The “IV” category at the bottom quickly calculates a fluid bolus and maintenance fluid rate based on the patient’s weight. The “weight” category at the bottom can also be used as a calculator, particularly for weight changes over time. This will obviously be very useful in dehydrated patients, in the newborn nursery, or during the first week or two of life when weight loss in infants is especially important. These calculators combined with the dosing function make this app useful for pediatricians who prefer to rely on one or two apps that will perform multiple functions. However, this app could be improved by expanding the drug list and listing more side effects.
Screen captures from an iPad using the Pedi QuikCalc app.
4. PALS Advisor 2012 Pediatric Advanced Life Support ($1.99). A fellow resident recommended this one, saying “This app is awesome!” She was right. No pediatrician wants to encounter an emergency situation unprepared. The PALS adviser can be used in two ways. First, by identifying an initial loss-of-consciousness scenario, steps of resuscitation can be clicked through by answering “yes” or “no” questions.
Alternatively, algorithms allow you to view resuscitation instructions in their entirety without multiple clicks. The app includes the most recent recommendations for basic life support, as well as neonatal resuscitation guidelines. For the neonatal resuscitation, I prefer the algorithm version instead of having to click through heart rates to get to the next step.
In an emergent situation, one may not have a free hand for clicking. This app will probably be more helpful in an ICU or hospital setting, but at some point, you’ll surely encounter very sick patients in your office. This will allow you to be better prepared when you may be personally overly stressed. Drawback: This is available for the iPhone and iPad only.
5. Pedistat ($2.99). Although somewhat similar to the PALS app in that it focuses mostly on advanced life support, the Pedistat app includes more everyday categories, including normal vital signs, toxicology, equipment, etc. This app is simple, straightforward, and does not require a lot of clicks.
To start, a weight may be entered, but the app will also estimate doses and sizes of equipment if only an age or height is available. For example, after selecting the “equipment” category after entering in an age, Pedistat will give you chest tube sizes, endotracheal tube (ETT) sizes, Foley catheter sizes, laryngoscope blade sizes, and so on. The “fluid resuscitation” category automatically calculates fluid maintenance rates and bolus amounts. The Glasgow Coma Scale portion of the app allows the user to calculate a score based on age appropriate response. Normal vital signs are based on age. This app is not nearly as detailed as the PALS app in regards to instructions for advanced life support, but simplicity is the beauty of this app.
6. BiliCalc ($1.99). Although I had a difficult time downloading this, it is extremely simple and user friendly for determining whether phototherapy is warranted based on the 2004 American Academy of Pediatrics (AAP) recommendations. The infant’s age in hours can be entered along with the child’s bilirubin level. Bilirubin concentrations that require phototherapy are then listed along with corresponding neurotoxicity risk groups (low, medium, and high).
The user can easily view neurotoxicity risk factors to determine which risk group should be used for the specific patient. Information is quickly obtainable and does not require Internet connectivity. Drawback: This app only calculates phototherapy levels for infants born at 35 weeks gestational age and up.
7. Breastfeeding Management 2 ($1.99). Although most of the information on this app is useful for the novice pediatrician or support staff, the calculator section is simple and straightforward. The weight-loss calculator is probably the most useful function, as weights in the office are often recorded in pounds, which makes it difficult to calculate the percent weight loss without a calculator. This app can calculate the percent weight change using either pounds or kilograms.
However, the feeding calculator is another useful component of this app that can be used to reassure new moms. The feeding calculator allows the pediatrician to enter the age of baby in days, number of feedings per day, and whether Mom had a cesarean section. It then calculates an average amount per feeding using data from the World Health Organization (WHO) for comparison. For example, an infant on the third day of life receiving 10 feedings a day after a vaginal delivery, the expected average amount per feeding is 0.8 oz. This is also helpful for moms who are pumping and concerned they are not supplying enough milk.
8. KidsDoc ($1.99). KidsDoc is an app developed by the AAP. KidsDoc is designed to help parents know when they should bring their child in to see the doctor, or when to wait; it also recommends home measures for specific symptoms. Parents can search either by body area affected, alphabetically, or by keyword.
For example, when selecting “diaper rash,” several presentation symptoms are given; the parent can select the ones that best fit their child. From there, the parent can see when to call the doctor, ranging from “now,” “during weekday normal hours,” or it may simply recommend self-care at home. If the parent selects “call the doctor,” a primary care physician can be programmed in and the app will dial the number for them.
Thorough care advice is given for more than 90 complaints. The app also instructs parents which over-the-counter medications they may find useful for their child’s symptoms. The app also lists dosages based on weight for frequently used medication, including, ibuprofen, diphenhydramine, and dextromethorphan, and acetaminophen.
9. Parenting Ages and Stages (free). This is an additional app you can confidently recommend to your patients’ families. Developed by Parenting magazine, this app contains a plethora of information, including articles addressing common questions that parents may have, such as about development, nutrition, sleep, and behavior and discipline. There is a search function in which the user may enter in a key word, for example, “vaccines.” (Which actually leads to a fantastic article identifying and addressing common misinformation about childhood vaccines.)
My favorite feature is the ability to click on the child’s approximate age and be given a choice of articles addressing common concerns by month of life. The content featured in this app will be helpful to most parents. Drawbacks: Aside from being difficult to sort through, another downfall with this app are the advertisements at the bottom of the screen, which constantly pop up and block the text.
10. Visual Dx (free). This app is by far the best dermatology guide I have discovered. This app is technically free for 15 days. After that, the app can be purchased on an annual basis for $49.99, which breaks my rule of $5 or less, but once I downloaded the free subscription, I was hooked.
The app allows one to either build a differential diagnosis, or to select a specific diagnosis using the diagnosis look-up. The differential diagnosis is built based on your selected characteristics of the rash. For example, choosing the age of the patient, you can choose visual findings such as macular and erythematous, or scaly and plaque-like. You then select body location, along with additional information, including timing and the patient’s general appearance.
Once all of the descriptions have been entered, a fairly thorough differential is given for the rash. Clicking on one of these differentials then displays several high-quality pictures, along with descriptions, management, treatment, prognosis, etc. An ICD-9 code is even included.
Drawbacks: This app is extremely thorough and even can be downloaded onto your personal computer, although when I did, the image quality was inferior to my iPad’s. The biggest disadvantage is the subscription cost, but the 15-day trial sold me that the investment was worth it.