Child Health Flashcards
When do dental cariers happen?
when oral bacteria metabolise sugar and produce acid that demineralises enamel and dentin from the hard coating of the tooth.
What can severe caries lead to?
pain, infection,sepsis, death
What is dental caries a common cause of?
common cause of school and work absenteeism and impact on quality of life and wellbeing
Who is most at risk of developing dental caries?
Children and adolescent
What is the management of dental caries?
involve tooth extraction
Why is tooth extraction bad?
- extremely expensive
- time consuming
- widely unavailable in low income countries
What is social deprivation associated with?
excessive intake of sugar
What occurs with dental caries?
obesity, disproportionally affecting disadvantaged populations
How can you prevent dental caries?
- sugar reduction in the diet
- maintaining good oral hygiene
How much sugar should be reduced?
Reducing free sugar intake to less than 10% of energy intake can minimise the risk of developing dental caries throughout the life course
What are some population wide approaches for dental caries?
- water fluoridation
- fluoride varnish programmes
- sugar-reduction programmes
What else do you need to involve with child health?
involve families and caregivers
What are examples of Adverse Childhood Experience (or an ACE)?
- Experiencing abuse: Physical, sexual, psychological or neglect.
- Witnessing domestic abuse
- Having a close family member or caregiver who misused drugs or alcohol
- Having a close family member or caregiver with mental health problems
- Having a close family member or caregiver who served time in prison
- Experiencing parental separation or divorce on account of relationship breakdown.
What is the association of ACE with physical inactivity, overweight or obesity, and diabetes (ORs of less than two)?
weak or modest
What is the association of ACE for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three)?
moderate
What is the association of ACE for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six)?
strong
What is the strongest association for ACE?
problematic drug use and interpersonal and self-directed violence (ORs of more than seven)
What are some international resolution for ACE?
Sustainable Development Goals
What can you have good consultations with children and families?
- Be opportunistic
- E.g. in ENT see dental carrier so suggest diet - Be sensitive
- Non-judgemental approach
- 47% of mothers and 52%of fathers with obese children think their child is a healthy weight
- Many parents find it difficult the know if their child is growing healthily - Strength based approach (focus on positives) ‘tell me about an activity you do that makes you feel strong’
- Focus of barriers of a particular importance to the child
What sort of barriers could a child have?
- You may see children with LT conditions such as asthma, diabetes, epilepsy or cancer where the family have concerns about the impact of physical activity aggravating the condition - when there are a multitude of benefits in LT conditions in children and physical activity can actually be safe and fun
- Moving medicine resource
What other things can you do to have good consultations with children and families?
- Relate to other children ‘ do you mind if I share some ideas with you that have helped other people your age ‘
- Engage parents and families - see if healthy start rather than talk about buying fresh food if can’t afford
- Specific and short term goals - eat the rainbow
- Part of daily routine - walk to school
What is the Leap criteria?
- Local
- Enjoyable
- And
- Practical
What is the national child measurement programme?
- Measure height and weight
- Defining children as overweight or obese is a complex process
- Children of different ages and sex grow and develop at different rates
- Therefore BMI is categorised differently than in adults
- LOOK AT BMI centile
What do you do if no BMI centile criterion?
- Universal prevention
- Consultation with frontline healthcare professionals
- Public health approaches
What are the options if BMI centile criterion is >91st centile?
- Intensive and community base
- Time specific
- Public health approaches
What are the options if BMI centile criterion is ?99.6th centile or >91st with morbidities / complex needs?
- Specialist MDT
- Weight management clinics
- Longer term follow up
Are surgical options available in children?
no
How would you ask questions to bring up health for families?
- ‘Would it be ok if I ask some questions about the families diet / physical activity’
- ‘How important is it to talk about the families health rn’
- ‘How do you feel about the families diet / lifestyle now’
- What solutions do you already have in mind
- What support would you like / what would be useful
- Do you want to come back and talk about this another time I can see you might not be ready to have this conversation
- Smart goals: when? / how?
What are the most expensive foods?
- Fruit and vegetables are the most expensive food group per 1000 calories on the “Eatwell Guide”
- Conversely, macronutrient dense and micronutrient poor foods much cheaper per 1000 calorie
What is hidden hunger?
- concept of over consumption of calories derived from cheaper, unhealthy, processed foods, which lack nutrients that are key to growth, brain development and immunity
- Sleep, physical activity, mental wellbeing and concentration are also affected by malnutrition
How can people become more active?
- UK active
- Active mile scheme
- Inclusive and accessible
- Try to make children enjoy activity for LT change
- Use schools as hubs during school holidays especially to low income families
- Tackle inequality gap
What drives how much sleep you need?
- How much sleep you need is driven by genetics
- Some people function on less than 4 as produce hypercreatin - increase orexin increase awake
- age
What are the effects of orexins?
- Autonomic function
- Food intake
- Energy expenditure and metabolic rate
- Glucose control
- Hormonal changes: inluin, glucagon, ACTH, GH, ecc
- Cerebral cortex activation and involvement of LC neurons: arousal star
What is your sleep cycle like at birth?
ultradian: cycles that repeat within a 24h period and circadian rhythm not developed until 2 months of age (breast feeding may help)
Do the circadian system change?
- Circadian system changes during teenage
- Circadian shift also related to sensitivity to light
- Late night Screen time, sleep disruption , caffeine, obesity
How much caffeine should you take during the day?
- Caffeine 400mg a day
- Half life around 5 hours
What happens if you have caffeine close to sleep?
crave more next time and sleep disturbed and becomes cyclical
What happens to the circadian system post adolescence?
circadian system starts to advance so sleep earlier and get up earlier
Why does the circadian system change post adolescence?
- Genetics
- Changes in neuropeptide expression
- Lifestyle
Production of what slows in old age?
melatonin slow in old age but not int hose maintained good health in elderly years (highlighting role of lifestyle medicine in longevity
Vulnerability to which sleep disorders changes during lifespan?
- insomnia (normal response to stress)
- Obstructive sleep apnoea (OSA)
What sleep disorders is common in adolescence?
-Sleep walking
-Night terrors
-Sleep paralysis
-Nocturnal enuresis
and tend to resolve over time
What sleep disorders is common in pregnanacy?
pregnant women restless leg syndrome when iron levels depleted
What type of sleep is associated with a negative health outcome?
Too much sleep or too little sleep
What are the key social determinants and lifestyle
behaviours identified that would be important to
address when taking a holistic approach to this
child’s health?
- poor dentition
- diet
- behavioural problems
- sleep
- immunisations
- sleep
- school absenteeism
- child in need plan
- previous DV
- family setting
How do ACE’s impact on health?
Individuals with at least four ACEs were at increased risk of multiple health outcomes
What are some ACEs with decreasing risk?
- Problematic drug use
- Interpersonal and self-directed violence
- Sexual risk taking
- Mental ill health
- Problematic alcohol use
- Smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, respiratory disease
- Physical inactivity
- Overweight or obesity
- Diabetes
How does ACEs affect development with toxic stress?
- Excessive chronic activation of stress response
- Leads to system disregulation
- Child’s developing brain
- Immune system
- Metabolic regulatory systems
- Cardiovascular system
How does ACEs affect development with epigenetics?
- Childhood experience (positive and negative) affects the ‘epigenome’ and gene expression
- Temporarily or permanently depending on how easily the gene is turned o or off
- Brain is developing most rapidly in early years so epigenetic expression shapes health and behaviour from this early stage
How can we reduce the impact of ACEs and intervention can prevent and counteract lasting harm?
- Early intervention is preferable
- Reducing stress, building responsive relationships and strengthening life and coping skills prevent the long-term effects of ACE
How do you create a lifestyle prescription?
- The symptoms web
- The 4 pillars
- How? What? When? -LEAP
- Lifestyle prescription
What is the symptoms web?
- Exercise
- Sunlight
- Genetics
- Stress
- Diet
- Infections
- Sleep
- Environment
What are the four pillars?
- Eat
- sleep
- Move
- relax
