Community pediatrics

Question 1

2 interventions that are the most successful in preventing SIDS?

Answer 1

Back to sleep

Reducing maternal smoking during pregnancy (1/3 decrease)

Question 2

Protective factors for SIDS

Answer 2

1. Back to sleep
2. Reduced maternal smoking during pregnancy
3. Sleeping in own crib/ bassinette/ cradle
4. Avoiding sleeping in car seats/ chairs/ bouncers
5. Sleeping in parents room (especially first 6 months) in own bed
6. Keeping sleep area free of blankets, toys, bumper pads etc
7. Avoid overheating infant
8. breastfeeding (especially exclusive BF for ist 6 months, can reduced upto 6 months)
9. pacifiers (but best to withhold until breastfeeding is established)

Question 3

when are children developmentally ready to handle 1. pureed foods 2. complicated foods such as hot dog wheels?

Answer 3

1. 4-6 months

2. 3 years

Question 4

if no food introduction at 6 months of age, the infant is at risk of the following deficiencies :

Answer 4

1. iron but also fat and zinc (other macronutrients)

Question 5

Key weaning recommendations:

Answer 5

1. exclusive breastfeeding for the first 6 months of life
2. support complimentary breastfeeding for upto 2 years and beyond with additional nutritional guidance
3. Iron fortified food first at 6 months of age
4. adise slow progressive weaning when possible
5. inform and support breastfeeding mothers while ensuring adequate nutrition of the baby, regardless of time of weaning

Question 6

frequency OF congenital hearing loss

Answer 6

1-3/1000

Question 7

Two provinces that have UNHF

Answer 7

Ontario and BC. Quebec has approved but waiting

Question 8

Types of hearing loss

Answer 8

conductive, sensorineuronal, mixed
most congenital is sensorineuronal
50% genetic
70% of genetic causes are non syndromic (ex: connexion 26)

Question 9

Risk factors for hearing loss

Answer 9

NCU stay > 2 days, assited ventilation/ ecmo/ exchange transfusion for hyperbili, ototoxic drugs
Genetic
TORCH infections
ear malformations
features suggestive of a particular syndrome

Question 10

2 types of tests

Answer 10

OAE -> measures cochlear vibrations

ABR: measures brainstem response, therefore can also pick up auditory neuropathy

Question 11

Prove that UNHS is effective

Answer 11

lower age of diagnosis
higher scores on school tests (20-40%) -> verbal, social
precise and reliable (false psotive 2%)

Question 12

what to do if hearing screen fail

Answer 12

refer and repeat as per testing pathway
is established, early ent assessment
ophthalmology
early intervention with parents and slp
genetics consultation

Question 13

Name three key features of conducting a genital exam in children:

Answer 13

1. No force or restraint should be used.
2. THe reasons and indications should be clearly explained prior to beginning the exam.
3. For children, keep parent close by. For older children or adolescents, have a nurse or a parent in the room, and the reason for their presence explained.

Question 14

Two problems with people choosing homeopathy

Answer 14

35% of practitioners do not actively recommend vaccines!

delay in seeking conventional treatment

Question 15

What are the key features to talk about when counseling someone on homeopathy

Answer 15

“like cures like principle
each compound diluted a lot, so not actually found in pill/ bottle in any significant amount
based on symptoms history
generally poor toxicity (2 reports: 1 of diaper rash MERCURY poisoning, one of mercury ingestion)
may be more effective than placebo, not more effective than conventional medicine
Problem is poorly designed studies and variations in practice