Community Pediatrics Committee - Part 2

Question 1

What kind of approach do we advocate for when we teach parents about toilet learning?

Answer 1

The child-oriented approach

Question 2

Most children in western countries achieve bladder and bowel control between which age?

Answer 2

24 months to 48 months

Question 3

What are 4 of the 7 signs of a child’s toilet learning readiness?

Answer 3

1. Able to walk to the potty chair
2. Stable while sitting on the potty
3. Able to remain dry for several hours
4. Receptive language skills allow the child to follow simple 1-step or 2-step commands
5. Expressive language allows the child to communicate the need to use the potty
6. Desire to please based on positive relationship with caregivers
7. Desire for independence and control of bowel or bladder function

Question 4

What should be done if a child expresses toileting refusal?

Answer 4

A one to three-month break from training is suggested

Question 5

What does the Canadian Dental Association recommend in regards to pacifier use (3 recommendations)?

Answer 5

1. Pacifiers are preferred over thumb sucking
2. Do not put sugar or sweetener on the pacifier
3. Sucking habit should stop before the permanent teeth erupt

Question 6

Most experts will agree that pacifiers are associated with which 3 negative outcomes? (not evidence proven)

Answer 6

1. Early breast weaning
2. AOM
3. Dental problems

Question 7

Early pacifier use signifies what to the HCP?

Answer 7

Possible breastfeeding difficulties

Question 8

In which patients should pacifier use be restricted in?

Answer 8

Patients with chronic or recurrent AOM

Question 9

At what age do children become aware of racial differences?

Answer 9

By 3 years of age

Question 10

At what age do children understand race permanence?

Answer 10

By 7 years of age

Question 11

In an infant or a school aged female child, what is the preferred position for a genital examination?

Answer 11

Girls can sit on the parent’s or caregiver’s lap in the supine frog-legged position

Question 12

In an infant or a school aged male child, what is the preferred position for a genital examination?

Answer 12

Lateral decubitus position

Question 13

What are the 4 identified causes of malnutrition in neurologically impaired children?

Answer 13

1. Inadequate intake
2. Increased losses
3. Altered metabolism
4. Oromotor dysfunction

Question 14

What are two additional measures that can be done in order to evaluate the nutritional status of a neurologically impaired child that may be more accurate than weight-for-height to detect malnutrition?

Answer 14

1. Triceps skinfold thickness

2. Mid-arm circumference

Question 15

What bloodwork should you do if you suspect osteoporosis in a patient with malnutrition?

Answer 15

Phosphorus, Calcium, Vitamin D, ALP

Question 16

It may be difficult to evaluate bone mineral density in neurologically impaired patients (due to skeletal deformities and inability to stay still). What may be an alternative option to BMD scans?

Answer 16

Bone quantitative U/S

Question 17

What is the indication for GJ tube?

Answer 17

Patients with reflux who are poor candidates for the anti-reflux procedure

Question 18

What should the weight for height percentile be for a neurologically impaired child who is wheelchair bound but able to accomplish transfers?

Answer 18

Weight-for-height should be in the 25th percentile

Question 19

What are three barriers to health care for foster children and youth?

Answer 19

1. Lack of or inadequate medical records
2. Lack of consistent care or follow-up due to temporary placements
3. Difficulty accessing services

Question 20

What is foster care?

Answer 20

Foster care is the provision of care and supervision by a family other than a biological parent or guardian, and is approved and arranged by a child welfare authority

Question 21

The AAP recommends an initial medical visit with a foster child after how many days of placement?

Answer 21

The initial medical visit should be within 24 hours of placement

Question 22

Name at least four common medical issues in the CPS statement found in foster children?

Answer 22

1. Poor hygiene
2. Underimmunization
3. Dental neglect
4. Contraceptive needs for adolescents

Question 23

Is routine ordering of tests recommended in the initial medical visit with a foster child?

Answer 23

No, but things to consider based on need include: complete blood count, ferritin, lead level, HIV, hepatitis B and C titres, b-hCG, cervical or urethral swabs for STIs, and Pap smear

Question 24

What does “housing need” mean?

Answer 24

The term ‘housing need’ is used to describe substandard living conditions

Question 25

What are the 4 populations at higher risk for housing need?

Answer 25

1. First Nations

2. Recent immigrant households (

Question 26

What does HOME mnemonic stand for in asking about housing need?

Answer 26

Harm - Is your home in need of major repairs
Occupancy - How many people live at home and how many rooms
Moves - How many times has your child moved
Enough/Income - Do you have enough money for housing, food, utilities?