Community Peds Flashcards
what are 4 things a physician should screen for in a child from a military family
depression/anxiety
behavioral concerns
academic concerns
high risk behaviours
what are 4 health impacts of housing need
poorer school performance food insecurity easier spread of disease asthma more aggressive behavior property offences unsafe neighbourhood- anxiety, less physical activity
what do these mean: Inadequate housing Unsuitable housing Unaffordable housing Unacceptable housing Core housing need
Inadequate housing- In need of major repairs
Unsuitable housing (crowded)- Fails to meet the National Occupancy Standard requirements for number of bedrooms for the size and make-up of the household
Unaffordable housing- 30% or more of gross household income spent on shelter costs
Unacceptable housing- Does not meet at least one of the standards of adequacy, suitability and affordability
Core housing need- Unacceptable housing and household would have to spend 30% or more of their gross household income to access acceptable housing in their community
what is the screening questionnaire for housing need?
H- HARM
O- OCCUPANCY
M- MOVES
E- ENOUGH INCOME
Harm- is your house in need of major repairs?
Occupancy- how many people live in your home? how many bedrooms?
M- how often has your child moved? have you ever used a shelter or temporary housing?
E- do you have enough money for housing, food and utilities
what percentage of Canadian households live in substandard housing or core housing need?
Approximately 30% of Canadian households live in substandard housing or core housing need.
what are the two treatment options for ankyloglossia
- conservative (parental education, lactation support, reassurance)
- frenotomy- if significant feeding difficulties
what are the 2 antibiotics that are recommended for UTI prophylaxis
- Nitrofurantoin
- Septra
1/4 to 1/3 of normal daily dose PO daily
should only be used for a max of 3-6 months then reassessed
if resistance to both them stop prophylactic antibiotics
no evidence that it prevents renal scarring
what are the 6 most common bugs to cause UTI
- E. Coli
- Klebisella pneumonia
- Enterobacter species
- Citrobacter species
- Serratia species
- Staph saprophyticus (female teens only)
How long should you treat for a febrile UTI?
afebrile UTI?
who should you give IV abx?
febrile UTI: 7-10 days
afebrile UTI: 2-4 days of PO abs
IV abx if <3 months or complicated UTI
what are 5 oral antibiotics that can be used to treat UTI
- amoxicillin
- amox/clav
- Septra
- Cefixime
- Cephalexin
what are 5 IV antibiotics that can be used to treat UTI
- Ceftriaxone
- Ampicillin
- Gentamicin
- Cefotaxime
- Tobramycin
what imaging should be done for a child <2 with their first febrile UTI
renal ultrasound during or within 2 weeks
looks for hydronephrosis
only do VCUG if renal ultrasound suggestive of issues
what are the two types of weaning from breastfeeding
- Infant led weaning- Gradual weaning occurs as the infant begins to accept increasing amounts and types of complementary food while still breastfeeding on demand.
- Mother led weaning- A planned wean occurs when the mother decides to stop exclusive breastfeeding without receiving infant’s cues about readiness for this change.
Advise slow, progressive weaning when possible
what is the most common surgery in children?
dental
what is the most common organism to cause early childhood caries
strep mutans
when should children have their first visit with the dentist?
dental assessment for infants within six months of their first tooth appearing and no later than one year of age
What is the dB for: normal hearing mild moderate severe profound
Normal hearing: 0–20 Mild: 20–40 Moderate: 40–60 Severe: 60–80 Profound: >80
what is the most common type of hearing loss in neonatal period
sensorineural
50-% genetic- non syndromic
what are 5 risk factors for sensorineural hearing loss
- family history of permanent hearing loss
- craniofacial abnormalities
- congenital infections
- physical findings associated with an underlying syndrome associated with hearing loss
- NICU stay >2 days or with any of the following:
- ECMO
- assisted ventilation
- ototoxic drug use
- hyperbilirubinemia requiring exchange transfusion
what are the two tests for newborn hearing
- OAE (otoacoustic emissions)
- AABR- automated auditory brainstem response (preferred for NICU as greater risk of auditory neuropathy)
auditory neuropathy only picked up on AABR
what are 4 reasons why ER ADHD medications are first line over IR preparations
1) improved adherence
2) reduced stigma (because the child or young person does not need to take medication at school)
3) reduce problems schools have in storing and administering controlled drugs, and
4) lower risk of diversion
Clinically useful normal visual development landmarks
Face follow:
Visual following:
Visual acuity measurable with appropriate chart:
Face follow: Birth to four weeks of age.
Visual following: Three months of age.
Visual acuity measurable with appropriate chart: 42 months of age.
what are the vision screening recommendations for: birth to 3 months 6 months to 12 months 3-5 years 6- 18 years
Newborn to 3 months
Complete exam of skin, external eye
Check red reflex
6 – 12 months red reflex cover- uncover test corneal light reflex Fixation and following of a target
3 – 5 years
add visual acuity
6 – 18 years
Screen as above during routine health visits or if there is a concern
At was age can children recognize Snellen letters and numbers
most by age 4
what 3 things should you screen for on an initial visit with a foster care child
vision
hearing
dental
what are 3 cardiac contraindications for flying
Uncontrolled hypertension
Uncontrolled SVT
Eisenmenger’s syndrome
Who should be screened for hypoxia prior to flying (7)
Patients with known or suspected hypoxemia
Patients with known or suspected hypercapnia
Patients with known chronic obstructive lung disease or restrictive lung disease
Patients who already use supplemental oxygen
Patients with a history of previous difficulty during air travel
Patients with recent exacerbation of chronic lung disease
Patients with other chronic conditions that may be exacerbated by hypoxemia
what are 4 health consequences of low literacy
Incorrect use of medications
Failure to comply with medical directions
Errors in administration of infant formula
Safety risks in the community, the workplace and at home
what are 3 treatment options for nocturnal enuresis
- Alarm- most efficacious (50% success long term), older children and highly motivated families
- Desmopressin- sleepover
- imipramine- dangers of overdose (TCA)
When do most children have continence
24-48 months
typically takes 3-6 months
What are signs that a child is ready for toilet training (7)
Able to walk to the potty chair
Stable while sitting on the potty
Able to remain dry for several hours
Able to follow simple (one- and two-step) commands
Able to communicate the need to use the potty with words or reproducible gestures
Desire to please based on positive relationship with caregivers
Desire for independence, and control of bladder and bowel function
Delayed sleep phase type
initiation of sleep significantly later than the desired bedtime
sleep latency >30 minutes
Sleep-onset association type
special conditions are required of caregivers before the child goes, or returns to sleep at night
what are some suggestions for sleep hygiene (6)
Stable bedtime and wake time Dark quiet space Avoid hunger (an excessive eating) before bed Relaxation techniques before bed Avoid caffeine, alcohol, nicotine Avoid screen time before bed
3 side effects of melatonin
headache
dizziness
abdominal pain
What are the two times when soiling develops
- toilet training
2. starting school
what are some recommendations you can make for constipation
- Education
- Behavioral modification- toilet sitting x 3-10min twice a day
- Disimpaction- PEG 1- 1.5g/kg/day
- PEG daily- 0.4-0.8g/kg/day
- Dietary changes- fibre 0.5g/kg day, adequate fluid intake, whole grains, fruits, vegetables
what are the 4 osmotic laxatives
Lactulose
PEG3350
Magnesium Citrate
Docusate- no evidence in peds
what are the 5 stimulant laxatives
Picosalax Glycerine suppository Bisacodyl Senokot Phosphate Enema
what are some risk factors for positional plagiocephaly (7)
Males
Firstborn
Torticollis
Supine sleeping at birth and at six weeks
Only bottle feeding
Tummy time <3 times per day
Lower activity level with slower achievement of milestones
what are 2 ways to prevent positional plagiocephaly
tummy time 15 min/day 3 times per day
alternating putting the head at the head and foot of the bed
By what age does positional plagiocephaly typically resolve
by age 2
what should you evaluate a baby for when you are seeing them for positional plagiocephaly (3)
- torticollis
- craniosynostosis
- cervical spine abnormalities
what are the treatment options for positional plagiocephaly (2)
Repositioning therapy plus physiotherapy as needed are the interventions of choice in most children with mild or moderate PP
helmet therapy can be consider for severe
must be started before 8 months of age
helmet therapy has been shown to influence the rate of improvement of asymmetry but not its final outcome
How can you differentiate lamboid craniosynostosis from positional plagiocephaly
ridging of the affected suture
The skull will show ipsilateral occipitomastoid bossing with posterior displacement of the ear.
This contrasts with the ipsilateral anterior displacement of the ear with PP
when should infants start wearing shoes?
when they are walking!
what are the two most important modifiable risk factors for SIDS
- Prone Sleeping
2. Maternal smoking during pregnancy
what are some methods to help reduce SIDS (8)
- Place on back to sleep (supine)
- Eliminate smoke exposure (Both during pregnancy and after)
- Only sleep in crib/cradle/bassinet
No soft sleeping surfaces, no soft bedding - Avoid overheating
- Do not leave to sleep in car seats, strollers, swings, etc.
- Room sharing for first 6 months
NOT bed sharing; even higher risk if sharing with smoker, under influence of alcohol, or overly tired. - Breastfeeding- Any breastfeeding for any duration is protective – goal is minimum of 6 months
- Pacifier use while falling asleep
what are the 2 insecticide treatments for lice? when should you repeat?
what is a non insecticidal treatment?
1) Permethrin 1%; repeat in 7 days
2) Pyrethrins = R&C shampoo; repeat 7-10 days
(>2 years of age for insecticidal treatments)
* 2 applications 7 to 10 days apart
Non insecticidal:
1) Resultz (must be >4 years of age)
what is required for the diagnosis of head lice?
Diagnosis requires detection of live head lice. Detecting nits alone does not indicate active infestation.
What is considered “normal” for stooling patterns in infants?
Remember that normal breastfed newborns may stool with each feeding or may not stool at all for 7-10 d
What is the difference between bedsharing and cosleeping?
-Bedsharing: baby shares same sleeping surface with another person
Co-sleeping: baby is within arm’s reach of another person but not on the same sleeping surface
When does longitudinal arch development occur in children?
Longitudinal arch development occurs before the age of 6-all children
What 3 characteristics of children lead to higher incidence of flatfoot?
- Greater laxity of ligaments
- Obesity
- Shoe wearing in early childhood
What are the complications of frenotomy? (3)
- Bleeding
- Infection
- Injury to Wharton’s duct
- Postoperative scarring resulting in worsened limitation of tongue movement
STI screening guidelines in adolescent who is sexually active
G/C screening in ALL who are sexually active
HIV screening in ALL who are sexually active and >15yo
No pap until >21yo
what is Ankyloglossia?
abnormally short lingular frenulum
prevalence: 5-10%
what converts nitrate to nitrite
gram negative bacteria
what is considered a complicated UTI and therefore requires IV antibiotics (6)
Hemodynamically unstable High serum Cr Abdo mass Poor urine flow No clinical improvement 24h post Abx Fever not coming down 48h post Abx
When stimulant medications for ADHD are indicated what medication class is first line?
extended release preparations
children in foster care should have routine screening for what?
development
mental health
dental health
sexually transmitted infections
initial medical visit within 24 h of placement, a comprehensive follow-up visit within 30 days of placement
Are healthy children on a prolonged flight at risk for deep vein thrombosis?
No evidence that healthy children on a prolonged flight are at risk for deep vein thrombosis
how long should children with AOM wait before air travel?
children with AOM should wait two weeks before air travel
what is secondary enuresis?
Secondary enuresis = incontinence recurs after at least 6 months of continence
- more common in boys
what are some recommendations for enuresis
Avoid caffeine-containing foods and excessive fluids before bed
Void before bedtime
Take out of diapers
Include child in morning cleanup in non-punitive manner
Preserve self-esteem**
only treat if distressing to the child
melatonin can be helpful for which 2 populations
ADHD
ASD
may be helpful in epilepsy, neurodevelopmental disabilities and Angelman syndrome.
what is the dose of melatonin in children? adolescents?
2.5-3 mg in children
5-10 mg in adolescents
how long does cps recommend for trial of stool softeners?
at least 6 months
neg things associated with helmet therapy for plagiocephaly? what is the maximum age for helmet therapy?
expensive 23h/d pressure sore, dermatitis max age for helmet therapy= 8 months Influences the rate of improvement of asymmetry but NOT its final outcome
what are the interventions of choice in most children with mild or moderate PP?
Repositioning therapy plus physiotherapy as needed are the interventions of choice in most children with mild or moderate PP.
