Community + Thoracic+Digital Flashcards
Neonatal hearing loss - most is sensorineural or conductive?
Sensorineural
Risk factors for neonatal SNL?
- FHx permanent hearing loss
- Craniofacial abnormalities incl those involving external ear
- Congenital infections (inc back meningitis, CMV, toxoplamosisi, rubella, herpes, syphilis)
- Physical exam findings consistent w underlying syndrome assoc w hearing loss
- NICU >2 days or any of the following (regardless of LOS):
- -ECMO
- -assisted ventilation
- -ototoxic drug use
- -hyperbilirubinemia req exchange transfusion
How to test hearing in newborn?
OAE in everyone
ABR if do not pass OAE or any risk factors
What is missed on newborn screening?
Less severe congenital hearing loss (<30 dB)
Progressive or late onset hearing impairment (ex CMV)
Criteria for Functional Constipation?
At least 1x/week for at least 2 months
Need 2 or more in a child with a developmental age of at least 4 years
1. Two or fewer defecations in the toilet per week.
2. At least one episode of fecal incontinence per week.
3. History of retentive posturing or excessive volitional stool retention. 4. History of painful or hard bowel movements.
5. Presence of a large fecal mass in the rectum.
6. History of large diameter stools that may obstruct the toilet.
What are the common times for children to develop functional constipation?
Transition periods - children are prone:
Toilet training
Start of school
Definition of constipation
large hard mass in the abdo or dilated vault filled w stool on rectal examination, often substantiated by a hx of overflow incontinence
Risk factors for positional plagiocephaly
Male sex
Firstborn
limited passive neck rotation at birth (congenital torticollis)
supine sleeping position
only bottle feeding
awake ‘tummy time’ fewer than three times per day
lower activity level with slower achievement of milestones
Sleeping with the head to the same side and positional preference when sleeping
Signs of craniosynysotisis?
Often have ridging of the affected suture
Ipsilateral occipitomastoid bossing with posterior displacement of the ear
PP: ipsilateral anterior displacement of the ear
Primary nocturnal eneuresis
- how often
- age
> 2x/week
>5yo
Military children - issues
- Mobility
- Separation
- Risk
Risk factors for coping difficulties in military family children
–Younger parent age
–Young children
–Family member with prior mental health issues
–Children with special needs
–Child with preexisting behavioral issues
–Spouse with English as second language
What are some issues with housing in Canada?
–Infestations
–Poor water and air quality
–Unsafe neighborhoods
–Unstable housing (> 3 moves in child’s life)
–Inaccessibility for those with disability
What are health impacts of housing needs?
More aggressive behaviour
Property offenses
Poorer school performance
More asthma symptoms
Lower overall health
Easier spread of infxn and more psychological distress in crowded housing
Food insecurity – as a result of high housing cost
Inaccessible housing (for special needs)
lowers self esteem & can lead to more accidental injuries
Exposure to environmental hazards
Infestations à allergic reactions and secondary infections, worsening asthma, anxiety
Unsafe or no water supply (First Nations)
Unsafe neighbourhoods
More anxiety, Less physical activity
Who is at greatest risk for housing needs?
Aboriginal families,
Recent immigrants,
single-parent families
those with developmental, mental health, or physical disabilities
How to assess about housing needs?
Harm (in need of repair?)
Occupancy (How many ppl)
Moves (How often move, use of shelter)
Enough/Income (Enough for house, food, utilities?)
Who to treat w prophylactic Abx for UTI?
What abs, dosing?
Length?
What if resistant?
Grade 4-5 VUR
Trimethoprim/sulfamethoxazole or nitrofurantoin
one-quarter to one-third of the daily total treatment dose
3-6 months
If resistant to TMP-SMP AND nitro, no abx at all because resistance
UTI
- what to look for on U/A
- Urine culture count
nitrite, Leuk esterase, microscopy WBC (>10/hpf)
UCx
Clean catch - >10^5 CFU/mL
I&O - >5*10^4 CFU/mL
SPA - any growth
Bugs for UTI?
E. coli Klebsiella pneumoniae Enterobacter sp. Citrobacter sp. Serratiasp. Staph saprophyticus (female teens only)
Treatment for UTI
Abx
Duration
PO = IV for UTI/Pyelonephritis
If < 3mo - Prefer initial IV
PO amox, clavulin, Cefixime
Gentamicin IV +/- Ampicillin
Cefotaxime or Ceftriaxone IV
UTI - Treat 7-10 days Afebrile UTI (cytitis) - 2-4 day course PO Abx
Signs of complicated UTI
Hemodynamically unstable High serum Cr Abdo mass Poor urine flow No clinical improvement 24h post Abx Fever not coming down 48h post Abx * Use IV antibiotics
Imaging in UTI
Renal U/S for children < 2 years with first febrile UTI
During or within 2 weeks of illness
Detects hydronephrosis
VCUG – best way to diagnose VUR
ONLY if RUS suggestive of issues
In children < 2 years with 2 documented UTIs
Perform after antibiotics completed
Use of prophylactic Abx before procedure is controversial
DMSA
Can diagnose acute Pyelonephritis and renal scarring (later)
Radiation and unlikely to alter management
Only do if Dx of UTI is in question
What drugs are contraindicated in breastfeeding?
Antimetabolites
Radioactive drugs
Drugs of abuse
How long should infants breastfeed
2 years and beyond
exclusive breast-feeding for the first 6 months
Most common chronic condition in children?
tooth decay
Most common surgery in children
dental
What is the most common bug in dental caries
Strep mutans
Who is at higher risk of dental issues?
Low SES
aboriginal
new Canadians
complex care pts
ADHD
- prevalence
- life issues
1/20
Reduced quality of life
Increased risk of injuries
Behaviour problems
Academic and social difficulties
Considerations with starting ADHD meds
adherence
stigma
school storage of drugs
pharmacokinetic profiles
What type of meds are recommended for ADHD
Extended release
more effective and equally efficacious as IR
less risk diversion
Early vision screening helps prevent
decreases prevalence of amblyopia
Amblyopia
= reduced vision in absence of ocular disease – brain doesn’t recognize input
Causes = strabismus, difference in refractive error
Refractive error
= inability to eye to focus on image - correctible with lens
Strabismus
= misalignment of eye
Visual Development Landmarjs
Birth - 4 mo - face follow
3 months - visual follow
42 months (3.5 years) - visual acuity measurable
What are screening tests for vision
- Red reflex
- Corneal light reflex – central position of light on each eye
- Fundoscopy
- Cover-uncover test = strabismus
Screening vision by age?
Newborn to 3 months”
- Complete exam of skin, external eye
- Check red reflex
6 – 12 months:
- Same exam
- Ocular alignment test (cover-uncover test; corneal light reflex)
- Fixation and following of a target
3 – 5 years
- Same exam
- Visual acuity
6 – 18 years
As above every routine visit + complaints
two common causes of amblyopia
Strabismus
Difference in refractive error
What does cover uncover test tell you
strabismus
Contraindications to flying?
- Contraindications for flight
- Uncontrolled hypertension
- Uncontrolled SVT
- Eisenmenger’s syndrome
What condition has there been some benefit with homeopathy
Diarrhea
What are concerns with using homeopathy
- reluctance on the part of those who practice homeopathy to support vaccinations
- delays in seeking conventional medical therapies while waiting for results from homeopathic treatments may jeopardize the child’s health.
Pacifiers:
Pros and Cons?
Cons: May be related to early wean from BF Risk factor for otitis media Issue w dentition past 2 years Fomite - infection
Pros May be protective against SIDS - but not enough ev to recommend Analgesia Good for Prems: Non-nutritive sucking, Comfort, Oromotor skills development, Better weight gain, Less NEC, Earlier discharge from hospital
Signs of a child’s toilet learning readiness
- Able to walk to the potty chair (or adapted toilet seat)
- Stable while sitting on the potty (or adapted toilet seat)
- Able to remain dry for several hours
- Receptive language skills allow the child to follow simple (one- and two-step) commands
- Expressive language skills permit the child to communicate the need to use the potty (or adapted toilet seat) with words or reproducible gestures
- Desire to please based on positive relationship with caregivers
- Desire for independence, and control of bladder and bowel function
When do most children obtain continence
24-48 months
reflex sphincter control by 18mo
Head lice
1st line
2nd line
Pyrethrins (R&C) & permethrin 1%
2nd line:
Isopropyl myrisate = Resultz; not for <4years
Dimeticone solution
Higher incidence of flat foot
wearing shoes early in childhood,
overweight,
more flexible ligaments
Sleep hygiene
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
Risk factors for SIDS
Male, premature, LBW babies, low SES Aboriginal babies **Prone sleeping **Maternal smoking during pregnancy
** Modifiable
Risk reduction for SIDS
- Place on back to sleep (supine)
- Eliminate smoke exposure (Both during pregnancy and after)
- Only sleep in crib/cradle/bassinet (No soft sleeping surfaces)
- Avoid overheating
- Do not leave to sleep in car seats, strollers, swings, etc.
- Room sharing for first 6 months (NOT bed sharing)
- Breastfeeding
- Pacifier use while falling asleep
when to screen for:
chlamydia/gonorrhea
HIV
Pap
chlamydia/gonorrhea: all sexually active
HIV: all sexually active > 15yo
Pap: >21yo
How should children ride in car?
Rear-facing car seats: 0-1 year and/or weigh <10 kg (22 lb).
Forward-facing car seats: 10-18 kg (22-40 lb) and > 12 month
Belt-positioning booster seat and use the vehicle’s lap-shoulder seat belt: >18kg/40lb AND >4 yo
Vehicle seat belt system: > 145 cm (4’ 9”) tall or 9 years of age
Back seat until 13 yo
Dx of asthma in preschooler
Airway obstruction (doc. wheeze) Reversibility (doc. improvement in airflow w SABA +/- steroid or course of ICS) No clinical evidence of alternative dx
Categories for PRAM score
O2 sat Suprasternal retraction Scalene muscle contracton Air entry Wheezing
Limits for screen time?
< 2yo: no screen time
2-5yo: <1 h/day
>5yo: <2h/day
How to deal with screen use?
MANAGE screen time
Encourage MEANINGFUL screen use
MODEL Healthy screen use
MONITOR for signs of problematic screen use
