CPS community peds Flashcards
Benefits of extended release vs immediate release in ADHD (3)
- more effective
- less likely to be diverted
- more likely to be used
Contraindication to commercial airline flight
- uncontrolled hypertension
- uncontrolled SVT
- Eisenmenger’s syndrome (when pressure in pulm As are so high, blood shunts from R to L ventricles causing cyanosis)
Flight recommendations
- AOM
- sickle cell
- cardiopulmonary disease
-AOM: if possible wait 2 weeks before air travel
Sickle cell and cardiopulmonary disease may require oxygen during flight
Management of constipation
- behaviour modification
- daily maintenance stool softeners
- dietary modification
+/- fecal dismpaction at outset
LEARN model for cross cultural communication
Listen Explain Acknowledge Recommend Negotiate
Shoes for children recommendations (2)
- infants do not need shoes until they are walking
- orthotics are not beneficial in management of physiological, flexible flatfoot, developmental in-toeing, mild torsional deformities
(refer to ortho if pain, functional impairment with lower limb deformities)
Children in foster care are often in poor health because of:
- poverty
- prenatal exposure to drugs/alcohol
- parental mental illness
- inadequate medical supervision before coming into care
Screening a child in foster care
- history and physical
- acute illness
- infection
- pregnancy
- chronic condition
- developmental delays
- mental health disorders
- assess for need for vision, hearing and dental screening
Initial eval for a child in foster care IF needed
- CBC, ferritin, lead level, HIV serology, Hep B and C titres, B-Hcg, cervical or urethral swabs for STIs, pap-smear on a case-by-case
Negative outcomes of inadequate, crowded, unaffordable housing
Physical health: asthma, health hazards, injury risk, communicable diseases, poor air quality, lead, food insecurity and inadequate nutrition
Mental health: aggressive behaviours, psychological distress
Developmental: diminished school performance
Social health: property offences
Youth with unstable housing (moving 3+ in lives) are at higher risk for:
- emotional problems
- repeating a grade
- being suspected or expelled
Otoacoustic emissions features
OAE = 10-15 minutes at bedside, best performed in infants > 24hr with a minimum of 34 weeks CGA
False + or - may be affected by: infant’s movements, environmental noise, dysfunction in middle or external ear
Identifies conductive and cochlear hearing loss
Automated Auditory Brainstem Response
features
- 15-20min, infants older than 23hr, minimum 34 weeks,
False + or - may be affected by: infant’s movements, environmental noise, dysfunction in middle or external ear - identifies conductive, cochlear and neural hearing loss from external ear to level of brainstem
When to use AABRs
- failed OAE
- risk factors e.g. fam history, craniofacial abN, NICU> 2 days, other risk factors
First line treatments for head lice in Canada
pyrethrin e.g. R+C shampoo and conditioner (repeat 7 days later)
Or
permethrin e.g. Nix creme rinse and repeat in 7 days
Treatment for lice if high resistance or resistance is proven
Resultz = isopropyl/myristate / ST-cyclomethicone solution
- repeat in 7 days
- not for children <4yrs
Direct and indirect effects of low literacy on health
Direct: med errors, failing to comply with medical direction, errors in admin of formula, safety risks
Indirect: poverty, occupational injuries, stress, unhealthy lifestyle practices
Development of early literacy skills
- book orientation
- narrative structure
- listening ability
- attention span
- page turning
- print recognition
Nocturnal enuresis
- prevalence
10-15% of 5 yr olds
8% of 8 years olds
1-2% of 15 yr olds
Preventing early childhood carries
- water fluoridation (most effective)
- topical fluorides
- feeding practices
- improving diet
- promoting oral health of caregivers
Risk factors for positional plagiocephaly (9)
- male sex
- first born
- limited passive neck rotation at birth (congenital torticollis)
- supine sleeping position at birth and at 6 weeks
- only bottle feeding
- < 3 awake tummy times per day
- lower activity level
- slower achievement of milestones
- sleeping with head to same size and position preference when sleeping
Craniosynostosis vs. positional plagiocephaly
Lambdoid craniosynostosis: posterior displacement of the ear
Treatment of positional plagiocephaly
- repositioning and physiotherapy = preferred interventions for those with mild/moderate
- moulding therapy can be considered for pts with severe asymmetry (overall outcome is similar)
Potential benefits and cons to pacifier use
Pros: protective against SIDS, comfort, oromotor development
Cons: otitis media, early weaning, dental problems
Risk factors for SIDS
- modifiable (2)
- non-modifiable (5)
Modifiable: infants sleeping in prone positioning, maternal smoking during pregnancy
Non-modifiable: male infants, premature, low birth weight, lower SES, Indigenous populations
How to decrease risk of SIDS (7)
- back to sleep
- no smoke exposure
- sleep in crib that meets regulations
- share room with caregvier x 6 months
- no bedsharing
- breastfeeding
- pacifiers once breastfeeding established
Signs of toilet leaning readiness
GM: able to walk to potty chair, stable sitting on potty
Bladder/bowel: able to reamin dry for several hours
Language: can follow simple 1 and 2 step commands, can communicate need for potty
Social: desire to please, desire for independence
Toileting refusal /failure of toilet trainign
- take a 1-3 month break from training
- if repeat attempts or > 4 yrs refer to a pediatrician/dev peds to rule out neurodevelopmental and explore parent0child relationship
- explore constipation
Breastfed infants of vegan mothers should be supplemented with
- vitamin B12
- zinc after 7 months of breastfeeding
Vegan kids supplementation
- ensure adequate vit B12 fortified food or supplement
- also need to make sure energy, calcium, iron, linolenic acid, vitamin D
Amblyopia
- definition
- causes
- reduced vision in absence of ocular disease when brain does not recognize input from that eye
- 2 common causes: strabismus, difference in refractive error
Circumstances affecting health of military children (4)
- frequent relocations
- deployment
- separation
- difficulty accessing medical and mental health services
RFs for coping difficulties in military families (9)
- young parental age
- young children
- family member with psychopathology
- children with special needs
- children with emotional or behavioural difficulty
- pre-deployment marital or financial problems
- spouse with ESL
- recent relocation
- no firm date of re-deployment
