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Royal College Peds 2021 > CPS Healthy Active Living > Flashcards

CPS Healthy Active Living Flashcards

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1
Q

What are the most common injuries seen in boxing?

-most common injury?

A

Facial fractures, closed head injuries, neck injuries since in boxing, you’re INTENTIONALLY punching someone in the head/face
-most common injury: concussion, followed by open wounds/cuts, then fractures

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2
Q

What is the most common cause of death in amateur and professional boxers?

A

Acute subdural hematoma

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3
Q

What is a long term neurological consequence of repeated blows to the head in boxing?

A

Chronic traumatic encephalopathy (occurs in up to 20% of professional boxers)
-can also occur in football/soccer/hockey, etc, wherever there are repetitive blows to the head

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4
Q

What are important psychosocial contributors to obesity?

A

Basically any stressors that trigger emotional eating:

  1. Being bullied: can increase emotional eating and also lead to an avoidance of physical activity as they don’t want to be seen exercising
  2. Suffering neglect and maltreatment
  3. Living situation where consistency, limit setting and supervision are lacking
  4. Inadequate sleep thus leading to overeating
  5. High levels of stress: impedes consistent physical activity, overactivated hypothalamic-pituitary axis results in increased cortisol which induces intra abdominal adiposity, insulin resistance and metabolic syndrome
  6. Poverty
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5
Q

What is “weight bias”?

A

Tendency to make unfair judgements based on a person’s weight

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6
Q

What are parental responsibilities in promoting healthy active living in their children? (6)

A
  1. Purchasing healthy foods for food consumption
  2. Good role modeling
  3. Setting limits
  4. Keeping to healthy family routines (eating meals and exercising together)
  5. Effective time and money management
  6. Ensure that a divorce or separation remains as untraumatic as possible
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7
Q

What are psychosocial sequelae from being obese? (8)

A
  1. Depression
  2. Teasing/bullying
  3. Social isolation
  4. Discrimination
  5. Diminished self-esteem
  6. Behavioural problems
  7. Dissatisfaction with body image
  8. Reduced quality of life
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8
Q

True or false: immigrants who have lived in Canada for 10 or more years have been shown to have a higher risk of developing obesity than recently arrived immigrants.

A

True!

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9
Q

True or false: prevalence of obesity is significantly higher in children and youth who miss breakfast.

A

True!

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10
Q

What are the health consequences of childhood obesity? (8)

A
  1. Type 2 DM
  2. Dyslipidemia
  3. Hypertension
  4. OSA
  5. Nonalcoholic steatohepatitis
  6. Insulin resistance
  7. Lowered self esteem
  8. Lowered quality of life
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11
Q

Which of the following is false:

a. children spending > 2 hr screen time/day are 2x as likely to be overweight or obese than peers watching

A

B is false! Early childhood sedentary behaviour patterns WORSEN with age!

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12
Q

Which subgroups in the pediatric population are more likely to be less physically active? (5)

A
  1. Older children
  2. Females
  3. Aboriginal children
  4. Children who are not involved in or dislike sport/recreation programs
  5. Children with disabilities or live in public housing
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13
Q

What are the physical activity guidelines for:

  • infants
  • toddlers
  • preschoolers (3-4 yo)
  • what is the recommended screen time for children < 2 yo?
  • what about children 2-4 yo?
A

**Overall, minimize the time infants/toddlers spend being carried/sitting in a stroller, etc. Should not be > 1 hr at a time

Infants:
-infants < 1 yo of age should be physically active several times daily through interactive floor based play

Toddlers 1-2 yo and preschoolers 3-4 yo: accumulate at least 3 hours of physical activity AT ANY INTENSITY spread throughout the day!

*****Children < 2 yo: screen time NOT recommended!

-for children 2-4 yo: limit screen time to < 1 hr/day

**Ex of activities: walking with family, supervised water play, running, dancing, tumbling, throwing and catching

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14
Q

What are the physical activity guidelines for children > 5 yo?
-how much screen time should they get?

A

For health benefits:

  • need to accumulate at least 60 minutes of moderate-vigorous intensity physical activity DAILY including: virogous intensity activities at least 3 days/week, activities that strengthen muscle and bone at least 3 days/week
  • screen time should be limited to no more than 2 hrs/day
  • limit transportation in a car/bus, limit time spent indoors
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15
Q

An adolescent patient presents to your clinic and is concerned about obesity and would like to pursue a healthy active lifestyle. What questions will you ask on history?

A
  1. Screen for medical causes of obesity: hypothyroidism, OSA
  2. Screen for sleep disturbance
  3. Determine amount of caloric intake
  4. Determine current physical activity level
  5. Determine extent of sedentary behaviours
  6. Determine how much junk food is eaten, including sugar-sweetened drinks
  7. Determine level of screen time per day
  8. Assess desire for change
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16
Q

What are strategies to improve healthy active living for families in terms of reducing sedntary activities?

A
  1. Counsel families to remove TVs and computers from bedrooms
  2. Avoid eating in front of the TV
  3. Replace screen time with physical activity
  4. Avoid sitting for prolonged periods of time
  5. Increase active transportation
  6. Engage families to mentor young children so they can develop suitable PA skills
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17
Q

An obese patient of yours would like to get more physical activity but they say they have no time. What recommendations can you make?

A
  1. Build activity into each day - ie. walk to school/work
  2. Take the stairs
  3. Get off bus a stop early
  4. Take physical education in school
  5. Play active games with friends
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18
Q

What are the benefits of exercise in children with JIA?

A
  1. Lowers obesity risk and thus decreases joint load
  2. Reduces loss of proteoglycans and cartilage damage, optimizes bone mineral density
  3. Increases range of motion, strength of joint
  4. Decreases disease activity
  5. Improves energy level and quality of life

***overall, physical activity does NOT exacerbate disease

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19
Q

What are the physical activity recommendations for children with JIA?
-what about for children with JIA of the neck or TMJ or uveitis?

A
  1. Can safely participate in sports without disease exacerbation
  2. Should participate in moderate fitness, flexibility and strengthening exercises
  3. Can participate in impact activities and competitive contact sports if the disease is well controlled and they have adequate physical capacity
  4. Should be encouraged to be physically active as tolerated (if too painful, then don’t do it)
  5. Should take individualized training within a group exercise format
    - for children with neck arthritis: need to have cervical spine xray before participation in collision/contact sports to decrease risk of spinal injury
    - TMJ arthritis: need appropriately fitted mouth guards to prevent jaw and dental injury
    - uveitis: should wear appropriate eye protection during activities with ocular injury risk to decrease further compromising vision
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20
Q

Why might a person with hemophilia have arthritis of joints?

A

This is known as hemophilic arthropathy!

  • Repeated joint hemorrhage causes synovitis, leading to joint degeneration and arthropathy
  • causes joint contractures, limited ROM and chronic pain
  • most commonly affects knees, ankles and elbows
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21
Q

What are the benefits of exercise in a patient with hemophilia?
-risks?

A
  1. May transiently increase factor 8 levels
  2. Strengthens joints and muscles to decrease risk of hemophilic arthropathy
  3. Reduces frequency of hemorrhage

Risks:
1. Chronic hemophilic arthropathy may lead to impaired neuromuscular function, decreased muscle strength/endurance and thus increase risk of injury and bleeding

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22
Q

What are the recommendations for physical activity in children with hemophilia?

A
  1. Should receive appropriate factor prophylaxis to reduce risk of bleeding in sport
  2. Should undergo vigilant assessment of joint and muscle function before sport selection. May need restricftions
  3. Should be carefully assessed before participation in contact or collision sports (consult with sports med or peds hematologist)
  4. Require written strategies before sport participation t prevent or treat bleeds
  5. Should wear protective equipment, undergo physical therapy or take prophylactic factor replacement therapy
  6. Require factor replacement, ice, splinting and rest to manage acute bleeds and avoid physical activity until joint pain or swelling has resolved
23
Q

How can you diagnose exercise induced bronchospasm?

A

Do an exercise challenge PFT: if there is a drop in 10-15% in FEV1 from baseline following virorous exercise x 6-8 minutes, this is diagnostic of EIB

24
Q

True or false: bronchial hyper-responsiveness decreases with decreasing hours of exercise per week in asthmatic patients.

A

FALSE!!! It’s the opposite! The more you exercise per week, the less your bronchioles will be hyper-responsive! Exercise increases the threshold for triggering bronchospasm. So exercise is good for children with asthma

25
Q

What are the physical activity recommendations for children with asthma?

A
  1. Can participate in any physical activity if symptoms are well controlled. Know that swimming is less likely to trigger exercise induced bronchospasm than running
  2. Keep an accurate history of symptoms, trigger exposures, treatments and course of recovery from episodes of bronchospasm
  3. Should get an exercise challenge PFT to formally diagnose EIB
  4. Use leukotriene inhibitors, inhaled corticosteroids and long acting beta 2 agonists for optimal long term disease control and avoid overuse of short acting beta 2 agonists
  5. Should take ventolin 15-30 mins before exercise
  6. Should not scuba dive if they have asthma symptoms or abnormal PFTs
  7. Those who compete nationally/internationally require therapeutic use exemption with confirmation of their asthma to use certain meds
26
Q

What testing is recommended in athletes to diagnose exercise induced bronchospasm?

A

Eucapnic voluntary hyperventilation testing

27
Q

What are the potential benefits of exercise in CF patients?

-potential risks?

A
  1. High aerobic fitness results in slower deterioration in lung function and greater survival rates
  2. Enhanced lung mucous clearance during intense exercise
  3. Improves strength of resp muscles

Potential risks:

  1. Oxygen desaturation/CO2 retention
  2. Cardiac dysfunction from CF resulting in lower cardiac output
  3. Decreased exercise tolerance due to decreased muscle mass/strength from chronic malnutrition
  4. Hyponatremic dehydration from sweat-related salt losses
  5. CF related diabetes causing hypoglycemia
  6. Portal hypertension and splenomegaly increases risk of splenic damage during contact or collision sports
28
Q

What are the physical activity recommendations for children with CF?

A
  1. Should be encouraged to participate in any physical activity. Consult sports med or peds resp first
  2. Should have individualized exercise programs that include strength training
  3. Require home exercises that increase HR by 70-80% of max to increase aerobic exercise tolerance
  4. Don’t stop activity just because they’re coughing
  5. Should ABSOLUTELY 100% avoid scuba diving (increases risk of air embolism/pneumothorax)
  6. Those with severe CF should undergo exercise testing first
  7. Should drink flavored sodium chloride containing fluids above thirst levels to prevent hyponatremic dehydration
  8. Avoid contact or collision sports if enlarged spleen or diseased liver from portal hypertension
29
Q

What are ways to prevent and treat hypoglycemia while at school?

A
  1. Reguarly scheduled meals and snacks with adequate time to eat them
  2. Adjust food intake or insulin doses for increased physical activity. This will mean an extra glucose check and/or snack before physical activity
  3. Clean area for blood glucose checks where hands can be cleaned with a sharps container to discard test strips and lancets
  4. Supervising young children in ways that help them recognize, treat and prevent hypoglycemia
  5. All children need easy access to their emergency kit (with glucose meter, fast acting sugar source, extr snacks, etc.)
  6. For older teens/children, may need accommodations for tests or exams since hypoglycemia affects test performance
30
Q

What are 4 potential barriers to safe and effective management of hypoglycemia in schools?

A
  1. Incomplete training of school personnel
  2. Unscheduled activity and inactivity
  3. Altered meal or snack times
  4. Lack of rapid access to emergency kit
31
Q

True or false: school absenteeism is significantly higher in children with diabetes compared with other children.

A

FALSE!!! It is not significantly higher, with the exception of absences for regular medical appointments

32
Q

What can health care providers give to parents to give to schools to ensure a child with T1DM gets the best possible care?

A

Individual care plan should be up to date and provided to the schools!!!
-should clearly outline roles and responsibilities of school personnel, parents and the child with diabetes and this should occur before the start of the school year

33
Q

How much time should a student with T1DM who has just experienced a hypoglycemic episode during an exam be given to recover before being expected to get back to the test?

A

30-60 minutes

-should always keep an emergency kit at their desk during an exam

34
Q

What are the 3 leading causes of injury-related deaths?

A
  1. Motor vehicle collisions2. Drowning3. Threats to breathing
35
Q

What is the leading injury cause of hospitalization for children?

A

Falls

36
Q

What is the CPS recommendation on body checking in youth hockey?

A
  1. Eliminating bodychecking from all recreational, non elite competitive male ice hockey2. Delaying the introduction of bodychecking in elite male competitive leaves until players are 13-14 yo (bantam level)3. Recommend that boys play in recreational/non elite hockey leagues that do not allow body checking***Girls and young women leagues already have no bodychecking rules
37
Q

What is the most common cause of hockey-related injuries?

A

Bodychecking

38
Q

What is the definition of a concussion?

A

Pathophysiological process affecting the brain induced by biomechanical forces resulting in the rapid onset of short-lived neurological impairment that resolves spontaneously.

39
Q

In adults and older adolescents, how long do concussion symptoms take to resolve? In younger children?

A

-Most resolve in 7-10 days-In younger children, can take weeks to months

40
Q

What are the cognitive effects of concussion (3)?

A
  1. Decreased attention and concentration2. Reduced information processing speed3. Impaired memory and learning
41
Q

What is malignant brain edema syndrome?

A

-aka second impact syndrome-Rare complication of head injury in children and adolescents-caused by loss of autoregulation in brain’s blood supply causing increased ICP and brain stem herniation

42
Q

If there is loss of consciousness following a head injury, what should be suspected?

A

-Cervical spine injury-Should take appropriate cervical spine precautions on transfer to hospital

43
Q

On history-taking for possible concussion, what are key questions to ask in order to identify patients at higher risk for prolonged recovery (5)?

A
  1. Previous history of head or facial injuries (including diagnosed concussions)2. History of headaches or migraines in the patient and in the family3. Mental health issues4. Sleeping difficulties5. Learning disabilities or ADHD
44
Q

When should athletes be allowed to return to sport after a concussion?

A

When symptom free and medically cleared-concussed athletes may increase risk for having another concussion or injury given cognitive impairments

45
Q

How long should a concussed athlete be monitored by an adult and for what signs (3)?

A

-Need to be monitored for 24-48 hrs after injury-Counsel to look for severe headache, persistent vomiting, seizure activity-Should check on them during the night but don’t wake them unless there is vomiting, seizure activity or difficulty breathing

46
Q

When should you order structural imaging for a patient with concussion (3)?

A
  1. Focal neurological deficit2. Prolonged unconsciousness3. Seizure activity
47
Q

What is the thought on neuropsychological testing in concussion?

A

Routine baseline testing is not recommended since kids are always developing rapidly and thus baseline tests would have to be repeated every 6 months for post-test to be useful

48
Q

In which concussion population would you recommend Neuropsychological testing?

A

-Multiple concussions-Prolonged postconcussive symptoms

49
Q

What are the stages of graduated return to learn protocol?

A

OVERALL, RETURN TO LEARN SHOULD PRECEDE RETURN TO SPORT1. Cognitive rest - no school, limit cognitive tasks and screen time at home2. Increase cognitive tasks - slowly increase cognitive tasks at home in 15-20 min increments3. Resume modified school attendance - half-days or only certain classes (avoid gym, music, shop). Homework x 15-20 min blocks4. Increase school attendance - full days with specific accommodations (frequent breaks, tests with unlimited time)5. Return to play - once symptom-free and back to full-time school without accommodations, can start with graduated return to play

50
Q

What are the stages of graduated return to play protocol?

A
  1. No activity - for recovery (should do this until symptom free for 7-10 days)2. Light aerobic exercise - increase heart rate (walking, swimming, stationary cycling)3. Sport-specific exercise - add movement (drills)4. Noncontact training drills - more complex drills5. Full contact practice - following medical clearance6. Return to play - normal game play
51
Q

What factors may result in prolonged or persistent concussion symptoms (3)?

A
  1. Younger age2. History of multiple concussions3. Learning disability or ADHD
52
Q

When should an athlete with a concussion consider retiring from a particular sport or to a less risky position to avoid recurrent head injury (4)?

A

When a concussion:1. occurs with less force2. results in more severe symptoms3. is more likely because of an athlete’s playing style, position or sport4. occurs in the setting of a concomitant learning disability or persistent cognitive symptoms

53
Q

Does protective equipment (helmet, mouth guard) prevent concussion?

A

NO! Certified helmets have been shown to protect against other head injuries though (ie. skull fracture)

54
Q

What is CBPR?

A

Community based participatory research

Royal College Peds 2021 (55 decks)

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