CPS statement volume 4 Flashcards
Which of the following is false?
a) formal training contributes to quality child care
b) high quality childcare may have positive effects on both behavioural and cognitive domains
c) for profit daycare centres had better scores than non profit centres in one study
d) only 16% of Canadians have access to regulated child care
c)false, the opposite, non profit was betteroverall quality was 60%, non profit was 62% vs 55% for for profit , need 67% to promote child development
for children at lowest income level, amount of non parental care directly proportional to household income
having at least an associate degree in early childhood education is recommended in the USA - in Canada 30% have ECE in homes, 36% in childcare centres
evidence is hard to study - methods issues, etc. lots of conflicting evidence’ good quality childcare can have benefits
d) true only 16% have access to regulated chip care, 50% in Quebec, Quebec 5$ per day, Manitoba also set a price
other Canadian provinces no
better language outcomes when good quality childcare compared to family member
What is the recommended caregiver to adult ratio for a 29 month old child?
a) 3:1
b) 4:1
c) 5:1
d) 7:1
b) 4:1
AAP and American Publich Heath recommends: for <24 months 3:1 for 24-30 month: 4:1 for 30-36 month: 5:1 for 36 months: 7:1 or less
the promotes more interaction for the child
very few onsite child care facilities in Canada, should consider getting more
Which of the following statements is false?
a) children in daycare have more foreign body aspirations that those cared for at home
b) children who spend more time in non parental child care have a reduced risk of unintentional injury
c) very few injuries are a result of purely environmental factors
d) most daycare injuries occur in boys on playground equipment, most injuries occur 1 hour before lunch
a) false - based on a Canadian study, more cuts/abrasions in the daycare group, but statistically fewer burns, poisonings and foreign body insertions compared with the nondaycare (control) group. most injuries were play yard injuries/collisions with other child etc.
b) true - might be because family day homes and daycare centres provide better supervision or safer equipment to play on
c) true - San Fran study - 56% child factors 42.9 % child and environment, 1.5% environment alone - supervision is critical
Which of the following is not a recommended intervention to make child care centres safer?
a) all personnel should be trained in PALS
b) play equipment should meet the current Canadian standards association
c) an injury reporting procedure and form should be available in all childcare centres
d) checklists may help make daycare centres more safe
a) false - should be trained in basic first aid and CPR
Which of the following age groups of children had the greatest respiratory illness sick days?
a) children in daycare age 3 months
b) child in daycare > 1 year old
c) children not in daycare age >3 months
b) children in daycare who are 1 or older
for the kids younger than 3 months - no huge effect, perhaps protection from maternal antibodies
thought to have protective effective of maternal antibodies or because this age group can’t move around and pick up germs as easily
daycare children every 9h in daycare 12% increase in respiratory sick days 3 fold increase in children without siblings
after 6 months in daycare, fewer otitis, URTI, conjunctivitis (compared to children fewer than 6 months in daycare)
Which of the following infections is known to be transmitted in childcare settings?
a) HIV
b) hepatitis B
c) hepatitis C
d) Helicobacter pylori
d) Helicobacter pylori, CMV and skin infections are transmitted
GI illnesses : rotavirus, vaccine helps, handwashing/purrell
vaccine preventable illness - pertussis (consider getting daycare workers updated for this), immunize children as per he schedule, annual influenza, ensure that tetanus and diphtheria are current
hep B small chance of infection with skin broken
HIV unlikely hep C unlikely
Which of the following children should be excluded from daycare?
a) 8month old with mild RSV who is feeling well
b) 3 year old with bloody diarrhea
c) 2 year old with bacterial conjunctivitis who started antibiotics 2 days ago
d) 5 year old with strep pharyngitis who started antibiotics 4 days ago
b) bloody diarrhea should not attend
for diarrhea - should exclude if can’t contain by diaper, can’t control by toilet trained child or signs of bacterial enteritis (fever, blood, mucus in stool)
child care centre should talk to public health- different policies for exclusion for shigella, ecoli, campylobacter, salmonella and giardia)
respiratory conditions can attend as well as well enough to participate (there is another part in the statement that talks about daycares making exclusions for children no being able to attend with URTI if they are on antibiotics, and how this might be related to increased antibiotic use)
for strep pharyngitis or bacterial conjunctivitis, after 24 hours of antibiotics can attend daycare
Which of the following is true?
a) currently, Canadian daycares are not obligated to have a policy on the management of a sick child
b) there are many sick child care centres in Canada
c) employers should not consider providing penalty free time off for parents to care for their sick children who are excluded from child care
a) true - currently not obligated to have a policy on the management of a sick child, but helpful for daycare providers to know about common conditions and serious infections
b) false - unknown exactly how many but doesn’t seem like much
c) false, they should do this, one study showed that working moms needed 5.6-28.8 days off of work each year to take care of their sick children
Which of the following has not been linked to poor oral health?
a) poor growth
b) excess iron
c) poor sleep
d) poor learning
e) low birth weight
b) in fact iron deficiency has been linked
the others have all been linked
as well associated with trouble with development, self-esteem, communication, worse attendance at school and parental absence at work
Which of the following is the most common chronic childhood disease in children age 5-17?
a) ulcerative colitis
b) ADHD
c) tooth decay
d) asthma
c) tooth decay - reported to be the most common by the CDC report, 5x more common in children aged 5-17
57% of Canadian school aged kids have had a cavity, on average 2.5 teeth are affected by each
What is the definition of early childhood caries?
one or more decayed, missing (due to cavities) or filled primary tooth in a preschool aged child
What is the prevalence of early childhood caries in some indigenous communities in Canada? As high as:
a) 5%
b) 25%
c) 75%
d) 90%
d) as high as 90% in some indigenous communities, in comparison, in advantaged Canadian communities, as low as 6-8%
What is the most common surgery performed in most Canadian children’s hospitals?
a) appendectomy
b) bronchoscopy
c) tonsiloadenoidectomy
d) extraction of teeth under anaesthesia
d) extraction of teeth under general anaesthesia for cavities, most common surgery in most Canadian hospitals
dental health - was not included in the final Romanow Commission report on the Future of Health Care in Canada in 2002; since then, there have been some steps to draw more attention to the subject
very bad wait times got a D - only 50-59% in appropriate wait time, very expensive costs to the heath care system, often after extraction get another cavity soon after (especially first nations)
True or false : dental care is covered under the Canada Health Act
false - historically not considered essential to care, and therefore not covered (ppl pay for most of their own dental care)
.
Name the tenets of the Canada Heath Act
publicly administered, universal, portable, accessible and comprehensive
Canadians pay for dental care in four different ways: through third-party insurance (employment-related dental coverage); through private dental insurance; by paying directly out-of-pocket; or through government-subsidized programs (eg, First Nations Non-insured Health Benefits [NIHB] or Veterans’ Affairs).
How many Canadians have no dental insurance?
32%
62% have private insurance, 6% have public insurance (so not that many!)
public programs don’t reimburse nearly as much as private ones, can lead to discrimination from dentists who won’t accept them (based on one study)
the working poor are the most marginalized by this system
50% of Canadians in the lower income bracket don’t have insurance
Which province has the lowest publicly funded dental care?
a) Ontario
b) Alberta
c) Yukon
d) Nunavut
a) Ontario - lowest publicly covered dental health 1.5%
in Nunavut the highest 77%
The Canadian government’s per capita public expenditure on dental treatment has increased from $11.00 in 1975 to just $19.54 in 2010, whereas private sector spending has almost tripled over the same period (from $135 to $379 per capita).[
Name 3 factors important to counsel patients to reduce dental caries
- reduce bottle propping
- reduce juice consumption
- improve diet
- water fluoridation
- use fluoridated toothpaste, counsel people to brush teeth
etc.
How many communities in Canada have fluoridated water?
only 45.1 %, in Ontario higher (76%) vs 1.5% in newfoundland and labrador
the canadian dental association endorses water fluoridation and topical fluoride use
Name one group that should receive regular topical fluoride?
First Nations and other high risk groups (
recent cochrane review
separate statement on this, need to review it
Which organism is most commonly associated with early childhood caries?
Streptococcus mutans
transmitted from caregiver to infant
can also be transmitted horizontally in child care setting
window for infectivity 19-31 months of age
early intervention for the caregiver and counselling are important strategies to decrease transmission to the child
early childhood caries - most likely to have cavities later
True or false - universal access to dental care will eliminate disparities in dental care
false - one study suggests that this won’t happen, there are more complicated factors that influence dental care
other things that can affect - distance/lack of dentists (i.e. First Natons) medically complex children (in this case, some dentists not trained, can also lead to delaying of procedures
True or false - all provinces offer some support for dental care for children on income assistance
true - for these kids, all provinces provide some help
in general dental health is a provincial responsibility
low income families usually get some provisions (look at the list for details0
often further targeted provisions in legislation concerning children with disabilities or children in foster care
overal treatment based rather than preventative based
Ideally, when should children have their first dental visit?
within 6 months after their first tooth appears, no later than 1 year old (Canadian Dental Association), AAP says the same thing
Rourke baby record 9-15 months for the first visit
but most people don’t follow this, limited uptake
most physicians don’t get any training in oral health
need surveillance and research
True or false Long term studies of lacto-ovo-vegetarians suggest that they can get enough energy intake from their diet
true there have been studies of these veggies (who each milk and eggs) and we know they can get enough energy to grow, insufficient evidence for vegans
2% of 6-17 year olds in US say vegetarian, 0.5% vegan
True or false - protein intake needs to be increased for children who are on vegetarian diets
this is true, because the proteins from plant sources have lower digestibility (so need more of them
increase by 30-35% for 6 year old
Therefore, recommended protein intakes are adjusted upward for children in the range of 10% to 15% compared with nonvegetarians
soy protein - can be as effective as animal protein
wheat protein - may be 50% as good as animal protein
Name the major plant sources of protein
legumes (beans and lentils), cereals, nuts and seeds, butters; Combining complementary proteins in each meal, however, is not believed to be necessary for children who eat often throughout the day
True or false - vegetarian children need more iron than meat eating children to avoid getting iron deficient
true- may need up to 1.8 x more iron because of different bioavailability
certain things like vitamin C (and other components in vegetables) enhance the absorption of non heme iron)
Other substances such as dietary fibre, phytates and tannins may inhibit absorption, and, therefore, a balance must be achieved
good iron sources - include iron fortified cereals, grain products, dried peas and beans, or supplementation
may need supplementation during periods of rapid growth
overal studies do suggest that they can maintain their iron levels if they follow good practices above
All of the following improve the bioavailability of zinc except the following?
a) phytates
b) sprouting seeds and grains
c) fermenting
d) none of the above (all improve the bioavailability)
a) phytates which are found in high quantities in vegetarian diets decrease the bioavailability of zinc
the others are ways to increase the bioavailabiily of zinc
breastfeeding gives sources of zinc until about 7 months
zinc deficiency is rare
vegans may need 60% more than omnivores
most zinc comes from animal protein
additional supplementation not recommended, but should eat high zinc foods (i.e. legumes, nuts, yeast-leavened breads, fermented soy products, etc)
True or false - calcium content in breastmilk is lower in the milk of a vegan mother
false - calcium content is unaffected by the intake of a vegan mother
overal, calcium deficiency is rare in lacto-ovo vegetarians (since they likely eat lots of dairy), however, do need to think about it in vegans (have shown that they can have lower than recommended calcium)
after weaning, ensure enough calcium intake fortified soy products, cereals, juices and leafy vegetables. Low-oxalate greens (bok choy, Chinese cabbage, kale, collards, etc) provide highly bioavailable calcium for the older child. may need supplementation
How should vegan children compensate for the lack of long chain omega 3 acids in their diet?
eat more precursor linolenic acid (found in flaxseed and canola oils, walnut and soy products), this will get converted to long chain omega 3 fatty acids (DHA and EHA)
omega 3 fatty acids should provide 1% of the caloric intake of vegetarians
A vegan mother is exclusively breastfeeding her 5 month old. What are 2 supplements the baby should get?
vitamin B12- vegans at high risk, breastfeeding mothers who are vegan also low in B12, should supplement
**the B12 deficient anemia may be masked because of high folic acid intake in most of these children, however, the neurological symptoms can still happen”
for older kids : It is recommended that at least three servings of food rich in vitamin B12 be included in the daily diet or supplementation be provided at 5 µg to 10 µg per day
vegetarians should get enough B12 from eggs
vitamin D : all kids should get it, vegan at more risk because we get some vitamin D from iver, fatty ocean fish and egg yolks,
inn addition, Canadian children younger than two years of age living above a northern latitude of 55°, those with dark skin and those avoiding sunlight should be supplemented with 800 U of vitamin D in the winter months from October to April; for kids >1 year old, should get 200 units (check the other new statement to see if this has changed)
True or false - riboflavin deficiency is common in vegetarian children
false - clinical deficiency not observed
True or false - preformed vitamin A is only found in meet
true - therefore, they need to convert dietary carotenoids – found in yellow and orange vegetables, leafy green vegetables and fruits rich in beta-carotene – into vitamin A. Three servings a day of such vegetable and fruit products is adequate
How much fiber should a child consumer ?
0.5 g/kg/day
some vegetarian kids, 3x that, may lead to poor nutrient absorption and growth
A breastfeeding mother comes to you for advice about what she should eat to ensure her baby gets enough nutrients. She is vegan. what do you tell her.
- B12 - ensure you eat enough fortified foods to give that
- calcium - your milk will still have good calcium levels, however you should take a supplement to make sure yo don’t get depleted
- vitamin D - in the winter months, all pregnant and lactating mothers should take 2000 units/day
- may have lower omega 3 levels, so ensure that you take lots of the precursor foods (i.e. flaxeed, cprecursor linolenic acid (found in flaxseed and canola oils, walnut and soy products), this will get converted to long chain omega 3 fatty acids (DHA and EHA) unsure of the significant of lower levels of this in the cord bloods of vegan mothers, but given that we think it’s important for eye and brain development should take it
Also, intake of foods containing inhibitors of DHA production (linoleic acid and trans fatty acids [shortening and stick margarines]) should be limited - zinc supply in bm should be okay till 7 months
