General Pedaitrics

Question 1

CPS statement on Discipline

Answer 1

-Effective discipline is about teaching and guiding children not forcing them to obey
• Foster acceptable and appropriate behaviour in the child
• Set developmentally realistic expectations
• Prioritize rules (safety > harm to others > annoying behaviour)
• Help the child learn self-discipline (healthy conscience and internal sense of responsibility)
• Consequences must be sufficient to be considered negative without being unduly harsh

Question 2

Characteristics of Effective Discipline

Answer 2

• Rules and commands must be clear and developmentally appropriate
  • Consequence must follow the behaviour in a timely fashion
  • Correct the behavior not the person
  • Consequence must be administered before the parent becomes angry
  • Expectation that after the punishment the child will follow the rule or complete the command
  • CONSISTENCY IS ESSENTIAL FOR EFFECTIVE DISCIPLINE

Question 3

Discipline strategies

Answer 3

• Natural consequences
• Child experiences the natural consequence of his or her action
• Time out
• Child is removed from the situation to a quiet place • No more than 1 min per year of age (max 5 minutes)
• “Away from the moment” discussions (anticipation of difficulties)

Question 4

Median daily crying times:

Answer 4

• 2weekinfantis 1 3⁄4hours
• Peaks at 2 3⁄4 hoursat 6 weeks
• Less than 1 hour by 12 weeks
• More crying occurs during the evening

Question 5

Ddx for infant crying

Answer 5

• Infectious: Meningitis, UTI, AOM
• GI: Cow’smilk protein allergy, GERD,Constipation,Hernia,Intussusception,Analfissure
• Metabolic: Hypoglycemia,Inbornerrorsofmetabolism
• Neurologic
• Hydrocephalus
• Trauma
• Non accidental injury,corneal abrasions,hair tourniquet

Question 6

Definition of colic (Rome III criteria):

Answer 6

• Paroxysm of irritability, fussiness or crying that starts and stops without
obvious cause
• Episodes last for at least 3 hours per day, at least 3 days per week for at least one week
• No failure to thrive

Question 7

Toilet training

-when to start

Answer 7

• Physiologic readiness comes before psychologic readiness
• By 18months they have mature sphincter control and myelination of extrapyramidal tract
• Physically need to walk to potty, sit with stability, remain dry for several hours,have appropriate language skills, have a desire independence and respond to positive reinforcement

Question 8

Incidence of Primary Nocturnal Enuresis

Answer 8

• 10-15% of 5 year olds
• 6-8% of 8 year olds
• 1-2%by15years

Question 9

Treatment for nocturnal enuresis

Answer 9

• Alarm devices

- DDAVP (dose 200-600 ug) but only for short term dose

Question 10

What is causative agent of dental caries?

Answer 10

Strep mutans

Question 11

Normal visual development milestones

Answer 11

• Birth to 4 weeks – Fix on face
• 3 months – Visual following
• 42 months of age – visual acuity is measurable