General Pediatrics

Question 1

What are the advantages of breastfeeding for the mother and for the infant?

Answer 1

• Advantages for Mother:
  
  • Improves weight loss
  • Delayed onset of menses
  • Decreased breast and ovarian cancer, heart disease and risk factors
  • Cheaper
• Advantages for Infant:
  
  • Decreased incidence of SIDS
  • Improved cognitive development
  • Decreased obesity later in life
  • Decreased infectious disease including meningitis, bacteremia, gastroenteritis, acute OM and UTI
  • Decreased childhood malignancies including lymphoma and leukemia
  • Decreased type 1 and 2 Diabetes Mellitus
  • ?Decreased allergic disease including atopic dermatitis and asthma
  • Decreased inflammatory bowel disease
  • Unclear
    
    • Decreased type 1 and 2 DM
    • Increased protection against ALL and AML
    • Decreased allergic disease including atopic dermatitis and asthma

Question 2

What are the risks of screen time in young children?

Answer 2

• Increased risk of becoming overweight
• Screens before bed increases risks of sleep problems
• Heavy early screen use is associated with language delays
• ? Attention difficulties (need very high exposure)
• Background TV
  
  • Negatively affects language use and acquisition, attention and cognitive development in kids < 5years
  • Decreases parent-child interaction and distracts from play
• E books are inferior to paper books

Question 3

What are ways to reduce the risk of SIDS?

Answer 3

• Placing infant on back to sleep
• Protecting infant from exposure to tobacco, before and after birth
• Providing a safe sleep environment - safest place is in a crib/bassinet free of soft, loose bedding in parent’s room for first 6 months
• Breastfeeding or at least 2 months
• Using safe practices for all sleeps
• Other modifiable factors:
  
  • Pacifiers
  • Alcohol and opiate use during pregnancy is associated with an increased risk

Question 4

What are the 5 key principles for supporting positive parenting?

Answer 4

1. Help parents build loving, responsive relationships with their children
2. Accept there are reasons for all behaviours, whether positive or negative and many can be managed if there is a secure parent-child relationship, attentive loving home and purposeful guidance from parents
3. Help mitigate early adverse childhood experiences (ACEs) in both children and parents by encouraging protective factors
4. Recognize and respect difference
5. Be aware and informed of the parenting literature and build links with at least one trusted, local early years resource

Question 5

What are the benefits of a harmonized immunization schedule?

Answer 5

• Larger bulk purchases of vaccines → more savings
• Simplified education on vaccines
• New programs can be introduced in an organized fashion
• HCPs only need to know about 1 schedule
• Children & youth would have equal access to vaccines

Question 6

What is the recommendation for cochlear implants in children?

Answer 6

• Electronic device surgically place in the cochlea to provide stimulation to the auditory nerve
• Cochlear implants have enabled highly functional language development
• Current recommendations: bilateral implantation between 8-12 months, coupled with auditory therapy

Question 7

What are signs of toilet learning readiness?

Answer 7

• 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

Question 8

What are ways that physicians can promote literacy?

Answer 8

• Parents want information from physicians regarding learning
• Parents receiving an intervention that promotes reading are 4-10 X more likely to read frequently to their child and this effect is greatest amongst the poorest children
• Incorporate literacy promotion into your everyday practice
• Help families develop literacy promoting habits

Question 9

What is the optimal level of vitamin D? What are the levels for deficient, insufficient, pharmacological and toxic?

Answer 9

• Deficient < 25 nmol/L
• Insufficient 25 to 75 nmol/L
• Optimal 75 to 225 nmol/L
• Pharmacological > 225nmol/L (may be associated with hypercalcemia)
• Toxic > 500nmol/L

Question 10

What are the different definitions for housing needs?

Answer 10

• Inadequate housing → in need of major repairs
• Unsuitable housing → fails to meet National Occupancy Standard requirement for # of bedrooms and size for make-up fo the household
• Unaffordable housing → 30%+ of gross household income spent on shelter costs
• Unacceptable housing → does not meet 1+ of standards of adequate, suitability, and affordability
• Core housing need → unacceptable AND must spend 30%+ of gross household income to access acceptable housing in their community