Introduction to Pediatrics Flashcards
What is the difference between a term and preterm neonate?
Term neonates are born between 37 and 42 weeks of gestational age
Preterm neonates are born at less than 37 weeks of gestational age
What are the three categories of preterm neonates?
Moderate to late preterm (32-37 weeks/ 8-9 months)
Very preterm (28-32 weeks/7-8 months)
Extremely preterm (less than 28 weeks/7 months or less)
What is gestational age?
It is the time since the first day of the mother’s last menstrual period
What is chronological age?
Also known as post natal age
Time elapsed after birth
described in days, weeks, and/or years
Why does characterizing neonates by age impact clinical decisons?
Age confers information about in-utero development and potential neonatal complications (can impact PK)
What is the age definition of an infant?
1 month to 1 year of age
What is the age definition of a child?
1 year through 12 years
Can be broken into three developmental periods:
- Toddler (1 to 3 years of age)
- Preschool (3 to 5 years of age)
- Gradeschooler (5 to 12 years of age)
What is the age definition for an adolescent?
12 to 18 years
Do not JPCH does not admit patients who are 17 and older
What wellness programs are available for mothers and neonates?
- Newborn Screening
- Postpartum Visits
- Newborn Hearing Screens
- Specialized Clinics
- Immunization Programs
What is included in newborn screening?
Routine care for all neonates born in SK
Test for congenital disorders
Completed after 24 hours of age (chronological age)
Blood test from heel poke and dry blood spot card
What is included in the postpartum visiting program?
A nurse will support and follow-up care at home after birth of a baby
Completed in the first 10-14 days of life
Assess mother’s recovery and baby health
Support with feeding
Answer questions
Refer and connect to community services
What is included in newborn hearing screens?
Hearing test is performed 12-16 hours after birth
Performed in hospital before discharge
Can help identify early hearing loss and can be addressed
Which specialized neonatal clinics are available to Saskatchewan mothers and neonates?
- Alvin Buckwold Child Development Centre (developmental pediatrics, physio, speech-language pathology)
- JPCH Pediatrics Clinics (general pediatrics and subspecialty clinics)
What do immunization programs for infants look like?
Many of the publically-funded vaccines are administered in the first few months of life.
What are some expected behaviours from infants?
- Waves “bye-bye”
- “Mama” or “Dada”
- Puts something in container
- Pulls up to stand
- Walks while holding onto furniture
What are some expected behaviours from toddlers?
- Follows simple routines
- Says about 50 words
- Plays pretend
- Knows at least one colour
- Twists things with hands
- Jumps with both feet
What are some expected behaviours from preschoolers?
- Role play
- Speaks sentences
- Knows colours
- Catches balls
How can drugs have different effects in children compared to adult patients?
- Brains are still developing
- Same disease states can present differently in children and youth (ex. Pharyngitis)
- Different PK (ADME) in children
What is the goal of the Pediatric Drug Action Plan?
Health Canada initiative to ensure Canadian children and youth have access to the medicines they need
What is the impact of caregivers in the treatment of pediatric patients?
Success of a child’s therapy often relies on a caregiver
Therefore, support both child and caregiver with medication use
What is Jordan’s Principle?
All First Nations children living in Canada can access the products, services, and supports they need, when they need them
Can be helpful when coverage and funding is a concern
What are the most common types of DTPs seen with pediatric patients?
- Dose too low
- Adverse drug reaction
- Dose too high
- Adherence
What are some causes of “drug dose too low” in pediatric patients?
Common DTP
Dosing references can be confusion (different units)
PK considerations (differences in ADME)
- Children often clear drugs faster than adults
What are some good pediatrics dosing references?
- Lexicomp (Peds Pages)
- PedMed
- Firstline
What medications should be avoided in children due to adverse effects?
- Codeine (respiratory depression risk)
- Tetracyclines (can impact bone growth and development)
- Fluoroquinolones (short term use could be okay)
- Alcohol excipients (insufficient or differential metabolism)
- ASA (risk of Reye’s syndrome, but can be used in specific situations)
What are some issues with administering solid dosage forms?
Can be difficult for young children to swallow
What are some ways issues with solid dosage form administration can be resolved?
Preferentially switch to commercially available liquid formulations
If commercial preparations are not available the following are options (no reliable stability data):
- Crush tablets (review Geri RxFiles)
- Partial tablets, opening capsules and mixing into a vehicle (ensure compatibility)
- Dissolve and dose (known amount of drug is dissolved into water to make a solution and dosed accordingly)
How can issues with drug taste be resolved?
- Mask with a stronger flavour (chocolate, raspberry)
- Compounded suspensions (added cost and less accessible)
- Popsicle to numb taste buds before administration
- Mix into food (be careful. child may start to dislike this type of food)
What are the main sources of medication errors in pediatric patients (hospital and outpatient)?
Hospital: incorrect dosing
Outpatient: incorrect administration by a caregiver (important role for pharmacists to improve counselling skills)
What are the most common types of medication errors in children?
- Weight-based dosing
- Diverse formulations (especially when compounding pharmacies are involved)
- Lack of evidence for optimal dosing, safety and efficacy
- Uneccessary polypharmacy
- Poor labellung of liquid medications (never accept prescriptions in mL, request weight units for accurate dosing)
- Multiple prescribers and caregivers
- Transitions of care
What are some drug coverage options for children?
Private insurance under their parents
Children’s Drug Plan covers medications until age 15
May need to apply for EDS coverage for medications that are normally covered for adults
Drug Appeals (mainly for off-label use biologics)
Special Support
Jordan’s Principle (can help indigenous pediatric patients recieve the therapy they need)
Why do HCPs try to avoid poking children with needles for bloodwork?
- Needle pain and fear (can become an issue later on in life)
- Anemia (maximum blood draw limits, especially in neonates)
What are some pediatric specific fluid status monitoring parameters?
- Urine output (wet diapers, how often your child uses the bathroom)
- Weight
- Fontanelle (in neonates and infants)
- Tear production (crying without tears)
- Fluid intake (milk, water, juice)
What are some pediatric specific pain monitoring parameters?
- Agitation/crying
- Non-weight bearing
- Unusual sleep patern
- Unusual playing patterns
What are some pediatric specific headache monitoring parameters?
- Very difficult to assess in young children
