Paediatrics seminar: child in the family Flashcards
What are live attenuated vaccines?
- Viral e.g. MMR, varicella, rotavirus
- Bacterial e.g. BCG
What are inactivated vaccines?
- Whole viral/bacterial e.g. polio, hep A
- Fractional e.g. hep B, influenza, acellular pertussis, HPV
- Polysaccharide based: pure polysaccharide e.g. PPSV23, conjugated vaccines: PCV13, Hib
What is the timeline for childhood vaccination in public sector?
What is the timeline for childhood vaccination in private sector?
Why is measles vaccine given at 12 months?
MMR and varicella vaccines are live vaccines
Circulating maternal antibodies in babies <12 months old could neutralize the vaccine
Why is MMR and varicella vaccines not given in combination at 1 years old?
The risk of febrile convulsion is slightly higher with the measles, mumps, rubella, varicella (MMRV) combination vaccine is given than MMR and varicella vaccines are given separately.
What is the definition of obesity in children?
- Sex- and age-specific BMI percentile
- Overweight: BMI 85th to 95th cenrile
- Obesity: BMI >95th cenrile
- severe obesity is defined as BMI ≥120% of the 95th percentile or a BMI ≥35kg/m2 (whichever lower)
What is the definition of overweight used in SHS?
What is the history for obesity in child?
Pathological vs simple obesity: onset of obesity, stunted growth (hypothyroidism or cushing syndrome), features of monogenic obesity
History on diet, excercise, screen time and sleeping habits
Comorbidities: joints pain, OSA symptoms, polyuria/polydipsia (rare in early T2D)
What is the age of onset of monogenic obesity?
What features?
Onset usually <5y
Other features:
* Extreme hyperphagia, developmental delay, unique dysmorphism (e.g., characteristic faces in Prader Willi syndrome; syndactyly, brachydactyly or polydactyly in Bardet-Biedl syndrome),
* Visual problem (e.g., retinal dystrophy in Bardet-Biedl syndrome, Alstrom syndrome and TUB deficiency)
* Hearing impairment (e.g., TUB deficiency)
What to do in child obesity physical exam?
What are the comorbidities of obesity?
- Pre-diabetes/type 2 diabetes
- Prehypertension/hypertension
- Obstructive sleep apnoea
- Dyslipidaemia
- Fatty liver
- Polycystic ovarian syndrome
- Evidence that obesity tracks from childhood to adulthood
- Persistent excess in adiposity would increase the risk of type 2 diabetes, hypertension, dyslipidemia, and carotid- artery atherosclerosis in adulthood
- Psychologicaleffects
- Depression, low self-esteem, emotional and behavioral problems..
What is the management of childhood obesity?
- To adjust the chronically positive energy balance
- A BMI reduction of > 0.25 SDS (~BMI reduction of 1 kg/m2)
- Associated with a reduction in cardiovascular risk
- Developmentally appropriate and agreeable by the child and adolescent
- Incremental goal in each clinic visit
- Initial goal: not aiming at weight reduction, but merely change in weight gain trajectory or modification in lifestyles
- Growing child: a static body weight would indeed translate to improvement in BMI
- Mainly focus only lifestyle modification: exercise and diet control
- Pharmacological agents/bariatric surgery: reserved for severe obesity refractory to lifestyle modifications/those with obesity related complications
What are common developmental problems?
* Global developmental delay/intellectual disability(ID) * Physical impairment
* Autism spectrum disorder(ASD)
* Attention deficit hyperactivity disorder
* Anxiety disorder
* Acquired brain injury with cognitive impairment * Specific learning disorder (SLD)
* Developmental coordination disorder (DLD)
* Hearing Impairment
* Visual impairment
What is global developmental delay?
Significant delay in at least 2 developmental domains from the following
* Gross or fine motor
* Speech language
* Cognition
* Social/personal
* Activities of daily living
What is intellectual disability
What are developmental red flags?
- No head control by 6m
- Noreachoutby6m
- Cannot stand with support by 12 m
- Not walking by 18 m
- No single words by 2 years
- No sentence by 3 years
- School age children with learning and self-care problems