Preventative Peds Flashcards
Routine testing for refugee children coming in
Hep B serology
Hep C
Syphilis
HIV
CBC
Stool Ova & parasite
IGRA/PPD
T. cruzi (Chagas; if endemic- Brazil)
If eosinophilia: toxocara canis, strongyloides, schistosoma (subsaharan Africa, SE asia, latin america)
>2 yo lymphatic filariasis serology
When is Rotavirus contraindicated
history of intussusception
SCID
When should you NOT start rotavirus series (age)
15 weeks
When should you not give rotavirus (max age of any vaccination)
8 mo
Earliest that first dose of rota can be given is ___
6 weeks
Blood pressure monitoring, who should get them
Healthy: start at 3 yo
Annually:
- obesity
- renal disease
- diabetes
- aortic arch obstruction
- taking meds that cause HTN
-* h/o prematurity <32 wk, SGA, very low birth weight, neonatal complication requiring UVL/UAL*
- congenital heart disease +/- repair
- Recurrent UTI, hematuria, proteinuria
- Urologic malformation
- f/o congenital renal disease
- Solid-organ transplant
- malignancy/ bone marrow transplant
- systemic illnesses associated with HTN
- evidence of increased ICP
Where should you take a BP, and when can you not
right arm
unless there is atypical aortic arch anatomy
cuff must circle 80-100% of mid-arm circumference
What’s the window of time that you have to give HBIG
within 12 hours of birth for <2g infants
within 7 days of birth for >2g infants
What is the “window period” in Hep B serology
When Hep B sAg disappears before HBsAb appears. HepB core Ab (IgM) will be still positive
When should you test infants born to HBsAg-positive mothers?
1-2 mo after last vaccine dose (>9mo)
Normal Hep B series
3-doses, ok to give 4th dose in combo vaccines
minimum intervals, 4wk, 8wk, 8wk (respectively between subsequent doses)
Shortest time between PCV13 and PPSV23
8 weeks
Normal PCV13 schedule
4-doses
2, 4, 6, 12
If premature infant has sustained desaturation <90%, >20 s, bradycardia <80) in car seat challenge, what’s the next step
rechallenge neonate in a car bed
Strabismus exam
Cover “good” eye, and the resting eye should move to where it is not.
“Good” eye should not move when resting eye is covered
Difference between eso/exo-phoria vs. eso/exo-tropia
phoria: manifests under cover-uncover test
tropia: constantly present
Diagnosis of burn infection
Tissue biopsy revealing 10^5 bacteria
All children ages 9-11 yo must obtain what routine screening?
lipid profile (non-fasting)
If you have risk factors, must obtain FASTING lipid profile
Criteria for receiving live vaccine after chemo
They have to be in remission
Needs evidence of immunocompetence
Cut-off age for 2-dose vs. 3-dose vaccine series for HPV
15 yo
Are infant walkers recommended?
NO – risk of injuries
Routine Hep A vaccine schedule
1yo, then 6 mo after
Risk factors for dental decay (7)
use of bottle/sippy cup
sleeping with bottle
frequent snacks with sugar
sugar-sweetened beverages
sugary medications
prematurity
Other meds: CF, DM, Sjogren
Toothpaste size per year old
<3yo: rice grain sized
>3yo: pea sized
When to start fluoride
6mo or when first tooth erupts
When does cerebral hypoxia start during drowning
3-5m after submersion
Age at which you must have adult supervision around any water
4yo or younger
Age at which you must have adult supervision around any water
4yo or younger
Meningitis ACWY routine schedule
2-dose
11-12 or 13-15, booster at 16yo
If first dose at 16yo, no need for booster
contraindication to MMR vaccination
severe anaphylactic allergy to neomycin or gelatin or severe allergy to previous MMR
do not give MMR and __ vaccine together because of risk of ___
varicella
febrile seizure
Preferred PEP for measles
vaccination
When should you give measles Ig
pregnant women, infants <6mo, immunocompromised individuals, those who received previous dose <28d prior
DTaP doses have to be how far apart?
1st and 2nd: 4 wk
2nd and 3rd: 4 wk
3rd and 4th: 6 mo
4th and 5th: 6 mo
Thin, tired children with macrocytic anemia, vegetarian, decreased DTR. Dx?
B12 deficiency
Thin, tired children with macrocytic anemia, vegetarian, decreased DTR. Dx?
B12 deficiency
Best way to feed infants intubated with respiratory failure
Nasojejunal feeding
NOT NGT
When do you place a G-tube?
when you expect infant requires feeding for 3 mo
CF patients usually have trouble absorbing which vitamins?
ADEK (fat soluble)
exclusively breastfed infants stool once every ___ days
3-4
Nutrition need for chronic liver disease and CF
fat and protein
+ MCTs and fat soluble vitamins
Nutrition for those with EoE
elimination of most common food allergens
amino acid-based elemental diet
Nutrition for FPIES
eliminate causative food
Nutrition for GERD
Infants: thickened (not enough evidence & xantham gum can cause NEC), reduce volume, increase frequency of feeds, protein hydrolysate formula
If severe, amino acid-based formulas
Older children: avoid coffee, chocolate, fatty, spicy foods.
Nutrition for IBD
monitor: iron, vitamin D, micronutrients
If ileal desease/resection, supplement fat soluble vitamins ?parenteral vit B12
Short bowel syndrome
May require MCT +/- vitamin supplement
High doses of folic acid might ___
mask vitamin B12 deficiency
If you see a child with multiple low-impact fractures who is otherwise healthy, what is the first thing you screen for?
Vitamin D 25 level
Nutrition need for Burn patients >40% of body
Requires more calories for increased resting energy expenditure
Enteral
+ nitrogen balance + reduce GI translocation
Vitamin C, A, zinc for wound healing
Children consuming ketogenic diet are at risk for ___
kidney stones
Others (more common): constipation, emesis, abd pain, HLD
Ketogenic diet screening consists of
urine calcium-creatinine ratio every 3 mo
Routine labs with serum acylcarnitine profile
Those who have had cancer treatment especially hypothalamic radiation therapy are at increased risk of ___
metabolic syndrome
Difference between preterm formula and term formula
Preterm formula has higher levels of protein, sodium, potassium, calcium, phos, and iron
WHen should preterm formula continue to be used?
Until corrected GA of 40 weeks
What is acrodermatitis enteropathica
congenital disorder of zinc metabolism
Kids with CKD should restrict ___ in their diet
phosphorous
For infant with prematurity and birth weight lower than 1800g, what calorie formula should they have?
22 cal/oz
Goal weight gain/day after reaching 2kg (infants)
20-30g/day
Who needs higher-calorie formula >24 cal/oz?
premature infants with bronchopulmonary dysplasia/poor weight gain while in NICU
Wight cutoff for “very low-birth-weight infants” and what formula should they have
<1500g
high calories (22-24 cal/oz), fortified human milk
Who should be given soy protein-based formula and what carbohydrate does it contain?
Congenital lactase deficiency
Galactosemia
Sucrose and corn syrup
Who can you start to introduce peanuts in and who shouldn’t you
Yes – no eczema to mild-mod eczema
No – severe eczema +/- egg allergy (need to test peanut allergens in office)
How do you test for protein-losing enteropathy (PLE)?
fecal alpha1-antitrypsin (marker of protein loss in intestine)
What is associated with protein-losing enteropathy?
- CMV, c. diff
- IBD, celiac, eosinophilic enteropathy
- Primary/ secondary lymphangiectasia
- Lymphoma
- NSAID
- HSP, SLE
Youngest age to give zofran
> 6 mo
Infant with diarrhea, arching with feeds on cow milk-based protein. What should you try next?
elemental/extensively hydrolyzed protein formula
Proximal bowel disease can decrease which serum vitamins? (3)
iron, folate, vitamin D
Weight gain goals for
0-3 mo
3-6 mo
6-12 mo
0-3 mo: 30g/day
3-6 mo: 15g/day
6-12 mo: 10g/day
Premature infant caloric need in kcal/kg/day
105-130
Specific nutrition need for premature infants
protein
fat
iron
protein: 3-4 g/kg
fat: 5-7 g/kg
iron: 2-4 g/kg
Recommended kcal/kg/day for congestive heart failure
140 kcal/kg/day
What can you give kids with ESRD to improve adult height
growth hormone!
Normal growth velocity in childhood
5-7 cm/year
Definition of adult growth restriction
Adult height of below 2.5 percentile
What maternal factor can contribute to developmental delay?
Postpartum depression
Screen until 6 mo
Short child with concordant bone age, high upper-to-lower body segment ratio (long trunk to leg ratio), normal BMI. What’t the diagnosis?
Skeletal dysplasia
OR precocious puberty
Lower segment = pubis symphysis down
Upper segment = height - pubis symphysis
Low upper-to-lower body ratio ddx
Klinefelter
Delayed puberty
Clues for constitutional delay of growth and puberty
Delayed bone age
Family history of delayed puberty/growth
Clues for familial short stature
height percentile corelates with adjusted midparental height
Calculate mid-parental height (girls and boys)
Girls: father’s height minus 13 cm (5in) + mother’s height /2
Boys: mother’s height plus 13 cm (5 in) + father’s height /2
For foster children, how often should they routinely visit the pediatrician?
Every 6 months between 24 mo and 21 yo
If you suspect that children/adolescents are sexualy exploited (human trafficking, comercial sexual exploitation), who do you report to?
the national trafficking organization hotline
be cautious of reporting to CPS, also many states still view commercial sexual exploitation of children as prostitution so minors can be criminals rather than seen as victims
When toddlers see parents go thru a divorce, what can be their response?
Separation anxiety
Older preschoolers or younger school-aged children might blame themselves
