Preventative Peds Flashcards
Polio vaccine for international Travel
Regular schedule: 4 doses of inactivated polio vaccine at ages 2, 4, and 6 to 18 months and 4 to 6 years is currently recommended for all infants and children. Min time btwn doses 1-2 is 4 wks, 2-3 is 4 wks, and 3-4 is 6 months BUT has to get one at 4 years or older.
- Adults who received a complete polio immunization series in childhood and intend to travel to and stay for more than 4 weeks in a polio-affected country should receive a single lifetime booster dose of IPV before departure.
- Unimmunized, incompletely immunized, or adult travelers with an unknown polio immunization status should receive 3 doses of IPV following the accelerated schedule and minimum intervals
- The following children and adolescents should receive an additional dose of IPV:
(1) those who are up to date with their polio immunization or completed the routine IPV series but traveling to a polio-endemic country and staying for more than 4 weeks, (2) those who received their last IPV dose more than 12 months before the date they will be departing the country to which they are traveling. Children who receive this additional 4th IPV dose between 18 months through 4 years will still need an IPV booster dose at age 4 years or later.
Lipid Screening
Children with a positive family history
- parent with total cholesterol of 240
- early coronary heart disease (< 55 male, < 65 female)
OR a moderate- or high-risk medical condition
should be screened at ages 2 to 8 years and 12 to 16 years with 2 fasting lipid profiles. The average of these 2 results should be used to dictate next steps.
Normal guidelines: ages of 9 and 11 years and then again at age 17 to 21 years.
Proper BP measuring techinque
- use a cuff bladder width that is 40% of arm circumference
- inflate the cuff to 20 mm Hg above the point at which the pulse is no longer palpated
- deflate the cuff no faster than 2 to 3 mm Hg per second.
Meningococcal vaccine for high risk group
Children with underlying conditions (sickle cell, functional asplenia, complement deficiencies that predispose to invasive meningococcal) bivalent or quadrivalent conjugate vaccine as part of a multidose series starting at the 2-month-old health supervision visit.
Boosters are given, typically at an interval of every 5 years for quadrivalent conjugate vaccine unless the initial series was given to a child younger than 7 years, in which case the first booster is recommended at a 3-year interval. Vaccination against serogroup B is also recommended for individuals with high-risk underlying conditions but not until 10 years of age.
Long term side effect of tanning
Exposure to artificial ultraviolet rays may cause sunburn, skin dryness, pruritus, and photokeratitis;
long-term exposure may cause cataracts**, skin aging, and cancer.
Rotavirus
Live vaccine that is highly effective at preventing gastroenteritis caused by rotavirus, should be administered routinely at 2 month visit. Rotateq is 3 doses: 2, 4, 6 mo.
There are age limits beyond which the vaccine should not be administered (14 weeks, 6 days for a first dose, 8 months, 0 days for the second or third doses); thus, delaying the vaccine could result in missed opportunities for protection.
There is a small, increased risk of intussusception with the first dose of the rotavirus vaccine. If you give it when children are older, they are more susceptible to intussusception and the benefits no longer outweight the risks, hence the age limits.
VZV post exposure prophylaxis
Varicella vaccine is recommended within 3 to 5 days of exposure for healthy VZV-nonimmune individuals older than 12 months. Individuals with a history of only 1 prior dose of vaccine should receive the second dose if 3 months have elapsed since the first dose. (NOT MMRV, VZV vaccine specifically).
Varicella-zoster immune globulin is indicated for VZV-exposed patients who lack evidence of immunity to VZV and who are immunocompromised or not candidates to receive the live virus varicella vaccine. Passive immunization should be administered as soon as possible within 10 days after exposure.
Pneumococcal vaccine for high risk groups
Conjugated pneumococcal vaccines PCV13 are indicated in healthy infants and children between the ages of 2 and 59 months as part of a 4-dose series that is typically administered at 2, 4, 6, and 12 to 15 months of age.
Polysaccharide pneumococcal vaccination PPSV23 is recommended for individuals at high risk of invasive pneumococcal infections in either a 1- or 2-dose series, depending on the risk factor, starting at 2 years of age.
For individuals at risk of invasive pneumococcal infections who are otherwise immunocompetent, only 1 dose of polysaccharide pneumococcal vaccine is recommended. For those with asplenia or immunocompromised, 2 doses.
Normal vision
At age 2 months, infants should be able to fixate on a familiar caregiver’s face.
At age 3 months, infants begin to visually track moving objects, such as toys.
Functional depth perception and the ability to reach for a visualized object develop by age 5 to 6 months.
Insect Bites Tx
Large local reaction (>10 cm) - ice, antihistamine, topical corticosteroids. Usually increases over first 24-48 hours
- only 5-10% chance of developing anaphylaxis to a subsequent insect sting.
Usually NOT cellulitis. Takes > 48 hours for infection to develop. Accompanied by fever, systemic signs of illness, and a greater degree of tenderness at the site.
If anaphylaxis, then epi pen rx and referral to allergist.
Gun stats
intentional and unintentional injuries and deaths related to firearms increases with age
MMR vaccine and pregnancy
- given to nonimmune women at least 1 month before conceiving.
- It is not recommended during pregnancy due to theoretical risk.
Car injuries
- most common is extremity injury from being crushed in door
Hep A prophylaxis
Exposure within last 2 weeks
< 12 month: Hep A IG
>/= 12 months: Hep A vaccine
Learning D/O
- effort spent on homework is out of proportion to school achievement.
- children with learning disorders often have normal IQs.
Abnormal growth parameters
U/L body ratio: The upper body segment/lower body segment (U/L) ratio decreases from birth and reaches its lowest point during early puberty. Because legs grow longer than upper body.
The average growth and weight gain for a child 3 years of age to the start of puberty
- 4 to 7 cm/year
- 2.5 kg/year, respectively.
Best way to screen development
Formal Tools!
Ages and Stages! Available for 1mo-66mo.
AAP recommends screening at 9, 18, 24-30mo.
MCHAT at 18 and 24 mo.
Strategies for obesity
Strategies shown to prevent and treat childhood obesity include promoting breastfeeding, eliminating sugar-sweetened beverages, limiting computer and television screen time, encouraging family meals, and promoting family-wide participation in physical activity.
Cow vs Human Milk
With the exception of infant formula, cow milk should not be introduced until 12 months of age because of the risk of gastrointestinal bleeding, iron deficiency anemia, and excessive renal solute load (high phos).
As compared to cow milk, human milk contains more available iron and carbohydrate, less protein and calcium, and similar amounts of fat.
How do burn injuries cause heart failure?
Hypocalcemia!
Burns cause hypermetabolic state.
And hypocalcemia and hypomagnesemia can occur.
Hypocalcemia leads to heart failure.
How many daily calories for a term baby, preterm, and prterm with chronic condition?
Term: 100-110
Preterm: 90-120
Preterm with chronic: 120-140
How do you prevent development of atopic disease/food allergies?
Use of a hydrolyzed formula during the first 4 months of life may help prevent the development of both atopic disease and cow milk protein allergy.
Early introduction of highly allergenic food foods may reduce the risk of food allergy
Vitamin deficiencies in CF
Fat soluble vitamins: ADEK
Vit E def can result in hemolytic anemia and neuro: weakness, ataxia, areflexia
Mild Intellectual Disability and what to expect:
ID: > 2 SD from the mean of 100. So < 70.
Mild (2 to 3 SDs; score of 55 to 70)
Moderate (3 to 4 SDs; score of 40 to 55)
Severe (4 to 5 SDs; score of 25 to 40)
Profound (> 5 SDs; score < 25)
Mild
- activities daily living - independent
- academic skills - up to 6th grade
- independent living with support
- independent employment with support
Laryngomalacia vs Tracheomalacia
Laryngo
- INSPIRATORY stridor
- supine is worse and when agitated/feeding
- usually 1-4 wks and resolves by 12-18 month
- severe = difficulty in feeding, FTT, cyanotic episodes
Tracheo
- EXPIRATORY stridor
- during periods of increased airflow (Crying, eating, coughing)
- improves by 6-12 months
Concussion - risk of neurocog deficits
Low if its FIRST concussion.
