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.
Most specific sign to differentiate OE from ruptured AOM
Pain with movement of the tragus/pinna
Constitutional delay
common cause of short stature - normal variant
would have delayed bone age and delayed puberty
usually + FHX
Reassurance!
Side effect of ORAL acyclovir vs. IV acyclovir
Oral = myelosuppresion and neutropenia. Usually after 6 months of therapy
IV = nephropathy due to tubular precipitation of acyclovir
When to refer undescended testicle for surgical repair?
If undescended by 6 months of age!
Would undergo orchipexy by 6-18 mo of age.
When is karyotype warranted in undescended testes?
If has penis and BOTH testes are NOT palpable, then workup with karyotype and hormone profile.
If has penis and one normal testes palpable, then you dont need it.
Early signs of autism
Absence of a social smile and/or limited eye contact by 6 months of age may be an early sign of autism.
Lack of pointing and babbling by 12 month
When to give MMR V in HIV patient?
Give it if CdD4 > 15% or >200 count
Give separately not MMRV
Give booster as soon as possible after to induce seroconversion
Always PPX HIV patients in cases of exposure even if received vaccine
Corn does not contain enough of what?
Niacin -> Pellagra
Niacin/B3 deficiency (called pellagra) presents with dementia, diarrhea, and dermatitis.
When to do PPD after MMR
Simultaneous tuberculin skin testing (TST) on the day of the immunization with MMR vaccine is acceptable.
Otherwise, testing should be postponed for 4 to 6 weeks because measles immunization may temporarily suppress tuberculin skin test reactivity
Pain management in fracture
Nonsteroidal anti-inflammatory medications (NSAIDs) may impair bone healing and should not be used by individuals with fractures that have a high risk of nonunion or other complication.
The most common adverse effect of NSAID use is gastrointestinal tract irritation.
Reye syndrome is an acute hepatitis and encephalopathy linked to aspirin use in children with viral infections, such as influenza and varicella.
Potassium replacement - IV or PO
KCl is preferred. Quicker repletion
If 3-3.5 = PO
Severe < 2.5 = muscle weakness beginning in lower extremities and then progressing to trunk and upper extremities. Prompt IV bolus!
Side effect of DTAP vaccine
irritability and crying for an extended period of time > 3 hours
MMR = thrombocytopenia, rash, arthralgia
Preterm infants receiving Hep B
Preterm infants weighing < 2 kg at birth and having an HBsAg-negative mother should receive the 1st dose of HepB vaccine series starting at 1 month of chronological age—or at hospital discharge if prior to 1 month of chronological age.
SQ vaccine
MMR
Catch-up for pertussis/tetanus
If the first dose of DTaP/DT or Tdap/Td was administered at ≥ 1 year of age, a Td vaccine is indicated in 4 weeks, followed by a 2nd Td vaccine 6 months after the 1st Td.
Dyslipidemia screening
9-11 years of age
17-21 years of age
Fluorosis
Whitish lines running across the teeth, chalky-brownish enamel discoloration, and/or dental pitting.
Chronic lead poisoning produces a blue line along the gums with bluish-black edging to the teeth, called Burton lines. It may weaken the bones and may cause caries.
Varicella catch-up
If < 13 years old, minimum time btwn 1st and 2nd dose is 3 months.
If > 13 years old, it’s 4 weeks.
Corticosteroid doses preventing live vaccine administration
> 2 mg/kg/dose BW of pred >/= 14 days
OR >/= 20 mg/dose for children > 10 kg >/= 14 days
= give live vaccines 4 weeks AFTER
If less than that dose = can give during treatment
if < 14 days, can get after treatment
Vitamin B 12 deficiency results in peripheral smear showing
anemia and hypersegmented, polymorphonucleated cells and enlarged (MCV > 110 fL) red blood cells on peripheral smear
Calories from fat vs protein and carbs
Fats have 9 kcal/g of potential energy while carbohydrates and protein have approximately 4 kcal/g.
Dietary fat is the highest density source of potential energy.
PCV vaccine in asplenia
Regular PCV13 at 2, 4, 6, and 12 mo
OR if catch-up, 1 dose of PCV13, followed 8 weeks later by a 2nd dose of PCV13
If > 2 years old,
1 dose of PPSV23 8 weeks after the 2nd dose of PCV13.
2nd dose of PPSV23 5 years after the 1st dose of PPSV23 (this 2nd dose only if asplenia, sickle cell, HIV, or immunocompromised)
What anemia in pts with crohn’s s/p ileal resection?
Megaloblastic anemia - vit B12
Fluid deficit (ml)
Fluid deficit = % dehydration x wt (kg) x 10
For 25 kg kid with 5% dehydration,
= 5 x 25 x 10 = 1250 mL
Most common cause of malodorous vag discharge in young child
Vulvovaginitis: vag discharge, pruritis, vulvar irritation, dysuria.
If discharge is NONpurulent, mucoid, and nonodorous - likely due to poor hygiene or contact with irritants
- improve hygriene
- eliminate tight fitting clothes and chemical irritants
If discharge is malodorous, most likely retained foreign body. Exam under anesthesia may be necessary
Adolescent - white discharge, pruritis, dysuria, vulvar erythema - then candida
Screen for sexual abuse if sexually active or history. Trichomonas
Vitamin C deficiency
Scurvy
- ecchymoses, bleeding gums, petechiae, purpura
- perifollicular hemorrhages
- hyperkeratosis and corkscrew hairs
- impaired wound healing
- generalized malaise
- arthralgias and joint swelling due to hemarthrosis**
- The bones have a “ground glass” appearance on plain radiographs. The bony cortex is thin and the epiphyseal ends sharply outlined—the “white line of Frankel.”**
Homeless ppl with drug or EtOH probs
Increased risk of febrile seizures if giving influenza and what vaccines?
PCV13 or DTAP
Intramuscular Injection Lengths
infants 2–12 months of age is 1”; the anterolateral thigh is the recommended injection site for this age group.
toddlers and children is
5/8–1” (for injection into the deltoid muscle)
1–1¼” (for injection into the anterolateral thigh).
for females 60–90 kg: 1–1 ½”
for females > 90 kg: 1 ½
for males weighing 60–118 kg: 1–1 ½
for males > 118 kg: 1 ½”
Protect newborn from pertussis if household contact has it
Azithro x 5 days.
There is little transplacental protection with pertussis from vaccine or natural infection
How do you treat perianal strep disease?
ORAL ABX
NOT mupirocin
Rash associated with Kwashiorkor
Sharply marginated, raised borders that peel off easily.
Reddish brown in color, scaly with underlying blanching erythema
Superficial desquamation and erosions
Edema, Dermatitis photosensitivity, easy bruisability, hypoalbuminemia
Vitamin A deficiency
EYES: bitot spots, conjunctival xerosis, poor night vision
Dry skin, hair, nails
Increased susceptibility to resp and GI infections
Poor growth, developmental delay, apathy
Niacin B3 deficiency
3 D’s
Diarrhea
Dermatitis
Dementia
What vaccines will temporarily suppress tuberculin reactivity?
live attenuated - MMR and V
Handedness
Usually develops btwn 4-6 years of age.
Handedness before 18 mo = may indicate a central or peripheral neurologic abnormality of opposite side like hemiparesis.
Questions to review: Growth
2017: 4
2018: 2, 4
2019: 6
Questions to review: Nutrition
2017:
2018:
2019: 2, 4
Questions to review: Preventative
2017: 7
2018: 4, 8, 10
2019: 1
Craniosynostosis
Crouzon:
- bilateral premature fusion of coronal sutures
- normal IQ and hands/feet
Apert:
- premature fusion of multiple sutures
- low iQ
- syndactyly (mitten hand) of hands/feet
Carpenter:
- also with CHD, orthopaedic, coronal
Pfeiffer:
- also with cloverleaf skull, midface hypoplasia
Intervention MOST likely to reduce child’s risk of drowning is
Life jackets
Cow’s milk vs. Human milk
breast milk
- more available iron and carbohydrate
- less protein and calcium
- similar amounts of fat
