Preventive Flashcards
contraindications to breastfeeding
galactosemia
maternal use of illegal drugs
ant-neoplastic agents
radiopharmaceuticals
folic acid recommended dosage for all women of childbearing age
0.4mg of folic acid daily
the only 6 diseases screened in NBS
phenylketonuria (PKU) MSUD CAH congenital hypothyroidism galactosemia G6PD
most common inborn of metabolism in the Philippines
MSUD
risk indicators for hearing screening (birth to 28 days)
- illness or condition requiring admission of 48 hours or greater to NICU
- stigmata or syndrome known to include sensorinueural or conductive hearing loss
- family history of permanent childhood sensorineural hearing loss
- ear and craniofacial deformities
- in utero infections (toxoplasmosis, rubella, cytomegalovirus or herpes)
risk indicators for hearing screening (29 days through 2 years)
- parental or caregiver concern regarding hearing, speech, language and/or developmental delay
- family hx of permanent childhood hearing loss
- stigmata or syndrome known to include sensorinueural or conductive hearing loss or Eustachian tube dysfunction
- postnatal infections associated with SNHL such as bacterial meningitis
- in utero infections
- hyperbilirubinemia requiring exchange transfusion, persistent pulmonary hypertension associated with mechanical ventilator
- syndromes associated with progressive hearing loss such as osteopetrosis, neurofibromatosis and Usher’s syndrome
- neurodegenerative disorders such as Hunter syndrome, or sensorimotor neuropathies such as Charcot-Marie-Tooth syndrome and Friedrich’s ataxia
- head trauma
- recurrent or persistent otitis media with effusion for at least 3 months
leading cause of childhood blindness
Vitamin A deficiency
AAP recommendation for eye examination
birth and well child visits
earliest possible age for visual acuity measurement
3 years old
located at front door of the car absorbs most of the impact energy in a collision
crumple zone
mandates installation and use of adult seat belts in front and rear seats
Republic act 8750 (RA 8750)
age prohibited from occupying the front seat of any moving motor vehicle
below 6 years old
specialized child seats required for
children weighing up to 60lbs (8years old)
Pedestrian safety rules
- cross only at corners so drivers can see you
- always use crosswalk when available
- cross only on the new green light
- cross with the “walk” sign only
- look all ways before crossing
- when crossing, watch for cars that are turning left or right
- never cross the street from between parked cars
- drivers can’s see you
- walk on the left side of the road, facing traffic, if sidewalks are not provided so you can see oncoming cars
- use a flashlight or wear or carry something retroreflective
leading cause of child injury and death in the Philippines
Drowning
leading mechanism of injury in burns
scalding
primary risk factor for developing ROP
prematurity
due to incomplete vascularization of the retina
the only consistent risk factors for ROP
decreasing gestational age and birth weight
mainstay therapy fro ROP
surgical intervention
screening guidelines for ROP
infants with birth weight <1500grams or <32 weeks gestation at birth
most common ingested poison
household cleaning agents
treatment for ingested watusi
children: 4-6 egg whites
adults: 6-8 egg whites
children should not carry backpacks weighing
more than 10% of their body weight and
never 4 inches below the waistline
most common non-nutritive sucking material used
pacifiers
advantages of pacifiers
soothe and calm the child
aids in dentition
can be used as analgesia for very preterm neonates
protective against sudden infant death syndrome
safe level for noise
less than 85 Db
WHO exposure limit to continuous noise in workplace
80 - 85 Db for maximum of 8 hours
WHO exposure limit to impulsive noise in workplace
140 Db at any one exposure
in Philippines, minimum employable age is
15 years old
children between 15 and 18 years old may be employed
in undertakings not hazardous or deleterious in nature; not more than 8 hours per day and not more than 40 hours per week
for neonates discharged in less than 48 hours after delivery, appointment should be made after?
48 hours
minimum criteria for discharging newborns <48 hours
uncomplicated course NSD, term, AGA, singleton stable VS during preceding `12 hours 1 stool and urine normal PE
has documented proper latch
no significant jaundice in the 1st 24 hours
educability and ability of parents to care for the child
if a neonate has to undergo blood transfusion, when is newborn screening done?
before 24 hours then repeat after 28 days
in neonates born in the hospital, hearing screening should be done
within 3 months of life
High risk infants should be referred to Ophthalmologist for comprehensive eye examination
- Premature infants born <32 weeks or younger, 1500grams or lighter or >32 weeks but with stormy course
- infants and children with metabolic disorders
- infants and children with medical conditions known to have associated eye problems
- infants and children with history of “squinting”
visual acuity of children 3 to 3 1/2
20/50
visual acuity of children 4 to 4 1/2
20/40
visual acuity of children 5yrs
20/30
developmental screening must be done
9, 18 and 30 months and yearly thereafter
autism screening tool is done at
18 and 24 months
included in Philippine National Immunization Program 2018
BCG Hep B Pentavalent (DTwP-Hib-HepB) Bivalent OPV, IPV PCV MMR MR Td HPV
*no longer includes Rotavirus and Dengue
give the deworming schedule and dosage
Albendazole
12-23mos: 200mg, single dose q6 months
>24mos: 400mg, single dose q6months
Mebendazole
12 mos and above: 500mg single dose q6 months
Taken on full stomach
deworming warnings
severe malnutrition high grade fever abdominal pain serious illness prev hypersensitivity to the drug
optimum time for 1st dental visit
time of first tooth eruption not later than 1 year old
recommended flouride in children 6 months to less than 2 years old
smear 2.5mm twice daily
recommended flouride in children 2 to 6 years old
pea size 5mm twice daily
recommended flouride in children 6 years old and above
full length of bristle 10-20mm twice daily
screening for Iron Deficiency Anemia (IDA)
CBC between the ff time intervals:
6-24 months
2- 6 years
10-19 years
Adolescent Health care
CBC at every stage of adolescence
urinalysis during 1st encounter
For sexually active: recommend STI screening and confidential HIV testing
Pap smear for sexually active female adolescents
Exposure to antigen leads to immunity through creation of antibodies by recipient
Active immunization
Transfer of humoral immunity in form of antibodies
Passive immunization
Transfer of maternal antibodies to fetus via placenta
Pssive immunization
Person contracted disease and immune system creates antibodies
Active immunization
Vaccination is what type of immunization
Active immunization
Live attenuated virus
BCG Measles MMR Varicella Rotavirus Typhoid (oral) Oral polio Dengue tetravalent Oral cholera Yellow fever Japanese B encephalitis
Inactivated vaccine
Hep B DTwP or Dtap Hib Pneumococcal Hepa A Meningo Influenza (IM) HPV Typhoid Rabies Cholera Jap B
Preferred site for IM injections in children younger than 1yr old
Anterolateral aspect of thigh
Preferred site for IM injections in children more than 1yr old
Deltoid muscle
Most vaccines can be safely and effectively given simultaneously except
Yellow fever and cholera (separate by at least 3 weeks)
> /= 2 inactivated vaccines or inactivated and live vaccine combinations
Can be simultaneously or at any interval between doses
Two parenteral vaccines
Can be given simultaneously
If not, interval of atleast 4 weeks
Two permanent contraindications to immunization
Anaphylactic reaction
Encephalopathy not due to another identifiable cause occuring within 7 days after pertussis vaccination
Two temporary contraindications to live vaccines but not with inactivated vaccines
Pregnancy
Immunosuppression
When is PPD needed prior to BCG
Congenital TB
History of close contact to known cases
Clinical symptoms suggestive of TB and/or
Chest xray suggestive of TB
Primary series and booster doses of DTwP-Hib-Hep B or DTaP-Hib-IPV are given when
Primary: 6-10-14 weeks
Booster: 12-18 months interval between 3rd and 4th dose is 6 months
And 4-6 years old
Primary and booster dose of OPV are given
Primary: 6-10-14 weeks
Booster: 4 years
Primary and booster dose of PCV 13 sre given
Primary: 6-10-14 weeks
booster: 6 months after 3rd dose
Rotavirus monovalent (RV1)
2 doses at 6-10 weeks
Rotavirus Pentavalent human Bovine vaccine (RV5)
3 doses 6-10-14 weeks
Maximum age of rotavirus
32 weeks old
Do not begin in older than 15 weeks old
How is Influenza vaccine given?
6 months to 8 yo: 2 doses with interval of 4 weeks if receiving for 1st time
9-18 yo: 1 dose annually
When is Jap Encephalitis vaccine given?
9mos to 17yo: 2nd dose given 12-24 mos after 1st dose
> /= 18: Single dose
When is MMR given?
2 doses atleast 4 weeks apart
2nd dose at 4-6yo
<12mos: given measles containing should receive additional 2 doses of MMR
When is varicella vaccine given?
12 months
2 doses
2nd dose: 4-6yo
When is Hepa A vaccine given?
12 months
2 doses 6 months apart
HPV vaccine given at
9 years old
9-14yo: 0 and 6 months
15yo and older: 0, 2, 6 months (3 doses)
For fully immunized 7-18 yo, when is Tdap given?
Received 5 doses of DTP or 4 doses DTP if 4th dose given >/= 4yo; 1 dose Tdap the Td booster every 10 years
For unvaccinated 7-18 yo, when is Tdap given?
3 doses at 0, 1, 6 months with Tdap as 1st dose and Tx for remaining doses
For incompletely vaccinated 7-18 yo, when is Tdap given?
1 dose Tdap then Td for remaining dose atleast 1 month after
For fully immunized pregnant adolescent
Give 1 dose of Tdap anytime after 20 weeks AOG
For unimmunized pregnant adolescent, when is Tdap given?
Give 3 doses of Td containing vaccine following 0-1-6 month schedule; Tdap should replace atd preferrably 20 weeks AOG
Mother is HBsAg positive
Give Hep B vaccine and 0.5ml HBIg at separate sites within 12hours regardless of birth weight
Test for HBsAg and anti-HBS at 9-12month
If Hep B delayed: test 1-2 months after final dose
Mother’s HBsAg status is unknown
Give Hep B vaccine within 12 hours regardless of weight
Infants <2000g: give 0.5ml HBIg in addition to Hep B vaccine within 12 hrs of birth
Determine mother’s HBsAg status immediately: if mother is HBsAg positive, give 0.5ml HBIg to infants >2000g asap, no later than 7 days of age
Suspicious findings for sexual abuse
Focal erythema in vestibule Localized abrasions within vestibule Laceration of posterior fourchette without history of straddle injury Peaked notch in posterior hymen STDs like herpes or chlamydia
Definitive evidence of sexual abuse
Recent bleeding from laceration or transection of hymen
Presence of sperm
Recent anal laceration
Complete absence of hymenal tissue between 3 and 9 o’clock position
Pregnancy in pubertal minor
Syphilis or gonorrhea
Deworming for children
1-12 years old
Iron supplementation for low birth weight
Drops 15mg elemental iron per 0.6ml
Dose: 0.3ml OD to start at 2 months old until 6 months old
Iron supplementation for infants 6-11 months old
Drops with 15mg elemental iron per 0.6ml
Dose: 0.6ml OD for 3 months
Iron supplementation for children 1-5 years old
Syrup with 30mg elemental iron per 5 ml
Dose: 5ml OD for 3 months or 30mg once a week for 6 months with supervised administration
Iron supplemetation for adolescent females 10-19 years old
Table with 60mg elemental iron with 400mcg folic acid (coated)
Dose: one tab once a day
earliest to have dental check up for caries
12 months
who are allowed to occupy front seat of any moving vehicle
AAP car seat policy: Use a rear-facing car seat from birth until ages 2–4. After outgrowing the rear-facing car seat, use a forward-facing car seat until at least age 5. Buckle all children aged 12 and under in the back seat
“Child Safety in motor vehicles act”
RA 11229 “Child Safety in motor vehicles act”
Child= 12 y/o and below
Section 8: Children in rear seats
No child shall be allowed to sit in the front seat of motor vehicle with a running engine or while such child is being transported on any road, street or highway.
Exception: a child at least 150cm or 59inches or 4’11 and is properly secured using the regular adult seatbelt may seat in the front seat…
(1) rear-facing car safety seats as long as possible; (2) forward-facing car safety seats from the time they outgrow rear-facing seats for most children through at least 4 years of age; (3) belt-positioning booster seats from the time they outgrow forward-facing seats for most children through at least 8 years of age; and (4) lap and shoulder seat belts for all who have outgrown booster seats. In addition, a fifth evidence-based recommendation is for all children younger than 13 years to ride in the rear seats of vehicles.
most common solid breast mass seen in adolescent girls
Fibroadenoma
most common cause of breast pain in adolescents
exercise and benign breast changes
most common cause of pelvic pain in adolescents
Primary dysmonorrhea
most common cause of secondary dysmenorrhea in adolescents
endometriosis
most common form of rape for victims 16-24 years
acquaintance rape
permanent contraindications to vaccination
anaphylactic reaction and
encephalopathy not due to another cause occurring within 7 days after pertussis vaccination
prophylactic DOC for animal bites category III
Co-Amoxiclav for 7 days
first dental visit
time of eruption of 1st tooth
and not later than 12mos of age
recommended age of deworming
all children 1-12 years old using Albendazole or Mebendazole every 6 months
Visual acuity tests in children
Picture test/HOTV/Tumbling E chart for 3-5 years old
Snellen Chart for 6 years old and above
reliable growth indicator when age is not known
weight for length/height
screening tests for sexually active females
Vaginal wet mount
PAP smear
non-culture test for gonorrhea and Chlamydia
screening tests for sexually active males
serologic tests for syphilis
non-culture test for gonorrhea and Chlamydia
best prognostic factors for autism spectrum disorder outcome
language impairment and presence or absence of intellectual disability
most common learning disability
dylexia
most common method of attempted suicide
ingestion of medication
most common preexisting psychiatric illness in those who complete suicide
Major depression
Special protection of children against child abuse, Exploitation, and Discrimination act
RA 7610
most common manifestation of physical abuse
Bruise
most common fracture in abused infants
Rib
metaphyseal
skull
