Preventive Pediatrics Flashcards
EINC
Essential Intrapartum and Newborn Care
“Unang Yakap”
EINC Steps
- immediate and thorough drying
- early skin-to-skin contact
- properly-timed cord clamping
- non-separation, early breastfeeding
EINC Step 1
immediate and thorough drying
EINC Step 2
early skin-to-skin contact
EINC Step 3
properly-timed cord clamping
EINC Step 4
non-separation, early breastfeeding
Exclusive breastfeeding up to _____.
6 months
Continued breastfeeding up to _____.
2 years
Pregnant women should be informed about the deleterious effects of _____, _____ and _____ during pregnancy.
smoking, alcohol, teratogens
_____ immunization should be started or continued during pregnancy.
Tetanus Toxoid
Discharging newborns before 48 hours:
_____ antepartum, intrapartum and postpartum courses for both mother and newborn.
Uncomplicated
Discharging newborns before 48 hours:
Outcome
SVD, singleton, ≥ 37 weeks, AGA
Discharging newborns before 48 hours:
Vital Signs during the preceding 12 hours
RR < 60
HR 100-160
axillary T 36.5-37.4 (clothed, open crib)
Discharging newborns before 48 hours:
Output
with UO
at least 1 BM
Discharging newborns before 48 hours:
Breastfeeding
proper latch milk transfer swallowing infant satiety (-) nipple discomfort
Discharging newborns before 48 hours:
PE
normal
Discharging newborns before 48 hours:
Jaundice
(-) jaundice for the first 24 hours
Discharging newborns before 48 hours:
_____ and ability of the parents to _____.
Educability, care for the child
Discharging newborns before 48 hours:
Follow-Up
within 48 hours
How often should adolescents undergo health screening?
annually
HEEADSSS: H
Home
HEEADSSS: E
Education/Employment
Eating
HEEADSSS: A
Activities
HEEADSSS: D
Drugs
HEEADSSS: S
Sexuality
Suicidal Ideations/Depression
Safety
Adolescent Health Care: PE
Tanner Staging/SMR
Breast Examination
Spine and Shoulders (scoliosis, kyphosis)
Genitals and Anus
Adolescent Health Care: CBC
every stage of adolescence
Adolescent Health Care: urinalysis
first encounter
Adolescent Health Care: vaginal wet mount/Pap smear
sexually active females
Adolescent Health Care: serologic syphilis test
sexually active males
Adolescent Health Care: test for gonorrhea and chlamydia
sexually active males and females
Adolescent Health Care: Anticipatory Guidance and Counseling
self breast examination
healthy lifestyle
sexual behavior (STDs, HIV)
injury and accident prevention
Developmental surveillance should be done _____.
at every well child visit
Developmental Surveillance Components
parent's concerns developmental history observation of the child risk and protective factors document the process and findings
Developmental Surveillance: specified ages
9, 18 and 30 months
every year thereafter
Social-Emotional Red Flags:
lack of smiles or other joyful expressions
6 months
Social-Emotional Red Flags:
lack of reciprocal (back-and-forth sharing of) vocalizations, smiles, or other facial expressions
9 months
Social-Emotional Red Flags:
failure to respond to name when called
absence of babbling
lack of reciprocal gestures (showing, reaching, waving)
12 months
Social-Emotional Red Flags:
lack of proto-declarative pointing or other showing gestures
lack of single words
15 months
Social-Emotional Red Flags:
lack of simple pretend play
lack of spoken language/gesture combinations
18 months
Social-Emotional Red Flags:
lack of two-word meaningful phrases (without imitating or repeating)
24 months
Social-Emotional Red Flags:
loss of previously acquired babbling, speech or social skills
any age
Social-Emotional Red Flags:
6 months
lack of smiles or other joyful expressions
Social-Emotional Red Flags:
9 months
lack of reciprocal (back-and-forth sharing of) vocalizations, smiles, or other facial expressions
Social-Emotional Red Flags:
12 months
failure to respond to name when called
absence of babbling
lack of reciprocal gestures (showing, reaching, waving)
Social-Emotional Red Flags:
15 months
lack of proto-declarative pointing or other showing gestures, lack of single words
Social-Emotional Red Flags:
18 months
lack of simple pretend play
lack of spoken language/gesture combinations
Social-Emotional Red Flags:
24 months
lack of two-word meaningful phrases (without imitating or repeating)
Social-Emotional Red Flags:
any age
loss of previously acquired babbling, speech or social skills
Motor Red Flags:
lack of steady head control when sitting
4 months
Motor Red Flags:
inability to sit
9 months
Motor Red Flags:
inability to walk independently
18 months
Motor Red Flags:
4 months
lack of steady head control when sitting
Motor Red Flags:
9 months
inability to sit
Motor Red Flags:
18 months
inability to walk independently
Receptive Language Red Flags:
does not alert or quiet to sound
2 months
Receptive Language Red Flags:
does not turn to source of sound
6 months
Receptive Language Red Flags:
does not respond to own name
10 months
Receptive Language Red Flags:
does not follow verbal routines/games
12 months
Receptive Language Red Flags:
does not understand simple questions
does not stop when told “NO”
does not understand at least 3 different words
15 months
Receptive Language Red Flags:
does not point to 3 body parts
does not follow simple commands
18 months
Receptive Language Red Flags:
does not follow 2 part commands
30 months
Receptive Language Red Flags:
does not answer simple questions
36 months
Receptive Language Red Flags:
2 months
does not alert or quiet to sound
Receptive Language Red Flags:
6 months
does not turn to source of sound
Receptive Language Red Flags:
10 months
does not respond to own name
Receptive Language Red Flags:
12 months
does not follow verbal routines/games
Receptive Language Red Flags:
15 months
does not understand simple questions
does not stop when told “NO”
does not understand at least 3 different words
Receptive Language Red Flags:
18 months
does not point to 3 body parts
does not follow simple commands
Receptive Language Red Flags:
30 months
does not follow 2 part commands
Receptive Language Red Flags:
36 months
does not answer simple questions
Expressive Language Red Flags:
does not coo
6 months
Expressive Language Red Flags:
does not babble
10 months
Expressive Language Red Flags:
6 months
does not coo
Expressive Language Red Flags:
absence of pointing
14 months
Expressive Language Red Flags:
does not say 3 different spontaneous words
16 months
Expressive Language Red Flags:
vocabulary of not more than 35-50 words
does not produce 2-word phrases
24 months
Expressive Language Red Flags:
no simple sentences
36 months
Expressive Language Red Flags:
intelligibility to unfamiliar adult at 50%
42 months
Expressive Language Red Flags:
not able to tell or retell a familiar story
54 months
Expressive Language Red Flags:
not fully intelligible to an unfamiliar adult
60 months
Expressive Language Red Flags:
not fully mature speech sounds
> 72 months
Expressive Language Red Flags:
6 months
does not coo
Expressive Language Red Flags:
10 months
does not babble
Expressive Language Red Flags:
12 months
absence of non-verbal purposeful messages (show objects)
Expressive Language Red Flags:
14 months
absence of pointing
Expressive Language Red Flags:
16 months
does not say 3 different spontaneous words
Expressive Language Red Flags:
24 months
vocabulary of not more than 35-50 words
does not produce 2-word phrases
Expressive Language Red Flags:
36 months
no simple sentences
Expressive Language Red Flags:
42 months
intelligibility to unfamiliar adult at 50%
Expressive Language Red Flags:
54 months
not able to tell or retell a familiar story
Expressive Language Red Flags:
60 months
not fully intelligible to an unfamiliar adult
Expressive Language Red Flags:
> 72 months
not fully mature speech sounds
Eye and Vision Screening:
Premature infants who are _____, _____ and _____ should undergo screening.
≤ 32 weeks
≤ 1500 g
stormy medical course
Eye and Vision Screening:
Infants and children with _____ and/or _____ should undergo screening.
metabolic disorders
medical conditions with associated eye problems
Eye and Vision Screening:
Infants and children with a history of _____, _____ and/or _____ should undergo screening.
squinting
head tilt
head turn
Eye and Vision Screening:
Children with _____ and/or _____ should undergo screening.
visual difficulties
learning problems
Eye and Vision Screening:
Family History
strabismus amblyopia congenital cataract congenital glaucoma retinoblastoma ocular and systemic genetic diseases
Visual Acuity Assessment Tests
Fixes and Follows Test
Subjective/Formal Visual Acuity Testing
Visual Acuity Assessment:
test for preschoolers or children who are not familiar with letters
LEA Pictures Chart
Visual Acuity Assessment:
test for literate children
Sloan Letters
HOTV Chart
Visual Acuity: 3 years old
20/50 (10/25)
Visual Acuity: 4 years old
20/40 (10/20)
Visual Acuity: 5 years old
20/30 (10/15)
Ocular Motility Assessment
Corneal Light Reflex
Versions and Ductions
Cross Cover Test
Red Orange Reflex Examination:
Light reflects back from the _____.
choroidal blood vessels
LEA Chart:
Age
3 years old
LEA Chart:
Distance
6 meters (20 ft) or 3 meters (10 ft) 34-40 cm (14-16 in) - reading distance
LEA Chart:
Test Result
at least 4/5 symbols read correctly
Use of Fluoride Toothpaste
twice daily
Use of Fluoride Toothpaste:
6 mos. to < 2 y.o.
Fluoride Concentration (ppm)
1000ppm
Use of Fluoride Toothpaste:
6 mos. to < 2 y.o.
Minimum Daily Use
twice daily
Use of Fluoride Toothpaste:
6 mos. to < 2 y.o.
Amount of Toothpaste
smear
2.5mm / 0.125g
Use of Fluoride Toothpaste:
6 mos. to < 2 y.o.
Amount of Fluoride (mg)
0.25mg
Use of Fluoride Toothpaste:
2-6 y.o.
Fluoride Concentration (ppm)
1000ppm
Use of Fluoride Toothpaste:
2-6 y.o.
Minimum Daily Use
twice daily
Use of Fluoride Toothpaste:
2-6 y.o.
Amount of Toothpaste
pea size
5mm / 0.25g
Use of Fluoride Toothpaste:
2-6 y.o.
Amount of Fluoride (mg)
0.5mg
Use of Fluoride Toothpaste:
> 6 y.o.
Fluoride Concentration (ppm)
1500ppm
Use of Fluoride Toothpaste:
> 6 y.o.
Minimum Daily Use
twice daily
Use of Fluoride Toothpaste:
> 6 y.o.
Amount of Toothpaste
full length of bristle
10-20mm / 0.5-1g
Use of Fluoride Toothpaste:
> 6 y.o.
Amount of Fluoride (mg)
1mg
Topical Fluoride Treatment
every 6 mos.
Benefits of Breastmilk
- safe, sterile, always available
- perfect nutrients up to 6 mos.
- easily digested
- contains antibodies
- contains fats (DHA)
Advantages of Breastfeeding
- emotional bonding
- protects mother’s health
- return to pre-pregnancy weight
- financial savings
Correct Breastfeeding Techniques:
_____ the baby’s head and the entire body.
Support
Correct Breastfeeding Techniques:
Head, back and hips should be facing the _____ and aligned in a _____ manner.
breast, straight
Correct Breastfeeding Techniques:
Maintain the position of the baby in such a way that he is _____.
face to face
chest to chest
tummy to tummy
Correct Breastfeeding Techniques:
Support the breast with the hand of the _____ arm in a _____ position.
opposite, C-hold
Correct Breastfeeding Techniques:
Stimulate the infant to open the mouth wide by _____.
stroking the corner of the baaby’s lips
Correct Breastfeeding Techniques:
Check that the chin touches the _____ and the lower lip is turned _____.
breast, outward
Correct Breastfeeding Techniques:
Ensure that the baby grasps the _____.
entire nipple plus one inch of the surrounding areola
Correct Breastfeeding Techniques:
Allow the baby to suck _____ per breast to extract both _____.
15-30 mins., foremilk and hindmilk
Correct Breastfeeding Techniques:
Empty the breast around _____ a day.
8-10 times
Breastmilk Storage:
Store in _____ containers labeled with _____ of breastmilk collection.
sterile polypropylene (cloudy hard plastic), date and time
Breastmilk Storage: room temperature (<25°C)
4 hours
Breastmilk Storage: room temperature (>25°C)
1 hour
Breastmilk Storage:
refrigerator (4°C)
8 days
Breastmilk Storage:
freezer of a 1-door refrigerator
2 weeks
Breastmilk Storage:
freezer of a 2-door refrigerator
3 months
Breastmilk Storage: deep freezer (-20°C)
6 months
Diet of a Lactating Mother:
rice
6 cups
Diet of a Lactating Mother:
fruits
vitamin C-rich
different varieties
4 pieces
Diet of a Lactating Mother:
vegetables
green leafy
yellow
1 1/2 cups
Diet of a Lactating Mother:
meat, fish, poultry, seafood
5 matchbox-size pieces
2 cups cut into small pieces
Diet of a Lactating Mother:
eggs
4 pieces a week
Diet of a Lactating Mother:
beans
1 1/2 cups 3x/week
Diet of a Lactating Mother:
milk
2 glasses
Diet of a Lactating Mother:
fats
7 teaspoons
Diet of a Lactating Mother:
fluids
7 glasses of water
1 glass of fresh fruit juice
Complementary food must be:
- timely
- adequate
- safe
- properly fed
Introducing Complementary Food:
Begin with _____ to be given for _____.
one new food at a time, 3 days
Introducing Complementary Food:
Start with _____, giving _____ a day.
porridge, cereal, fruits, vegetables
1-2 teaspoons
Introducing Complementary Food:
pureed food
6 months
Introducing Complementary Food:
finger food
8 months
Introducing Complementary Food:
lumpy or chopped food
10 months
Introducing Complementary Food:
table food
12 months
Introducing Complementary Food:
6-8 mos., frequency
2-3x/day
Introducing Complementary Food:
9-24 mos., frequency
3-4x/day
Introducing Complementary Food:
snacks
1-2x/day
Introducing Complementary Food:
Do not add SALT before _____.
1 y.o.
Introducing Complementary Food:
Give _____ if diet is primarily plant based.
iron, zinc, calcium, vitamin B12
Child Maltreatment:
Recognize and report ongoing child maltreatment.
R.A. 7610
Child Maltreatment:
R.A. 7610
Recognize and report ongoing child maltreatment.
Child Maltreatment:
Establish Women and child protection in all government hospitals.
DOH Administrative Order 2013-0011
Child Maltreatment:
DOH Administrative Order 2013-0011
Establish Women and child protection in all government hospitals.
Anticipatory Guidance for Prevention of Violence Against Children (VAC):
Infancy
domestic violence
infant crying
dangers of shaking
Anticipatory Guidance for Prevention of Violence Against Children (VAC):
Toddler
domestic violence
positive discipline
safety in others’ homes or with other people
Anticipatory Guidance for Prevention of Violence Against Children (VAC):
Pre-School
domestic violence positive discipline safety in others' homes or with other people normal sexual behavior good vs. bad touch
Anticipatory Guidance for Prevention of Violence Against Children (VAC):
School Age
domestic violence positive discipline safety in others' homes or with other people normal sexual behavior good vs. bad touch bullying peer relationships mobile phone and internet safety
Anticipatory Guidance for Prevention of Violence Against Children (VAC):
Adolescence
domestic violence positive discipline safety in others' homes or with other people normal sexual behavior good vs. bad touch bullying peer relationships mobile phone and internet safety alcohol and substance abuse dating violence
Child Maltreatment:
Protective Factors
secure attachment parental care (-) delinquent or substance-abusing peers warm and supportive relationship (-) abuse-related stress
Child Maltreatment:
promising Child maltreatment Prevention Programs
Home Visits
Parent Education
Sexual Abuse Prevention (schools)
Hospital-Based Parent Education (Shaken Baby Syndrome)
7 Steps to Protect Children
- Learn the facts.
- Minimize opportunities for abuse.
- Talk about it.
- Stay alert.
- Act on any suspicion of abuse.
- Learn how to react.
- Get involved.
Windows of Achievement:
sitting w/o support
4-9 mos.
Windows of Achievement:
standing with assistance
5-12 mos.
Windows of Achievement:
crawling
5-14 mos.
Windows of Achievement:
walking with assistance
6-14 mos.
Windows of Achievement:
standing alone
7-17 mos.
Windows of Achievement:
walking alone
8-18 mos.
Developmental Milestones of Early Literacy:
6-12 months
Motor Development
holds head steady
sits in lap without support
grasps book, puts in mouth
drops, throws book
Developmental Milestones of Early Literacy:
6-12 months
Communication and Cognition
smiles, babbles, coos likes and wants your voice likes pictures of baby faces begins to say "ma", "ba", "da" responds to own name pats pictures to show interest
Developmental Milestones of Early Literacy:
6-12 months
Anticipatory Guidance
talk back and forth
make eye contact
cuddle, talk, sing, read,play
point at and name things
follow baby's cues ("more", "stop")
play games
Developmental Milestones of Early Literacy:
6-12 months
What to Read
board and cloth books
baby faces
nursery rhymes
Developmental Milestones of Early Literacy:
12-24 months
Motor Development
holds and walks with books
no longer puts book in mouth right away
turns book pages
Developmental Milestones of Early Literacy:
12-24 months
Communication and Cognition
says single words, then 2-4 word phrases gives book to read points at pictures turns book right side up names pictures follows simple stories
Developmental Milestones of Early Literacy:
12-24 months
Anticipatory Guidance
smile and answer when your child speaks or points
let your child help turn the page
keep naming things
use books in family routines
use books to calm or distract while waiting
Developmental Milestones of Early Literacy:
12-24 months
What to Read
board books
rhymes
pictures
naming things
Developmental Milestones of Early Literacy:
2-3 years
Motor Development
learns to turn pages 2-3 pages at a time
starts to scribble
Developmental Milestones of Early Literacy:
2-3 years
Communication and Cognition
adds 2-4 new words per day
names familiar objects
likes to read the same book
completes sentences and rhymes in familiar stories
Developmental Milestones of Early Literacy:
2-3 years
Anticipatory Guidance
ask questions (“where”, “what”)
read the same book
talk about the pictures
use books in daily routines
Developmental Milestones of Early Literacy:
2-3 years
What to Read
rhymes
pictures books that tell stories
search and find books
Developmental Milestones of Early Literacy:
3-4 years
Motor Development
turns pages one at a time, left to right
sits still for longer stories
scribbles and draws
Developmental Milestones of Early Literacy:
3-4 years
Communication and Cognition
recites whole phrases
moves toward letter recognition
begins to detect rhyme
pretends to read to toys
Developmental Milestones of Early Literacy:
3-4 years
Anticipatory Guidance
ask questions ("What happens next?")
point out letters and numbers
point out words and pictures that begin with the same sound
make up stories about the pictures togetherDevelopmental Milestones of Early Literacy:
3-4 years
What to Read
picture books that tell longer stories
counting and alphabet books
Developmental Milestones of Early Literacy:
4-5 years
Motor Development
starts to copy letters and numbers
sits still for even longer stories
Developmental Milestones of Early Literacy:
4-5 years
Communication and Cognition
can listen longer recognizes numbers and letters can retell familiar stories can make rhymes learning letter names and sounds
Developmental Milestones of Early Literacy:
4-5 years
Anticipatory Guidance
relate the story to your child’s own experiences
let your child see you read
ask your child to tell the story
encourage writing and drawing
point out the letters in your child’s name
Developmental Milestones of Early Literacy:
4-5 years
What to Read
fairy tales and legends
books with longer stories
fewer pictures
Z-Score Interpretation:
Length/Height for Age below 2
stunted
Z-Score Interpretation:
Length/Height for Age below 3
severely stunted
Z-Score Interpretation:
Weight for Age below 2
underweight
Z-Score Interpretation:
Weight for Age below 3
severely underweight
Z-Score Interpretation:
Weight for Length/Height above 3
obese
Z-Score Interpretation:
Weight for Length/Height above 2
overweight
Z-Score Interpretation:
Weight for Length/Height above 1
possible risk of overweight
Z-Score Interpretation:
Weight for Length/Height below 2
wasted
Z-Score Interpretation:
Weight for Length/Height below 3
severely wasted
Z-Score Interpretation:
BMI for Age above 3
obese
Z-Score Interpretation:
BMI for Age above 2
overweight
Z-Score Interpretation:
BMI for Age above 1
possible risk for overweight
Z-Score Interpretation:
BMI for Age below 2
wasted
Z-Score Interpretation:
BMI for Age below 3
severely wasted
Immunization:
Bacillus-Calmette Guarin (BCG)
type
live attenuated
Immunization:
Bacillus-Calmette Guarin (BCG)
route
intradermal (ID)
Immunization:
Bacillus-Calmette Guarin (BCG)
dose
- 05 ml for < 12 mos.
0. 1 ml for > 12 mos.
Immunization:
Bacillus-Calmette Guarin (BCG)
schedule
ideally at birth
first 2 months
Immunization:
Bacillus-Calmette Guarin (BCG)
PPD prior to vaccination
congenital TB
close contact to case of TB
clinical/x-ray findings suggestive of TB
*induration > 5mm is considered positive
Immunization:
Hepatitis B (Hep B)
route
intramuscular (IM)
Immunization:
Hepatitis B (Hep B)
schedule
first 12 hours of life
Immunization: Hepatitis B (Hep B) minimum interval
4 weeks
Immunization: Hepatitis B (Hep B) final dose
not earlier than 24 weeks
*another dose is needed if the last dose was given at age < 24 weeks
Immunization:
Hepatitis B (Hep B)
preterm, HBsAg (-) mother
1st dose at 30 days
*another dose for those < 2 kg whose 1st dose was given at birth
Immunization:
Hepatitis B (Hep B)
HBsAg (+) mother
HBV and HBIg (0.5ml) within 12h, no later than 7 days
Immunization:
Hepatitis B (Hep B)
unknown HBsAg status, ≥ 2 kg
give HBV within 12 hours
determine mother’s HBsAg status
Immunization:
Hepatitis B (Hep B)
unknown HBsAg status, < 2 kg
HBV and HBIg (0.5ml) within 12h
Immunization:
Diphtheria and Tetanus Toxoid and Pertussis Vaccine (DTP)
route
intramuscular (IM)
Immunization:
Diphtheria and Tetanus Toxoid and Pertussis Vaccine (DTP)
schedule
minimum 6 weeks
Immunization:
Diphtheria and Tetanus Toxoid and Pertussis Vaccine (DTP)
interval
4 weeks
- 4-6 months between 3rd and 4th dose
- 5th dose may not be given if the 4th dose was given at ≥ 4 y.o.
Immunization:
Haemophilus influenzae type B (HiB)
type
conjugate vaccine
Immunization:
Haemophilus influenzae type B (HiB)
schedule
3-dose primary series
minimum 6 weeks
Immunization:
Haemophilus influenzae type B (HiB)
interval
4 weeks
Immunization:
Haemophilus influenzae type B (HiB)
booster
12-15 months
6 months from 3rd dose
Immunization: Poliovirus Vaccine (OPV/IPV) type
live attenuated
Immunization:
Poliovirus Vaccine (OPV/IPV)
route
OPV - per orem (PO)
IPV - intramuscular (IM)
Immunization:
Poliovirus Vaccine (OPV/IPV)
schedule
3-dose primary series
minimum 6 weeks
Immunization: Poliovirus Vaccine (OPV/IPV) interval
4 weeks
Immunization:
Poliovirus Vaccine (OPV/IPV)
booster
≥ 4 y.o.
6 mos. from previous dose
Immunization:
Pneumococcal Conjugate Vaccines (PCV)
route
intramuscular (IM)
Immunization:
Pneumococcal Conjugate Vaccines (PCV)
schedule
3-dose primary series
minimum 6 weeks
Immunization:
Pneumococcal Conjugate Vaccines (PCV)
interval
4 weeks
Immunization:
Pneumococcal Conjugate Vaccines (PCV)
booster
6 mos. after 3rd dose
Immunization:
Pneumococcal Conjugate Vaccines (PCV)
Healthy children 2-5 y.o. w/o previous PCV vaccination may be given _____ or _____.
1 dose of PCV 13
2 doses of PCV 10 8 weeks apart
Immunization:
Rotavirus Vaccine (RV)
route
per orem (PO)
Immunization:
Rotavirus Vaccine (RV)
schedule
minimum 6 weeks
- monovalent human RV (RV1) - 2 doses
- pentavalent human bovine (RV5) - 3 doses
Immunization: Rotavirus Vaccine (RV) interval
4 weeks
Immunization: Rotavirus Vaccine (RV) last dose
32 weeks
Immunization:
Influenza Vaccine
route
trivalent - intramuscular (IM) or subcutaneous (SC)
quadrivalent - subcutaneous (SC)
Immunization:
Influenza Vaccine
schedule
minimum 6 months
Immunization:
Influenza Vaccine
dose
6-35 mos. - 0.25 ml
36 mos. - 18 y.o. - 0.5 ml
Immunization:
Influenza Vaccine
Children 6 mos. - 8 y.o. receiving influenza vaccine for the first time should be given _____.
2 doses with a 4 week interval
Immunization:
Influenza Vaccine
If only 1 dose was given during the previous influenza season, give _____ then _____ thereafter.
2 doses
1 dose annually
Immunization:
Influenza Vaccine
Children aged 9-18 y.o. should receive _____.
1 dose annually
Immunization:
Influenza Vaccine
Vaccination should begin in _____.
February
Immunization:
Measles Vaccine
type
live attenuated
Immunization:
Measles Vaccine
route
subcutaneous (SC)
Immunization:
Measles Vaccine
schedule
9 months
*6 months in cases of outbreaks
Immunization:
Japanese Encephalitis Vaccine (JE)
route
subcutaneous (SC)
Immunization:
Japanese Encephalitis Vaccine (JE)
schedule
one primary dose
9 mos. - 17 y.o.
Immunization:
Japanese Encephalitis Vaccine (JE)
booster
12-24 mos. after primary dose
Immunization:
Japanese Encephalitis Vaccine (JE)
Individuals ≥ 18 y.o. hould receive _____.
1 dose only
Immunization:
Measles-Mumps-Rubella (MMR)
type
live attenuated
Immunization:
Measles-Mumps-Rubella (MMR)
route
subcutaneous (SC)
Immunization:
Measles-Mumps-Rubella (MMR)
schedule
2-dose primary series
minimum 12 months
2nd dose at 4-6 y.o.
*given earlier if recommended by PH
Immunization:
Measles-Mumps-Rubella (MMR)
interval
4 weeks
Immunization:
Measles-Mumps-Rubella (MMR)
Children below 12 mos. given any Measles containing vaccine should be given _____.
2 additional doses
Immunization:
Varicella Vaccine
type
live attenuated
Immunization:
Varicella Vaccine
route
subcutaneous (SC)
Immunization:
Varicella Vaccine
schedule
2-dose primary series
1st dose at 12-15 mos.
2nd dose at 4-6 y.o.
Immunization:
Varicella Vaccine
interval
< 13 y.o. - 3 mos.
> 13 y.o. - 4 weeks
*if 2nd dose was administered 4 weeks after the first dose, it can be considered valid
Immunization:
Measles-Mumps-Rubella-Varicella (MMRV)
type
live attenuated
Immunization:
Measles-Mumps-Rubella-Varicella (MMRV)
schedule
12 mos. - 12 y.o.
Immunization:
Measles-Mumps-Rubella-Varicella (MMRV)
interval
3 months
Immunization:
Hepatitis A (Hep A)
route
intramuscular (IM)
Immunization:
Hepatitis A (Hep A)
schedule
2-doses primary series
minimum 12 mos.
*2nd dose is given 6 mos. after the 1st dose
Immunization:
Tetanus and Diptheria Toxoid (Td) / Tetanus and Diptheria Toxoid aand Acellular Pertussis (Tdap)
route
intramuscular (IM)
Immunization:
Tetanus and Diptheria Toxoid (Td) / Tetanus and Diptheria Toxoid aand Acellular Pertussis (Tdap)
booster
every 10 years
Immunization:
Tetanus and Diptheria Toxoid (Td) / Tetanus and Diptheria Toxoid aand Acellular Pertussis (Tdap)
fully immunized pregnant adolescent
1 dose of Tdap after 20 weeks AOG
Immunization:
Tetanus and Diptheria Toxoid (Td) / Tetanus and Diptheria Toxoid aand Acellular Pertussis (Tdap)
unimmunized pregnant adolescent
3-dose series
0-1-6 month schedule
Immunization:
Human Papilloma Virus (HPV)
route
intramuscular (IM)
Immunization:
Human Papilloma Virus (HPV)
schedule
3-dose series
minimum 9 y.o.
bivalent - 0-1-6 month schedule
quadrivalent - 0-2-6 month schedule
Immunization:
Human Papilloma Virus (HPV)
interval
1 mo. bet. 1st and 2nd dose
3 mos. bet. 2nd and 3rd dose
6 mos. bet. 1st and 3rd dose
Immunization:
Human Papilloma Virus (HPV)
A _____ is an option for girls 9-14 y.o.
2-dose schedule 6 mos. apart
Immunization:
Human Papilloma Virus (HPV)
The quadrivalent HPV can bbe given to males _____ of age for the prevention of _____.
9-18 y.o., anogenital warts
Immunization:
Rabies Vaccine
route
intramuscular (IM) or intradermal (ID)
Immunization:
Rabies Vaccine
Intramuscular Regimen
Purified Vero Cell Rabies Vaccine (PVRV) 0.5 ml
Purified Chick Embryo Cell Vaccine (PCECV) 1 ml
0-7-21-28 days
Immunization:
Rabies Vaccine
Intradermal Regimen
Purified Vero Cell Rabies Vaccine (PVRV) 0.1 ml
Purified Chick Embryo Cell Vaccine (PCECV) 0.1 ml
0-7-21-28 days
Immunization:
Rabies Vaccine
It should never be given in the _____ since absorption is unpredictable.
gluteal area
Immunization:
Rabies Vaccine
In subsequent exposure, those who completed _____ will only require booster doses on _____.
3 doses, 0-3 days
Immunization:
Rabies Vaccine
booster
IM - PVRV 0.5 ml or PCECV 1 ml
ID - PVRV 0.1 ml or PCECV 0.1 ml
Immunization:
Typhoid Vaccine
route
intramuscular (IM)
Immunization:
Typhoid Vaccine
schedule
minimum 2 y.o.
revaccination every 2-3 years
Immunization:
Typhoid Vaccine
Recommended for _____.
travelers to areas where there is risk of exposure and for outbreak situations
Immunization:
Dengue Vaccine
type
live attenuated
Immunization:
Dengue Vaccine
route
subcutaneous (SC)
Immunization:
Dengue Vaccine
schedule
3-dose series
9-45 y.o.
0-6-12 months
Immunization:
Cholera Vaccine
route
per orem (PO)
Immunization:
Cholera Vaccine
schedule
2-dose series
minimum 12 mos.
Immunization:
Cholera Vaccine
interval
2 weeks
Immunization:
Cholera Vaccine
Recommended for _____.
outbreak situations
natural diasters
Immunization:
Meningococcal Vaccine
route
tetravalent conjugate vaccine (ACYW-135, MCV4-D, MCV4-TT, MCV4-CRM) - intramuscular (IM)
tetravalent polysaccharide vaccine (MPSV4) - intramuscular (IM) or subcutaneous (SC)
Immunization:
Meningococcal Vaccine
Indicated for _____.
thoseat high risk for invasive disease persistent complement comonent deficiencies anatomic/functional asplenia HIV outbreak hyperendemic areas
Immunization:
Meningococcal Vaccine
schedule - MCV4-D
9-23 mos.
2 doses 3 months apart
*≥ 2 y.o. give one dose only
Immunization:
Meningococcal Vaccine
schedule - MCV4-TT
12 mos.
single dose
Immunization:
Meningococcal Vaccine
schedule - MCV4-CRM
2 y.o.
single dose
Immunization:
Meningococcal Vaccine
Revaccinate with MCV4 every _____.
5 years
Immunization:
Meningococcal Vaccine
schedule - MPSV4
2 y.o.
single dose
Immunization:
Meningococcal Vaccine
If MPSV4 is used for high risk individuals as the 1st dose, a 2nd dose using _____ should be given _____ later.
MCV4, 2 mos.
Immunization:
Meningococcal Vaccine
MCV4-D and PCV13 should be given _____ apart.
4 weeks
Immunization:
Pneumococcal Conjugate Vaccine (PCV) / Pneumococcal Polysaccharide Vaccine (PPSV)
route
intramuscular (IM)
Immunization:
Pneumococcal Conjugate Vaccine (PCV) / Pneumococcal Polysaccharide Vaccine (PPSV)
Indicated for children with _____.
high risk medical conditions
Immunization:
Pneumococcal Conjugate Vaccine (PCV) / Pneumococcal Polysaccharide Vaccine (PPSV)
2-5 y.o., incomplete schedule of 3 doses
1 dose of PCV 13
Immunization:
Pneumococcal Conjugate Vaccine (PCV) / Pneumococcal Polysaccharide Vaccine (PPSV)
2-5 y.o., unvacccinated or incomplete schedule of < 3 doses
2 doses of PCV 13 8 weeks apart
Immunization:
Pneumococcal Conjugate Vaccine (PCV) / Pneumococcal Polysaccharide Vaccine (PPSV)
2-5 y.o., 4 doses fo PCV 7
1 dose of PCV 13
Immunization:
Pneumococcal Conjugate Vaccine (PCV) / Pneumococcal Polysaccharide Vaccine (PPSV)
6-18 y.o., unvaccinated
1 dose of PCV 13 + 1 dose of PPSV after 8 weeks
Immunization:
Pneumococcal Conjugate Vaccine (PCV) / Pneumococcal Polysaccharide Vaccine (PPSV)
high risk medical conditions
2nd dose of PPSV 5 years after 1st dose
Immunization:
Haemophilus influenzae type B (HiB)
type
conjugate vaccine
Immunization:
Haemophilus influenzae type B (HiB)
route
intramuscular (IM)
Immunization:
Haemophilus influenzae type B (HiB)
12-59 mos., unimmunized or 1 dose of HiB before 12 mos.
2 additional doses 8 weeks apart
Immunization:
Haemophilus influenzae type B (HiB)
12-59 mos., ≥ 1 dose of HiB before 12 mos.
1 additional dose
Immunization:
Haemophilus influenzae type B (HiB)
≤ 5 y.o., HiB booster dosewithin 14 days of starting chemotherapy/RT
repeat dose 3 mos. after completion of therapy
Immunization:
Haemophilus influenzae type B (HiB)
hematopoetic stem cell transplant
reimmunized with 3 doses 4 weeks apart, 6-12 mos. after transplant
Immunization:
Haemophilus influenzae type B (HiB)
unimmunized children ≥ 15 mos. undergoing elective splenectomy
1 dose 14 days before procedure
Immunization:
Haemophilus influenzae type B (HiB)
unimmunized children 5-18 y.o. with anatomic/functional asplenia and HIV
1 dose
Immunization of Teens:
Hep B
recommended age
unvaccinated 7-18 y.o.
Immunization of Teens:
Hep B
dose
3
Immunization of Teens:
Hep B
schedule
0-1-6 months
Immunization of Teens:
Hep B
route
intramuscular (IM)
Immunization of Teens:
Hep B
precautions and contraindications
severe allergic reaction to vaccine component, moderate to severe illness
Immunization of Teens:
Hep A
recommended age
unvaccinated 7-18 y.o.
Immunization of Teens:
Hep A
dose
2
Immunization of Teens:
Hep A
schedule
2nd dose 6 months after 1st dose
Immunization of Teens:
Hep A
route
intramuscular (IM)
Immunization of Teens:
Hep A
precautions and contraindications
severe allergic reaction to vaccine component, moderate to severe illness
Immunization of Teens:
MMR
recommended age
unvaccinated 7-18 y.o.
incompletely vaccinated 7-18 y.o.
Immunization of Teens:
MMR
dose, unvaccinated 7-18 y.o.
2
Immunization of Teens:
MMR
dose, incompletely vaccinated 7-18 y.o.
1
Immunization of Teens:
MMR
schedule, unvaccinated 7-18 y.o.
4 weeks betwen doses
Immunization of Teens:
MMR
schedule, incompletely vaccinated 7-18 y.o.
2nd dose 4 weeks after 1st dose
Immunization of Teens:
MMR
route
subcutaneous (SC)
Immunization of Teens:
MMR
precautions and contraindications
severe allergic reaction to vaccine component, moderate to severe illness, pregnancy, immunosuppression, recent blood transfusion
Immunization of Teens:
Varicella
recommended age
unvaccinated 7-12 y.o.
unvaccinated ≥ 13 y.o.
incompletely vaccinated 7-18 y.o.
Immunization of Teens:
Varicella
dose, unvaccinated 7-12 y.o.
2
Immunization of Teens:
Varicella
dose, unvaccinated ≥ 13 y.o.
2
Immunization of Teens:
Varicella
dose, incompletely vaccinated 7-18 y.o.
1
Immunization of Teens:
Varicella
schedule, unvaccinated 7-12 y.o.
3 month interval
Immunization of Teens:
Varicella
schedule, unvaccinated 7-12 y.o.
1 month interval
Immunization of Teens:
Varicella
schedule, incompletely vaccinated 7-18 y.o.
7-12 y.o. - 3 mos. from 1st dose
≥ 13 y.o. - 4 weeks from 1st dose
Immunization of Teens:
Varicella
route
subcutaneous (SC)
Immunization of Teens:
Varicella
precautions and contraindications
severe allergic reaction to vaccine component, moderate to severe illness, pregnancy, immunosuppression, recent blood transfusion
Immunization of Teens:
Influenza
recommended age
9-18 y.o.
Immunization of Teens:
Influenza
dose
annually
Immunization of Teens:
Influenza
schedule
begin immunization in February
Immunization of Teens:
Influenza
route
intramuscular (IM) or subcutaneous (SC)
Immunization of Teens:
Influenza
precautions and contraindications
severe allergic reaction to vaccine component, moderate to severe illness, history of Guillain-Barre Syndrome following previous dose
Immunization of Teens:
HPV
recommended age
females: 9-18 y.o. (bivalent, quadrivalent)
males: 9-18 (quadriavalent)
Immunization of Teens:
HPV
schedule
bivalent - 0-1-6 months
quadrivalent - 0-2-6 months
*females, 9-14 y.o., 2 doses, 0-6 months
Immunization of Teens:
HPV
route
intramuscular (IM)
Immunization of Teens:
HPV
precautions and contraindications
severe allergic reaction to vaccine component, moderate to severe illness, if found to be pregnant after starting immunization delay remaining doses until completion of pregnancy
Immunization of Teens:
Td/Tdap
recommended age
unvaccinated 7-18 y.o.
incompletely vaccinated 7-18 y.o.
fully vaccinated 7-18 y.o.
*fully vaccinated - 5 doses of DTap or 4 doses of DTap if the 4th dose was given ≥ 4 y.o.
Immunization of Teens:
Td/Tdap
dose, unvaccinated 7-18 y.o.
3
Immunization of Teens:
Td/Tdap
dose, incompletely vaccinated 7-18 y.o.
1-2
Immunization of Teens:
Td/Tdap
dose, fully vaccinated 7-18 y.o.
1
Immunization of Teens:
Td/Tdap
schedule, unvaccinated 7-18 y.o.
0-1-6 months with Tdap as the first dose then Td for the remaining doses
Immunization of Teens:
Td/Tdap
schedule, incompletely vaccinated 7-18 y.o.
1 dose Tdap and Td for the remaining doses
Immunization of Teens:
Td/Tdap
schedule, fully vaccinated 7-18 y.o.
1 dose Tdap the Td every 10 years
Immunization of Teens:
Td/Tdap
route
intramuscular (IM)
Immunization of Teens:
Td/Tdap
precautions and contraindications
severe allergic reaction to vaccine component, moderate to severe illness
Prenaatal Education Components
Breastfeeding Newborn Care Anticipatory Guidance Avoidance of Smoking, Alcohol and Teratogens Tetanus Toxoid Immunization Maternal Nutrition
Every infant must be _____ at birth and monitored _____ until discharge.
appraised, daily
_____ is the perfect first food.
Colostrum
Latching-on and breastfeeding must be initiated during the first _____ after delivery.
30-60 min.
Red Flag Signs for Atopy
Respiratory Nasal Ocular Skin Gastrointestinal
Red Flag Signs for Atopy:
Respiratory
chronic cough ± wheezing shortness of breath chest tightness trouble sleeping due to coughing fatigue problems with feeding grunting during infancy
Red Flag Signs for Atopy:
Nasal
frequent sneezing
rhinorrhea
itchiness
nasal congestion
Red Flag Signs for Atopy:
Ocular
bluish-brownish discoloration around both eyes puffiness under the eyes redness tearing itchiness
Red Flag Signs for Atopy:
Skin
dryness
itchiness
Red Flag Signs for Atopy:
Gastrointestinal
itchiness of the roof of the mouth and throat colic vomiting stomach cramps diarrhea bloody stools
Recumbent Length for children _____.
< 2 y.o.
Standing Height for children _____.
≥ 2 y.o.
Recumbent Length = Standing Height + _____
0.7 cm
_____ is a reliable growth indicator even when the age is unknown.
Weight-for-Length/Height
_____ measurement standards enable early detection and prevention of overweight and obesity problems.
Body Mass Index (BMI)
Routine BP measurement should start at _____ and should be done to _____.
3 y.o., ill patients, at rsk patients
BP < 90th percentile
normotensive
BP < 95th percentile
pre-hypertensive
*adolescents - 120/80
BP ≥ 95th percentile
hypertensive
*on 3 or more occasions
RA No. 9288
Newborn Screening Act of 2004
Newborn Screening should be done _____.
immediately 24 hours after birth.
Expanded Newborn Screening has been made available since _____.
December 2014
RA No. 9709
The Universal Newborn Hearing Screening and Intervention Act of 2009
Hearing screening should be done _____.
before discharge, first 3 months
If with (+) Hearing Screening result, referral for intervention should be done _____.
before the age of 6 mos.
RA No. 9482
Anti-Rabies Act of 200
Rabies pre-exposure prophylaxis for children _____.
5-14 y.o.
Iron Supplementation:
LBW Infants
Preparation
drops: 15 mg elemental iron/0.6 ml
Iron Supplementation:
LBW Infants
Dose/Duration
0.3 ml OD 2-6 mos.
Iron Supplementation:
6-11 mos.
Preparation
drops: 15 mg elemental iron/0.6 ml
Iron Supplementation:
6-11 mos.
Dose/Duration
0.6 ml OD x 3mos.
Iron Supplementation:
1-5 y.o.
Preparation
syrup: 30 mg elemental iron/5 ml
Iron Supplementation:
1-5 y.o.
Dose/Duration
1 tsp OD x 3 mos.
30 mg/week x 6 mos.
Iron Supplementation:
10-19 y.o. Adolescent Girls
Preparation
tablet: 60 mg elemental iron with 400 mcg folic acid
Iron Supplementation:
10-19 y.o. Adolescent Girls
Dose/Duration
1 tab OD
Vitamin A Supplementation:
6-11 mos.
Preparation
100,00 IU
Vitamin A Supplementation:
6-11 mos.
Dose/Duration
1 dose only
*usually given at 9 mos. during Measles immunization
Vitamin A Supplementation:
12-59 mos.
Preparation
200,000 IU
Vitamin A Supplementation:
12-59 mos.
DOse/Duration
1 capsule every 6 mos.
Zinc supplementation prevents _____.
pneumonia, diarrhea
Deworming shouldbe done for children _____.
1-12 y.o.
Deworming: Albendazole Dose
12-23 mos. - 200 mg, single dose every 6 mos.
≥ 24 mos. - 400mg, single dose every 6 mos.
Deworming: Mebendazole Dose
≥ 12 mos. - 500mg, single dose every 6 mos.
Albendazole and Mebendazole are given on a _____.
full stomach
Deworming should not be done on children with _____.
severe malnutrition high-grade fever profuse diarrhea abdominal pain serious illness previous hypersensitivity to antihelminthic drug
In municipalities endemic for filariasis, mass treatment with _____ and _____ are given to children _____.
Diethylcarbamazine Citrate (DEC), Albendazole, ≥ 2 y.o.
First dental visit should be done at the time of _____ and no later than _____.
eruption of first tooth, 12 mos.
Age-Approprieate physical activities for children should be done _____ daily on _____.
60 min., most days of the week
Sedentary activity should be limited to _____.
2 hours/day
Parents and children should be counseled to prevent injuries from _____.
birth to adolescence
RA No. 7610
Anti Child Abuse Law
_____ is an ubiquitous environmental toxicant that can cause cognitive impairment.
Lead
CBC should be done at least once during _____.
6-24 mos.
2-6 years
10-19 years
CBC:
Special attention should be given to infants _____.
6-12 mos.
12-23 mos.
PPD:
Drugs Used
5 TTU PPD
2TU-RT23
PPD should be read _____ after
48-72 hours
PPD:
> 5 mm induration is positive if there is _____.
history of close contact with known or suspected TB
clinical findings or CXR suggestive of TB
immunosuppressed condition
PPD:
An induration of _____ is considered poritive.
> 10 mm
