Preventive Pediatrics Pt I + Policy Statements (Drowning, MVA, BF) Flashcards
Perfect first food for the newborn
Colostrum
Latching on and breastfeeding must be initiated during
First 30 minutes to 1 hour
Follow up of newborns discharged less than 48 hours should be within
48 hours of discharge
6 key motor development milestones
1) Sitting without support 2) Standing with assistance 3) Hand-and-knees crawling 4) Walking with assitance 5) Standing alone 6) Walking alone
Most powerful instruments available to the pediatrician in identifying concerns that may need monitoring or referral
History, observing the child, and thorough PE
Research shows that this helps children develop language and literacy skills, thus making them ready to learn and read in school
Reading aloud during the first years of life
Milestones of early literacy: Drops, throws book
6-12 mos
Milestones of early literacy: Turns board book pages
12-24 mos
Milestones of early literacy: Learns to turn paper pages
2-3 years
Milestones of early literacy: Starts to scribble
2-3 years
Milestones of early literacy: Turns pages one at a time
3-4 years
Milestones of early literacy: Sits still for longer stories
3-4 years
Milestones of early literacy: Scribbles and draws
3-4 years
Milestones of early literacy: Starts to copy letters and numbers
4-5 years
Milestones of early literacy: Likes pictures of baby faces
6-12 mos
Milestones of early literacy: Responds to own name
6-12 mos
Milestones of early literacy: Pats picture to show interest
6-12 mos
Milestones of early literacy: 2- to 4-word phrases
12-24 mos
Milestones of early literacy: Gives book to adult to read
12-24 mos
Milestones of early literacy: Points at picturs
12-24 mos
Milestones of early literacy: Turns book right-side up
12-24 mos
Milestones of early literacy: Adds 2-4 new words per day
2-3 yrs
Milestones of early literacy: Likes the same book again and again
2-3 yrs
Milestones of early literacy: Completes sentences and rhymes in familiar stories
2-3 yrs
Milestones of early literacy: Recites whole phrases from books
3-4 yrs
Milestones of early literacy: Moves toward letter recognition
3-4 yrs
Milestones of early literacy: Begins to detect rhyme
3-4 yrs
Milestones of early literacy: Pretends to read to dolls and stuffed animals
3-4 yrs
Milestones of early literacy: Recognizes numbers and letters
4-5 yrs
Milestones of early literacy: Can retell familiar stories
4-5 yrs
Milestones of early literacy: Can make rhymes
4-5 yrs
Red flag signs for atopy
Family history of atopy + recurrent or persistent symptoms of 1 or more of the ff: Ocular, nasal, respiratory, GI, skin
The Phil Society for Adol Med Specialists reccommends screening and preventive services scheduled every
Year/annually
T/F In adolescent PE, health care provider is preferably of the same gender as the teen patient
T
In addition to routine PE, what should be done
1) Tanner/SMR 2) Breast exam 3) Exam of spine and shoulders for scolio/kyphosis 4) Exam of genitals and anus
Adolescent check up schedule: CBC
Every stage of adolescence
Adolescent check up schedule: Urinalysis
First encounter
Special adolescent labs: Sexually active females
Vaginal wet mount, pap smear
Special adolescent labs: Sexually active males
Serologic test for syphilis
Special adolescent labs: Sexually active males and females
Non-culture test for gonorrhea and chlamydia
Immunization of Teens and Pre-teens: Recommended vaccines (7)
Hep A, Hep B, MMR, Varicella, Flu, Tdap/Td, HPV
Immunization of Teens and Pre-teens (age-doses-sched-route-precautions/contraindications): Hep B
Unvaccinated 7-18; 3; 016 mos; IM; severe allergy to component, mod-severe illness
Immunization of Teens and Pre-teens (age-doses-sched-route-precautions/contraindications): Hep A
Unvaccinated 7-18; 2; 06 mos; IM; severe allergy to component, mod-severe illness
Immunization of Teens and Pre-teens (age-doses-sched-route-precautions/contraindications): MMR
Unvaccinated or incompletely vaccinated 7-18 ; unvacc 2, incom 1; 01; SC; severe allergy to component, mod-severe illness, pregnancy, immunosuppression
Immunization of Teens and Pre-teens (age-doses-sched-route-precautions/contraindications): Varicella
Unvaccinated 7-12, >/13, incom 7-18; unvacc 2, incom 1; 7-12 03, >13 1, SC, severe allergy to component, mod-severe illness, pregnancy, immunosuppression
Immunization of Teens and Pre-teens (age-doses-sched-route-precautions/contraindications): Influenza
9-18; annual, starting Feb; IM/SC; severe allergy to component, mod-severe illness, history of Guillan-Barre following a previous dose
Immunization of Teens and Pre-teens (age-doses-sched-route-precautions/contraindications): HPV Bivalent
9-18 FEMALES; 3; 016; IM; severe allergy to component, mod-severe illness, if found to be pregnant after starting immunization delay remaining doses until completion of pregnancy
Immunization of Teens and Pre-teens (age-doses-sched-route-precautions/contraindications): HPV Quadrivalent
9-18 FEMALES and MALES; 2; 026; IM; severe allergy to component, mod-severe illness, if found to be pregnant after starting immunization delay remaining doses until completion of pregnancy
Immunization of Teens and Pre-teens (age-doses-sched-route-precautions/contraindications): HPV Bivalent alternate sched for females
9-14 FEMALES; 2; 06; IM; severe allergy to component, mod-severe illness, if found to be pregnant after starting immunization delay remaining doses until completion of pregnancy
Immunization of Teens and Pre-teens (age-doses-sched-route-precautions/contraindications): Td/Tdap
7-18 unvacc, incom, com; unvacc 3, incom 1-2, com 1; unvac 016, incom 1 Tdap, the rest Td, com 1 dose Tdap then Td every 10 years; IM; severe allergy to component, mod-severe illness
When to use recumbent length vs standing height
Recumbent length for <2 y/o, standing height for >/2 y/o (if <2 will not lie down, may measure standing; if >/2 will not stand, may measure recumbent WITH APPROPRIATE ADJUSTMENT IN VALUE MEASURED)
Difference between recumbent and standing height
Recumbent length is longer by ~0.7cm
Reliable growth indicator even when child’s age is not known
Weight for length or height
Enable early detection and prevention of overweight and obesity problems
BMI
What to do if measurements taken for plotting on WHO growth charts is done in a patient with edema
Note on growth chart that child has edema
A child is normotensive if BP is ___
<90percentile for age, height, and gender
The Pediatric Nephro Society recommends routine BP measurement for children starting what age
3 y/o; regardless of age on all patients who are ill and and at risk
Prehypertension in children is defined as
Average SBP AND/OR DBP >90th but <95th percentile; 120/80 in adolescents
Hypertension in children is defined as
SBP AND/OR DBP >/95th pecentile on THREE or more occasions
RA 9288
Newborn screening act of 2004
Article 3 Section 54 of the Newborn Screening Act of 2004
Obligation to Inform: Any health practitioner who delivers/assists in delivery of a newborn in the PH shall, PRIOR to delivery, inform parents or legal guardian of availability, nature, and benefits of NBS
NBS shall be ideally done when
Immediately after 24 hours from birth
Expanded NBS has been made available since
December 2014
The PPS Policy Statement on National Hearing Screening recommends screening for
All NB, whether high-risk or not
RA 9709
Universal NHS and Intervention Act of 2009
Section 5 of RA 9709
Obligation to Inform: Any health practitioner who delivers/assists in delivery of a newborn in the PH shall, PRIOR to delivery, inform parents or legal guardian of availability, nature, and benefits of hearing loss screening among NB or children 3 months old and below
Section 6 of RA 9709
Obligation to Perform
All infants born in hospitals in the PH shall be made to undergo NHS when
Before discharge, UNLESS parents or legal guardians of the newborn object
All infants who are not born in hospitals in the PH shall be made to undergo NHS when
Within 3 months after birth
In the event of a positive NHS, newborn shall undergo audiologic diagnostic evaluation when
In a timely manner to allow appropriate follow up, recall, and referral for intervention before 6 MONTHS
In the event of a positive NHS, newborn shall undergo audiologic diagnostic evaluation where
NHS centers duly CERTIFIED by the DOH
Recommended timing of regular eye and vision screening in pediatric patients
From infancy until maturation of their visual system
Single most effective way to determining a child’s eye health
Non-invasive and simple eye and vision screening test
Components of eye and vision screening in pediatric patients (5)
1) History 2) VA 3) External inspection 4) Ocular motility 5) ROR
High risk infants who should be referred to an ophtha for comprehensive eye exam
1) Premature infants: 32 weeks, 1500g, any age/weight with a stormy course in the NICU 2) With metab disorders 3) With medical conditions known to have associated eye problems 4) With history of squinting, head tilt, head turn 5) With history of visual difficulties and learning problems 6) Family history of eye problems
VA test done for infants and pre-verbal children
Fix and follow test with unoccluded eyes and with 1 eye occluded
VA test done for children who can participate in subjective/formal testing and are NOT familiar with letters
LEA pictures chart
VA test done for children who can participate in subjective/formal testing and are literate
Sloan chart
VA of children 3-3 11/12 y/o
20/50 (10/25) or better
VA of children 4-4 11/12 y/o
20/40 (10/20) or better
VA of children 5 y/o and older
20/30 (10/15) or better
Tests done to assess ocular motility
1) Corneal light reflex 2) Versions and ductions 3) Cross cover test
In corneal light reflex test, light reflex should be seen simultaneously at
Center of the pupil of each eye
T/F Any limitations or lag in the eye movements in versions and ductions test should warrant a referral
T
T/F Any movement noticed during the corss over test warrants a referral
T
T/F The ROR test should be done under bright illumination
F, under a darkened surrounding
In ROR test, where is light directed?
Through the pupil
A normal ROR shows a red orange glow through the ophthalmoscope signifying light was able to enter the eye and reflected back from the
Choroidal blood vessels
ROR findings that indicate referral to an ophtha
1) Absence of ROR 2) White reflex pupil
LEA chart or its equivalent is preferably done at what age
3 years old
Distance for VA should be tested at what distance
6m (20 ft) or 3m (10 ft) and reading distance of 34-40cm (14-16 inches)
T/F VA testing in children should start with both eyes open
T, then with one of each eye occluded
VA is recorded as
Last line on which 4 of the 5 symbols are read correctly
T/F In VA testing in children, a child who wears glasses should wear his/her glasses
T
T/F In VA testing in children, examiner pointing at the line to be read is preferable over pointing at a specific symbol
T
Most common presenting signs of retinoblastoma
Leukocoria and strabismus
RA 9482
Anti Rabies Act of 2007
RA 9482 mandates provision of FREE routine immunization and pre exposure prophylaxis for what population
5-14 y/o
Iron supplementation: LBW
15mg elemental iron/0.6mL, 0.3mL OD from 2m-6m old
Iron supplementation: 6-11 months
15mg/0.6mL, 0.6mL OD x 3 mos
Iron supplementation: 1-5 y/o
30mg/5mL, 1 tsp [5mL] OD x 3 mos OR once a week for 6 mos
Iron supplementation: Adolescent girls (10-19)
60mg elemental iron with 400mcg folic, 1 tab OD
Vitamin A supplementation: 6-11 mos
100,000 IU, 1 dose (capsule) only given at any time but usually at 9 months of age during measles immunization
Vitamin A supplementation: 12-59 mos
200,000 IU, 1 cap every 6 months
PPS Policy Statement on Zinc Supplementation in Children cites beneficial role in the prevention of
Pneumonia and Diarrhea
Deworming should be done among children aged
1-12 y/o
Drugs recommended for deworming
1) Albendazole 2) Mebendazole
Dose of albendazole for deworming
12-23 mos: 200mg single dose every 6 months; 24 months and above: 400mg single dose every 6 months ON FULL STOMACH
Dose of mebendazole for deworming
12 mos and above: 500mg single dose every 6 months ON FULL STOMACH
Deworming must not be done in what conditions (6)
1) Severe malnut 2) High-grade fever 3) Profuse diarrhea 4) Abdominal pain 5) Serious illness 6) Previous hypersensitivity to antihelminthic drug
Nat’l filariasis elimination program is implemented in municipalities endemic for filariasis and involves mass treatment with
DEC and Albendazole from 2 years and above
Recommended first dental visit
Time of eruption of first tooth and no later than 12 mos of age
Recommended frequency of use of flouride toothpaste among children
AT LEAST 2x a day
T/F Children should be taught to spit out toothpaste and to avoid rinsing after brushing
T
Recommended use of fluoride toothpaste in children: 6 mos to <2 y/o
1000ppm AT LEAST 2x a day; 2.5mm SMEAR; 0.125 x 2 = 0.25mg/day
Recommended use of fluoride toothpaste in children: 2-6 y/o
1000ppm AT LEAST 2x a day; 5mm PEA-SIZE; 0.25 x 2 = 0.50mg/day
Recommended use of fluoride toothpaste in children: 6 y/o and above
1500ppm AT LEAST 2x a day; 10-20mm full length of bristle; 0.50 x 2 = 1mg/day
Has been proven to prevent or reverse enamel demineralization
Professionally applied topical fluoride
Professionally applied topical fluoride is recommended for
1) Children at moderate risk for caries, at least every 6 months 2) Children at high risk for caries, more frequently
T/F Cleansing infant’s teeth as soon as they erupt with either a washcloth or soft brush will help reduce bacterial colonization
T
T/F Use of dental floss in children is important to reduce interproximal caries
T
T/F Factors that impact child’s caries rate: Prolonged bottle feeding
T
T/F Factors that impact child’s caries rate: Bottle feeding while asleep
T
T/F Factors that impact child’s caries rate: Good oral hygiene in the mother
T
Breastfeeding protects mother’s health against (3)
Cancer (breast, uterus, ovaries), obesity, post-partum hemorrhage
T/F While breastfeeding, head, back, and hips should be aligned in a straight manner
T
T/F While breastfeeding, support breast with the hand of the opposite arm in a C-hold position
T
T/F While breastfeeding, the chin should touch the breast
T
T/F While breastfeeding, ensure that the entire nipples plus 1 inch of the surrounding areola
T
While breastfeeding, how long should the baby suck
15-30 mins per breast to extract both foremilk and hindmilk
To ensure adequate milk supply, the breast should be emptied how many times per day
8-10x
Material recommended for use in milk storage
Polypropylene plastic
Recommended breastmilk storage period:
>25C - 1 hr <25C - 4 hrs Ref (4C) - 8 days Freezer (1-door ref) - 2 wks Freezer (2-door ref) - 3 mos Deep freezer with constant temp -20C - 6 mos
Complementary food must be PAST
Properly fed, adequate, safe, timely
Introducing complementary food: One food at a time to be given for
3 days
Introducing complementary food: Start with
Lugaw or cereals, fruits or vegetables; 1-2 tsp a day
Introducing complementary food: Start pureed food at
6 mos
Introducing complementary food: Start finger foods at
8 mos
Introducing complementary food: Start lumpy or chopped food at
10 mos
Introducing complementary food: Start table food at
12 mos
Introducing complementary food: Feed 6-8 month old ___x a day
2-3
Introducing complementary food: Feed 9-24 month old ___x a day
3-4
Introducing complementary food: Give additional nutritious snacks ___x a day
1-2
Introducing complementary food: Do not add salt before
1 y/o
Introducing complementary food: If diet is primarily plant-based, give supplements of (4)
Iron, zinc, calcium, vitamin B12
Recommended duration and frequency of age-appropriate physical activities for children and adolescents
60 mins daily or on most days of the week
Prolonged periods of sedentary activity is defined as a duration of
2 hours per day
LEADING cause of childhood INJURY in the PH
Drowning
T/F Drowning rates are higher in low-income countries
T
In the Western Pacific Region, ___ is the leading cause of INJURY-RELATED DEATH among children less than 5
Drowning
Case fatality rate of drowning is as high as
50%
Epidemiologic characteristics and risk of unintentional drowning: 0-4 years
At home while bathing or in open water in urban settings
Epidemiologic characteristics and risk of unintentional drowning: >/5 years
Natural bodies of water and public pools
Epidemiologic characteristics and risk of unintentional drowning: adolescents 15-19
Associated with alcohol in 15%, majority in swimming pools
3rd leading OVERALL cause of MORTALITY in the 5-15 age group
Traffic crashes
RA that mandates the installation and use of adult seatbelts in front and rear seats of any private motor vehicle
RA 8750
Children below ___ are prohibited from occupying the front seat of any moving motor vehicle
6 y/o
T/F According to AAP, child seats provide effective restraint and minimize risk of death and injury during car crashes if used appropriately
T
Specialized child seats are REQUIRED for children weighing up to ___ or ___ y/o
60lbs, 8 y/o
Built in car seatbelts is mandated for children older than ___ y/o
8
3rd leading cause of INJURY among hospitalized motor vehicle injury patients
Jeepney crashes
4th leading cause of INJURY among hospitalized motor vehicle injury patients
Passenger tricycle injury
T/F Pedestrian injuries account for majority of all road injuries
T, 51%
2nd most common type of ACCIDENT in children 1-12 y/o
Traffic accidents
Safety equipment that works by dissipating the sharp energy of a blow over a large surface area
Helmet
Also known as the Rooming-In and Breastfeeding Act of 1992
RA 7600
Studies show strong evidence that breastfeeding protects the infant from (6)
1) UTI 2) OM 3) Bacteremia 4) Bacterial meningitis 5) Botulism 6) Necrotizing enterocolitis
T/F Infants who are breastfed have shown to have lowered risk for SIDS
T
T/F Infants who are breastfed have shown to have lowered risk for IDDM
T
T/F Breastfeeding improves long-term cognitive and motor abilities in term infants especially with prolonged breastfeeding
T
Studies done in the PH showed that “not breastfeeding” especially within the first 6 months of life increased the rate of mortality associated with (2)
1) Diarrhea (8-10x) 2) Acute lower respiratory tract infection (6x)
It has been shown that bottle feeding increase the risk of what childhood illnesses (2)
1) Otitis media 2) H. influenzae bacteremia and meningitis
It has been shown that bottle feeding increase the risk of death from ___ as high as 20x
Diarrhea
Absolute contraindications to breastfeeding (2)
1) Galactosemia 2) Maternal use of illicit drugs, anti-neoplastic agents, and radiopharmaceuticals
Relative contraindications to breastfeeding
1) Active Tb infection 2) Maternal HIV infection
T/F During the 2 weeks of treatment, breast milk can still be given to the infant
T, by cup or dropper
T/F In feeding infants of mothers with active Tb in the first 2 weeks of treatment, milk expressed in an aseptic manner should be given to the infant by the mother
F, by a caregiver other than the mother
This method has been shown to effectively kill HIV in expressed breast milk from an HIV-positive mother
Heat treatment
T/F There are some instances when breastfeeding is preferred even if the mother is HIV-positive
T
T/F Exclusive breastfeeding of infants of HIV-positive mothers for 3 months or more had no excess risk of HIV infection over 6 months than those never breastfed
T
Feeding practice in the first 6 months of infancy that is proven to be related to higher cumulative probabilities of HIV detection by 6 months
Mixed breastfeeding
“The Baby-Friendly Hospital Initiative” in 1992 advocates (10)
1) Written breastfeeding policy that is routinely communicated 2) Train health care staff in implementation 3) Inform pregnant women about benefits and management of BF 4) Help mothers initiate BF within half an hour of birth 5) Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants 6) No food or drink other than BM unless medically indicated 7) Practice rooming-in 8) BF on demand 9) No artificial teats/pacifiers 10) Foster establishment of support groups and refer mothers on discharge
In 2003, only ___% of children <6 months are exclusively breastfed
37
T/F Incentives for mothers who decide to breastfeed may be provided
T
Policy on advertisements for milk formulas in the PH
Should first pass an Advertising board created by the DOH under the Maternal and Child Committee BEFORE ads are aired
