Psych/Development/Pharm Flashcards
What are the 3 Ps to pain management?
- Pharmacological
- Physical
- Psychological
In what 3 circumstances is LET contraindicated?
List 3 topical anesthetics. Which works fastest? Which works for longest?
List 2 non-pharmacological managements to managing fracture pain.
- < 3 mo
- Mucosal surfaces
- Large, deep or contaminated wounds
Topical anesthetics
- Maxilene (liposomal lidocaine 4%; amide anesthetic)
- Ametop (amethocaine 4%/tetracaine; ester anesthetic)
- Emla (lidocaine-prilocaine 5%; amide anesthetic)
- Pain ease (vapocoolant spray; pentafluoropropane tetrafluoroethane)
Onset: Pain ease → Ametop/Maxilene (30min) → Emla (60min)
Duration: Pain ease (1 min) → Emla (1-2h) → Maxilene → Ametop (4h)
Fracture pain: Immobilize, icing
Provide 3 examples of physical pain management
Provide 3 examples of psychological pain management
How can you minimize injection pain? List 3
Physical
- Skin-to-skin (kangaroo) care
- Pacifier
- Swaddling
- Tucking
- Sitting upright
Psychological
- Parental presence
- Age-appropriate preparation
- Distraction
- Deep breathing
- Hypnosis
- Music
Injection pain
- Topical anesthetic
- Buffered lidocaine: add bicarbonate to lidocaine in 1:10 ratio
- Inject slowly
- Use solution warmed to body temperature
- Small gauge needle (27G-30G)
What are the 4 recommendations from the CPS for pharmacare in Canada
- All governments should:
- Develop/implement pharmacare plans that mandate universal, comprehensive, portable prescription drug coverage for children/youth
- Develop a comprehensive, evidence-informed national list of paediatric drugs for inclusion to the pharmacare program
- Modernize processes for drug approvals to expand access and ensure appropriate paediatric labelling for all medications marketed in Canada
- Support drug trials, cost-effectiveness research and the development of commercial paediatric drug formulations
What percentage of medications are currently administered “off label” in Canada?
80%
Why are children more affected by climate related changes? List 2.
Which children are at greatest risk?
- Metabolize more water/air/food per kg than adults
- Rapid growth/development, physiologically dynamic systems and risk exposure over a longer life course
Greatest risk
- Low socioeconomic status
- Indigenous
- Living with a chronic disease
List 5 specific climate related risks children may face and one example of each.
- Depletion of ozone → ↑skin cancer
- ↑air pollution → ↑respiratory disorders/asthma + cardiovascular illnesses, ↑risk for cancer
- ↑natural disaster events →
- Displacement of home/living in overcrowded shelters
- Inability to access chronic disease management
- Loss of possessions/routines
- Loss of loved ones
- Heat/cold injuries → burns/frostbite (due to immature temperature regulation systems)
- Contaminated water sources d/t heavy rain/flooding overwhelming sewage treatment facilities → water-borne infections (Salmonella typhi, E coli, Cryptosporidium, amebiasis)
- Inset, tick and roden related infections → Lyme disease, Equine encephalitis, RMSF
List 4 risk factors for lead toxicity
- Live in home built before 1960 for ≥6mo (esp if water supplied by lead pipes, original paint is chipping, under renovation)
- Sibling/housemate/playmate with lead poisoning
- Pica, lick/mouth painted surfaces or eat paint chips
- Emigrated or international adoption from country with higher lead levels
- Infant born to mother with lead exposure or mineral deficiency (zinc, calcium, iron, magnesium)
- Any above risk factors + known or suspected neurodevelopmental disorder
List 2 low-lead symptoms and 4 toxicity symptoms
Low-lead:
- Neurodevelopmental signs
- Inattention
- Hyperactivity
- Hearing impairment
- Poor balance
- Speech delay
- Cognitive delay
Lead toxicity:
- CNS: headache, clumsiness, somnolence, seizure
- GI: abdominal pain, constipation, vomiting
- Heme: anemia (microcytic)
- GU: renal failure
- possible death
What are 4 long-term consequences of lead poisoning?
- Hypertension
- Vascular disease
- Renal impairment
- Aberrant behaviour/cognitive delay
You want to order a screen for suspected lead exposure.
What tests do you order?
- Serum lead level (venous)
- CBC
- Ferritin
- Calcium, protein, albumin
What are the 3 ranges for management of serum lead levels?
When do you need to repeat testing?
What intervention is recommended?
-
5-14 mcg/dL
- Repeat in 1-3 months, if stable - 3 months
- Nutrition counselling (fruit with every meal, encourage iron containing foods)
- Supplement if iron deficient
- Contact public health for guidance
- Full neurodevelopmental assessment and follow-up
- PEHH for sources of exposure
-
15-44 mcg/dL
- ABOVE, except repeat in 1-4 weeks
- AXR to r/o foreign body
- If asymptomatic, no chelation
-
>44 mcg/dL
- ABOVE, except repeat in 48h
- Admit to hospital
- Chelation therapy with Poison control centre
What are the 4 Ms for promoting healthy screen use in school-aged children + adolescents?
-
Monitor for problematic screen use
- Complaints about being bored/unhappy without access
- Oppositional behaviour in response to screen limits
- Screen use that interferes with sleep, school, face-to-face interactions, offline play or physical activities
- Negative emotions following interactions or video games or while texting
-
Model
- Review your own media habits, plan time for alternative hobbies, outdoor play and activities
- avoid screens 1h before bedtime
- Discourage recreational bedroom use
-
Meaningful
- Prioritize face-to-face interaction, sleep and physical activity over screens
- Choose educational, active or social activities on screens
-
Manage
- Family media plan
- Co-view and talk about content whenever possible
- Review acceptable/unacceptable behaviours proactively
- Get passwords
- Discourage multitasking during homework
When does educational TV use peak?
When does entertainment TV + social medial take up more leisure time?
Preschool
By 8 years
List 4 benefits of screen use in school-aged children
List 4 benefits of screen use in adolescents
School-age Benefits
- Improve academic performance → enrich knowledge + literacy skills
- Develop positive relationships with teachers and peers
- Increased math proficiency + reduced learning gaps
- Cooperative or competitive video games can offer opportunities for identify, cognitive and social development
- Increase sense of well-being, prosocial behaviour
- Lower depression risk vs no screen time if 1h/day
- help make and maintain friendships (more diverse and gender-inclusive)
Adolescents (moderate use 2-4h/d)
- Improves self-concept
- Validating
- Affirming
- Increased cognitive skills with game-specific, short-term action video games (especially in executive function and visual spatial working memory)
- Enhanced well-being
List 4 risks of digital media in school-aged children.
List 4 risks of digital media in adolescents
- Poor sleep duration and quality
- Inhibit melatonin release → emotional arousal, disrupted sleep rhythms
- ↑ sedentary time + obesity risk
School-aged
- Conduct problems by 7yo if ≥3h/day at 5yo
- ↑depressive symptoms
- ↓ physical activity
- ↑exposure to harmful/negative content if not superfised
- Multitasking
- Impairs problem solving
- Undermines confidence in ability to do homework
- Disrupts reading efficacy
- Being economically disadvantaged or minority/marginalized is associated with more media use
Adolescent
- No use or excessive use → feelings of alienation and social exclusion
- Depression risks
- Receiving negative content in instant messages (also anxiety)
- Excessive use (>6h/d)
- Passively surfing internet when one has few or no close friends
- Lower English + math scores
- Weaker working memory
- Lower sustained attention
- Greater impulsivity
- If >50% free time is spent on gaming → hyperactivity, conduct problems, peer issues and emotional problems
*
What approach should you use to strength relationships with and within families you see.
List 2 ways to increase family engagement and build trust
- Ask questions
- Build on family’s relational strenghts
- Counsel with family-centred guidance
- Develop plans for changing behaviours related to sleep or discipline PRN
- Educate about positive parenting strategies
Engagement
- Ask parent about their childhood (“how did your parents help you deal with emotions”)
- Screen relational issues/social isolation (“who do you turn to for support”)
- Motivational interviewing
- Reframe negative exchanges (“I wonder if there’s a more helpful way to think about this behaviour”)
What are the issues that parents most often seek advice from health care providers regarding?
How should parents approach disciplining their children?
- ‘Positive discipline’
- Teaches child appropriate behaviour rather than punishing them for inappropriate behaviour
- Uses “I statements” “ I don’t like it when you do that”
- Purpose: foster independence and communication skills, problem solve, take responsibility for behaviour
Be consistent without being rigid
Wait until both child and parent are emotionally ready to re-engage
“Redirect”
- Reduce words
- Embrace emotions
- Describe (without lecturing)
- Involve the child in discipline
- Reframe a ‘no’ into a ‘yes’ (with conditions)
- Emphasize the positive
- Creatively approach a disciplinary situation
- Teach
When does a baby develop normal circadian rhythm cycle?
List 3 healthy strategies to promote self-soothing at bedtime for babies
What should be the first line strategy to prevent sleep problems in infants and young children?
At least 6 months of age
- Consistent, calming sleep routines (“bath, book, bed”)
- Settling babies into their cribs drowsy, but still awake
- Putting babies to bed without a bottle
- Waiting a few minutes to see if they settle to sleep on their own after waking
- Avoiding overstimulation during night-time feeds or diaper changes
Gradually withdraw parental attention while maintaining a presence at bedtime (lying near but not interacting with children until they fall asleep) or leaving room and not returning for 2-5 minutes before responding to crying, then lengthening that interval
How can paediatricians help parents with problem behaviours? What approach should you take?
ABCs
-
Antecedants (what events precede the behaviour and how are parents responding)
- Time-ins: Connect then redirect
- Behaviours
- Consequences
Environmental factors (may be contributing to stress but can be modifiable): living conditions, transitions, scheduling, possible interferences
Serious, disruptive or intractable child behaviours - early clinical recognition, connect with evidence-based Parent Management Training program
Provide guidance regarding crying behaviours for a mother that has a baby with infantile colic
- Crying is a form of communication - how they call for help, physical closeness or to have their basic needs met
- Responding consistently, quickly and warmly helps develop secure attachment
- Episodes become shorter when parents learn to anticipate and respond to early cues
- Cannot “spoil” an infant with warmth and comforting
- Parents need regular social/emotional support
- Feelings of frustration are normal
- If feeling overwhelmed, stress or exhausted, take regular brief breaks or ask partner, trusted family member or frient to some child care
- Share evidence-based informaiton on soothing strategies
List 2 protective parenting factors
- Consistent care provider
- Healthy routines
- Being read to
- Using community resources
- Parent’s social network
- Positive work-life balance
- Limited family screen time
- Healthy bedtime routine
