Flashcards in An update to the Greig Health Record: Preventive health care visits for children and adolescents aged 6 to 17 years - Technical report Deck (81):
What do the fonts mean in the Greig Health Record?
Boldface means good strength of recommendation
Italics means fair
Regular means based on consensus or inconclusive evidence
What topics is office counselling known to be effective for?
1. Promoting helmet use
2. Condom use to prevent STI
3. More physical activity
4. Responsible TV viewing
5. Parental smoking cessation
6. Increasing seat belt use (maybe effective)
What are exceptions to the rules of confidentiality?
1. Homicidal ideation
2. Suicidal ideation
3. Emotional, physical or sexual abuse
What is the recommended frequency of preventive visits in children and youth?
Every one to two years (consensus)
What are the three age ranges of the checklist templates for the Greig Health Record?
6 to 9
10 to 13
14 to 17
What are the section headings for the Greig Health Record?
1. Weight, Height, and BMI
2. Psychosocial history and development
3. Nutrition, Education, and Advice
4. Specific Concerns
What are the changes from the 2010 to 2014 WHO growth charts adapted for Canada?
1. 0.1%ile was removed
2. There is a new dashed line between 97th to 99.9th percentile on the 5-19yo BMI curves to assess further
3. Do not assess weight for age alone after 10yo
How do you calculate BMI?
mass in kg/(height in metres)2
What is the BMI definition of overweight for the WHO growth curves?
BMI between 85th to 97th percentile
What is the BMI definition for obesity for the WHO growth curves?
BMI above the 97th percentile
What should be reviewed in the social history taking for younger children?
1. Family structure and dynamics incld. discipline
2. School performance and enjoyment
3. Extracurricular activities
4. Peer relationships esp. bullying
What screening questionnaire should be used as a guide for the psychosocial interview for adolescents?
-Education and Employment
-Drugs, Drinking, and Dieting
-Suicide and Depression
-Safety/Violence and Abuse
What are risk factors for low income?
4. Headed by a lone female parent
5. Raising a disabled child
What does low SES make one more at risk for?
1. Infant mortality
2. Childhood asthma
3. Overweight and obesity
4. Injuries and deaths from injuries
5. Mental health issues including learning and emotional disorders
6. Poorer adult health incld. physical disability, clinical depression, and premature death
What is the rate of childhood poverty in Canada?
1 in 7
What is bullying?
"a form of aggression in which one or more children repeatedly and intentionally intimidate, harass, or physically harm a victim who is perceived as unable to defend herself or himself." It includes physical and verbal aggression, more subtle, relational aggression, and technology assisted bullying (i.e. cyberbullying).
What are victims of bullying at increased risk for?
1. Self harm
2. Long term sequelae into adulthood
What are bullies at increased risk for?
3. Dysfunctional long-term relationships later in life
What are methods of primary prevention of bullying?
Parental cognitive simulation and emotional support. Attending to early cognitive deficits such as language problems, imperfect causal understandings, and poor inhibitory control.
What age range is routine screening for depression recommended?
There is insufficient evidence in children 7-11yo
What percentage of grade 7-12 students in Ontario in 2011 reported feeling elevated psychological distress in the preceding 12 months?
What percentage of grade 7-12 students in Ontario in 2011 reported serious suicidal ideation in the preceding 12 months?
What percentage of grade 7-12 students in Ontario in 2011 reported history of a suicide attempt?
What are recommended for the treatment of MDD and anxiety?
What are associated behaviors with problem gambling?
1. Parental concern re: emotional health
2. Academic performance problems
3. Sleep problems, substance use
4. Criminal activities or money missing from the home
What are screening questions for a gambling problem?
1. Frequency - at least once per week is a risk
2. Limits - do they gamble more than planned
3. Secrecy - hiding gambling, lying
*Ask about depression/suicide in those aware that they have a problem
What increases the risk of developing a gambling problem?
6. Antisocial traits
7. Learning disabilities
What is the DSM-5 criteria for dependence?
Three or more of the following features:
3. withdrawal symptoms
4. difficulty controlling use
5. continued use despite negative consequences
6. Neglecting other activities
7. desire to cut down
What percentage of Ontario students report symptoms of a gaming problem?
What are evidence proven primary care-relevant behavioral interventions?
Prevention of smoking in children and youth BUT not cessation
Insufficient evidence for alcohol or drug abuse prevention strategies
What screening questionnaire can be used to screen for alcohol and drug problems in adolescents and young adults under 21yo?
CRAFFT screening questionnaire
What is included in the CRAFFT screening questionnaire?
1. Have you ever ridden in a CAR driven by someone who was "high" or had been using alcohol or drugs?
2. Do you ever use alcohol or drugs to RELAX , feel better about yourself or fit in?
3. Do you ever use alcohol or drugs while you are by yourself or ALONE?
4. Do you ever FORGET things you did while using alcohol or drugs?
5. Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?
6. Have you ever gotten into TROUBLE while you were using alcohol or drugs?
What are Health Canada recommendations regarding limiting ingestion of caffeine?
1. 45mg/day for 4-6yo
2. 62.5mg/day for 7-9yo
3. 85mg/day for 10-12yo
4. Insufficient evidence for teens
5. 400mg/day for adults
What is precocious puberty?
Appearance of physical signs of puberty before age 9 in boys and before age 7-8yo in girls. But it maybe normal for breast and pubic hair development as young as 6yo in certain ethnicities
What screening should occur for girls with both breast and pubic development at 7-8yo?
1. Growth and history reviewed
2. Bone age for height prediction
What are the Canadian age for consent for sexual activity?
1. 16yo for non-exploitative activity
2. 18yo for exploitative activity (e.g. prostitution, pornography, relationships with difference in authority or dependence)
3. for 14-15yo within 5years of their age
4. for 12-13yo within 2 years of their age
5. No consent under age 12
What is sexting?
The sending or receiving of sexually explicit messages or images electronically
What are the rates of intimate partner violence in Canada?
43% occurs to women 15-24yo
13% of girls who have been in a relationship have been physically abused
54% of girls 15-19yo have experienced "sexual coercion" in a dating relationship
How can emergency contraception be obtained in Canada?
Without prescription everywhere excluding Saskatchewan where its behind the counter and in Quebec where it requires a pharmacist prescription
What are the recommendations regarding cervical cancer screening?
Screening every three years beginning at 21yo if sexually active
Why is cervical cancer screening not recommended under age 21?
Because abnormal test results are likely to be transient and to resolve on their own; in addition, resulting treatment may have an adverse effect on future child-bearing
What are the recommendations for STI testing?
STI testing in all sexually active women under 25yo at least annually
Screen males with risk factors
What are the recommended sexuality screening questions?
1. Partners: sex with men, women, both or people who identify in other ways? how many partners in the past 2 months/12 months? any partners having sex with someone else while in a sexual relationship with you?
2. Pregnancy prevention: what are you doing to prevent pregnancy?
3. STI Protection: what do you do to protect yourself from STIs and HIV?
4. Practices: vaginal/anal/oral sex? condom use?
5. Past STI history: have you or a partner ever had a STI, injected drugs, or exchanged sex for drugs or money?
What are the screening recommendations for gonorrhea and chlamydia?
1. Urine sample for males
2. Urine testing for asymptomatic women
3. Cervical or vaginal swabs for symptomatic females or those who have been in contact with infected person
4. Male who have sex with males gonorrhea screening for urethral, pharyngeal and rectal infections
Who should be screened for HIV?
Screen all sexually active individuals older than 15yo and screen those under 15yo with risk factors. Risk factors include: MSM, IVDU, those w/ STI or requesting STI testing, unprotected vaginal or anal intercourse, having sexual partners who are infected w/ HIV, bisexual or injecting drugs, exchanging sex for drugs or money
Who should be screened for syphilis?
Screen for those at increased risk, including high community prevalence
Who should be screened for Hep B and C?
Screen high risk
Who should be screened for HPV?
Insufficient evidence for primary screening
Who should be screened for herpes simplex?
Primary screening not recommended
What is the recommendations regarding breast and testicular cancer screening?
Breast and testicular routine or self-examination not recommended
What is a leading cause of absenteeism from school and work in adolescents?
What is the definition of complementary and alternative medicine?
a broad domain of healing resources that encompasses all health systems, modalities, and practices and their accompanying theories and beliefs, other than those intrinsic to the politically dominant health systems of a particular society or culture in a given historical period. CAM includes herbs, homeopathic medicines, acupuncture, energy healing, yoga, special diets, biofeedback techniques
What is the rate of CAM use?
20-40% in healthy children
50% in children w/ chronic, recurrent, or intractable health conditions
70% in street-involved youth
What is the prevalence of overweight 5-17yo?
What is the prevalence of obesity in 5-17yo?
What populations are at increased risk of obesity and overweight?
1. low SES
2. living in a rural or remote area
3. First Nations people living off reserve
What are recommendations to prevent excess childhood weight gain?
1. >5 servings of fruits and vegetables per day
2. Avoid sweetened fruit drinks, sport-drinks, and soft-drinks
3. Eat breakfast daily
4. Eat family meals, as many times as possible, includes breakfast, lunch and dinner
5. Do not eat in front of the television
6. Minimize meals outside of the house and no "fast foods"
7. Food portions should be self regulated by child
8. Minimum of 60 minutes per day of physical activity
9. Adequate sleep
10. Maximum of 2h per day of screen time after 2yo, no TV or video games in the bedroom
What are the recommendations regarding physical activity and reducing sedentary behavior?
1. >60min of moderate to intense physical activity daily
2. Include vigorous physical activity for 60min >3 days per week
3. Include muscle and bone strengthening >3 days per week
4. Limit passive transportation e.g. by car
5. Limit sitting for prolonged periods of time
6. Encourage periodic or incidental movement during times of prolonged sitting
7. Allow time for free play
What are the recommendations regarding recreational screen time?
Includes television, computers, video games, electronic games, handheld games, some phone activities
Ages 5-17yo - maximum 2h per day of recreational use. Less is better for additional health benefits
What are the benefits of increasing physical activity and reducing sedentary behaviors?
1. decrease obesity
2. improve BP
3. improve lipids and glucose
4. improve muscle and bone health
5. improve cognitive executive function
6. improve cognitive testing
7. improve working memory
8. reduce depressive symptoms
9. improves fitness
10. improves body composition
11. improves body satisfaction in girls
12. improves general self-esteem
13. improves pro-social behaviors
Are active video games recommended?
What are the recommendations for daily sleep?
What are the sequelae of sleep deprivation?
1. weight gain and concurrent and adult obesity
2. increased risk of glucose intolerance and diabetes
3. suicidal ideation
4. cardiovascular risk factors
What are benefits of sleep?
1. Better cognitive performance
2. Better working memory and memory consolidation
3. Fewer behavioral problems
4. Better school performance
5. Improved emotional regulation
What are nightime symptoms for OSA?
Gasping during sleep
What are daytime symptoms for OSA?
What is the most common cause of OSA in preschoolers?
Hypertrophy of the adenoids and tonsils
What are sequelae of OSA?
1. Cardio-metabolic consequences
2. Neurocognitive deficits (impaired learning and memory)
3. Behavioral problems
What are strategies for good sleep habits in school age children?
1. maintain a relaxed predictable sleep routine - consistent and earlier bedtimes for all family members
2. encourage relaxed settings at bedtime (dim lights, calm environment)
3. identify and avoid negative sleep associations
4. decrease time, attention given to night waking
5. acknowledge night time fears and provide reassurance
6. avoid daytime napping
7. interact with children at bedtime
8. avoid replacing parental attention w/ TV, computer or video games
9. no electronic or media in the bedroom
10. limit screen time before bedtime (avoid 1-2h before bedtime)
11. reading is an essential part of the bedtime routine
12. no foods or drinks that contain caffeine (including chocolate and soft drinks) before bed, as it may interfere with sleep onset and quality
13. avoid stimulant medications e.g. cough medicine, decongestants
14. consult with a primary care practitioner about snoring or other sleep concerns
What are strategies for good sleep habits in adolescents?
1. have a consistent bedtime routine
2. try to keep sleep and wake times the same for weekdays and weekends
3. avoid daytime napping
4. have a relaxed setting at bedtime (dim lights, calm environment)
5. get exercise every day, but avoid high-intensity exercise within 3h of bedtime
6. fall asleep in your bedroom, not on the couch
7. avoid caffeine after mid-afternoon and later
8. don't smoke and don't use alcohol, herbal products or OTC sleep aids to help you sleep
9. avoid media/electronics in the bedroom
10. limit screen time before bedtime (avoid 1-2h before bedtime)
11. consult with a PCP about snoring or other sleep concerns
What safety topics should be discussed?
1. Helmet use with bicycles
2. Booster seats for children 5-7yo
3. Seat belts for children >8
4. ATV and snowmobile drivers should be >16yo
5. Children should not ride as passengers on ATVs or snowmobiles
6. No trampoline use in home environments
7. No participation in trampolines for children <6yo
8. Parental supervision for children in water
9. Pools should be fenced
10. No swimming alone
11. Swimming lessons should be encouraged and begin at about 5yo
12. Children and youth <18yo should be banned from commercial tanning facilities
13. Recommend elimination of firearms in homes and communities
14. recommend safer gun storage
15. No checks to the head in hockey
16. avoid head-to-head contact
17. wear appropriate protection
18. skiiers and snowboarders should wear helmets
19. wrist guards should be used while snowboarding
20. Avoid bodychecking in hockey
21. Limit teens to <20h per week of work
22. Smoke detectors should be properly installed, checked regularly and replaced every 10y
What is second hand smoke associated with?
2. Altered respiratory function
4. Cardiovascular effects
5. Behavior problems
6. Sleep difficulties
7. Increased cancer risk
8. Higher likelihood of smoke initiation
What is recommended for dental care?
1. Professional dental care including fluoride application and selective use of sealants
2. Regular brushing with fluoride-containing toothpaste
3. Regular flossing
4. Fluoride supplementation if not in the water
What should be screened in the physical examination?
4. Visual acuity screening
What is the prevalence of hypertension in obese children and youth in the US?
What is the first line treatment for obese children with hypertension?
Lifestyle modification: weight reduction if overweight or obese, increasing physical activity, reduce sodium, engage in health education and counselling
Is screening recommended for idiopathic scoliosis in asymptomatic adolescents?
What investigations are recommended?
1. No routine
2. Rubella immunity confirmed in sexually active females
3. Ferritin screening for those at risk for iron deficiency
4. Sickle cell screening in at-risk populations
5. Lipid and plasma glucose in overweight or obese children >10yo
What are pain reduction strategies for vaccinations?
1. use the least painful brand
2. keep the child in a non-supine position
3. rapid injection without aspiration
4. inject the most painful vaccine last
5. rub or stroke the skin of the injection site with moderate intensity before and during vaccination
6. parent-led distraction or coaching may be used
7. clinician led or child led distraction should be used
8. have child do slow deep breathing or blowing during vaccination
9. use combined psychological interventions
10. avoid telling child, "It won't hurt"
What are the changes to recommendations for vaccinations?
1. Two doses of varicella with the second dose at 18m or 4-6yo
2. Two doses of MMR: 12m and 18m or 4-6yo
3. Can use the combo MMRV
4. Meningococcal C conjugate vaccine in early adolescence
5. Meningococcal B for those at high risk
6. HPV recommended for both genders 9-26yo
7. TB screening in high risk groups only