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Community pediatrics Flashcards

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1
Q

MOH

duties of an MOH

A
  • Conduct polyclinics - antenatal, postnatal, child welfare
  • School medical inspection
  • Supervise immunization
  • Health education
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2
Q

MOH

Staff under MOH

A
  • PHNS - Supervising PHM, PHM
  • Supervising PHI - PHI
  • Non health staff
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3
Q

MOH

Rough population under MOH

A

60,000 population

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4
Q

MOH

Number of MOH in SL

A

328

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5
Q

MOH

Rough population under PHI

A

10,000

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6
Q

MOH

One MOH area needs…. PHIs

A

6

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7
Q

MOH

Public health midwife (PHM) covers

A

3500- 5000 population

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8
Q

Antenatal care

antenatal care is conducted by

A
  • MO
  • Registered or assistant MOs
  • Nursing officers
  • Public health midwives
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9
Q

Antenatal clinic

registration methods

A
  • walk-in registration
  • informing PHM
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10
Q

Antenatal clinic

Booking visit consists of

A
  • detailed Hx
  • Examination
  • Ix-FBC/ HB, Blood grouping, Rh typing
  • VDRL
  • HIV
  • Urine for sugar and protein
  • OGTT (28 weeks)
    Mx
  • Referred to hospital for shared care
  • Folic acid 1mg daily
  • Thriposha 2 packets/ daily
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11
Q

PMH

total no. of routine home visits

A

9 routine visits

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12
Q

Low risk PG mothers should attend the clinic on

A
  1. 6-8 weeks
  2. 12-14 weeks
  3. 18-20 weeks
  4. 22-24 weeks
  5. 26-28 weeks
  6. 32-34 weeks
  7. 36 weeks
  8. 38 weeks
  9. 40 weeks
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13
Q

Activities of an antenatal clinic

A
  • Hx
  • Examination- weight, Pallor, edema, BP, Abd ex, Auscultate FHS, mental health
  • Ix- OGTT, Hb, Urine for protein and sugar
  • Supplements given
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14
Q

supplements given in the antenatal clinic

A
  • folic acid 1mg daily from day 1
  • Calcium lactate 300mg mane (from 12 weeks onwards)
  • ferrous sulphate 200mg nocte (12 weeks onwards)
  • Vit C 100mg daily (12 weeks onwards)
  • tetanus toxoid
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15
Q

Where is USS done in PG

A

done in hospitals. not available in MOH

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16
Q

Antenatal classes

A

3 classes. 1 per Trimester. couples participate together

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17
Q

The antenatal classes

A
  1. Nutrition
  2. post partum contraception
  3. delivery and breast feeding
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18
Q

No of home visits done by a midwife during a PG

A

3 in low risk PG ( one per trimester)

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19
Q

Post partum home visits after NVD

A

4 home visits
1. 1st week
2. 2nd week
3. 3rd week
4. 6th week

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20
Q

No of home visits for a home delivery

A

3 within the first 10 days after a delivery

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21
Q

When should the PMH refer every mother to a postpartum clinic

A

4-6 weeks after delivery

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22
Q

micronutrients issued in the postpartum clinic

A

Folic acid 1mg mane
Ca lactate 300mg
FeSO4 200mg nocte
Vit C 100mg nocte

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23
Q

Postpartum clinic

when is post partum depression screening done

A

at home visit and PNC at 1 month

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24
Q

Postpartum clinic

conditions that needed to be reported by the PMH

A
  • Low birth weight
  • Antenatal and postnatal morbidities
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25
# Postpartum clinic Family planning advices are given in
Postpartum clinic
26
# Child welfare clinic Who attends
PHM PHNS
27
# Child welfare clinic Goals of Child welfare clinic
* Growth * Development * breast feeding/ nutrition * immunization * create awareness among parents
28
# Child welfare clinic frequency
10 visits between 0-5 years
29
How often is a school medical inspection held
annually
30
Grades the SMI is included if the total number of students were <200
done in all grades
31
Grades the SMI is included if the total number of students were >200
Grades 1, 4, 7, 10
32
33
Types of schools covered by the SMI
all government schools and requested private schools
34
SMI is conducted by
* MOH - hospital, GPs, well- wishers * MOMCH (Medical officer maternal and child health)
35
SMI is organized by
PHI
36
What happens in an SMI
* Complete assessment of health * Micronutrient supplementation according to WIFS * Referrals to clinics * Annual sanitary survery * Suwanari clinic for teachers * Awareness programs/ lectures * Monitor the implementation of dental programs, mosquito control, supervision of school canteen * Immunization
37
Referral form used in SMI
Referral card H606
38
children who are referred in SMI is supposed to attend clinics on
* secondary clinics * tertiary clinics * saturday clinics * evening clinics
39
Annual sanitary survery is conducted by
the PHI
40
Vaccine given at one year if not given before
DT/OPV
41
Vaccine given at 7 years
aTD
42
Vaccine given at grade 8
MMR- if a rubella containing vaccine is not given before
43
# CHDR parts of the educational component
* Home visits by PHM * Exclusive breast feeding * Complimentary feeding * weight assessment * length/ height assessment * love and care for baby * family planning
44
# CHDR the neonatal examination details are filled by the
doctor
45
# CHDR Immunization details
* vaccine given * date of administration * batch number * AEFI (ADRs to immunization) * BCG Scar
45
# CHDR Vitamin A dose for the mother and the baby
* mother - 200,000 IU * 6 month to 5y/o- 100,000 IU
46
# CHDR frequency of worm Rx for 18 month to 5 year old child
every 6 monthly
47
# CHDR hearing and vision assessment is done by
parents upto 1 year
48
# CHDR Developmental milestones are assessed from
6 weeks to 5 years
49
# CHDR developmental milestones are assessed by
initially by parents later by PHM
50
# CHDR child health record is done by
the medical officer of health
51
# CHDR child health record includes
* assessment of eyes and vision * hearing * growth * development * CVS assessment * Hip joint * Congenital deformities * Any other disease condition
52
# CHDR the dental hygiene covers
6 months to 18 months
53
# CHDR Preschool medical examination is done by
the MOH at 3 years of age
54
# CHDR weight assessment
* 0-2 years- monthly * 2-5 years- every 3 monthly
55
# CHDR weight scales used 1. 0-1 years 2. 1-2 years 3. >2 years
1. seca scale 2. salter scale 3. weighing scale
56
# CHDR height assessment is done on
* at 4 months * 9 months * 12 months * 1-5 years- 6 monthly
57
# CHDR BMI is calculated at
>2 year old children
58
# CHDR referrals and hospital admissions are included. (T/F)
T
59
# CHDR Educational components pages are
yellow colour
60
# CHDR important growth charts
* weight for age * height for age * weight for height * BMI charts * Head circumference chart
61
# Immunization programme Immunization programme is done according to
EPI ( expanded program for immunization)
62
# Immunization programme How many vaccines are given in the first year of life
five
63
# Immunization programme time durations the vaccines are given during the first year of life
1. during 0-4 weeks 2. on completion of 2 months 3. on completion of 4 months 4. on completion of 6 months 5. on completion of 9 months
64
# Immunization programme vaccines given during the first year of life
1. 0-4 weeks BCG 2. 2 months OPV and pentavalent (DTP-HepB-Hib) (1st dose) flPV (Fractional IPV) (1st dose) 3. 4 months OPV and pentavalent (DTP-HepB-Hib) (2nd dose) flPV (Fractional IPV) (2nd dose) 4. 6 months OPV and Pentavalent (DTP- HepB- Hib) (3rd dose) 5. 9 months MMR (1st dose)
65
# Immunization programme ideal time to give the BCG vaccine
within 24 hours of life before leaving the hospital
66
# Immunization programme If the BCG scar doesn't appear whats the next step
if it doesn't appear by six months can repeat the vaccine after six months upto 5 years
67
# Immunization programme Why is the repeat BCG vaccine not done after five years
BCG vaccine offers protection upto five years
68
# Immunization programme MMR doses are given on
1. on completion of 9 months 2. on completion of 3 years
69
# Immunization programme how many vaccines are given during the second year of life
two vaccines
70
# Immunization programme vaccines given during the second year of life
1. on completion of 12 months - live JE 2. on completion of 18 months - OPV and DTP (4th dose)
71
# Immunization programme vaccine given during completion of 5 years
OPV and DT (5th dose)
72
# Immunization programme the vaccines given during completion of 10 years
* HPV (1st dose) * HPV (2nd dose)
73
# Immunization programme time gap between the HPV vaccines
6 months
74
# Immunization programme generally HPV vaccine is given in grade
10
75
# Immunization programme vaccine given during grade 7
aTd (adult tetanus diptheria)
76
# Immunization programme collectively how many tetanus diptheria vaccines are given under EPI
six doses
77
# Immunization programme another MMR is given during
15- 44 years of females in the child bearing age
78
breast feeding is indicated to start within
30 minutes to 1 hour
79
# Breastfeeding colostrum comes upto
48 hours
80
# Breastfeeding exclusive breastfeeding
until 6 months
81
# Breastfeeding Breastfeeding is continued upto
2 years
82
# Breastfeeding who trains the post-natal clinic on skills to train mothers on proper breastfeeding
Public health midwife
83
# Breastfeeding First step to successful breastfeeding
Hospital policies- hospitals support mothers to breastfeed by 1. not promoting infant formula, bottles, teats 2. making breastfeeding care standard practice 3. keeping track of support for breastfeeding
84
# steps to successful breastfeeding Second step to successful breastfeeding
Staff competency- hospitals support mothers to breastfeed by 1. training staff on supporting mothers to breastfeed 2. assessing health workers' knowledge and skills
85
# steps to successful breastfeeding Third step to successful breastfeeding
Antenatal care- hospitals support mothers to breastfeed by 1. discussing the importance of breastfeeding for babies and mothers 2. preparing women in how to feed their baby
86
# steps to successful breastfeeding Fourth step to successful breastfeeding
Care right after birth- hospitals support mothers to breastfeed by 1. encouraging skin- to skin contact between mother and baby soon after birth 2. helping mothers to put their baby to the breast right away
87
# steps to successful breastfeeding Fifth step to successful breastfeeding
Support mothers with breastfeeding 1. checking positioning, attachment and suckling 2. giving practical breastfeeding support 3. helping mothers with common breastfeeding problems
88
# steps to successful breastfeeding Sixth step to successful breastfeeding
Supplementing 1. Giving only breast milk unless there are medical reasons 2. prioritizing donor human milk when a supplement is needed 3. helping mothers who want to formula feed to do so safely
89
# steps to successful breastfeeding Seventh step to successful breastfeeding
Rooming-in 1. letting mothers and babies stay together day and night 2. making sure that mothers of sick babies can stay near their baby
90
# steps to successful breastfeeding Eighth step to successful breastfeeding
Responsive feeding 1. Helping mothers know when their baby is hungry 2. not limiting breastfeeding times
91
# steps to successful breastfeeding Ninth step to successful breastfeeding
Bottles, teats, pacifiers 1. counsel mothers on the use and risk of feeding bottles, teats and pacifiers
92
# steps to successful breastfeeding Last step to successful breastfeeding
Discharge 1. referring mothers to community resources for breastfeeding support 2. working with communities to improve breastfeeding support services
93
# Breastfeeding proper positioning of breastfeeding
1. head is supported 2. one hand in the child 3. other hand in the breast un C shape meneuver
94
# breastfeeding proper attachment of baby on mother's breast
1. baby's mouth wide open 2. lower lip turned outwards 3. baby's chin touches mother's breast 4. majority of areolar inside baby's mouth
95
# Breastmilk, cow's milk, infant formula Protein content is high in
cow's milk
96
# Breastmilk, cow's milk, infant formula Whey is high in
breastmilk
97
# Breastmilk, cow's milk, infant formula Fat is lowest in
breast milk
98
# Breastmilk, cow's milk, infant formula Sodium, calcium, phosphorus is high in
cow's milk
99
# Breastmilk, cow's milk, infant formula iron content is high in
formula
100
# Breastfeeding Advantages for the infant
* provides ideal nutrition for infants during 4-6 months of life * life saving in developing countries * reduce the risk of GI infections, and necrotising enterocolitis in pre-term infants * enhance the mother- child relationship * reduce the risk of insulin- dependant diabetes, HTN, obesity
101
# Breastfeeding advantages for the mother
* promotes close attachment between mother and baby * increase the time interval between children, which is important to reduce the birth rate in developing countries * helps with a possible reduction in premenopausal breast cancer
102
# Breastfeeding Disadvantages of breast feeding
* Unknown intake * transmission of infections- maternal CMV, Hep B, HIV * breast milk jaundice- mild, self-limitng * transmission of drugs- antimetabolites * nutrient inadequencies- only breast milk after 6 months can lead to poor weight gain and rickets * Vit K deficiency- may cause hemorrhagic disease of the newborn * potential transmission of environmental contaminants - nicotine, alcohol, caffeine * less flexible- difficult in public places, other family members cannot help * emotional upset
103
# Breastfeeding Does the mother being anemic affect breast milk flow
no unless the mother is severely anemic
104
# Breastfeeding does LSCS affect breast milk production
no unless adequate analgesia is given
105
# Breastfeeding composition may vary depending on whether the baby was pre-term or term, also from mother to mother
yes
106
weaning?
introduction of other food in addition to breast milk
107
# weaning why is it necessary to introduce one food at a time
to detect if any allergy occurs
108
# WEANING what types of food and amount of food needs to be introduced
energy dense and extra protein rich food frequent small feeds mashed and soft variety of food
109
# weaning why is it necessary to give variety of food
to keep the child wanting to eat more, rather than the same food
110
# Nutritional assessment anthropometry
* weight * height * Mid- arm circumference * skin- fold thickness
111
# Malnutrition Kwashiorkor
children with protein deficient diets
112
# Kwashiorkor common age of presentation
6 months to 3 years
113
# Kwashiorkor clinical manifestations
* preserved subcutaneous fat * edema * enlarged fatty liver * ribs are not very prominent * lethargic * muscle wasting mild or absent * poor appetite * poor wound healing * ascites * xerosis and itchy rash
114
# malnutrition energy preserved but protein is low in
Kwashiorkor
115
# malnutrition energy and protein are both low in
marasmus
116
# Kwashiorkor fatty liver?
carrier protein to carry fat from the liver is absent
117
# Kwashiorkor Refeeding syndrome Sx
* Vomiting * Diarrhea * Vitamin deficiency- exhausted from trying to digest food * electrolyte imbalance * Phosphate disorders
118
# Kwashiorkor refeeding Xd mechanism
if a child with Kwashiorkor is fed with a high protein diet, they will be digested to Amino acids and then to ammonia. The body doesn't have NH3 detoxifying enzymes. so NH3 accumulate and leads to encephalopathy
119
# Kwashiorkor Mx
* NG tube feeding * start with a low calorie, low protein diet * gradually increase
120
# Marasmus clinical manifestations
* subcutaneous fat is not preserved * no edema * no fatty liver * prominent ribs * alert and irritable * severe muscle wasting * voracious feeder
121
# Marasmus Mx
diet with adequate protein, carbs and fats
122
estimated body weight calculation
(Age+4) x 2
123
chronic malnutrition
weight and height both reduced
124
acute malnutrition
weight reduced height normal for age
125
complications of reduced weight
* hypoglycemia * dehydrated * hypothermia * sodium, potassium imbalance
126
Severe acute malnutrition
weight for height <-3SD
127
Moderate acute malnutrition
weight for height between -2SD and -3SD
128
Mild acute malnutrition
weight for height between -1SD to -2SD
129
protein malnutrition can be detected by
reduced mid- arm circumference for age and sex
130
fat malnutrition can be detected by
reduced skin fold thickness for age and sex
131
typical age of onset for malnutrition
6 months when breast feeding is weaned off
132
complications of SAM
* hypoglycemia * electrolyte imbalance * dehydration * hypothermia * infections * loss of protein * iron deficiency anemia * vitamin deficiency * heart failure * hypothyroidism

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