Community Pediatrics Flashcards

Question

Strategies for disciplining children

Answer 1

Natural consequences * Child experiences the natural consequence of his or her action Time out: * Child is removed from the situation to a quiet place * No more than 1 min per year of age (max 5 minutes) * “Away from the moment” discussions (anticipation of difficulties) NOTE: Disciplinary methods that are angry or violent are detrimental to both the parent and child’s wellbeing

Answer 2

* Catch the child being good! * Praise positive behaviour * Ignore unimportant or irrelevant behaviour * Give choices * Plan ahead

Answer 3

* Can disrupt the development of brain architecture and other organ systems * Increases the risk for stress-related disease and cognitive impairment

Answer 4

3 hours Median daily crying times: 2 week infant = 2 hours 6 weeks = 3 hours 12 wks = <1hr More crying occurs during the evening

Answer 5

* Infectious: Meningitis, UTI, AOM * GI: Cow’s milk protein allergy, GERD, Constipation, Hernia, Intussusception, Anal fissure * Metabolic: Hypoglycemia, Inborn errors of metabolism * Neurologic: Hydrocephalus * Trauma: Non-accidental injury, corneal abrasions, hair tourniquet

Answer 6

* Apneic episodes * Cyanosis * Respiratory distress * Vomiting * Bloody stools * Fever

Answer 7

3 + 3= 6 3 hrs of crying, 3 days a week in a <6mo old Definition of colic (Rome IV criteria): * Birth to 5 months * Recurrent and prolonged episodes of irritability, fussiness or crying that starts and stops without obvious cause * Episodes last for at least 3 hours per day, at least 3 days per week * No failure to thrive * Total daily crying greater or equal to 3 hours when measured by at least one prospectively kept 24 hour diary * Etiology is unknown * There is little evidence that dietary modification makes a difference and it should not be encouraged

Answer 8

Order a complete breath count- breath holding spells. Iron deficiency anemia is a risk factor for these events. If seizure did not stop or hx not compatible, consider EEG or sending to a tertiary centre.

Answer 9

Lactobacillus reuteri may reduce symptoms (CPS, 2022)

Answer 10

Encourage mom to continue breast feeding

Answer 11

Conditions requiring antibiotics: - Preterm and Low Birth Weight infants with SEPSIS (multi-strain) - NEC in neonates >1000g - Antibiotics-associated diarrhea (Lactobacillus rhamnosus and Saccharomyces boulardii ) - Clostridium difficile-associated diarrhea (CDAD) for children on antibiotics (Use of probiotics to treat established CDAD is not recommended) - Helicobacter pylori in conjunction with standard therapy (assist with eradication and decrease side effects of treatment) Other Conditions: - IBS and other functional GI disorders (lactobacillus) -Infantile Colic (Lactobacillus reuteri) - Atopic dermatitis and eczema

Answer 12

Methylphenidate Can use stimulants in co-occuring tic disorders with ADHD but need to monitor closely

Answer 13

Rotavirus vaccine - presenting with intussussception

Answer 14

Education and reassurance (physiological GER)

Answer 15

1. Understand the key role that sound vaccine advice from a health care provider can play in parental decision-making, and do not dismiss vaccine refusers from your practice 2. Use presumptive and motivational interviewing techniques to understand a parent’s specific vaccine concerns 3. Use simple, clear language to present evidence of disease risks and vaccine benefits, fairly and accurately 4. Reduce barriers to vaccine administration 5. Community protection (herd immunity) does not guarantee personal protection Three new recommendations follow: - Be sensitive to the lived realities of racialized and Indigenous parents, and their resultant distrust of the health care system. Whenever possible, engage an Indigenous or racialized health care team to help with vaccine counselling. -Directly address issues of pain and anxiety when parents raise them on behalf of children. -Whenever possible, facilitate or refer parents to special or after-hours vaccine clinics.

Answer 16

a) The first teeth to erupt are usually the lower central incisors at 5-8 months ** 57 % (!) of Canadian children 6-11 years have had a cavity with an average of 2.5 teeth affected by decay

Answer 17

the presence of one or more decayed, missing (due to caries) or filled tooth in any primary tooth in a preschool aged child 6-8 % have ECC but >90% in some Indigenous communities **Children with ECC have a higher risk of tooth decay in permanent teeth**

Answer 18

Delayed eruption hypopituitarism hypothyroidism osteoporosis Gaucher disease Down Syndrome cleidocranial dysplasia Rickets

Answer 19

Dental Caries

Answer 20

Early childhood caries (ECC): Defined as tooth decay in any primary tooth in a child <6yo - Transmission of Streptococcus mutans from caregiver to child - Prolonged bottle feeding - Consumption Sugar sweetened beverages and sugary snacks - Exposure to tobacco smoke - Obesity is also a RF (unclear if separate from dietary factors) - Oral hygiene Causative triad: cariogenic bacteria, fermentable carbohydrates, host susceptibility (integrity of tooth enamel)

Answer 21

- prenatal care for Moms (to prevent transmission of strep mutans) - Fluoride (in toothpaste, in water) - oral health education (esp at time of first tooth eruption) - community based promotion of less sugary drinks and encourage breastfeeding

Answer 22

Advocate for alternatives to sweetened beverages

Answer 23

- occur at an earlier age - higher prevalence (eg 90% in some indigenous communities vs 6% in urban centers) - be more severe Earlier acquisition of Strep mutans in this population likely due to increased rates of poverty (household crowding, family size, nutrition and other behavioural factors)

Answer 24

1. Caries risk assessment Anticipatory guidance, fluoride varnish, referral to dentist 2. Sealants On primary molars after eruption, fluoride varnish every 3-6 months in high risk populations 3. Interim Therapeutic Restorations Minimally invasive dental restorative techniques to prevent dental caries in young and uncooperative children 4. Silver Diamine Fluoride Caries arrest (side effect of turning lesion hard and black) Goal to prevent operative repair of severe ECC 5. Repair under GA Expensive, failure of prevention 6. Access to Early Oral Health care "dental home" established within 6 mo of first tooth eruption Comprehensive dental health care by 12mo of age Shortage in indigenous communities

Answer 25

reduced vision in the absence of ocular disease as a result of the brain not recognizing input from the eye. Often due to strabismus or a refractive error

Answer 26

<3y brushed by adult w/ grain of rice sized portion of fluoridated toothpaste 3-6yo assist brushing w/ green pea sized portion of fluoridated toothpaste BID

Answer 27

* Inhibits plaque by killing/inhibiting bacteria * Inhibits demineralization by making teeth more resistant to acid * Enhances remineralization * Reduces dental caries (strong evidence) * Risk is fluorosis (dental discolouration) if more than 0.7 * Regular use of fluoride mouth rinses have been shown to reduce tooth decay in older children * The Canadian Dental Association endorses water fluoridation and topical fluoride use

Answer 28

misalignment of the eye in any direction which may be constant or intermittent

Answer 29

inability of the eye to focus the image. Usually correctable with a lens

Answer 30

opacification of the lens

Answer 31

Fix on face (0-1mo)

Answer 32

around 3 years old (42 months)

Answer 33

examine external eye structures red reflex

Answer 34

ocular alignment for strabismus - have them fix and follow a target (plus same screening as 0-3 mo of red reflex and examining external eye structures)

Answer 35

Visual Acuity Testing Plus all previous testing: strabismus, red reflex, external eye structures

Answer 36

-Without early diagnosis, diagnosis is usually at 2 years old and associated with poor communication and social skills -Language impairment (directly proportional to degree of hearing impairment) -- *Permanent hearing loss is one of the most common congenital disorders*

Answer 37

Hearing loss is defined based on the degree of loss measured in decibels Profound hearing loss is > 80 dB (Normal 0-20 dB)

Answer 38

sensorineural, conductive and mixed

Answer 39

damage to the cochlea (inner ear) or auditory nerve Most common form of neonatal hearing loss

Answer 40

mechanical problems of the outer ear, tympanic membrane, or ossicles that interfere with conduction of sound to the inner ear eg. middle ear fluid

Answer 41

Genetics, infection (meningitis, CMV, etc), gentamicin, cisplatin, hyperbili and blasting music through headphones -- 50% genetic (1/3 syndromic: Alport's, Jervell-Lange-Nielsen, Neurofibromatosis, CHARGE) Congenital Infections: CMV, toxoplasmosis, rubella, syphilis, zika Infection: Meningitis (most common cause of postnatally acquired ԁеаfոеss in ϲhilԁhοoԁ) Severe hyperbilirubinemia (bilirubin is toxic to auditory nerve) Ototoxic Medications: - Aminoglycoside antibiotics (Gentamicin, Tobramycin) - Chemo (Cisplatin) Trauma: kids blasting music through headphones

Answer 42

Mild congenital hearing loss can be missed in most programs

Answer 43

Otoacoustic Emission (OAE) or Automated Auditory Brainstem Response (AABR) Both meet WHO guidelines -- Otoacoustic Emission (OAE) * OAE is a form of energy measured as sound which is generated by the outer hair cells of the human cochlea in response to auditory input * Probes in the baby’s ear canal sends a sound stimulus and then simultaneously records emissions returning from the outer hair cells of the cochlea via the middle ear * OAEs can be recorded in 99% of normally hearing ears * If there is a loss of 30 dB or greater the response is absent Automated Auditory Brainstem Response (AABR) * Records brainstem electrical activity in response to sounds presented via earphones * Evaluates the auditory pathway from the external ear to the level of the brainstem

Answer 44

- multidisciplinary team (GP, pediatrician, ENT, SLP, audiologists) - speech therapy - sound amplification devices - hearing aids - cochlear implants (surgically placed in the cochlea to stimulate auditory nerve)

Answer 45

1.5 years old: 98% of 36-month-olds can control when they pee

Answer 46

Begin at 2-3 years old (slightly younger in girls) Can take up to 6 months to achieve full control -- Fun Fact: kids are physiologically ready by 18 mo (control of sphincter etc.) but not psychologically ready (need language skills, desire for independence, respond to positive reinforcement)

Answer 47

Bedwetting in 5+ year olds "urinary incontinence during sleep in children >5 yrs old"

Answer 48

Primary = never attained night-time bladder control Secondary = achieved night-time bladder control for >6 months before enuresis. Usually psychological or physical comorbidity Monosymptomatic Enuresis (MSE) = just bedwetting Non-Monosymptomatic Enuresis (NMSE) = enuresis plus one of: - Excessive (≥8 times/day) or minimal (≤3 times/day) voiding frequency - Voiding postponement, holding maneuvers - Daytime incontinence - Urgency or dysuria (without urinary tract infection) - Interrupted flow - Sensation of incomplete emptying

Answer 49

Constipation (82%) Developmental Delay OSA Mental Health Issues

Answer 50

DDAVP for sleepover

Answer 51

diabetes mellitus or diabetes insipidus, renal disease, hyperthyroidism, spinal dysraphism (=spina bifida occulta), infections, seizure disorders, cardiac arrhythmias, child maltreatment, trauma, and psychosocial stressors, including bullying

Answer 52

Yes, strong genetic link (gene on Chromosome 13q)

Answer 53

10% -- Enuresis Incidence: * 15% of 5 year olds * 10 % of 7 year olds * 5 % by 10 years * 2 % of adults

Answer 54

Obtain a urinalysis urinalysis and voiding diary are the mainstay of investigations for Secondary and Non-Monosymptomatic Enuresis (NMDE) No investigations are required for Primary Monosymptomatic Enuresis

Answer 55

In primary monosymptomatic enuresis, the mainstay of management is education and reassurance that no treatment is necessary. Virtually all children and adolescents will outgrow their bedwetting with time. First Line Tx: Education and Reassurance Second Line Tx (for ongoing distress despite education and reassurance): - void when they wake up and before bed, and every 2-3 hrs - drink less water after dinner - avoid constipation ^^reward kids who do this^^ Do not incentivize “dry nights” which are not in their control

Answer 56

Alarm x 4 months + Desmopressin PRN (for sleepovers) Alarm devices * Aims to teach child to respond to full bladder while asleep by alarming when voiding begins * Parent and child need to be motivated * Can take months to see improvement (12-16 weeks) * Costs about $80 * Permanent cure rate of up to 50 % (initial response of 60-80 % with relapse rate of up to 50% when alarm is stopped) vs 15 % spontaneous remission per year * Discontinue when dry x 14 consecutive nights Desmopressin acetate (DDAVP) 0.2mg – synthetic analogue of ADH * Recommended for short term use (sleepover camps, sleepover parties etc.) OR continuous use for 3 months then 2 weeks break to see if they are cured, if not then continue for another 3 months (hugely positive psychological benefit of being dry for 3 months) *alarms have higher success rate so still preferable over continuous DDAVP *you MUST counsel to drink less water after dinner (80% of water before 4pm) * Half the dose for the last two weeks * Monitor ‘lytes q 3months

Answer 57

Must have 2 or more of the following and have a developmental age of at least 4 years old: * Two or fewer defecations in the toilet per week. * At least one episode of fecal incontinence per week. * History of retentive posturing or excessive volitional stool retention. * History of painful or hard bowel movements. * Presence of a large fecal mass in the rectum. * History of large diameter stools that may obstruct the toilet * Must fulfil criteria once per week, for at least 2 months and not meet criteria for Irritable Bowel Syndrome (IBS)

Answer 58

Above the gluteal fold Red flags > 2.5cm from the anal verge, > 0.5cm width across the base deep, unable to visualize base associated cutaneous findings eg hemangioma, tufts of hair)

Answer 59

TENS Transcutaneous electrical neurostimulation (TENS) provides electrical stimulation to the sacral nerves responsible for bladder control

Answer 60

Dental Fluorosis Too much fluoride can cause dental fluorosis - at around 0.7ppm of fluoride.

Answer 61

?Constitutional delay in growth --- Approach to Short Stature (Height <3rd percentile) Otherwise well or associated low weight, dysmorphic or delayed puberty (red flags)? If well, assess bone age. If Bone Age = Chrono Age, it is Familial short stature. If Bone age < Chronological age, it is Constitutional Delay If red flags, are height and weight proportionate or disproportionate? If disproportionate, Rickets or Achondroplasia If proportionate and dysmorphisms = Tris 21 or Turner (or Prader-Willi or Russel-Silver) if proportionate and non-dysmorphic, child not getting enough nutrients (intake, neglect, disordered eating, celiac, IBD, chronic disease like renal failure, CF or congestive heart failure), endocrinopathy (hypothyroid, GH deficiency etc) or intrauterine insult (IUGR, SGA or fetal alcohol syndrome)

Answer 62

Repeat in 6 months This patient has "elevated BP" Definition of HTN : = BP elevated BP at 3 separate visits Elevated BP > 120/80 Stage 1 BP >130/80 Stage 2 BP >140/90 Hypertensive Crisis: Elevated BP with end organ effects Recall: If cuff too small, can falsely elevate BP Cuff on lower limbs, can false elevate BP

Answer 63

Best cuff location is Right (Pre-Ductal) Arm - just in case they have aortic coarctation

Answer 64

This is primary HTN Children ≥6 yrs do not require an extensive evaluation for secondary causes of HTN IF they have a positive family history of HTN, are overweight/obese, or do not have findings suggestive of secondary hypertension

Answer 65

<6 years old Teenagers with low BMI and no other RFs for hypertension (obesity, family history of HTN)

Answer 66

Renal (MOST COMMON): GN, interstitial nephritis, renal scarring, obstructive nephropathy, polycystic kidney disease Endocrine: hyperthyroidism, Cushing syndrome, neuroendocrine tumours Coarctation of the Aorta Iatrogenic: Medications, Fluid Overoad Prematurity; Bronchopulmonary Dysplasia

Answer 67

BP >150/100 HYPOkalemia Diastolic HTN Needing ≥ 2 antihypertensive drugs Creatinine goes up with ACEi use Genetic syndrome associated with HTN Vasculitis Trauma to kidneys (or vascular insult) Mid-abdominal bruit

Answer 68

Begin annual screening at 3 years old for everyone If obese, diabetes, kidney disease, CoA or drugs that raise BP, screen more often than once per year Begin screening younger than 3 yrs old if: - Baby things: premature <32 wks, SGA, VLBW, umbilical arterial catheter (UAC), congenital heart disease - Sick Kids: cancer, raised ICP, renal disease (includes UTIs, proteinuria, hematuria)

Answer 69

This is "Elevated" BP as >120/80 Recommend: DASH diet Normal BMI Exercise then rpt BP in 6 months if still high, check again in 6 months if still high, ambulatory BP monitor and do HTN work up +/- refer to nephro

Answer 70

This is stage 1 HTN as >130/80 Recommend: DASH diet Normal BMI Exercise then rpt BP in 2 weeks if still high, repeat in 3 months if still high, ambulatory BP monitor and do HTN work up +/- refer to nephro

Answer 71

This is stage 2 HTN as >140/90 Recommend: DASH diet Normal BMI Exercise then rpt BP in 1 week if still high, do HTN work up AND refer to nephro within 1 week

Answer 72

Need to do 3 measures to confirm hypertension Creatinine, BUN, lytes, UA, renal US with doppler to r/o RAS for <6 or >8 if normal wt, suspected renovascular complications of HTN Lipid profile, fasting glucose if obese, add A1c, AST/ALT and fasting lipids

Answer 73

Despite DASH diet and exercise, elevated or stage 1 HTN persists for 6 months Stage 2 HTN Co-Morbid diabetes Chronic Kidney Disease

Answer 74

Prior to starting pharmacotherapy for HTN, all children must receive an ECHO to assess for target end organ damage (Ex: LVH) 1st Line: ACEi (Perindopril, etc.) ARB (Candesartan, Losartan) Calcium channel blocker (Amlodipine, Nifedipine) thiazide diuretic (Hydrochlorothiazide) Increase dose q2-4 wks until BP <90th percentile

Answer 75

Lifestyle modification Repeat BP in 6 month - three separate measures of hypertension to make a diagnosis

Answer 76

Osteopenia Soy formula use in preterm infants with BW <1800g results in low phos, high ALP and osteopenia

Answer 77

Behavioural modification at home (for parents) -- Redacted CPS statement Eating should be enjoyable - no coercion, coaxing, bribing, threatening or punishing Forcing leads to resistance

Answer 78

Autism Diagnostic Observation Schedule (ADOS): diagnostic tool for > 12 months We are tryring to diagnose ASD and this is the correct tool for this age -- Note what is DIAGNOSTIC vs SCREENING Childhood Autism Rating Scale (CARS): diagnostic tool for 2+ years old Autism Diagnostic Observation Schedule (ADOS): diagnostic tool for > 12 months Social “Responsiveness” Scale: for 2.5-4.5 year olds (preschool age for screening for early ASD sx) Weiss Scale: functional impairment scale for ADHD

Answer 79

a. IDM Sacral genesis is defined as the absence of part or all of >/2 lower vertebral bodies. They have a flattened buttock, and a low, short gluteal cleft, but usually have no orthopaedic deformity. Some have high-arch feet. Palpation of the coccygeal area detects the absent vertebrae. This condition is more common in infants of Diabetic mothers.

Answer 80

Duration of Feeds Her feed time would add up to 6 hours a day, likely tiring out and potentially increasing metabolic demand which can lead to losing weight Not FTT, 50 to 40%ile is not passing growth curves GERD well managed Only had 1 aspiration PNA so not "recurrent"

Answer 81

- neurological impairment (mention early) - poor oral intake and wt loss despite calorie supplementation - recurrent aspiration pneumonia - refractory GERD - refractory dysmotility *consider GJ if severe GERD or recurrent aspirations

Answer 82

- improved nutritional status (weight) - reduced need for hospitalization - antibiotics for chest infections - decreased feeding times - decreased caregiver worry about nutrition - ease of medication administration and - improvement of quality of life

Answer 83

Short term (complications from insertion): - peritonitis (2%) - bleeding - infection - anaesthesia related - organ puncture - perioperative death (rare) Long term: - tube blockage, dislodgement, breakage - stoma infection, bleeding, hypergranulation - granuloma - consider silver nitrate - Worsening GERD

Answer 84

HPV vaccination Pap smear is not indicated until 21 yrs Recommended catch up given sexually active and vaccine recommended >9yo

Answer 85

21 years old

Answer 86

Direct Transmission: through mucous membrane contact (usually sexually) Vertical Transmission: Juvenile-onset Recurrent Respiratory Papillomatosis (JoRRP) = recurrent papillomas of the respiratory tract, mainly the larynx. - presents 2-6 yrs old - progressive dysphonia (hoarseness), followed by stridor and respiratory distress - from HPV 6 and 11 - no cure, just remove the papillomas, often need a tracheostomy HPV incidence lifetime 70%

Answer 87

Human Papillomavirus (HPV) Clinical Manifestations: - Asymptomatic (most common) - Warts (HPV 6, 11 cause 90%) - Malignancies (cervical, anal, penile, oropharyngeal) - 80% from HPV 16 or 18; needs to persist for 1 year in cervix before it comes malignant

Answer 88

- many sexual partners, early age of sexual intercourse, sexual abuse, STIs - tobacco/marijuana use - immunosuppressed - HIV infection - MSM MSM, HIV, immunosuppressed are higher risk for adverse outcomes from HPV

Answer 89

9-13 years old 2 doses, 6 months apart Catch up for 15-26 year olds: 3 doses If immunocompromised, also 3 doses (HPV is not a live vaccine) GOAL is to administer vaccine BEFORE exposure to HPV (ie pre-sexual contact)

Answer 90

Vit C - which is important for absorbing iron -- All of these vitamins would most likely be low in ASD pts with restrictive diets: - Vit A deficiency => Xerophthalmia - Vit C deficiency => Scurvy - Vit D deficiency => Rickets - Vit B12 - often ASD kids eat lots of milk and cheese, which have vit B12 - Iron Deficiency

Answer 91

Something else - AKA thorough history and physical exam based on index of suspicion. Per CPS “An STI from sexual abuse is rare in prepubescent children in Canada… testing for STIs should be considered on a case-by-case basis

Answer 92

800 IU daily

Answer 93

Chlamydia, gonorrhea and HIV testing No PAP before 21

Answer 94

Recommend <2h per day

Answer 95

Sleep onset association disorder

Answer 96

Zinc supplement Zinc deficiency causes vesiculobullous, eczematous, dry, scaly skin lesions in diaper and perioral area Zinc deficiency may be due to: * breastmilk being low in zinc or, *congenital zinc deficiency (autosomal recessive disorder with inability to absorb zinc, classically presents with rash and diarrhea when weaning off of breastmilk to cow's milk) *causes growth delays *requires zinc supplementation for life

Answer 97

Observe and Reassure This is GERD, not a BRUE (since we have an explanation) -- recall low risk BRUE: >60d, >32wk, only 1 BRUE, duration <1min, no CPR from healthcare provider (not parent), no concerning features like dysmorphism/seizures tx: hx and exam, observe, no overnight monitoring (4 hr enough), no investigations (could consider ECG and pertussis swab) 2019 AAP: what to do with high risk BRUE pts? - CRM monitor for 4 hrs in emergency department - screen for NAS - observe feed - all high risk: do ECG, RPP, pertussis swab, CBC (look for anemia or polycythemia), blood sugar, gas with lactate. Do more ix if concerns on history or exam. RECALL that if there is any diagnosis then it is not BRUE

Answer 98

Guanfacine --- Guanfacine (Intuniv) is a selective alpha 2a-adrenergic receptor agonist which means it blocks norepinephrine and epinephrine from being released from the sympathetic nervous system (ie blocks the fight or flight response) alpha 2 adrenergic blockers like guanfacine (intuniv) and clonidine decrease HR and BP, increases blood flow to muscles/brain and slows digestion THUS there is a danger of REBOUND HYPERTENSION when guanfacine is abruptly stopped CPS statement describes how to titrate down when stopping it

Answer 99

CBC and ferritin -- Restless Leg Syndrome is associated with iron deficiency and low ferritin, and frequently comorbid with ADHD patients The five diagnostic criteria for RԼЅ are: An urge to move the legs, usually accompanied by uncomfortable or unpleasant sensations in the legs The symptoms begin or worsen during rest or inactivity (eg, lying down or sitting) The symptoms are relieved by movement The symptoms occur exclusively or predominantly in the evening or night These symptoms are not solely accounted for by another medical or behavioral condition if ferritin <50, treat with iron supplement 3mg/kg (up to 130mg) if normal ferritin, consider gabapentin

Answer 100

Parent behavioural training (2024 consensus)

Answer 101

in-utero alcohol/tobacco exposure, low BW, hypoxic-anoxic brain injury, epilepsy, TBI

Answer 102

Fragile X Turner Syndrome Tuberous sclerosis Neurofibromatosis 22q11 deletion syndrome

Answer 103

enroll in a parent training program

Answer 104

DSM-5: Symptoms are severe, persistent (present before age 12, continuing longer than 6mo) and inappropriate for age/developmental level > 6 symptoms up to 16yo (adult > 5) either inattention or hyperactivity or both Symptoms associated with impairment in academic achievement, peer and family relations and adaptive skills Several symptoms in > 2 settings. Discrepancy of symptoms across setting, important to identify why Specify type (combined, inattentive, hyperactive/impulsive) and severity (mild/moderate/severe based on sx and functional impairment) *not better explained by another disorder

Answer 105

- Learning Disorder, intellectual disability, language disorder - Sleep Disorder - Conduct disorder, ODD, anxiety, substance use, depression - Eating Disorder - Tic disorder - Autism spectrum disorder - Developmental Coordination Disorder (DCD)

Answer 106

- psychoeducation (helps parents understand ADHD better, reduces misperceptions, results in fewer parent-reported symptoms and increased pro-social behaviour) - shared decision making (review goals for improvement of academics, behaviour and interpersonal relationships; review all tx options) - parent behavioural therapy (teaches parental skills for behaviour problems; FIRST LINE FOR PRESCHOOLERS) -classroom management - daily report cards (improves adherence to classroom rules and academic productivity) - cognitive training (when older; working memory training) -organizational skills training - diet if dietary deficiency - Exercise (improves core ADHD sx and related anxiety/cognitive functions)

Answer 107

Review Caddra; know stimulant and non-stimulant options

Answer 108

Rpt CXR in 4wks we do NOT recommend follow up CXRs if symptoms resolve. the persistant consolidation is likely radiographic delay. can rpt in 4 wks to prove it is gone. No more abx, CT or resp consult required if symptoms are resolved

Answer 109

CMV PCR Urine this infant has failed the screening test. They need to be referred to Audiology. CMV is a cause of congenital hearing loss - it must be tested within the first 21 days of life so do not delay in ordering it. the next best step is to order the CMV and refer to audiology so they have the result at assessment

Answer 110

Close follow up - likely antibiotic associated collitis, but well appearing.

Answer 111

Does not need to be restricted from returning to school

Answer 112

Pyrethrins shampoo or permethrin 1% 2 treatments, 1 week apart must be >2 months old to use -- Apply to dry hair and leave on for 10 mins Create lather and then rinse Note: environmental decontamination not warranted (at most, can wash hats, pillowcases and combs)

Answer 113

do not need second round of treatment, this is a common side effect

Answer 114

Bacterial infection, depression, stigmatization, insomnia this is scabies

Answer 115

5% Permethrin cream (leave on for 12hr) 2 doses, 7d apart must be >3mo stay home from school for initial treatment series wash ALL bedding and linen and clothes

Answer 116

hypersensitivity side effect of 5% Permethrin cream no indication for treating again

Answer 117

only with new lesions (burrows, papules) (persistent itchiness for a couple weeks is side effect of permethrin)

Answer 118

poverty, overcrowding, bed-sharing, indigenous

Answer 119

burrows erythematous papules usually in fingers, wrist/elbow flexures, genitals, breasts generalized pruritis (worst at night)

Answer 120

secondary bacterial infections stigma, depression, financial costs (Eg related to housing) insomnia (from pruritis)

Answer 121

Sulphur (8-10%) in petroleum jelly daily for 3 consecutive days safe in infants (unlike first line tx of 5% permethrin cream)

Answer 122

for initial treatment series

Answer 123

continue non-interventional observation -- No evidence that prophylactic ABx prevent renal scaring or long term sequalae May still be considered in grade IV or V VUR or significant urologic anomaly NNT is large (9-42)! (less if higher grade reflux) and increases risk to abx resistance Not indicated for any grade of VUR Managing constipation is helpful – will reduce risk for UTI If using prophylaxis, use only for 3-6 months Septra or nitrofurantoin should be used unless hx of resistance DON’T use cipro or cefixime, just increases the risk of resistance

Answer 124

assess she is stable confirm uncomplicated UTI do renal US then outpt abbx they return after this: failure of tx, unstable give bolus, broad spectrum abx and admit

Answer 125

Consider UTI in: > 2mo kids (<2mo approach like sepsis) Uncircumcised boys (overestimates due to contamination (up to 20%)) <3y + fever and no source up to 8% likely: urinalysis + culture (particularly>390 and>48h) Boys >3y: unusual to have first UTI w/o instrumentation - is there abN anatomy? this is a red flag

Answer 126

Dipstick: Best predictor is combo of Nitrites (gram-), Leuks (pyuria), and positive microscopy(bacteria). Most specific: nitrites at 98% specificity Babies can be nitrate negative but are febrile and have leuks CFU/ml: midstream clean catch - 1 x 10^8 CFU/L, In/out cath- 5x10^7 CFU/L suprapubic aspiration - any growth

Answer 127

Renal function tests if: Complicated UTI or aminoglycosides>48h (do levels also) If not improving after 24 hours Persistent fever past 48hrs Hemodynamically unstable Blood cultures only if hemodynamically unstable

Answer 128

if > 2months old and well apart from fever, no change to antibiotics if <2mo, treat like sepsis

Answer 129

this is probably cystitis, give 2-4d of cefexime

Answer 130

cefixime 8mg/kg/d PO for 7-10 days dosed once daily if >12yrs old, ciprofloxacin (or younger pts if hx of resistance) other options are amox, amoxclav or septra

Answer 131

complete renal US either during treatment or within 14 days if hydronephrosis (suggestive of VUR), then also add VCUG

Answer 132

VCUG if diagnoses VUR, and it is grade IV or V, refer to uro/nephro

Answer 133

constipation ADHD, developmental delay OSA

Answer 134

Have a salt rich snack and fluids after exercising

Answer 135

Ask the mother to restrict soy and dairy from her diet (then if that fails then switch to extensively hydrolyzed formula)

Answer 136

erosive esophagitis including hematemesis, failure to thrive or feed PPIs (eg. lansoprazole): increases risk for infection (pneumonia) Increased risk for NEC and neonatal infections in VLBW infants Increased fracture risk

Answer 137

Graduated: baked good, then ..., then eggs

Answer 138

hearing screen

Answer 139

90% are asymptomatic

Answer 140

SGA, microcephaly, jaundice, hydrops Petechiae Hepatosplenomegaly Seizures, poor suck, hypotonia, lethargy Hearing loss chorioretinitis, optic atrophy, microphthalmia, cortical visual impairement

Answer 141

- low platelets - elevated ALT - elevated conjugated bilirubin - pleocytosis on CSF

Answer 142

Avoid contact with bodily fluids Avoid mucosal to mucosal contact with saliva (i.e. shared toothbrush) Avoid new sexual partners Hand hygiene (diaper changes, children’s toys, children’s laundry)

Answer 143

**A failed newborn hearing screen or confirmed sensorineural hearing loss (SNHL)** - symptoms of CMV - maternal CMV infection - Fetal ultrasound with findings suggestive of cCMV - Placental pathology consistent with CMV infection potential risk: -HIV exposure -Primary immunodeficiency

Answer 144

Urine CMV PCR BEFORE 21 days of life (gold standard) -- can test saliva but must be confirmed with urine PCR

Answer 145

CNS disease: seizures, poor suck, hypotonia, lethargy Chorioretinitis Severe single or multi-organ disease

Answer 146

6 MONTHS of valganciclovir (16mg/kg PO BID) treatment MUST commence within the first month of life

Answer 147

CBC, bilirubin, ALT/AST Head US Hearing evaluation ophthalmological evaluation

Answer 148

Poor vertical growth

Answer 149

- POOR LINEAR GROWTH (#1 symptom) - poor weight gain - anorexia - N/V - malaise - headache - abdominal pain - myalgia/arthralgia - psychiatric sx - CUSHINGOID features adrenal suppression is so vague and looks like a minor viral illness

Answer 150

- hypotension - hypoglycemia - seizure or coma

Answer 151

>2 weeks of glucocorticoids Multiple short courses of GC Higher doses, longer courses, evening dosing ICS doses > 500mcg/day fluticasone Concomitant intranasal steroid use > 3 mo of use Swallowed oral budesonide for tx of EoE for > 1 mo NEED TO ORDER MORNING CORTISOL IN THESE CASES AS WE DONT WANT TO MISS ADRENAL SUPPRESSION Cortisol level less than 100 nmol/L is concerning!

Answer 152

NO TAPER < 1 month of use 1-2 week taper for 1-3 mo of exposure 3-4 week taper for > 6 mo of exposure Higher risk for AS when GC dose of 8 mg/m2/day hydrocortisone equivalent Consider testing morning cortisol level (concerning level <100nmol/L)

Answer 153

both of those meds can cause adrenal suppression - pause the ICS Meds that increase risk for ICS: CYP3A4 inhibitors, including several antiretrovirals (e.g., ritonavir), antifungal agents (e.g., ketoconazole), and select antibiotics (e.g., clarithromycin), prolong the biologic half-life of GCs. These medications have been implicated in several cases of symptomatic AS associated with relatively low doses of ICS, and are reported to prolong duration of AS in systemic GC exposure

Answer 154

Decreased linear growth - usually 0.5cm to 1cm decrease in final height.

Answer 155

A first morning cortisol between 100-275nmol/L should be used as a threshold for risk for AS in asymptomatic patients ACTH stim test expect to see a rise in cortisol levels between 350-500nmol/L

Answer 156

Interrupt the behaviour with a time out before it escalates

Answer 157

Parenting courses

Answer 158

5 years old (unless in a dysfunctional home)

Answer 159

Parenting program

Answer 160

Hearing and vision screen Diet/feeding irregularities Sleep problems Screen for ADHD Screen for ASD Screen for primary language delay/communication disorder Consider separation/anxiety disorders

Answer 161

HUGE RED FLAG Consider w/u for abuse, GDD, LD, anxiety, etc Head banging only normal up to 4 years old, very weird for it to start for the first time 5+ yrs old

Answer 162

a- choose one parent and picks sides. b - pick sides and blame the other parent Developmental considerations 7-9mo attachment to primary parent <5yo: developmental vulnerability and age of peak attachment formation -> need predictable and safe environment with consistent access to emotionally available caregivers who response to their needs in a consistent/sensitive way. 4-5 yo children often blame themselves and become increasingly clingy with separation anxiety, externalizing behaviors, excessive fears of abandonment School aged children: strong sense of rules and fairness – prone to loyalty conflict and may take sides Adolescent: personality and identity are consolidated, youth need access to both parents and may choose to move between homes

Answer 163

Reassure Easy ways to remember which bili level is concerning (low risk): 24 hours – Treat if > 200 48 hours – Treat if > 250 72 hours – Treat if > 300 96 hours or greater – treat if > 340

Answer 164

Severe hyperbili: > 340 any time in the first 28 days of life Critical hyperbili > 425 in the first 28 days of life Consider G6PD testing in ALL infants with severe hyperbili Either TSB or TcB concentration should be measured in all infants during the first 72 h of life. Conjugated bilirubin fraction should be measured if persistent jaundice ( > 2 weeks) and/or hepatosplenomegaly

Answer 165

“ A suitable trade-off between caries and fluorosis occurred at around 0.7 ppm of fluoride ” need to balance reducing cavities and preventing side effect of fluoride which is fluorosis (Unsightly mottling and pitting of the teeth, enamel striations, and in severe cases, ‘snow-capped cusps’ )

Answer 166

When concentration of fluoride in the water is <0.3 ppm, then fluoride supplementation for THEE" recall 3 and thee as memory aid

Answer 167

Global Developmental Delay (GDD): applies to children < 5 years of age ONLY Significant delay (at least 2SD below mean) in at least 2 developmental domains

Answer 168

Deficits in intellectual functioning Deficits in adaptive functioning Onset of intellectual and adaptive deficits during the developmental period

Answer 169

Step 1: history and physical **audiology** **optho/optometrist** EEG if suspect seizure Step 2: **chromosomal microarray** **fragile X ** brain MRI if abN neuro exam, seizures, micro/macrocephaly MECP2 in girls **Tier 1 TIDE Investigations:** - amino acids - acylcarnitine, carnitine - homocysteine - copper, ceruloplasmin - biotinidase - urine: organic acids - urine creatine metabolites - urine purines, pyrimidines - urine glycosaminoglycans Tier 2: Brain MRI if not done Genetics/Metabolics consult for Tier 2 of TIDE protocol and gene panels Additional Testing: Thyroid testing - although TSH is on newborn metabolic screen Iron, Vitamin B12 - consider if pica Lead TORCH infections

Answer 170

Consanguinity Recurrent episodes of vomiting, ataxia, seizures, lethargy, coma Unusual dietary preferences Psychosis at a young age Organomegaly Severe hypotonia Progressive sensory deficits (cataracts)

Answer 171

Buildings with chipped or peeling paint built before 1978 (US) Lead in water source (lead water pipes) MEXICAN CANDY with tamarind Herbal remedies (particularly from India and China) Soil can contain lead particles

Answer 172

40% can only be ordered by genetics for now

Answer 173

No investigations needed

Answer 174

Ask the mother to restrict soy and dairy from her diet -- - If we think it is FPIAP then would be elimination from mothers diet - If we think it is FPIES (because of FTT piece) then would be trial of extensively hydrolyzed formula Dr. Bouma said she would choose Ask the mother to restrict soy and dairy from her diet but that this kid is likely going to end up on a hydrolyzed formula

Answer 175

informal milk sharing is not encouraged

Answer 176

stop oral feeds and start NG feeds

Answer 177

Hydrolyzed formula (although amino acid based formula could be considered, this answer based on CPS)

Answer 178

Introduce allergenic foods at 6 months

Answer 179

Reassure · Median daily crying times: 2 week infant is 1 3⁄4 hours · Peaks at 2 3⁄4 hours at 6–8 weeks · Less than 1 hour by 12 week

Answer 180

Continue feeding as is

Answer 181

Normal amount For children 2 to 5 years, limit routine or sedentary screen time to about 1 hour or less per day

Answer 182

B12 - vegan mom's need to provide either b12 fortified fodos or supplements. Breastfeeding by B12-unsupplemented vegan mothers can place an infant at risk for vitamin B12 deficiency.

Answer 183

Scurvy (Vit C Deficiency) Features of Scurvy: - bleeding gums - petechiae -coiled hairs - hyperkeratosis - ecchymoses -arthralgias

Answer 184

Transient Myeloproliferative Disorder Associated leukocytosis, coagulopathy, hepatomegaly no splenomegaly, low albumin commonly seen in T21

Answer 185

Refer to dietician May need supplementation of all of above (but definitely vit D).

Answer 186

Offer parents CPR training -- this is a LOW risk BRUE Low risk: Age > 60 days Gestational age > 32 weeks and post-conception age > 45 weeks Occurrence of only 1 BRUE (no prior BRUE, no clustered events) Duration of BRUE < 1 minute No CPR by trained medical provider required No concerning historical features No concerning examination findings

Answer 187

recall low risk BRUE: >60d, >32wk, only 1 BRUE, duration <1min, no CPR from healthcare provider (from parent is fine), no concerning features like dysmorphism/seizures or abN neuro exam RECALL that if there is any diagnosis then it is not BRUE

Answer 188

hx and exam, observe, no overnight monitoring (4 hr enough), no investigations (could consider ECG and pertussis swab)

Answer 189

- CRM monitor for 4 hrs - screen for NAS - observe feed - all high risk: do ECG, RPP, pertussis swab if underimmunized, CBC (look for anemia or polycythemia), blood sugar, gas with lactate. Do more ix if concerns on history or exam.

Answer 190

must detect a living louse presence of nit = previous infection Misdiagnosis is common – must visualize a living louse

Answer 191

3-4 wks Itching usually starts after 4-6 weeks of inoculation!!!!!!!! they have had lice for a long time before they start itching EWW

Answer 192

infection with lice

Answer 193

direct hair-hair contact, CARPETS at school and PETS are not vectors

Answer 194

Immediately - per CPS: "“Excluding children with nits or live lice from school or child care has no rational medical basis and is not recommended.”

Answer 195

Scabies skin scraping, ink test, dermatoscopy

Answer 196

secondary bacterial infections stigmatization depression insomnia financial costs

Answer 197

poverty overcrowing bed-sharing indigenous community

Answer 198

Non-accidental injury transphyseal is a synonym of metaphyseal metaphyseal fractures are high risk for NAI 18mo is minimally ambulating as well Femur fracture in non-ambulatory child is also high risk for NAI -- High-risk fractures for NAI: 1. rib fractures in absence of overt trauma 2. metaphyseal fractures 3. Humerus fractures <18 months (inflicted are more often spiral or oblique, midshaft/proximal location) 4. Femur fracture in non-ambulatory child 5. Scapular, spinous process, sternal fractures Multiple fractures Fractures of different ages Presence of other injuries (bruising - esp trunk, ears, neck, oral trauma) If there is another serious injury, need to have significant traumatic forces clear on history.

Answer 199

Give MMR now and will need her 12 month dose -- standard MMR vaccine schedule is two doses at 12 and 18 months if travelling to high risk zone for measles outbreak, can give as early at 6 months but will still need the standard two doses at 12 and 18 months

Answer 200

ECG Patients with personal history of cardiac disease or family history of cardiac history should undergo ECG before staring stimulant medications for ADHD

Answer 201

Parent Skills Teaching this patient has oppositional defiant disorder (ODD) Treatment modalities include parent management training (PMT), school-based interventions, individual child therapy, and family therapy

Answer 202

Reassurance -- this patient is having Night Terrors Wake up suddenly, very upset (may scream and jump out of bed, appear terrified), often sweating, breathing fast or hear racing. do NOT wake them up - just stay with the child until the night terror is over (usually last 10-20min) and they will go back to sleep. parents will be UNABLE to calm their child night terrors can happen frequently (2-3 times per week)

Answer 203

Gradual return to school -- School Avoidance likely from anxiety but first step is to slowly reintroduce them to school they may need medications if this is unsuccessful

Answer 204

ondansetron metoclopramide and domperidone are for gastroparesis or chemo-induced vomiting dimenhydrinate is antihistamine

Answer 205

B. Difficulty making friends - difficult peer relationships

Answer 206

Asthma Bronchiolitis typically doesn't respond well to Ventolin Technically this case stem does have 2 warning signs for primary immunodeficiency: 2 or more ear infections within 1 year (5 AOM in a 2 year old is 2.5 AOM per year, unless they mean 3 year old by toddler) recurrent viral infections (no specific definition for how many viral infections constitute recurrent, and stem only states “many” admissions for bronchiolitis) However, this toddler is growing well and frequent AOM and bronchiolitis is fairly common

Answer 207

Erythema Toxicum Neonatorum (ETN) -Typically appears at 24–48 hours of life -Multiple pustules on an erythematous base -Commonly involves the chest, neck, and extremities -Affects 40–70% of full-term neonates; it is benign and self-limited -Resolves by 2 wks of life

Answer 208

Amox 75-90mg/kg BID x 5 days TID = 45-60mg/kg/d BID = 75-100mg/kg/d <2 year old = 10d >2 year old = 5d Diagnostic criteria: 1. Acute onset symptoms (otalgia) 2. Middle ear fluid (loss of movmt, bony landmarks, air fluid level) and significant inflammation of middle ear 3. OR decrease in TM mobility as visualized with a pneumatic otoscope (good sensitivity and specificity for Middle ear effusion)

Answer 209

9 mo ex 33+6 wk with chronic lung disease requiring home O2

Answer 210

Neonatal Pustulosis (Transient Neonatal Pustular Melanosis, TNPM) -- Can be present at birth or appear shortly after. Lesions include pustules and pigmented macules (post-inflammatory hyperpigmentation) after pustules resolve.typically on face and sacrum No erythematous base - distinguishes from erythema toxicum

Answer 211

Disimpaction: 1-1.5g/kg/d, enema, or admit to hospital for NG clean out with PEG *digital disimpaction not recommended Maintenance: Peg 0.4-1g/kg/d, behaviour modification (toilet sit 3-10min post-prandially BID, foot stool, praise for sitting, diary). Treat for minimum 6 months. Banalced diet with lots of fluid and fiber (0.5g/kg/d)

Answer 212

end of grade 3

Answer 213

literacy Reading is the single most important activity parents can do with their child to promote eventual reading success.

Answer 214

reading, speaking, singing and storytelling ‘Serve and return’ interactions help foster emergent literacy skills

Answer 215

Incorporate literacy promotion into your everyday practice Help families develop literacy promoting habits Parents receiving an intervention that promotes reading are 4-10 X more likely to read frequently to their child!! this effect is greatest amongst the poorest children

Answer 216

* ADHD * Learning Disabilities * Mild Intellectual Disabilities * ODD / Conduct disorder * Sensory impairments (vision, hearing) * Seizures * Mental health – Anxiety, Depression * Autism Spectrum Disorder

Answer 217

prematurity, low birth weight, spontaneous abortion, SIDS and neurobehavioural abnormalities

Answer 218

48-72 hours As late as 5-7 days for Methadone and Buprenorphine

Answer 219

10-30 day duration of NAS 15 day is average length of hospital stay

Answer 220

Eat, Sleep, Console judges physiologic distress due to NAS as demonstrated by inability to eat, sleep and console, as well as apnea, seizures, excessive weight loss/poor weight gain Replaces Modified Finnegan scoring

Answer 221

Increase Non-Pharm: - feed on demand - swaddle and hold - low stimulation environment - parental presence if still not improved, begin Morphine 0.05 mg/kg/dose q3h can increase by 0.01 each dose

Answer 222

* Sleeping in prone * Exposure to tobacco prenatally and after birth * ‘Back to sleep’ campaign resulted in 50 % reduction in SIDS

Answer 223

CXR - this is community acquired PNA

Answer 224

Sleep hygiene then send for ferritin

Answer 225

Ondansetron

Answer 226

d. Recommend to stop marijuana because risks to developing neonatal brain are unknown

Answer 227

Introduce whole cow's milk at 12 months. 6mo = prioritize iron rich foods (not fruit and veg)

Answer 228

Blepharitis Chalazion: obstruction of the ducts of the eyelid. Presentes with a frim, non tender eyelid mass (within the lid). Usually not infected despite swelling and discharge. Management is warm compress Dacryocystitis: infection of the tear sac, or lacrimal sac, that occurs when the nasolacrimal duct is blocked. More common in infants < 1 month old. Management is nasolacrimal massage and systemic antibiotics. Surgical management should be considered if there is respiratory compromise, acute infection or no resolution with conservative management Corneal Abrasion: you would expect to see some conjunctivitis on the examination

Answer 229

No intervention required as mainstay of treatment is education and reassurance

Answer 230

Vit C (Scurvy)

Answer 231

Better sexual education

Answer 232

Refer for surgical correction If the exam of an infant between 6 and 12 months of age is consistent with cryptorchidism, they should be referred to a pediatric urologist for surgical consultation orchidopexy needs to occur between 6-18 mo no investigations (such as imaging or karyotype) are recommended for cryptorchidism per the pediatric canadian urological association The only time we recommend repeat evaluation is if an infant has retractile testes (not cryptorchidism), then we re-examine them between 6 and 12 months of age. the stem says that you cannot palpate the testes

Answer 233

Urgent transfer to ED for evaluation and safety assessment. Transient psychosis known s/e of cannabinoid use. Additionally, possible but RARE side effect of stimulants.

Answer 234

Nephrolithiasis

Answer 235

There is no contraindication - those with disordered eating can receive nicotine replacement

Answer 236

Cannabis withdrawal - abdominal pain

Answer 237

20g/ day 1-3mo is 30g/d 3-6 mo is 20g/d 6-12 mo is 10g/d

Answer 238

gynecomastia

Answer 239

Experiencing at least 2 of 5: Irritability Anxiety Depressed mood Sleep disturbance Appetite changes And at least 1 of 6 physical symptoms: Abdominal pain Shaking Fever Chills Headache Diaphoresis Symptoms usually 24-72h after last use, persist 1-2 weeks (sleep disturbance up to 1 month)

Answer 240

DTAP/IPV/Hib + Pneumococcal + Hep B

Answer 241

Live vaccines may be given immediately on discontinuation of high dose steroid therapy if duration was < 14 days. Today - pneumococcal polysacharide (23-valent vaccine) (recommended for nephrotic syndrome patients due to them voiding out antibodies).

Answer 242

this is OCD Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) for 5 to 18 years classic features of OCD is not letting food touch each other, order of food to be eaten and not stepping on cracks

Answer 243

- steroid therapy is short-term (<14 days) - low-to-moderate dose (prednisone equivalent of less than 2 mg/kg/day or less than 20 mg/day if weight > 10 kg) - is physiologic replacement therapy or administered topically, inhaled, or locally injected (e.g., joint injection). - An exception is live attenuated virus, which is contraindicated in individuals with severe asthma who are currently receiving high dose inhaled steroids.

Answer 244

Parallel Play with Siblings (the most delayed and in keeping with ASD) Parallell play is typical milestone at 18 mo, cooperative, pretend play is typical at 3 yrs, and elaborate fantasy play and preferred friend at 4 years

Answer 245

Strattera no stimulants with substance abuse CPS statement mentions both atomoxetine and guanfacine as options in history of substance abuse --> however AAP has atomoxetine listed as primary non-stimulant option when stimulants are contraindicated

Answer 246

Arrange to meet with the child and parent individually (concern for intimate partner violence) CPS: Recognizing and responding to children with suspected exposure to intimate partner violence between caregivers. CPS: Supporting the mental health of children and youth of separating parents

Answer 247

Say that it is routine that all adolescents have time alone with appointments.

Answer 248

Bring a dental therapist in monthly to the local community health center.

Answer 249

ignore behaviour while ensuring safety Time out – not great <2y, 1 min per child age Head Banging is ++ common UNUSUAL IF >5y – consider ASD, anxiety, abuse

Answer 250

Biphentin Beads can be sprinkled on soft food

Answer 251

physical therapy

Answer 252

parents choose WHAT to offer kids choose HOW MUCH meals (and nutrient dense snacks ok as long as doesn't impact next meal, no grazing) should be enjoyable :) limit table time to 20 min then remove all food, offer again at next meal/snack stimulate update with play/exercise for 15min pre-meals

Answer 253

Contraindications - immune compromised - severe asthma on high dose ICS or recent oral steroids, or exacerbation within the last 7 days - <2yrs - on aspirin

Answer 254

Inactivated vaccine for mom right now; Either inactivated influenza vaccine or live attenuated influenza vaccine may be used for children and youth 2 to 17 years old who are not immunocompromised

Answer 255

Back at school full time with no symptoms and no accommodations To begin Return To Play: Successful return to school Symptom free and off any meds prescribed to treat the concussion Normal neuro exam Back at baseline balance and cognitive performance measures

Answer 256

145cm Must be at least 145cm tall to start safely sitting in the car without a booster seat

Answer 257

Until at least 2 years old. Once they have outgrown the larger rear-facing car seat and is at least 2 years old, they can move to a forward facing car seat with a 5 point harness

Answer 258

Chronic illness

Community Pediatrics Flashcards

(289 cards)