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Flashcards in Community Pediatrics Deck (54)
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1

Why is vision screening important?

Amblyopia affects up to 5% of the population (>10 million Americans). In the first 4 decades of life amblyopia causes more vision loss than all other ocular diseases combined.

Amblyopia has a “window period” for treatment in early childhood. Screening can prevent otherwise fatal disorders such as retinoblastoma.

2

Refractive Errors

-Nearsighted
-Farsighted
-Astigmatism
-Anisometropia

3

Amblyopia

Unilateral or bilateral decrease of visual acuity caused by vision deprivation AND/OR Abnormal binocular interaction for which no organic cause can be detected. The Physician sees nothing and the Patient very little.

The eye is capable of taking the picture but the brain doesn’t recognize that there is an image.

4

Screen for causes of amblyopia

1. Refractive errors
2. Obstruction of optical pathway (e.g. cataract or corneal scar)
3. Strabismus
4. Other: anything that blocks input of visual information to the brain

5

Strabismus

Ocular misalignment

6

Esotropia

Eyes turn in

7

Exotropia

Eyes turn out

8

Hypertropia

One eye higher than the other

9

AAP standards for visual acuity

-20/40 for children 3-5 years old
-20/30 for 6 year old
-20/20 for > 8 year old

10

Hearing Screening

Universal newborn hearing screening (UNHS) programs (false + rates: range between 2.5% and 8%). Start hearing screening at 3 years or older!

11

Dental referral

-Incisors erupt at approximately 6 months
-Recommend routine cleaning with soft cloth or brush with child safe toothpaste
-Fluoride varnish (1- age 6)
-Caries warrant dental referral
-Neonatal teeth
-ADA at age 1

12

Laboratory Screening

Most screenings are now risk based (AAP periodicity schedule)

13

When do we do Hemoglobin Screening?

1. At 1 year (Iron deficiency anemia is more common in breastfed infants).
2. If excessive milk ingestion, iron poor diet.
3. Hemoglobin screening with menses

14

When do we do Lead Screening?

Age 1, 2 (3-6 if not previously screened, hi risk zip codes, immigrants)

15

What is the most common nutritional deficiency?

Iron Deficiency --Adversely affects motor & cognitive development

16

Iron Deficiency Anemia is most common in _______.

toddlers

17

Symptoms of Iron Deficiency Anemia

Abnormal sleep cycles, anemia, behavioral problems, cognitive effects

18

Risk Factors for Iron Deficiency Anemia

Risk factors: preterm, low birth weight birth, multiple pregnancy, iron deficiency in mother, non-­‐fortified formula or cow’s milk before age 12 mo, infant diet low in iron containing foods , Children with special health needs (chronic infections or restricted diets)

19

Prevention and Screening for Iron Deficiency Anemia

Prevent by adequate dietary means including feeding infants iron containing cereals by 6 mo., avoiding low-iron formula during infancy and limiting cows milk in 1-5 yo. Universal screening at 12 mo age by Hb/Hct and then again at 15 mo.

20

Treatment for Iron Deficiency Anemia

Iron dosing, (3-­‐6 mg/kg of elemental iron)

21

When do we start Lead Screening?

Screen @ 1 and 2 years of age

22

What do we see in Lead Screening?

-Elevated BLLs in children are a major preventable health problem that affects children's mental and physical health.

-The higher a child's BLL and the longer it persists, the greater the chance that the child will be affected.

23

Elevated blood Lead levels can result in:

learning disabilities, behavioral problems, mental retardation & at extremely high levels (70 µg/dL or higher), seizures, coma, and even death.

24

How to screen for Lead?

A VENOUS SAMPLE IS PREFERRED OVER CAPILLARY

-Fingerstick (capillary samples)
-Venous blood lead is most accurate & should confirm evel > 5 mcg/dL
-Home inspection for persistent elevated levels

25

Childhood Lead Poisoning Screening in Florida: Quick Reference for Medical Professionals

1. Does your child live in or regularly visit (once a week or more) any house or building built before 1978?
2. Does your child live in or regularly visit any house or building that has recently undergone renovation or contains vinyl mini-blinds, lead pipes, pipes with lead solder joints, or had metal pipes replaced or repaired within the last five years?
3. Does your child have a mother, sibling or playmate that has or did have lead poisoning?
4. Does your child frequently come into contact with an adult whose job or hobby involves exposure to lead?
• Occupations: building renovation, battery factory or recycling, auto or radiator repair, highway bridge sandblasting or painting, welding metal structures, wire cable cutting
• Hobbies: refinishing furniture, home renovation, casting bullets, auto battery or radiator repair, making stained glass, ceramics, toy soldiers, dive weights, or fishing weights
5. Does your child eat food or drink fluids that were stored in leaded crystal, imported ceramic, or pewter dishes?
6. Does your child have contact with cosmetics, kohl, candies, spices, jewelry, ceramic dishware and home (or folk) remedies not made in the United States?
7. Does your child play in loose soil, near a busy road or near any industrial sites such as a battery recycling plant, junk yard or lead smelter?
8. Have you ever seen your child eat dirt or mouth on painted surfaces, paint chips, toy jewelry or vinyl mini-blinds?
9. Has your child recently visited another country for an extended period of time, lived in a foster care home or in a country other than the United States?

26

Symptoms of Lead Poisoning

Typically asymptomatic, can lead to seizures and coma, neuropsychological deficits

27

Lead Levels and Their Effects

14 mcg/dL + evaluate cognitive development
45 mcg/dL + chelation of lead required
High blood levels are > 70 mcg/dL = urgent!

28

Prevention of Lead Poisoning

Universal lead screening at age 1 and 2, targeted screening for older kids living in communities w/ high % of old housing, or high % of kids with elevated blood lead levels

29

Who do we use Lipid Screening on?

Screen children older than 2yo with a + FH of dyslipidemia or premature cardiovascular disease (CVD).

Screen > 2 years to 10 yrs. if unknown FH or other CVD risk factors.

30

Risk Factors that need Lipid Screening

--Overweight (BMI > 85%)
--Obesity (BMI > 95%)
--Hypertension (BP > 95%)
--Cigarette smoking
--Diabetes mellitus