Introduction to Pediatrics

Question 1

Pediatrics is concerned with?

Answer 1

Not only concerned with particular organ systems and biological processes, but also with environmental and social influences which have a major impact on the total development of the child.

Question 2

what is the cutoff for a pediatric consult in the Philippines

Answer 2

17 years, 364 days

Question 3

where does HPI come from for pediatric patients?

Answer 3

Caregiver

Question 4

Because of the paucity of signs in infants/children,

Answer 4

making a diagnosis is difficult.

Question 5

what is the 5th Vital sign?

Answer 5

Weight

Question 6

A Child’s World

Answer 6

(10% nature; 90% nurture)

Question 7

FACTORS THAT IMPACT THE HEALTH OF THE CHILD

Answer 7

● economic conditions
● educational, social, and cultural considerations
● health and social welfare infrastructure
● climate and geography
● agricultural resources and practices (nutritional
● resources)
● stage of industrialization and urbanization
● gene frequencies for certain disorders
● ecology of infectious agents and their hosts
● social stability
● political focus and stability

Question 8

B. CHILDREN POPULATION IN THE WORLD

Answer 8

● Worldwide, children (< 15 years) represent 14%
of the world’s 7.2 billion persons (2015)
● In the Philippines, children < 15 years represent
33.4% of the nation’s 92.34 million population
(NSO, 2010)
● Current Philippine population: 92.34 million (NSO,
2010)

Question 9

PERINATAL PERIOD

Answer 9

20th week of gestation to the first

seven days after birth

Question 10

NEWBORN/ NEONATAL PERIOD

Answer 10

● Birth to 28 days (important when we talk about
infections eg. Early septicemia)
● Very early (<24 hrs), Early (24 hrs to 7 days), Late
(7 to 28 days)
● Average weight: 3 kg (for Filipinos it is 2.5 kg),
Average length: 50 cm

Question 11

When are the infants most vulnerable to infection?

Answer 11

During the neonatal period

Question 12

INFANCY

Answer 12

● Birth to two years old
● Infant proper (0-12 months)
○ Very rapid physical growth and
maturation

Question 13

What is the Birth weight of an Infant as compared to their birth weight?

Answer 13

Triple

Question 14

Late infant or Toddler (12-24 months)

Answer 14

○ Growth slows down
○ Total weight gain in 2nd year equivalent
to BW
○ Weight: quadrupled (2 years old)
○ Marked improvement in language skills
(50-100 words)
○ Language skills should be developed
before 2 years of age
○ More interested in play = decrease in
appetite

Question 15

PRESCHOOL

Answer 15

● 2 to 5 years old
● Further physical growth deceleration
● Average weight gain: 2 kg
● Average Height increase: 7-8 cm annually
○ It is important to get the weight and height
then plot it in the growth chart to see who
is lagging behind.
● Gross and fine motor skills become more
enhanced.
● Some children are in school during this time
(nursery and pre-kindergarten)
● Bladder and bowel conditioning are achieved.
● Learn about fast food and gadgets

Question 16

MIDDLE CHILDHOOD

Answer 16

● 6 to 10 years
● Average annual weight gain 3-3.5kg.
● Average height increase is 6-7 cm.
● More independent; perform higher order motor
skills.
● Self-esteem is very important
● Deciduous teeth start to fall
● Lymphoid tissues are normally hypertrophied
with enlarged tonsils and adenoids.

Question 17

ADOLESCENCE

Answer 17

● 10 to <19 years old
● The transition from childhood to adulthood
● Rapid growth
● Marked psychological and physical growth
○ Early Adolescence
■ 10-13 years old
○ Middle Adolescence
■ 14-16 years old
○ Late Adolescence
■ 17 to <19 years old

Question 18

when did Modern Pediatrics start in the Philippines?

Answer 18

Philippine Pediatric Society (1947)

Question 19

who is considered as the Mother of the Philippine Pediatric Society

Answer 19

Dr. Fe del Mundo (Countless kids)

Question 20

ORGANIZATION OF THE PROFESSION AND THE GROWTH OF SPECIALIZATION

Answer 20

● American Academy of Pediatrics, 1930
● Indian Academy of Pediatrics, 1963
● Pakistani Pediatrics Association, 1970
● Malaysian Pediatric Association, 1982
● Canadian Pediatric Society, 1922
● Philippine Pediatric Society, 1947

Question 21

what are the various subspecialties of Pediatrics

Answer 21

● Pediatric Gastroenterology
● Child Psychiatry
● Pediatric Radiology
● Pediatric Surgery
● Pediatric Dentistry
● Pediatric Ophthalmology
● Pediatric Otolaryngology
● Pediatric Hematology and Oncology
● Pediatric Dermatology
● Pediatric Nephrology
● Pediatric Urology
● Clinical Genetics
● Child Protection Specialist
● Pediatric Infectious Disease

Question 22

Has mortality improved in Phil?

Answer 22

There is a gradual drop in infant mortality

Question 23

MORTALITY RATE, UNDER 5 (Per 1000 Live Births)

Answer 23

● Under 5 mortality rate
○ is the probability per 1000 that a newborn
baby will die before reaching age five.
● The value of mortality rate, under-5 (per 1000
live births) in the Philippines was 28.4 as of 2018.
(Over the past 58 years, this indicator reached a
maximum value of 103.6 in 1960 and a minimum
value of 28.4 in 2018)

Question 24

UNANG YAKAP

Answer 24

to address the high neonatal mortality rate

Question 25

what are the leading causes of Infant mortality in the Philippines?

Answer 25

```  Congenital Pneumonia  Intrauterine hypoxia and birth asphyxia  Other congenital malformations  Diarrhea and gastroenteritis of presumed infectious origin  Neonatal aspiration syndromes  Congenital malformations of the heart  Disorders related to short gestation and low birth weight  Respiratory distress of newborn  Bacterial sepsis of newborn  Pneumonia ```

Question 26

INFANT DEATH RATE

Answer 26

● Declined from 18.9 to 12.1 | ● 36% decrease

Question 27

MATERNAL DEATH RATE

Answer 27

● Declined from 1.1 to 0.9 | ● 18% decrease

Question 28

FETAL DEATH RATIO

Answer 28

● Declined from 5.7 to 4.4 | ● 23% decrease

Question 29

FETAL DEATHS BY AGE OF MOTHER

Answer 29

Ages 40-44 pregnancies are most at risk for mortality

Question 30

CHILD MORTALITY, 1-4 YEARS (PHILIPPINES, 2013)

Answer 30

1. Pneumonia 2. Diarrheas and gastroenteritis of presumed infectious origin 3. Congenital anomalies 4. Septicemia 5. Other diseases of nervous system 6. Accidental drowning & submersion 7. Dengue fever & DHF  Dengue is number 7 here because in these years, children are minimally exposed to the outside world. 8. Chronic lower respiratory diseases 9. Meningitis 10. Leukemia

Question 31

causes of death for AGE 5-9 YEARS

Answer 31

1. Pneumonia 2. Dengue fever & DHF 3. Accidental drowning & submersion 4. Other diseases of the nervous system 5. Transport Accidents 6. Congenital anomalies 7. Leukemia 8. Meningitis 9. Septicemia 10. Diarrheas and gastroenteritis of presumed origin

Question 32

AGE 10-14 YEARS

Answer 32

1. Pneumonia 2. Accidental drowning & submersion 3. Other diseases of the nervous system 4. Transport Accidents 5. Congenital anomalies 6. Dengue fever & DHF 7. Chronic rheumatic heart disease 8. Leukemia 9. Septicemia 10. Nephritis nephrotic syndrome

Question 33

DEVELOPED COUNTRIES

Answer 33

malignant disease, cystic fibrosis

Question 34

Neurodevelopmental disorders -

Answer 34

language delay, reading difficulties, clumsiness, cerebral palsy

Question 35

Behavioral and emotional disorders -

Answer 35

attention deficit hyperactivity disorder, anorexia nervosa

Question 36

Excessive consumption -

Answer 36

obesity

Question 37

Drug and alcohol abuse,

Answer 37

smoking, teenage pregnancy

Question 38

BOTH DEVELOPED AND DEVELOPING COUNTRIES

Answer 38

● Relative socioeconomic disadvantage among the ‘have-nots’ - lack of money, unemployment, inadequate housing and education ● Lack of family cohesion ● Healthcare - not available or poor quality or inequality of access

Question 39

DEVELOPING COUNTRIES

Answer 39

● The high mortality rate for children, especially infants ● Infection tuberculosis, HIV ● Malnutrition ● Poor sanitation, water supply, food hygiene ● Road traffic and other accidents ● Developmental and learning problems of organic pathology ● High birth rate requiring health care relative to population

Question 40

Malnutrition is common among children.

Answer 40

○ 26.2% 0-5 years are underweight for age | ○ 27.9% 0-5 years are short for age (8,000 kids malnourished Pampanga, 2014)

Question 41

Decreased prevalence of Vitamin A deficiency

Answer 41

(from 40.1% in 2003 to 15.2% in 2008) because of vitamin A supplementation provided by government programs. Midwives giving vitamin A supplementation

Question 42

WHO GUIDELINES TO OPTIMAL INFANT FEEDING

Answer 42

1. Breastfeeding directly at mothers breast 2. Expressed breast milk from the mother 3. Expressed breast milk from a donor o if a mother cannot directly breastfeed a child 4. Artificial infant milk (formula milk). o There are milk banks, infant milk is pasteurized and fed to sick neonates

Question 43

Dollars spent by Filipinos to formula | feed their babies.

Answer 43

922 million

Question 44

11,000 dollars spent on funerals

Answer 44

of 16,000 child deaths. That could have been prevented if they were breastfed.

Question 45

cost of out-patient treatment for acute respiratory infections. That could have been prevented if they were breastfed

Answer 45

1.2 million dollars

Question 46

spent on hospitalization costs for | formula-fed infants

Answer 46

557,000 dollars

Question 47

what is the main reason for the cessation of breastfeeding

Answer 47

Inadequate milk flow

Question 48

10 commandments to avoid MalNutrition

Answer 48

``` ● Eat a variety of foods. ● Breastfeed the baby during the first 6 months after birth; afterward, complementary foods may be given as well. ● Eat fruits and vegetables every day. ● Eat fish, meat, and other protein-rich food. ● Drink milk; eat Calcium-rich food. ● Ensure clean and safe food and water. ● Use iodized salt. ● Limit salty, fatty, and sweet foods. ● Maintain the appropriate body weight. ● Be active. Avoid alcohol. Don't smoke. ```

Question 49

An expanded program of immunization (EPI)

Answer 49

BCG, DPT, OPV, Hepatitis B, measles, rotavirus and Hib

Question 50

ORS

Answer 50

for diarrheas

Question 51

UFC

Answer 51

An intervention designed to meet the major demands for child health in both urban and rural areas

Question 52

Low-cost comprehensive child care

Answer 52

``` focusing on: ○ Treatment of common childhood illnesses (Acute Respiratory Illnesses, Diarrheas, Malnutrition, and Micronutrient Deficiency) ○ Primary prevention through: ■ Growth Surveillance ■ Immunization ■ Promotion of Breastfeeding, ORT, and Family Planning ■ Environmental Sanitation ■ Counselling mothers on health matters, safety and protection of child’s psychosocial environment, and how to set priorities for health ○ Identification of at-risk children, and prompt management of recognized problems or diseases, and its possible complications ○ Promotion of parent-child relations ```

Question 53

what are the objectives of IMCI

Answer 53

○ Reduce deaths, and the frequency and the severity of illness and disability ○ Contribute to improved growth and development

Question 54

exposure time for tech per age

Answer 54

○ 0-2 years = No exposure to technology ○ 3-5 years = 1 hour per day ○ 6-18 years = 2 hours per day

Question 55

Who are the kids that are at most risk of emotional, behavioral, and social problems?

Answer 55

>3 hours a day of tech exposure and no exercise

Question 56

Underweight children

Answer 56

■ Have low weight for age ■ Easiest to address ■ Increasing food intake will usually address it

Question 57

Stunted children

Answer 57

``` ■ Are short for their age ■ Reflects chronic undernutrition ■ Effects become irreversible by age 5 ■ Affects 3M Filipino children under 5 years old ```

Question 58

Wasted children

Answer 58

``` ■ Are short for their age ■ Reflects chronic undernutrition ■ Effects become irreversible by age 5 ■ Affects 3M Filipino children under 5 years old ```

Question 59

THE UNITED NATIONS CONVENTION ON THE | RIGHTS OF THE CHILD

Answer 59

● Survival rights: the child’s right to life and to the most basic needs (food, shelter and access to health care) ● Developmental Rights: to achieve their full potential - education, play, freedom of thought, conscience and religion. Those with disabilities to receive special services. ● Protection rights: against all forms of abuse, neglect, exploitation and discrimination. ● Participation rights: to take an active role in their communities and nations (for empowerment)

Question 60

The role of the pediatrician in the community as:

Answer 60

``` ○ an educator ○ a consultant ○ a coordinator ○ a health planner ○ a counselor ○ a group worker ```