Introduction to Pediatrics

Question 1

What is the difference between a term and preterm neonate?

Answer 1

Term neonates are born between 37 and 42 weeks of gestational age

Preterm neonates are born at less than 37 weeks of gestational age

Question 2

What are the three categories of preterm neonates?

Answer 2

Moderate to late preterm (32-37 weeks/ 8-9 months)

Very preterm (28-32 weeks/7-8 months)

Extremely preterm (less than 28 weeks/7 months or less)

Question 3

What is gestational age?

Answer 3

It is the time since the first day of the mother’s last menstrual period

Question 4

What is chronological age?

Answer 4

Also known as post natal age

Time elapsed after birth

described in days, weeks, and/or years

Question 5

Why does characterizing neonates by age impact clinical decisons?

Answer 5

Age confers information about in-utero development and potential neonatal complications (can impact PK)

Question 6

What is the age definition of an infant?

Answer 6

1 month to 1 year of age

Question 7

What is the age definition of a child?

Answer 7

1 year through 12 years

Can be broken into three developmental periods:
- Toddler (1 to 3 years of age)
- Preschool (3 to 5 years of age)
- Gradeschooler (5 to 12 years of age)

Question 8

What is the age definition for an adolescent?

Answer 8

12 to 18 years

Do not JPCH does not admit patients who are 17 and older

Question 9

What wellness programs are available for mothers and neonates?

Answer 9

• Newborn Screening
• Postpartum Visits
• Newborn Hearing Screens
• Specialized Clinics
• Immunization Programs

Question 10

What is included in newborn screening?

Answer 10

Routine care for all neonates born in SK

Test for congenital disorders

Completed after 24 hours of age (chronological age)

Blood test from heel poke and dry blood spot card

Question 11

What is included in the postpartum visiting program?

Answer 11

A nurse will support and follow-up care at home after birth of a baby

Completed in the first 10-14 days of life

Assess mother’s recovery and baby health

Support with feeding

Answer questions

Refer and connect to community services

Question 12

What is included in newborn hearing screens?

Answer 12

Hearing test is performed 12-16 hours after birth

Performed in hospital before discharge

Can help identify early hearing loss and can be addressed

Question 13

Which specialized neonatal clinics are available to Saskatchewan mothers and neonates?

Answer 13

• Alvin Buckwold Child Development Centre (developmental pediatrics, physio, speech-language pathology)
• JPCH Pediatrics Clinics (general pediatrics and subspecialty clinics)

Question 14

What do immunization programs for infants look like?

Answer 14

Many of the publically-funded vaccines are administered in the first few months of life.

Question 15

What are some expected behaviours from infants?

Answer 15

• Waves “bye-bye”
• “Mama” or “Dada”
• Puts something in container
• Pulls up to stand
• Walks while holding onto furniture

Question 16

What are some expected behaviours from toddlers?

Answer 16

• Follows simple routines
• Says about 50 words
• Plays pretend
• Knows at least one colour
• Twists things with hands
• Jumps with both feet

Question 17

What are some expected behaviours from preschoolers?

Answer 17

• Role play
• Speaks sentences
• Knows colours
• Catches balls

Question 18

How can drugs have different effects in children compared to adult patients?

Answer 18

• Brains are still developing
• Same disease states can present differently in children and youth (ex. Pharyngitis)
• Different PK (ADME) in children

Question 19

What is the goal of the Pediatric Drug Action Plan?

Answer 19

Health Canada initiative to ensure Canadian children and youth have access to the medicines they need

Question 20

What is the impact of caregivers in the treatment of pediatric patients?

Answer 20

Success of a child’s therapy often relies on a caregiver

Therefore, support both child and caregiver with medication use

Question 21

What is Jordan’s Principle?

Answer 21

All First Nations children living in Canada can access the products, services, and supports they need, when they need them

Can be helpful when coverage and funding is a concern

Question 22

What are the most common types of DTPs seen with pediatric patients?

Answer 22

• Dose too low
• Adverse drug reaction
• Dose too high
• Adherence

Question 23

What are some causes of “drug dose too low” in pediatric patients?

Answer 23

Common DTP

Dosing references can be confusion (different units)

PK considerations (differences in ADME)
- Children often clear drugs faster than adults

Question 24

What are some good pediatrics dosing references?

Answer 24

• Lexicomp (Peds Pages)
• PedMed
• Firstline

Question 25

What medications should be avoided in children due to adverse effects?

Answer 25

- Codeine (respiratory depression risk) - Tetracyclines (can impact bone growth and development) - Fluoroquinolones (short term use could be okay) - Alcohol excipients (insufficient or differential metabolism) - ASA (risk of Reye's syndrome, but can be used in specific situations)

Question 26

What are some issues with administering solid dosage forms?

Answer 26

Can be difficult for young children to swallow

Question 27

What are some ways issues with solid dosage form administration can be resolved?

Answer 27

Preferentially switch to commercially available liquid formulations If commercial preparations are not available the following are options (no reliable stability data): - Crush tablets (review Geri RxFiles) - Partial tablets, opening capsules and mixing into a vehicle (ensure compatibility) - Dissolve and dose (known amount of drug is dissolved into water to make a solution and dosed accordingly)

Question 28

How can issues with drug taste be resolved?

Answer 28

- Mask with a stronger flavour (chocolate, raspberry) - Compounded suspensions (added cost and less accessible) - Popsicle to numb taste buds before administration - Mix into food (be careful. child may start to dislike this type of food)

Question 29

What are the main sources of medication errors in pediatric patients (hospital and outpatient)?

Answer 29

Hospital: incorrect dosing Outpatient: incorrect administration by a caregiver (important role for pharmacists to improve counselling skills)

Question 30

What are the most common types of medication errors in children?

Answer 30

- Weight-based dosing - Diverse formulations (especially when compounding pharmacies are involved) - Lack of evidence for optimal dosing, safety and efficacy - Uneccessary polypharmacy - Poor labellung of liquid medications (never accept prescriptions in mL, request weight units for accurate dosing) - Multiple prescribers and caregivers - Transitions of care

Question 31

What are some drug coverage options for children?

Answer 31

Private insurance under their parents Children's Drug Plan covers medications until age 15 May need to apply for EDS coverage for medications that are normally covered for adults Drug Appeals (mainly for off-label use biologics) Special Support Jordan's Principle (can help indigenous pediatric patients recieve the therapy they need)

Question 32

Why do HCPs try to avoid poking children with needles for bloodwork?

Answer 32

- Needle pain and fear (can become an issue later on in life) - Anemia (maximum blood draw limits, especially in neonates)

Question 33

What are some pediatric specific fluid status monitoring parameters?

Answer 33

- Urine output (wet diapers, how often your child uses the bathroom) - Weight - Fontanelle (in neonates and infants) - Tear production (crying without tears) - Fluid intake (milk, water, juice)

Question 34

What are some pediatric specific pain monitoring parameters?

Answer 34

- Agitation/crying - Non-weight bearing - Unusual sleep patern - Unusual playing patterns

Question 35

What are some pediatric specific headache monitoring parameters?

Answer 35

- Very difficult to assess in young children