Preventative Peds Flashcards by Vanessa Soetanto

Routine testing for refugee children coming in

Hep B serology
Hep C
Syphilis
HIV
CBC
Stool Ova & parasite
IGRA/PPD
T. cruzi (Chagas; if endemic- Brazil)
If eosinophilia: toxocara canis, strongyloides, schistosoma (subsaharan Africa, SE asia, latin america)
>2 yo lymphatic filariasis serology

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When is Rotavirus contraindicated

history of intussusception
SCID

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When should you NOT start rotavirus series (age)

15 weeks

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When should you not give rotavirus (max age of any vaccination)

8 mo

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Earliest that first dose of rota can be given is ___

6 weeks

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Blood pressure monitoring, who should get them

Healthy: start at 3 yo

Annually:
- obesity
- renal disease
- diabetes
- aortic arch obstruction
- taking meds that cause HTN
-* h/o prematurity <32 wk, SGA, very low birth weight, neonatal complication requiring UVL/UAL*
- congenital heart disease +/- repair
- Recurrent UTI, hematuria, proteinuria
- Urologic malformation
- f/o congenital renal disease
- Solid-organ transplant
- malignancy/ bone marrow transplant
- systemic illnesses associated with HTN
- evidence of increased ICP

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Where should you take a BP, and when can you not

right arm
unless there is atypical aortic arch anatomy

cuff must circle 80-100% of mid-arm circumference

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What’s the window of time that you have to give HBIG

within 12 hours of birth for <2g infants
within 7 days of birth for >2g infants

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What is the “window period” in Hep B serology

When Hep B sAg disappears before HBsAb appears. HepB core Ab (IgM) will be still positive

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When should you test infants born to HBsAg-positive mothers?

1-2 mo after last vaccine dose (>9mo)

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Normal Hep B series

3-doses, ok to give 4th dose in combo vaccines
minimum intervals, 4wk, 8wk, 8wk (respectively between subsequent doses)

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Shortest time between PCV13 and PPSV23

8 weeks

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Normal PCV13 schedule

4-doses
2, 4, 6, 12

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If premature infant has sustained desaturation <90%, >20 s, bradycardia <80) in car seat challenge, what’s the next step

rechallenge neonate in a car bed

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Strabismus exam

Cover “good” eye, and the resting eye should move to where it is not.

“Good” eye should not move when resting eye is covered

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Difference between eso/exo-phoria vs. eso/exo-tropia

phoria: manifests under cover-uncover test
tropia: constantly present

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Diagnosis of burn infection

Tissue biopsy revealing 10^5 bacteria

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All children ages 9-11 yo must obtain what routine screening?

lipid profile (non-fasting)

If you have risk factors, must obtain FASTING lipid profile

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Criteria for receiving live vaccine after chemo

They have to be in remission
Needs evidence of immunocompetence

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Cut-off age for 2-dose vs. 3-dose vaccine series for HPV

15 yo

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Are infant walkers recommended?

NO – risk of injuries

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Routine Hep A vaccine schedule

1yo, then 6 mo after

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Risk factors for dental decay (7)

use of bottle/sippy cup
sleeping with bottle
frequent snacks with sugar
sugar-sweetened beverages
sugary medications
prematurity
Other meds: CF, DM, Sjogren

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Toothpaste size per year old

<3yo: rice grain sized
>3yo: pea sized

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When to start fluoride

6mo or when first tooth erupts

When does cerebral hypoxia start during drowning

3-5m after submersion

Age at which you must have adult supervision around any water

4yo or younger

Age at which you must have adult supervision around any water

4yo or younger

Meningitis ACWY routine schedule

2-dose 11-12 or 13-15, booster at 16yo If first dose at 16yo, no need for booster

contraindication to MMR vaccination

severe anaphylactic allergy to neomycin or gelatin or severe allergy to previous MMR

do not give MMR and __ vaccine together because of risk of ___

varicella febrile seizure

Preferred PEP for measles

vaccination

When should you give measles Ig

pregnant women, infants <6mo, immunocompromised individuals, those who received previous dose <28d prior

DTaP doses have to be how far apart?

1st and 2nd: 4 wk 2nd and 3rd: 4 wk 3rd and 4th: 6 mo 4th and 5th: 6 mo

Thin, tired children with macrocytic anemia, vegetarian, decreased DTR. Dx?

B12 deficiency

Thin, tired children with macrocytic anemia, vegetarian, decreased DTR. Dx?

B12 deficiency

Best way to feed infants intubated with respiratory failure

Nasojejunal feeding NOT NGT

When do you place a G-tube?

when you expect infant requires feeding for 3 mo

CF patients usually have trouble absorbing which vitamins?

ADEK (fat soluble)

exclusively breastfed infants stool once every ___ days

3-4

Nutrition need for chronic liver disease and CF

fat and protein + MCTs and fat soluble vitamins

Nutrition for those with EoE

elimination of most common food allergens amino acid-based elemental diet

Nutrition for FPIES

eliminate causative food

Nutrition for GERD

Infants: thickened (not enough evidence & xantham gum can cause NEC), reduce volume, increase frequency of feeds, protein hydrolysate formula If severe, amino acid-based formulas Older children: avoid coffee, chocolate, fatty, spicy foods.

Nutrition for IBD

monitor: iron, vitamin D, micronutrients If ileal desease/resection, supplement fat soluble vitamins ?parenteral vit B12

Short bowel syndrome

May require MCT +/- vitamin supplement

High doses of folic acid might ___

mask vitamin B12 deficiency

If you see a child with multiple low-impact fractures who is otherwise healthy, what is the first thing you screen for?

Vitamin D 25 level

Nutrition need for Burn patients >40% of body

Requires more calories for increased resting energy expenditure Enteral + nitrogen balance + reduce GI translocation Vitamin C, A, zinc for wound healing

Children consuming ketogenic diet are at risk for ___

kidney stones Others (more common): constipation, emesis, abd pain, HLD

Ketogenic diet screening consists of

urine calcium-creatinine ratio every 3 mo Routine labs with serum acylcarnitine profile

Those who have had cancer treatment especially hypothalamic radiation therapy are at increased risk of ___

metabolic syndrome

Difference between preterm formula and term formula

Preterm formula has higher levels of protein, sodium, potassium, calcium, phos, and iron

WHen should preterm formula continue to be used?

Until corrected GA of 40 weeks

What is acrodermatitis enteropathica

congenital disorder of zinc metabolism

Kids with CKD should restrict ___ in their diet

phosphorous

For infant with prematurity and birth weight lower than 1800g, what calorie formula should they have?

22 cal/oz

Goal weight gain/day after reaching 2kg (infants)

20-30g/day

Who needs higher-calorie formula >24 cal/oz?

premature infants with bronchopulmonary dysplasia/poor weight gain while in NICU

Wight cutoff for "very low-birth-weight infants" and what formula should they have

<1500g high calories (22-24 cal/oz), fortified human milk

Who should be given soy protein-based formula and what carbohydrate does it contain?

Congenital lactase deficiency Galactosemia Sucrose and corn syrup

Who can you start to introduce peanuts in and who shouldn't you

Yes -- no eczema to mild-mod eczema No -- severe eczema +/- egg allergy (need to test peanut allergens in office)

How do you test for protein-losing enteropathy (PLE)?

fecal alpha1-antitrypsin (marker of protein loss in intestine)

What is associated with protein-losing enteropathy?

- CMV, c. diff - IBD, celiac, eosinophilic enteropathy - Primary/ secondary lymphangiectasia - Lymphoma - NSAID - HSP, SLE

Youngest age to give zofran

>6 mo

Infant with diarrhea, arching with feeds on cow milk-based protein. What should you try next?

elemental/extensively hydrolyzed protein formula

Proximal bowel disease can decrease which serum vitamins? (3)

iron, folate, vitamin D

Weight gain goals for 0-3 mo 3-6 mo 6-12 mo

0-3 mo: 30g/day 3-6 mo: 15g/day 6-12 mo: 10g/day

Premature infant caloric need in kcal/kg/day

105-130

Specific nutrition need for premature infants protein fat iron

protein: 3-4 g/kg fat: 5-7 g/kg iron: 2-4 g/kg

Recommended kcal/kg/day for congestive heart failure

140 kcal/kg/day

What can you give kids with ESRD to improve adult height

growth hormone!

Normal growth velocity in childhood

5-7 cm/year

Definition of adult growth restriction

Adult height of below 2.5 percentile

What maternal factor can contribute to developmental delay?

Postpartum depression Screen until 6 mo

Short child with concordant bone age, high upper-to-lower body segment ratio (long trunk to leg ratio), normal BMI. What't the diagnosis?

Skeletal dysplasia OR precocious puberty Lower segment = pubis symphysis down Upper segment = height - pubis symphysis

Low upper-to-lower body ratio ddx

Klinefelter Delayed puberty

Clues for constitutional delay of growth and puberty

Delayed bone age Family history of delayed puberty/growth

Clues for familial short stature

height percentile corelates with adjusted midparental height

Calculate mid-parental height (girls and boys)

Girls: father's height minus 13 cm (5in) + mother's height /2 Boys: mother's height plus 13 cm (5 in) + father's height /2

For foster children, how often should they routinely visit the pediatrician?

Every 6 months between 24 mo and 21 yo

If you suspect that children/adolescents are sexualy exploited (human trafficking, comercial sexual exploitation), who do you report to?

the national trafficking organization hotline be cautious of reporting to CPS, also many states still view commercial sexual exploitation of children as prostitution so minors can be criminals rather than seen as victims

When toddlers see parents go thru a divorce, what can be their response?

Separation anxiety Older preschoolers or younger school-aged children might blame themselves