Preventive Pediatrics Flashcards
(165 cards)
1
Q
ESSENTIAL ELEMENTS OF A WELL CHILD HEALTH
SUPERVISION VISITS
A
● Immunizations ● Nutritional assessment ● Growth and Developmental assessment ● Periodicity - frequency and content for well-child care activities
2
Q
PRIMARY PREVENTION
A
● Activities applied to a whole population
● Goal is to protect people from developing disease or
experiencing an injury
● Ex. Immunization, Healthy lifestyle
3
Q
SECONDARY PREVENTION
A
● Activities aimed at patients with specific risk factors
● These interventions happen after an illness or serious
risk factors have already been diagnosed
● Disease strategies are individualized. It is not applied
to us. It will depend on the risk factor that you have
identified on the patient
● Goal is to halt or slow the process of disease in its
earliest stages
● Ex: BP monitoring, Heart attack, Stroke. Not all of us
regularly check our BP but only those who are at risk.
4
Q
TERTIARY PREVENTION
A
● Focuses on helping people manage complicated, longterm health problems
● Goals include preventing further physical deterioration
and maximizing quality of life
● Ex: People who have diabetes or stroke and partial
disability. It includes physical rehabilitation and pain
management to patients with cancer or debilitating
illnesses.
5
Q
ANTICIPATORY GUIDANCE
A
● Instructions given to parents on what do they need
to expect from a child
● Focus is on the wellness and strengths of the family
● Help the family address relationship issues, broach
important safety topics and access community
services
● Ex. Advise the parents that toddlers are prone to
accidents, so safety measures should be observed.
The dangers of tobacco smoke or alcohol
consumption
6
Q
Maternal nutrition (folic acid supplementation) folic acid
A
- prevents neural tube defects
7
Q
Benefits of breastfeeding
A
o Safe and sterile- At times mothers think that the cow’s formulated milk is actually better than the mother’s milk just because it’s expensive, But NO!
o Easily digested and absorbed
o Contains antibodies
o Contains fats (DHA)
o Sustains growth and development (birth to 6 months)
8
Q
ADVANTAGES of BF
A
● Promotes emotional bonding of mother and baby
● Protects the mother’s health against cancer (breast,
uterus, ovaries), obesity and postpartum
hemorrhage
● Promotes early return to pre-pregnancy weight
● Reduced postpartum bleed because of oxytocin
● Delays return to fertility
● Gives the family big financial savings
9
Q
● Room Temp (<25°C)
A
- 4 hrs
10
Q
Room Temp (>25°C) -
A
1 hr (Philippines)
11
Q
● Refrigerator (4°C) -
A
8 days
12
Q
● Freezer compartment (1 door)
A
- 2 weeks
13
Q
● Freezer compartment (2 doors) -
A
3 months
14
Q
● Deep freezer with constant temp (-20°C) -
A
6 months
15
Q
BREASTFEEDING TECHNIQUES
A
● Support head and entire body; aligned in straight manner
● “face to face”, “chest to chest”, “tummy to tummy”
● Support breast with other hand C-hold position
● Stimulate infant’s mouth wide (stroking corner of mouth)
● Entire nipple plus an inch of surrounding areola there
should be quiet sucking, when there is sound then it will cause cracking of nipple
● 15-30mins per breast
● 8-10x a day or more (adequate milk supply)
16
Q
BREAST MILK EXTRACTION AND STORAGE
A
● Breast pump
● Manual breast extraction
● Store in sterile polypropylene (cloudy hard plastic)
17
Q
Minimum criteria for discharging newborns before 48
hours (Philippine Society of Newborn Medicine)
A
● Uncomplicated antepartum intrapartum and
postpartum for both mother and newborn
● Vaginal delivery, single baby that was born,
completed 37 weeks, AGA (appropriate for
gestational age)
● Normal and stable vital signs preceding 12 hours
○ Respiratory Rate: <60 breaths/min or 40-60
/min
○ Cardiac Rate: 100-160/min
○ Temp 36.5C-37.5C
○ Physiologic weight – should not loss 10% of the
weight; weight loss should be regained at the
10th of life
● Has urinated and passed at least one stool
○ To detect Hirschprung’s disease
● Has documented proper latch, milk transfer,
swallowing, infant satiety and absence of nipple
discomfort
○ The mother and the baby should be able to
demonstrate feeding well
● If the baby is bottle fed, there should at least be 2
episodes that the baby has bottle fed efficiently
● If not breastfed, the baby should have tolerated at
least 2 feedings with documented coordinated
sucking, swallowing and breathing while feeding.
● Normal physical examination
● No evidence of significant jaundice 1st 24 hrs. of life
○ If jaundice is present before the 1st 24 hours
then it can be pathologic due to blood
incompatibility of mother and child and if it is
after the 1st 24 hours then it is physiologic.
● Educability and ability of parents to care for the child
(recognize signs of illness, care of the umbilical
cord/skin/genitalia, maternal confidence in feeding
her infant and parent’s understanding of the
importance of follow-up visit or emergency
consultation)
● Must follow-up within the next 48 hours.
18
Q
5 COMPONENTS OF DEVELOPMENT
SURVEILLANCE
A
- Eliciting and attending to the parents’ concerns
about their child’s development - Maintaining a developmental history
- Making accurate and informed observations of the
child - Identifying the presence of risk and protective factors
- Documenting the process and findings
19
Q
DEVELOPMENTAL SCREENING
A
Usually given at 9, 18, and 30 months and every year
thereafter
20
Q
MOTOR DELAYS
A
● Lack of steady head control while sitting at 4 months
● Inability to sit at 9 months
● Inability to walk independently at 18 months
● Poor head control by 3 months
● Hands still fisted by 4 months
● Unable to hold objects by 7 months
● Does not sit independently by 10 months
● Cannot stand on one leg by 3 years
21
Q
WINDOWS OF ACHIEVEMENT DEVELOPMENTAL
MILESTONES
A
● sitting with support ● standing with assistance ● hands and knees crawling ● walking with assistance ● standing alone
22
Q
6 MONTHS
A
Lack of smiles or joyful expressions
Does not turn to the source of sound
Child does not coo
Not searching for dropped objects
23
Q
9 MONTHS
A
Lack of reciprocal vocalizations,
smiles or other facial expressions
24
Q
12 MONTHS
A
Failure to respond to name when called, absence of babbling, lack of reciprocal gestures Does not follow verbal routines/games Absence of non-verbal purposeful messages (show objects) No object permanence
25
15 MONTHS
Lack of proto-declarative pointing or
showing gestures, lack of single
words, child should have a ONE
TRUE WORD with meaning
Does not understand simple
questions, does not stop when told
“NO”, does not understand at least 3
different words
26
18 MONTHS
Lack of simple pretend play, lack of
spoken language/gesture
combinations
Does not point to 3 body parts, does
not follow simple commands
27
24 MONTHS
Lack of 2-word meaningful phrases
| without imitating or repeating
28
ANY AGE
Loss of previously acquired
babbling, speech or social skills
(Massive red flag)
29
2 MONTHS
The baby does not alert or quiet to
sound
Not alert to mother
30
10 MONTHS
Does not respond to own name
| Does not babble
31
14 MONTHS
Absence of pointing
32
16 MONTHS
Does not say 3 different
| spontaneous words
33
24 MONTHS
Vocabulary of not more than 35-50
words, does not produce 2 word
phrases
Does not categorize similarities
34
36 MONTHS
No simple sentences
| Does not know the full name
35
42 MONTHS
Intelligibility to unfamiliar adults at
| <50%
36
54 MONTHS
Not able to tell or retell a familiar
| story
37
60 MONTHS
Not fully intelligible to an unfamiliar
| adult
38
72 MONTHS
Not fully mature speech sounds
39
18 MONTHS
No interest in cause and effect
| games
40
4.5 YEARS
Cannot count sequentially
41
5 YEARS
Does not know letters or colors
42
5.5 YEARS
Does not know own birthday or
| address
43
SCHOOL-AGE CHILDREN
```
● Slow to remember facts
● Slow to learn new skills, relies heavily on
memorization
● Poor coordination
● Unaware of physical surroundings
● Prone to accidents
● May be awkward and clumsy
● Has trouble with fine motor skills
```
44
READING SKIILLS (FOR SCHOOL AGE)
```
● Slow in learning connection between letters and
sound
● Confuses basic words
● Repeats, omits or add words
● Does not read fluently
● Does not like reading at all
● Avoids reading aloud
● Uses fingers to follow a line of print when reading
● Makes consistent reading errors
○ Letter reversals b-d, p-q
○ Letter inversion m-w
○ Transpositions felt – left
○ Word reversals was – saw
○ Number reversals 14 – 41
```
45
Philippine Ambulatory Pediatric Association
stress
to parents the importance of reading, studies have shown
that if you read to your child early, this enhances their
literacy and learning skills and they are eager and ready
to learn when they start schoo
46
DEVELOPMENTAL SURVEILLANCE AND
| SCREENING (ADOLESCENTS)
HEEADSSS Assessment for Adolescents
```
Home
Education
Eating
Activities
Drugs
Sexual activity
Suicide/Depression
Safety
```
Be careful of the privacy
47
PHYSICAL EXAMINATION FOR ADOLESCENTS
```
● Tanner Staging
● Sexual Maturity Rating
● Breast examination
● Examination of spine and shoulders
● Inspection of the Genitals
```
48
LABORATORY TESTS
● Can also ask for CBC such as
hemoglobin/hematocrit (at every stage of
adolescence)
● Urinalysis (on first visit)
● Vaginal wet mount/ pap smear (for sexually active
females)
● Serologic tests for syphilis (for sexually active males)
● Tests for gonorrhea and chlamydia (for both M and
F – sexually active)
● Immunization update
49
ANTICIPATORY GUIDANCE
● Self breast examination for females
● Healthy lifestyle (physical activity, diet, avoidance of
alcohol, smoking & drug use)
● Sexual behavior and risk of acquiring STDs including
HIV
● Injury and accident prevention (Use of sports
protective gear, seat belts, no driving under the
influence of alcohol, no smoking in bed, no handgun use)
50
. PHYSICAL EXAM
```
Respiratory Symptoms
Nasal Symptoms
Ocular Symptoms
Skin Symptoms
Gastrointestinal Symptoms
```
51
WEIGHT, LENGTH/HEIGHT & HEAD
| CIRCUMFERENCE
The WHO Global database on Child Growth and
Malnutrition uses a z-score cut-off point:
○ +2 SD classifies high
weight for age and high height for age
52
Growth Indicator
So if the length/height of your patient is plotted and
the point goes below -2 It is interpreted stunted.
● This is the table that we use to interpret your Zscores.
53
measure recumbent length
<2 y/o
54
– measure standing
| height
More than or equal to 2 y/o
55
In general, standing height is approximately
0.7 cm less than the recumbent length
56
Weight for length/ height
reliable growth
| indicator even when age is not known
57
Indicate on the growth chart if the patient being
| weighed has edema
Falsely elevated weight because of water
58
BLOOD PRESSURE
● Recommended to be routinely measured by the
Pediatric Nephrology Society of the Philippines at 3
years of age
● Must be done regardless of age in all ill patients and
at risk or in the presence of PE finding suggestive of
a possible renal or vascular involvement regardless
of age
59
NORMOTENSIVE
○ If the BP is <90th percentile for age, gender and height percentile
○ Encourage healthy diet, sleep, and physical activity
60
PREHYPERTENSION in CHILDREN:
PREHYPERTENSION in CHILDREN:
○ Average SBP or DBP levels that are equal to
or greater than 90th but less than 95th
percentile
○ Adolescents with BP levels equal to or greater
than 120/80 should be considered prehypertensive
○ Counseling on physical activity, diet
management and weight management if
Obese
○ Medical investigation for the presence of
factors that might need pharmacologic therapy.
61
HYPERTENSION:
| ○ Average SBP and/or DBP equal to greater than the 95th percentile on 3 or more occasions
○ Investigate for causes
62
Republic Act No. 9288-
Newborn screening act of
| 2004
63
Newborn screening must be performed after
24 hours of life, but not later than 3 days from complete delivery of the newborn
64
Newborns that must be placed in ICU are
| exempted
3-day rule but must be
| tested in 7 days of age
65
Initially, there were only 6 diseases included in the
| Philippine newborn screening
```
○ Congenital Hyperthyroidism
○ Phenylketonuria
○ Galactosemia
○ G6PD Deficiency
○ Congenital Adrenal Hyperplasia
○ Maple Syrup Urine Disease
```
66
Most common screening
G6PD
67
Republic Act No. 9709 --
The Universal Newborn
| Hearing Screening and Intervention act of 2009
68
The Philippine Society of Pediatric Ophthalmology
and Strabismus (PSPOS) and the Philippine
Academy of Ophthalmology (PAO
recommend
regular eye and vision screening examination of
children from infancy until maturity of their visual
system.
69
Retinoblastoma.
This is to detect strabismus or leukocoria which are
the most common presenting signs of a cancer of the
eye
70
Visual acuity assessment
```
○ Fixes and Follows Test
○ Subjective/Formal Visual Acuity Testing
We use the Lea picture chart for
preschoolers or children not familiar with
letters and the Sloan letter or HOTV Chart
for literate children.
For children who are less than 3 years
of age up to 3 years and 11 months
their visual acuity should be 20/50
(10/25) or better
Children 4 years to 4 years and 11
months should be 20/40 (10/20) or
better.
5 years and older are expected to be
20/30 (10/15
```
71
EXTERNAL INSPECTION OF THE EYE, PUPIL, AND
| ADNEXA
● External inspection of the eyes to look for
abnormalities (Eyelid deformities, Ptosis, and
Hemangioma)
● Pupils should be centered and constrict to light
72
Corneal light reflex:
Using a penlight as a target, corneal light reflex
should be seen simultaneously at the center of
the pupil of each eye.
73
Vertions and ductions
Using a penlight or any interesting object as a target, the eyes should be able to move together in all directions of gaze (ocular
motility)
74
Cross over cover test (Alternate cover test)
○ Alternately cover the eyes while the patient is
fixing on a target
○ so any movement of the eye or if the eye
appears jiggly, then this also warrants referral
because the eye should be steady
75
Key steps for the prevention of blindness in children:
○ Proper dietary supplementation
○ Measles immunization
○ Routine pediatric eye evaluation for all patients
○ Subsequent referral of children at high risk for
blindness.
76
BCG (Bacille Calmette-Guerin)
● Will prevent serious forms of TB like TB meningitis
or widespread TB not the primary form of TB
● Live vaccine
● Given Intradermally
● Dose is 0.05 ml for children less than 12 months and
0.1 ml for those older than 12 months
● Should be given at the earliest possible age after
birth preferably within the first 2 months of life.
● For infants more than 2 months of age who were not
yet given BCG, PPD (Purified protein derivative) is
recommended prior to vaccination if any of the
following are present: suspected Congenital TB,
History of close contact to known or suspected
infectious cases of TB, clinical findings suggestive of
TB and/or Chest X-ray suggestive of TB
● If PPD test (Mantoux skin test) is performed to this
child, and the result is more than or equal to 5mm in
diameter it indicates a positive test and BCG in not
advised because the child is already infected
77
DTP
● Given IM (Intramuscular)
| ● Give at a minimum age of 6 weeks with a minimum interval of 4 weeks.
78
The preferred interval for the 3rd and 4th dose of DTP
6 months
79
DTwP
whole-cell pertussis has been used
acellular type of pertussis toxoid has been used
more reactogenic
80
HEPATITIS B VACCINE
Given IM
● 1st dose should be given at birth or at least within
the first 24 hours of life for those who are more than
2 kg
○ If the vaccine is given when the baby is less
than 2 kg, then that is not considered valid.
81
HEP Vac
● Subsequent doses are given at least 4 weeks apart
● A 4th dose in needed for the following: If the 3rd dose
is given at age of < 24 weeks and for preterm infants
less than 2 kg whose 1st dose was given at birth.
82
BCG
Birth
83
Hepatitis B
Birth
84
DPT-Hib-Hep B
6-10-14 weeks of age (3
| doses)
85
OPV
6-10-14 weeks of age (3
| doses)
86
PCV
6-10-14 weeks of age (3
| doses)
87
Measles containing
vaccine (either
monovalent or
MMR)
9 months of age
88
MMR
12 months of age
89
RV
Minimum age of 6 weeks
with minimum interval of
4 weeks, between doses
90
TETANUS AND DIPHTHERIA TOXOID (Td) /
TETANUS AND DIPHTHERIA TOXOID AND
ACELLULAR PERTUSSIS VACCINE (Tdap)
Tetanus is the one that is capitalized and the
other parts of the vaccine are the in small letters,
because the antigens in small letter are already
reduced since they are more reactogenic for the
older age groups so it is only Tetanus that
remains in its original concentratio
91
Td is given
intramuscularly
● In children who are fully immunized , Td booster
doses should be given every 10 years
● Fully immunized= 5 doses of DTP or 4 doses of
DTP if the 4th doses was given on or after the 4th
birthday
92
For fully immunized pregnant adolescents
○ It is recommended that they receive 1
dose of Tdap during 27 to 36 weeks AOG
regardless of previous Td/Tdap
vaccination
○ You can administer 3 dose Td following a
0-1-6 schedule
○ Tdap should replace 1 dose of Td given
during the 27 to 36 weeks AOG
● Children >7 years- a single dose of Tdap can be
given and can replace Td. It can be administered
regardless of the interval since the last Td
vaccine and subsequent doses are given as Td
93
HEPATITIS A
● Given intramuscularly
● Food/water borne
● Given to >1 year of age
● Two doses are recommended (6 months interval)
● Recommended for all children >12 months
○ This is the time when the child eats table
food or sometimes, the child is given
street food.
94
VARICELLA (Chickenpox)
● Live vaccine
● Given subcutaneously
● Two doses are recommended
● 1st dose: age 12-15 months
● 2nd dose: 4-6 years or at an earlier age provided
the interval between the first and the second dose
is at least 3 months for children less than 13 years
of age
○ If however the 2nd dose was given 4
weeks from the first dose, it is still
considered valid even if it is less than 3
months interval
● For children 13 years and above, the
recommended minimum interval between doses
is 4 weeks
95
MMRV
● Given subcutaneously
● Live vaccine
● Tetravalent vaccine (Measles, Mumps, Rubella &
Varicella)
● Given at a minimum age of 12 months
● It may be given as an alternative to separately
administered MMR and Varicella vaccines
● The maximum age is up to 12 years of age
● The recommended interval between doses is at
least 3 months
96
HPV
```
● Given intramuscularly
● Protect against cervical cancer
● Bivalent (2 serotypes),Quadrivalent(4 serotypes)
and Nonavalent ( 9 serotypes)
```
97
HPV 9-14 Bivalent,
Quadrivalent or
Nonavalent HPV
```
2 dose series
1 st dose: 0 (first day)
2 nd dose: 6 months after
Interval: At least 6 months
If the interval between the first and
second dose is less than 6
months, a 3rd dose is
recommended and the minimum
interval between and the 2nd and
the 3rd dose should be at least 3
months.
```
98
```
15 years &
older
Bivalent,
Quadrivalent or
Nonavalent HPV
```
```
3 dose series
1 st dose: 0 (first day)
2nd dose: 2 months after
3rd dose: 6 months after
Minimum Intervals
1st & 2nd dose: 1 month
2 nd & 3rd dose: at least 3 months
1st and 3rd dose: at least 6 months
```
99
9-18 y/o
(Males)
Quadrivalent or
Nonavalent HPV
```
Vaccine can be given not for
cervical cancer but for
prevention of anogenital warts
and anal cancer
**Bivalent vaccine does not
provide this protection
```
100
INFLUENZA VACCINE
```
● 2 influenza vaccines available:
○ Trivalent influenza vaccine given
intramuscularly or subcutaneously
○ Quadrivalent influenza vaccine given
intramuscularly (preferred)
● Recommended for all children aged 6 months to 18 years
```
Annual vaccination should begin February here in
our country but it may be given throughout the
yea
101
INFLUENZA VACCINE Dose
○ 6 months to 35 months: 0.25ml
○ >35 months: 0.5ml
● Given yearly because every year, each Influenza vaccine has a different component from the previous year.
102
JAPANESE ENCEPHALITIS VACCINE
● Live vaccine
● Given subcutaneously
● Given at a minimum age of 9 months
● 9-17 years: 1 primary dose followed by a booster
dose 12-24 months after the primary dose
● 18 years of age and older: one single dose only
103
MENINGOCOCCAL VACCINE
● Tetravalent meningococcal conjugate vaccine (MCV4-D, MCV4-TT. MCV4-CRM) given intramuscularly
● Advantage: not much booster needed
104
In the Philippines Mennincocoal
○ MCV4-D (conjugated to diphtheria)
| ○ MCV4-TT (conjugated to tetanus toxoid)
105
● Indicated for those at high risk for invasive
| disease MCV
```
○ Persistent complement component
deficiencies
○ Anatomic/functional asplenia
○ HIV
○ Travelers to or residents of areas where
meningococcal disease is hyperendemic
or epidemic, including countries in the
African meningitis belt or the Hajj or
belonging to a defined risk group during
a community or institutional
meningococcal outbreak
```
106
MCV4-D (Brand name: Menactra)
```
■ For children 9-23 months: 2 doses, 3
months apart
■ For children >/= 2 years old- 1 dose
except in cases of asplenia, HIV and
persistent complement deficiency (2
doses, 8 weeks apart)
○ MCV4-TT (Brand name: Nimenrix)
■ For children >/= 12 months:1 dose
○ MCV4-CRM (Brand name: Menevo)
*not available in the Philippines
■ For children >/= 2 years: 1 dose
● Revaccinate with MCV4 every 5 years as long as
the person remains at increased risk of infection,
but if the child is otherwise healthy, you can give
just one dose
```
107
MCV4-D and PCV13
If MCV4-D is administered to a child with
asplenia (including sickle cell disease) or
HIV infection, do not administer MCV4-D
until 2y/o and at least 4 weeks after
completion of all PCV13 doses
108
MCV4-D and Tdap
If MCV4-D is to be administered to a child
at high risk for meningococcal disease, it
is recommended that MCV4-D be given
either before or at the same time as DTap
109
MCV4-TT with tetanus toxoid (TT) containing
| vaccine
```
Whenever feasible, MCV4-TT should be
co-administered with TT-containing
vaccines, or administer MCV4-TT 1
a month before the other TT-containing
vaccines
```
110
TYPHOID FEVER
● Given intramuscularly
● A polysaccharide vaccine (if polysaccharide
vaccine, always give to 2 years and older)
● Recommended for travelers to areas where the is
risk of exposure to S. typhi and for the outbreak
situations as declared by health officials
● It is given at a minimum age of 2 years old with
revaccination every 2-3 years
111
RABIES VACCINE
● PVRV – Purified Vero Cell Rabies Vaccine
| ● PCECV – Purified Chick Embryo Cell Vaccine
112
Intramuscular PVRV
| PCECV
0.5 ml & 1ml 0, 7, 21 or
| 28 days
113
Intradermal PVRV
| PCECV
0.1 ml 0, 7, 21 or
| 28 days
114
Route of Admin Rabies
```
Repeat dose should be given if the vaccine is
administered inadvertently through
subcutaneous route (it should either be
intradermal or intramuscular)
```
Rabies vaccine should never be given in the
gluteal area because absorption in this area is
unpredictable
● In the event of subsequent exposures, those who
have completed 3 doses of the pre-exposure
prophylaxis, regardless of the interval between
exposure and last dose of the vaccine, will require
only booster doses given on day 0 and day 3.
Booster doses may be given intramuscularly or
intradermally.
○ Benefit of having pre-exposure
prophylaxis: no need to give rabies
immunoglobulin
115
Pneumococcal polysaccharide vaccine
| (PPSV23
○ 23 serotypes
○ It can only be given to children 2 years of
age and older because it is not very
immunogenic in the younger age group
116
Pneumococcal conjugate vaccine (PCV)
13 serotypes
117
Pneumococcal vacc route
Given intramuscularly
118
Who should get Pneumicoccal
```
Indicated for children with high-risk medical
conditions:
○ Chronic heart, lung, kidney disease
○ DM
○ CSF leak
○ Cochlear implant
○ Sickle cell disease and other
hemoglobinopathies
○ Congenital or acquired asplenia or
splenic dysfunction
○ HIV infection
○ Chronic renal failure and nephrotic
syndrome
○ Immunosuppression
○ Malignancy
○ Solid organ transplantation
```
119
Pneumococcal Children >2 through 5 years of age:
```
○ Give 1 dose of PCV13 if an incomplete
schedule of 3 doses of any PCV was
given previously
○ Give 2 doses of PCV 13 at least 8 weeks
apart if unvaccinated or any incomplete
schedule of less than 3 doses of any PCV
was given previously
○ Give supplemental dose of PCV13 if 4
doses of PCV7 or other age appropriate
complete PCV7 series was given
```
120
For children with no history of PPSV23
| vaccination
give PPSV23 at least 8 weeks after
the most recent PCV13
● All recommended PCV doses should be given
ideally prior to PPSV23, the two vaccine should
not be co-administered
121
Preferably, the PCV
is given first before
the PPSV, if polysaccharide is given first,
you can still give PPSV 8 weeks after
122
If a dose of PPSV23 is inadvertently given earlier than the recommended interval
the doses need not be repeated
123
Children 6 through 18 years of age: PCV13
```
Give 1 dose of PCV13 if they have not
previously received this vaccine
regardless of whether the previous
vaccine received was PCV7 or PPSV23
followed by one dose of PPSV23 at least
8 weeks later
○ Give 1 dose of PPSV23 at least 8 weeks
after the most recent PCV13 if w/
previous PCV13 but w/o PPSV
immunization
```
124
2 to 64 y/o with any of the listed
immunocompromising conditions should
get 2 doses of PPSV23,
5 years apart.
125
2 to 64 years with listed conditions, there should be at least 5 years apart
```
Congenital or acquired
immunodeficiencies including B- or
T- lymphocyte deficiency,
complement deficiencies, and
phagocytic disorders (excluding
chronic granulomatous disease), HIV
infection, chronic renal failure,
nephrotic syndrome, leukemia or
lymphoma, Hodgkin’s disease,
generalized malignancy, iatrogenic
immunosuppression, solid organ
transplant, multiple myeloma
```
126
HAEMOPHILUS INFLUENZAE TYPE B (Hib)
```
Indications for children with high conditions:
○ Chemotherapy recipients
○ Anatomic/functional asplenia including
sickle cell disease
○ HIV infection
○ Immunoglobulin or early complement
deficiency
```
127
Children 12-59 months HiB`
○ Unimmunized or w/ 1 dose received
before 12 months, give 2 additional
doses, 8 weeks apart
○ Given >/=2 doses before 12 months, give 1 additional dose
128
Children =5 years old who received a booster
dose during or w/in 14 days of starting
chemotherapy/radiation treatment
receive
a repeat dose at least 3 months after completion
of therapy
129
Children who are hematopoietic stem cell
| transplant recipients should be
reimmunized w/ 3
doses, 6-12 months after transplant regardless of
vaccination history,; doses are given 4 weeks
apart
130
Unimmunized children 15 months and older
| undergoing elective splenectomy
give 1 dose at
least 14 days before surgery
● Give 1 dose to unimmunized children 5-18 years
old who have anatomic/functional asplenia
(including sickle cell disease) and HIV infection
131
CHOLERA VACCINE
● Given per orem
● Not readily available, two availabilities only in RITM
● Given at a minimum age of 12 months as a 2- dose series 2 weeks apart
● Recommended for outbreak situations and natural disasters as declared by health authorities
132
IRON SUPPLEMENTATION LBW
Drops: 15mg elemental iron/0.6ml
```
0.3 ml once a day
to start at 2 months
of age until 6
months when
complementary
foods
are given
```
133
Infants
(6-11
months Fe supp.
Drops: 15mg 0.6 ml once a day
for 3 months
elemental
iron/0.6ml
134
Children
| (1-5 y/o) Fe`
```
Syrup: 30mg
elemental iron/5ml
5 ml once a day for
3 months or 30 mg
once a week for 6
months with
supervised
administration
```
135
Adolescent
girls
(10-19y/o) Fe
```
Tablet: 60mg
elemental iron with
400 mcg folic acid
(coated) especially
for those are
actively
Menstruating and
fad dieters because
they
are at risk for IDA
One tablet once a
day
```
136
Infants
(6-11
months) Vit A
```
100,000 I.U.
1 dose only (one capsule is
given anytime between 6-11
months but usually given at 9
months of age during the
measles immunization)
```
137
Children
(12-59
months) Vit a
200, 000 I. U
| 1 capsule every 6 months
138
DEWORMING
● The DOH recommends deworming for all children
aged 12 months to 12 years
● Both the WHO and DOH recommend the use of
either albendazole or mebendazole
139
Albendazole
■ 12 months- 23 months: 200mg
single dose every 6 months
■ 24 months and above: 400mg
single dose every 6 months
140
Mebendazole
12 months and above: 500mg
| single dose every 6 months
141
Contraindications / Deworming must not be done
| in children with
```
○ Severe malnutrition
○ High-grade fever
○ Profuse diarrhea
○ Abdominal pain
○ Serious illness
○ Previous hypersensitivity to the antihelminthic drug
```
142
. DENTAL VISIT
● First dental visit is recommended to be done at
the time of eruption of the first tooth and no later
than 12 months of age
143
Fluoride toothpaste
○ Twice daily use of fluoride-containing
toothpaste is recommended as a primary
preventive measure
○ Young children must always be
supervised while brushing and should be
taught to spit out the toothpaste and to
avoid rinsing after brushing
○ Parents can be advised to use fluoride
toothpaste even if the child is as young
as 5 months / 6 months of age.
○ If they will use toothpaste that does not
contain fluoride, it will only clean the teeth of the baby, but it will not give any
protection against cavities
144
6 months
to less than 2
years old
```
000ppm Twice
daily
Smear
2.5 mm
0.125g
(Amount is
very small
so even if
they swallow
it, it wont
cause
fluorosis)
2 x
0.125=
0.25mg
```
145
2 to 6
years
old
```
1000ppm Twice
daily Pea size
5 mm
0.25g 2 x
0.25=
0.50mg
```
146
6 years
old and
above
```
1500ppm
Twice
daily
Full length
of bristle
10-20 mm
0.5-1.0g
(As long as
they know
how to spit)
2 x
0.50=
1.0 mg
```
147
TOPICAL FLUORIDE TREATMENT
● Recommended for those who are susceptible to
dental caries.
● Professionally applied topical fluoride has been
proven to prevent or reverse enamel
demineralization
● Children at moderate caries risk should receive
professional fluoride treatment at least every 6
months and those with high caries risk should
receive topically applied fluoride more frequently
(every 3 months).
148
. NUTRITIONAL COUNSELING
● Continue breastfeeding counseling that was
started during prenatal period
● Encourage mothers to breastfeed exclusively up
to 6 months and continued up to 2 years
● Start complementary feeding using fresh, natural
and indigenous food beginning at 6 months
149
How to introduce complementary food?
Begin with one new food at a time to be
given for 3 days. So that the child will
react to the food, you will immediately
know which food is allergic to the child
Start with lugaw or cereals, fruits or
vegetables in any order giving one to two teaspoons a day
```
Start with pureed food at 6 months of
age. Introduce “finger foods” around 8
months of age; lumpy or chopped foods
at 10 months of age; table food at 12
months of age.
```
Feed 6 to 8-month-old infants 2-3x/day; 9 to 24-month-old infants give semi solid
food 3-4x/day. Give additional nutritious
snacks 1-2x/day
Offer a variety of foods to improve the
quality of food intake; avoid drinks with
low nutrient value (sweet beverages)
Do not add salt to the infant’s diet before
1 year of age
Give supplements of iron, zinc, calcium,
and vitamin B12 if the diet is primarily
plant-based
```
Practice responsive feeding. Feed
infants directly and assist older children.
Feed slowly and patiently. Do not force
feed; make feeding a pleasurable
experience
```
150
PHYSICAL ACTIVITY
● Can be in the form of sports and games, dance, physical recreational activities, household chores
● Encourage physical activity for at least 1hour/day (Can also break down one hour into several parts Ex: 30-30 or 15-15-15-15)
● Limit total entertainment screen time to fewer than 2 hours per day (As per the American Academy of Pediatrics, those from 0-2 yrs age have no screen time. After 2 yrs of age limit to 2 hours per day)
● Create an “electronic media-free” environment in children’s rooms
151
CHILD SAFETY IN PRIVATE MOTOR VEHICLE
Most of the motor vehicles in our streets are made up of private motor vehicles, approximately 80% of all vehicles on Philippine roads. In the 5- 15-year-old age group, traffic crashes are the 3rd
the leading cause of mortality.
152
Recommendations for Traffic safety
● Parents, caregivers or guardians should not allow children below six years of age to sit at the
front of any moving motor vehicle
● Parents, caregivers or guardians should acquire age-appropriate child seats and restraints for young children less than nine years of age because adult seatbelts are not fit to protect
young children.
● Parents, caregivers or guardians should not allow their children to ride two-wheeled motorcycles
● Parents, caregivers or guardians should not allow the use of motorized/ battery-operated vehicles outside designated areas.
● Experienced adult drivers should accompany teenage student drivers at all times
153
CHILD SAFETY IN PUBLIC MOTOR VEHICLES
● Parents, guardians, and caregivers should not allow children below 6 years of age to sit in the front of any moving vehicle
● Parents, guardians, and caregivers should teach children to alight from public utility vehicles only in designated unloading areas.
154
Street crossing habits that must be taught to
| children
● Cross only at corners so drivers can see you
● Always use a crosswalk when it is available. But remember, painted lines can’t stop cars
● Cross only on the new green light so you have time to cross safely
● Cross with the “walk” sign only
● Look all ways before crossing the street to see cars, pedestrian, and bicyclists
● When crossing, watch for cars that are turning left or right
● Hospital records in Metro Manila reveal that pedestrian injuries account for 51% of all road injuries. That is why it is very important for us to teach children to cross the street properly.
● Never cross the street from between parked cars
○ Drivers can’t see you
● Walk on the left side of the road, facing traffic, if sidewalks are not provided so you can see oncoming cars
● Use a flashlight or wear or carry something retroreflective at night to help drivers see you
155
Recommendations (Pedestrian Injury Prevention):
● Parents, caregivers, and guardians should demonstrate appropriate pedestrian behavior to be good examples for children
● Parents, caregivers, and guardians should not allow children to play along highways and roadsides. Appropriate areas are backyards, back lots, playgrounds, and schoolyards.
● Parents, caregivers, and guardians are
encouraged to accompany young children when walking to and from school to reinforce safe street-crossing habits
156
CHILD HELMET USE
Parents, caregivers, and guardians should fit their children with appropriate helmets when riding motorcycles, motorized scooters,bicycles,non-powered scooters, skateboards, roller skates, roller shoes, and other forms of open/wheeled vehicles. Helmets should fit the head snugly and be worn properly over the head. The right size and right fit can effectively
reduce brain injury by 63-88%
157
The 5th leading cause of road injury, accounting
| for 3% of all road injuries.
Bicycle injuries
158
Parents, guardians, and caregivers should not
| allow
children below 9 years of age to ride as
passengers on motorcycles and motorized
scooters.
159
Motorcycles
Are the most dangerous part of
motorized transport. Motorcyclists are three times more likely than passenger car occupants to be injured in a car crash, and 16 times more likely to die of head injury.
160
Parents, guardians, and caregivers should
| closely
supervise children below 9 years of
age when riding on skateboards, nonpowered scooters, and roller skates; and
when using roller shoes
161
DROWNING PREVENTION
● Parents, guardians, and caregivers of young children (less than 5 years of age) should be reminded about the risk of drowning in the home or the surrounding community during well visits. Since very young babies drown most commonly in bathtubs or buckets, parents must
empty and properly store buckets or water containers immediately after use. Never allow babies and children to bathe in tubs and buckets unattended and unsupervised. Even 2 inches
level of water can cause drowning to a baby
● Parents, guardians, and caregivers must be cautious about open roadside canals, deep wells, manholes, water pails, basins, and portable infant tubs
162
. LEAD POISONING PREVENTION
● Ensure that children do not have access to peeling paint or chewable surfaces painted with lead-based paint − Regularly was children’s hands and toys
● Regularly wet-mop floors and wet-wipe window components
● Take off shoes when entering the house to prevent bringing lead-containing soil in from
outside − Prevent children from playing in bare soil. If possible, provide them with sandboxes
163
PROCEDURE FOR PATIENTS AT RISK
COMPLETE BLOOD COUNT (CBC)
urinanalysis
.WORK-UP FOR SEXUALLY ACTIVE
ADOLESCENTS
164
MANTOUX TEST
```
● 5 TTU PPD or 2 TU-RT23
● Screening test for TB
● Intradermal injection
● Induration is felt and measured (Not the
redness) − After 48-72 hours you ask the
child to come back
```
165
+ mantoux
`● Induration of >/= 5mm in the presence of any or all of the following
● History of close contact with a known or
suspected case of TB
▪ Clinical findings suggestive of TB
▪ Chest x-ray suggestive of TB
▪ Immunosuppressed condition
● Induration of >/= 10mm in the absence of the above factors
