PEDIATRICS 1 (6M) Preventive Pediatrics: Part 2

Midterm Quiz Dr. Gallardo | March 22, 2016

BLACK: Slides | BLUE/ITALICS: Audio | RED: EMPHASIZED

 THE PRESCHOOL CHILD (2-5 YEARS)
Iron Supplementation
 Physician visits may be spaced every 3 months
TARGETS PREPARATION DOSE/DURATION
unless the child is sickly (Also parents are anxious)
Low birth Drops: 15mg 0.3ml OD to start
 Routine blood pressure measurement starting at
weight elemental at 2mos of age
3 years of age Important aspects of health care
iron/0.6ml until 6mos
 Important aspects of health care (need to be Infants 6- Drops: 15mg 0.6ml once a day
emphasized on) 11 months elemental for 3 months
 Nutrition
iron/0.6ml
 Update of immunizations
 Dental Care Children 1- Syrup containing 1 tsp OD for 3
 Accident Prevention 5 years 30mg elemental mos or 30mg
 Deworming iron/5ml once a week for 6
 TV and Internet Access mos with
supervised
NUTRITION administration
 Include a glass of milk with each meal Adolescent Tablet One tablet OD
 Train children to eat a balanced diet and avoid girls (10-19 containing 60mg
unhealthy foods (Blame the parents who buy years) elemental iron
junkfoods, not the child) *risk for with 400mcg
- Too sweet (sweetened beverages, candies) anemia folic acid
- Too salty (chips, junk food) * Do it under direct supervision
- Too oily (gravies, dressings)
 Vitamin and iron supplements if necessary DENTAL CARE
 Follow food pyramid * Don’t visit when the child had tooth decay, but visit during
the first eruption of teeth at about 6 months/earlier
FOOD PYRAMID  First dental visit
- Recommended to be done at the time of
eruption of the first tooth (6 mos.) and no later
than 12 months of age
 The following are assessed:
- Child’s general health, growth and behavior
- Child’s oral hygiene and periodontal health
- The risk for developing oral disease
 Use of fluoride toothpaste
- Use of fluoride-containing toothpaste 2x a day is
a recommended primary prevention measure
- Use only half a pea (2-6years) or a pea-sized (6
years and above)
- Supervise young children while brushing and
teach them to spit out the toothpaste (because
there is a risk of hyper fluoridation but in spots)
Vitamin A Supplementation  Topical Fluoride Treatment
(Given at local health centers) - Has been proven to prevent or reverse enamel
TARGETS PREPARATION DOSE/DURATION demineralization
Infants 100,000 I.U. 1 dose only (one - Children at moderate caries risk:
6-11 capsule is given o Should receive professional fluoride
months anytime between 6- treatment at least every 6 months
11months but usually - Children with high caries risk:
given at 9mos of age o Receive treatment more frequently
during the measles  Educate parents about the following:
immunization) - CARIOGENICITY of some foods and beverages
Children 200, 000 I.U. 1 capsule every 6 - Dental caries and its relationship with
12-71 months prolonged bottle feeding or bottle feeding
months while asleep
- Maintenance of good oral hygiene:
 o Use of dental floss to reduce interproximal
caries
- Regular dental check-ups
ACCIDENT PREVENTION
 Drowning Prevention
 Burn Injury Prevention
 Child safety in motor vehicles
A. DROWNING
(PPS Policy Statement series 2004 Vol. 1 No. 11)
- leading cause of child injury death in the
Philippines
- Young children: Home Drowning
- Older children: Public pools and natural bodies
of water (More adventurous)
- Adolescent: due to alcohol use
 Physicians must include drowning prevention among
issues raised during well visits
Role of parents, guardians and caregivers in
DROWNING PREVENTION:
1. Parents of young children (<5y/o) should be
reminded of risk of drowning in the home or
surrounding community. 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
2. Parents must be cautious about open roadside
canals, deep wells, manholes, water pails, basins
and portable infant tubs (That is why there are
barriers. It doesn’t hurt if you are too cautious.)
3. Swimming skills may be a protective factor
against drowning. Parents are encouraged to
enrol their children in swimming lessons.(You
must know how to swim, it is a survival skill.)
4. Parents should have basic skills in resuscitation
in the event of a drowning.
B. BURNS
(PPS Policy Statement series 2004 Vol. 1 No. 12)
- Among worst forms of physical and
psychological injury in children
- Majority of pediatric burn injuries occur at
home and affect children <5 years old.
- Burn injury may result from scalding, naked
flame, explosions, and electric shock
Role of parents and caregivers in
BURN INJURY PREVENTION:
1. Strictly prohibit children from picking up
firecrackers in the streets, whether used or
unused. (It is already banned)
2. Avoid purchasing firecrackers and report
establishments selling illegal firecrackers and
other pyrotechnic devices
3. Place plug covers in all electric outlets in the
home
4. Use of properly installed residential smoke
detectors and alarms is highly recommended.
Acquisition of fire extinguishers should also be
advised.
5. Keep cigarette lighters out of reach of children.
6. Be especially watchful during food preparation
and in the kitchen.
7. Use of gas lamps at home should be
DISCOURAGED.
C. MOTOR VEHICLES
(PPS Policy Statement series 2004 Vol. 1 No. 8)
Role of parents, guardians and caregivers in
CHILD SAFETY IN MOTOR VEHICLES:
1. Children below 6 years of age should NOT be
allowed to sit in front of any moving vehicle
(very strict in other countries, eh sa atin?)
2. Teach children to alight from public utility
vehicles only in designated unloading areas
(We don’t have loading and unloading areas in
Baguio and Philippines. In other countries, they
have rules. Still in the end, it is a matter of
discipline.)
3. Parents should acquire age appropriate
child seats and restraints from young children
< 9 years old
4. Parents should NOT allow their children to ride 2
wheeled motorcycles (Use of helmets. In the
philippines, it is more of riding in tandem)
6M PEDIATRICS: Preventive Pediatrics 
DEWORMING
 Department of Health A.O. No. 176 s.2004
- Recommends deworming for all children aged
12 months to 14 years
 Any of the following drugs can be used:
- Albendazole
 12 months to 24 months old: 200 mg single
dose every 6 months
 24 months and above: 400 mg single dose
every 6 months
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 - Mebendazole
 12 months and above: 500 mg single dose
every 6 months
Contraindications to deworming:
1. Severe malnutrition
2. High-grade fever (systemic infection)
3. Profuse diarrhea (delay deworming)
4. Abdominal pain (presence of other illness)
TV AND INTERNET ACCESS
 Maximum of 2 hour TV viewing, including playing
computer games preferably in the presence of a
responsible adult (Everything is at your fingertips right
now, all are online)
 Internet access should be regulated and strictly
monitored (It is okay if you put firewalls)
 Parental controls on the internet and must be
established and enforced
 SCHOOL AGE
 Healthy children will need a well child check up
2x a year preferably before the start of each school
semester (golden period of paediatrics - they should
definitely not be seen frequently. Otherwise, the child
may be sickly)
 Assess growth and development
 Screen for disabilities in vision and hearing (learning
disabilities come out here)
 Screen for developmental learning, communication
and emotional problems (Anticipatory care should
be directed on how your child is doing on school and
interacting with peers & his siblings)
 Assess nutritional status and provide dietary advice
 Update immunizations (*next meeting)
 Encourage regular physical activity and preparations
in sports and other extra-curricular activities (Boy or
Girl scouts, etc) (Let them join but do not overwhelm
your child. I know you have lots of frustrations but
make sure that your child have play time, rest and let
him do what he wants to do. But encourage physical
activity.)
 Teach simple skills such as gardening, carpentry, etc.
 Television viewing should be limited
 Children must NOT be allowed to watch violent
programs with sexually provocative themes (You
made them develop ADHD)
 Internet use must be monitored
 Children should be taught not to enter chat rooms or
talk with strangers online (The most damaging
thing)
Prevention of Childhood Obesity (5-2-1-0)
 5 or more fruits and vegetables
 2 hours or less of screen time
 1 hours or more of active play/physical activity
 0 sugary drinks, more water and low-fat milk
 **8 hours of sleep each night (You need sleep,
but at your RISK. You might miss my lecture You
need to sleep, you need to be energized.)
CHILDREN PEDESTRIAN INJURY PREVENTION
(PPS Policy Statement series 2004 Vol. 1 No. 9)
 Parents should demonstrate appropriate pedestrian
behavior to be good examples for children
 Parents should not allow children to play along
highways and roadsides. Appropriate areas are
backyards, back lots, playgrounds, and schoolyards
 Accompany young children when walking to and
from school to reinforce safe street-crossing habits
 ADOLESCENCE (10-20 YEARS)
(The most TURBULENT period)
 Annual health screening should be done due to
rapid physical, cognitive and psychosocial changes
occurring in this age group (children with so much
stresses & hormones raging in the body)
 Confidentiality - MAJOR ISSUE
 The following should be done:
1. Complete history taking and risk
assessment/screening
2. Physical examination
3. Laboratory tests
4. Immunization update
5. Anticipatory guidance and counselling
1. Complete history-taking and risk assessment/screening
(HEADSSS FORMAT)
H- ome
E- ducation, Eating behavior or habits
A- ctivities (smoking, alcohol)
D- rugs
S- exual activities (Age of sexual debut of Filipinos is at 15)
S- uicidal ideations
S- exual development (use Tanner Sexual Maturity Rating)
*Menstrual history in females
2. Physical Examination (be very careful)
 Should be done with privacy and preferably by
health care provider of the same gender as the
teen patient (Male doctors are not allowed to
6M PEDIATRICS: Preventive Pediatrics 
examine a female patient, he must be accompanied
with a female doctor)
 The following should be done:
a. Tanner staging/sexual maturity rating
b. Breast examination
c. Examination of spine and shoulders (scoliosis &
kyphosis)
d. Inspection of genitals and anus
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3. Laboratory Tests
a. CBC at every stage of adolescence
b. Urinalysis on first visit
c. Vaginal wet mount and PAP smear for sexually
active females
d. Serologic test for syphilis for sexually active males
e. Non-culture test for Gonorrhea and Chlamydia for
sexually active males and females

4. Immunization update (*Next meeting) QUIZ:

5. Anticipatory Guidance and counseling
a. Self-breast examination for females
b. Healthy lifestyle: physical activity, diet, avoidance
of alcohol, smoking, drug use
c. Sexual behavior and risk of acquiring STDs incldg.
HIV
d. Injury and accident prevention
- Use of sports protective gear, seatbelts, NO DUI of
alcohol, no smoking in bed, no hand gun use
 ADOLESCENT DRIVERS are at greater risk for motor
vehicle crashes than adults: (Because they are not yet
experienced, most of them are in peer pressure, in drugs,
in alcohols, etc.)
1. Lack of driving experience
2. Risk taking behavior influenced by emotions, peer
group pressure, and other stresses
3. Use of alcohol and other drugs
4. Low rate of safety belt use
5. Lack of experience in night time driving
 Parents should be prepared to recognize EARLY SIGNS of
serious problems
 School truancy
 Fall in academic performance
 Change in usual interrelationships
 Late night activity
 Manifestations of rebelliousness or indifference
 Depression
 Use of alcohol
 Excessive cigarette smoking
Identification
1. Preparation of Vit. A in a.) 6-11months infants? And b.) 12-
71 months children?
2. First dental visit should be done when?
3. Among worst forms of physical and psychological injury in
children.
4. Dosage for albendazole and mebendazole?
Enumeration
1. 3 Things observed in Accident Prevention
2. Contraindications to deworming
3. Prevention of Childhood Obesity
4. (HEADSSS FORMAT)
True/False
1. Train children to eat a balanced diet and avoid unhealthy
foods such as less sweet, less salty and not oily.
2. Majority of pediatric burn injuries occur at home and
affect children <5 years old
3. Drowning in adolescent is due to public pools?
4. Healthy children will need a well child check up 3 x year
preferably before the start of each school semester
5. Parents should acquire age appropriate child seats and
restraints from young children < 9 years old
6. Monthly health screening should be done due to rapid
physical, cognitive and psychosocial changes occurring in this
age group

END OF NOTES…  6M PEDIATRICS: Preventive Pediatrics 

Notetakers:
MAYO, Maria Dominica Rose 
RAGUINDIN, Erica Joy 
SUNGA, Juliane Angela Marie 

Proofreader:
LEUNG, Arvin Ray 

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Answers
IDENTIFICATION
1. a. 100,000 I.U. b. 200, 000 I.U.
2. eruption of first tooth and no later than 12 months
of age
3. Burns
4. Albendazole :
12 months to 24 months old: 200 mg single dose
every 6 months
24 months and above: 400 mg single dose every 6
months
Mebendazole
12 months and above: 500 mg single dose every 6
months

ENUMERATION
1. Drowning Prevention, Burn Injury Prevention, Child
safety in motor vehicles
2. Severe malnutrition, High Grade fever, Profuse
diarrhea, Abdominal pain.
3. 5 or more fruits and vegetables
2 hours or less of screen time
1 hours or more of active play/physical activity
0 sugary drinks, more water and low-fat milk
**8 hours of sleep each night
4. H- ome
E- ducation, eating behavior or habits
A- ctivities (smoking, alcohol)
D- rugs
S- exual activities(Age of sexual debut of Filipinos is at
15)
S- uicidal ideations
S- exual development (use Tanner Sexual Maturity
Rating)

True/False
1. F (too sweet, too salty and too oily)
2. T
3. F (due to alcohol use)
4. F (2x a year
5. T
6. (F) Annual
6M PEDIATRICS: Preventive Pediatrics 