Topic: PREVENTIVE HEALTH CARE IN PEDIATRICS

Lecturer: Grace H. Padilla, MD, DPPS

Date: June 20, 2013
Objectives:
To discuss the importance of preventive health
care in pediatrics
To describe different level of prevention
To discuss aims of prevention in pediatric age
group
To discuss specific prevention as specified in the
Preventive Healthcare Handbook of PPS.
PREVENTIVE PEDIATRICS
preventive health care approach

science of pediatrics is a science of health and

development.

regular scheduled visits to assure adequate

nutrition, detect and immunize against
infectious diseases, and observe the child's
development.
Essential Elements of the Well Child Health
Supervision Visit

Immunization

nutrition assessment

developmental assessment
The tasks of each Well Child visit include:
Disease detection

Surveillance
- occurs in every health encounter
- enhanced by the opportunity for repeated visits
- observations with advancing developmental stages
Screening
-

is a more formal process utilizing some form of

tool, which has been validated and has known
sensitivity and specificity.

DISEASE PREVENTION
Primary prevention- whole population
Health Promotion
Specific Protection
Secondary Prevention- activities aimed at patients with
specific factors of risk
- Early detection and treatment
Health Promotion and Anticipatory Guidance
shift the focus to wellness and to the strengths
of the family
an opportunity to help the family address
relationship issues, broach important safety
topics, access community services, and engage
with extended family, school, neighborhood,
and church.

Disease prevention
Health promotion

Preventive Pediatric Health Care Handbook 2012

Anticipatory Guidance

Annotations #1
Prenatal Education

CLINICAL DETECTION

accomplished by both surveillance and

screening

- structured mothers class

- face to face counseling with a
healthcare professional

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 Areas of concern: breastfeeding, Newborn care

and procedures at birth, anticipatory guidance,
prevention of smoking, tetanus toxoid for
mothers, maternal nutrition
Annotation #2
Care of newborn

Home, Education, Abuse, Drugs, Safety, Sexuality/sexual

Identity, Family and Friends, Recreation,
Spirituality/Connectedness,Threats/Violence
ANNOTATION #7
Windows of Achievement
Describe the the range and timeline of the 6 key
motor of development milestones.

Colostrum food for the newborn

Latching on and breastfeeding initiated
during the first 30 mins to one hour after
delivery of the infant.

Importance of reading aloud to their children

during the first years of life.

Annotation #3
Home instructions
If discharged < 48 hours after delivery
> follow up must be made for the infant to be
examined within 48 hours of discharged

Research shows this help them develop

language and literacy skill
Annotation #8
Red Flag signs for Atopy
>Close monitoring

ANNOTATION #4
Counseling

- family history of atopy

(asthma, atopic dermatitis, allergic rhinitis, drug
and food allergy)

Developmental, psychosocial and chronic

disease issues for children and adolescent
-may require frequent counseling and treatment
separate from routine preventive care visits

recurrent/ persistent symptoms of

1 or more of the following:
-

Annotation #5
Updating Care Services
The preventive care services should be brought
up to date at the earliest

Annotation #6
Adolescent history taking
H- ome, E-ducation, A-buse D-rugs
S-ex, S- afety , S uicidal Ideation
Nelsons 19th edition
HEADS/ SF/ FIRST

GI symptoms
( colic, diarrhea, vomiting, bleeding)

skin rash,

ocular manifestation, puffiness under the eyes,

nasal symptoms
( rhinorrhea, itchiness, sneezing, stuffiness)

- coughing with or without wheezing

ANNOTATION #9
Thorough PE
Must be age appropriate
Respect for privacy and minimizing child's
discomfort.
Additional procedures listed

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 Additional procedures listed

Annotation #10
WHO Child Growth Standards
Reference standards for weight, height and
head circumference
Based on Z scores (standard deviation scores)
Annotation # 11
BP measurements
BP measurement starts at 3yo
Done to all children at risk

Vaccines
Pink EPI vaccines ( BCG, Hep B, Measles, Oral
polio Vaccine, DTwP, Hib, MMR and Rotavirus
Black Recommended Vaccines (DTaP,
Hepatitis A, Human Papillomavirus, IPV,
influenza, MMRV, Pneumococcal, Rotavirus,
Tdap, Varicella
Blue- Special Group Vaccines
Typhoid, meningococcocal, Rabies
Annotation #17
Iron Supplementation

Annotation 12
Procedures
General Procedures may be modified
depending upon entry point into schedule and
individual needs
Annotation 13
Newborn Screening
RA 9288
After 24 hours
Not later than 3 days
Annotation #18
Vitamin A Supplementation
Annotation 14
Neonatal Hearing Screening
RA 9709: The Universal Newborn Hearing
Screening and Intervention Act of 2009
Annotation 15
Eye Screening
Proper diet supplementation
Routine eye examination of infants ad children
for early detection of leukocoria and strabismus

Zinc supplements in Children- supplementation

of Pneumonia and Diarrhea.
Annotation #19
Deworming

Annotation #16
Childhood Immunization
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 Deworming recommends deworming for all

children aged 12 months to 14 years.
Albendazole
12-24 months 200mg single dose
every 6 months
>24 months 400 mg single dose
every 6 months
Mebendazole
- 12mos and above- 500 mg single dose every 6
months
ON FULL STOMACH
Filiariasis Diethylcarbamazine Citrate Albendazole
Do not Deworm
Severe malnutrition
High Grade Fever
Profuse Diarrhea
Abdominal Pain
Serious Illness

Annotation # 22
Breastfeeding counseling
Exclusive breastfeeding for the first 6 months
up to 2 years and beyond.
Complementary feeding 6 months
Nutrition Guide
Hand Hygiene
Food Pyramid

Previous hypersensitivity to antihelminthic drug

Annotation #23
Physical Activity

Annotation # 20
Counseling

Physical activity and well balance diet major

principle in healthy living

Age appropriate discussion and counseling is

the integral part of each visit

carried on adulthood

Annotation #21
Dental Care
First Dental visit- recommended to be done at
the time of eruption of the first tooth. Not later
than 12 months old.
Recommendation of flouride varnish

Physical activity in the form of games, sports,

dance, physical recreational activities,
household chores, lifestyle related activities
Annotation # 24
PPS Policy Statements
Child Safety in Private Motor vehicle
Child Safety in Public Motor Vehicle
Child Pedestrian Injury Prevention

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 Child Helmet Use

2-6 years

Drowning Prevention

10-19 years

Household Products poisoning

Backpacks and Children

Annotation # 28
Urinalysis screening

Noise in the environment

Recommends screening urinalysis on the first

encounter with an adolescent patient.

Recreational Noise

Done in patients with signs and symptoms

Fetal and Neonatal Exposure to Noise

Fireworks Related Injury

Female: wet mount and Pap smear

Annotation #25
Child maltreatment

Annotation # 29
Sexually Active Screening

Males: Serologic test for syphilis

7 steps to Protect Children

Effect of media sex and violence on Children

and Adolescents
Child learns behaviors and have their value
systems shaped by television, movies, music,
music videos,video games, computer games and
internet.
RA 7610 Anti Child Abuse Law
- report in writing or orally children who suffered
abuse within 48 hours
Annotation # 26
Lead exposure
Environmental toxicant
Effect is cognitive impairment
Annotation # 27
Iron Deficiency Anemia

Both : annual non culture test for gonorrhea

and Chlamydia
Annotation # 30
Screening for Tuberculosis
Use 5 TTU PPD or 2TU RT 23 test
read as 48-72 hours.
> > 10 mm positive
5 mm is positive
Presence of the following: history of close
contact with suspected TB, clinical findings
suggestive of TB, Chest xray suggestive of TB
Immuno-compromised condition
APPENDIX 1
PRENATAL VISIT, EDUCATION, COUNSELING
Breastfeeding exclusive for the 1st 6 months

Associated with cognitive and psychomotor

abnormalities in children

Rooming in, newborn screen, hearing screen,

immunization with hep B and BCG

Recommends CBC at least once between the

following time intervals for those at risk:

Inquire on genetic or chromosomal abnormality

6-24 mos
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APPENDIX 2
DISCHARGE AND FOLLOW UP OF HEALTHY TERM
NEWBORN

- low birth weight (<1500gms)

- infants (1500-2000) stormy
course

Minimum criteria for discharging newborn < 48

hours

Infants with metabolic disorders

Purpose of follow-up visit

Family history of retinoblastoma, congenital

cataracts

Hx of maternal infection (rubella)

- infant assessment, hydration,

jaundice
- sucking pattern
- mother and infant interaction
APPENDIX 3
ADOLESCENT HEALTH CARE

APPENDIX 6
PREVENTIVE DENTAL CARE
Topical flouride treatment
- every 6 months

Annual health screening and preventive services

Complete hx and thorough PE
TANNER STAGING
Laboratory test
Immunization updates
Anticipatory guidance ( self breast exam,
smoking avoidance, sexual behavior, injury and
accident prevention.)
APPENDIX 4
Developmental Surveillance and Screening
RED FLAGS
- motor delay
- language delay
- psychosocial delay
- cognitive delay
APPENDIX 5
SCREENING FOR EYE/VISUAL DEFECTS (See last page for
the chart)

Cleansing with wash cloths, soft brush

Use of dental floss
Education on foods
Bottlefeeding while asleep and prolonged bottle
feeding
APPENDIX 7
BREASTFEEDING
A. BREASTFEEDING

Premature (<32 wks) AOG

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 Benefits (safe, sterile, always available)

Advantages

Annotation #10
WHO Child Growth Standards

Breastfeeding techniques
Breastmilk expression and storage
Breastmillk storage period
B. DIET OF LACTATING MOTHER
C. COMPLEMENTARY FOOD (6MO)

Appendix 8
Child Maltreatment
7 STEPS TO PROTECT CHILDREN
1. Learn the facts
2. Minimize the opportunity
3. Talk about it
4. Stay Alert
5. Act on any suspicion of abuse
6. Learn how to react to the knowledge of abuse
7. Get involved

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ANNOTATION #7
Windows of Achievement

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