Pediatric Screenings

What makes a good screening test

• Easy to Do

• Measures Directly to Disease

• Low Risk

• High Sensitivity and Specifity

• Cheap

What are adverse sides to screening disease

• False positives and negatives

• Cost

What are the types of screenings

• Universal

• Selective

• Risk Based

Who makes screenings for peds

American Academy of Pediatrics
CDC Healthy People 2030

Bright Futures

National initiative to improve children's health.

Anticipatory Guidance

educating parents and caregivers about what to expect in the next phase of development

What are the pediatric age types

Newborn
Infant
Early Childhood
Middle/Late Childhood
Adolescence
Early Adult

What is considered newborn

Birth to 1 month

What is considered infant

1 month to 1 year

What is considered early childhood

1 year to 5 year

What is considered middle/late childhood

6 year to 12 year

What is considered adolescence

12 to 17 years

What is the considerd early adult

18 to 25 years

What should be assessed in every pediatric age group

Nutrition
Behaviors
Growth and Development
Social Determinants
Anticipatory Guidance

What are some considerations for social determinants with peds patients

Child Care
Transportation
Car Seat / Crib
Finances
Food Insecurity

What health screenings should be done for newborns

• Phenylketonuria
• Congenital Hypothyroidism
• Bilirubin
• CHD
• Hearing Screening

What is a big concern for screening for post-partum mother

Maternal Depression
Social Determinants

What are the feeding methods for newborn

Breastfeeding
Forumla

What is the ideal length for exclusive breastfeeding

6 months

How frequently should a newborn feed

8-12 feedings per day

What are some things to NOT do for newborn feeding

Propping the bottle
Any other fluids

What are some care concerns for a newborn

Cord Care
Infant Capabilities
Calming the Baby
Illness Prevention

What are some patient education to give for cord care?

Keep diaper below the navel to keep dry
No full baths until the cord falls off

What is some patient education for sleeping newborn?

Lying on back
Nothing else in the crib

In a car, a newborn should be in

Rear-Facing Seat

What is the timeline for hearing deficit for newborns?

Screening = 1 month
Dx = 3 months
Tx = 6 months

How frequently do we screen maternal depression post-partum

• 1 month
• 2 month
• 4 month
• 6 month

What should be screened in infants

Iron Deficiency
Lead Exposure
TB

What is the screening for iron deficiency in peds?

4 months = Risk Assessment
12 months = Hgb & Hematocrit
15 months = Risk Assessment
18 months = Risk Assessment
24 months = Risk Assessment
30 months = Risk Assessment

Annual Risk Assessment Past 30 months until 5 year

What are risks associated with iron deficiency in peds?

• Prematurity
• Low Birth weight
• Diet
• Low Socioeconomic status
• Lead Exposure

When do we screen for lead exposure in peds?

6 months = Risk
9 months = Risk
12 Months = Risk + Capillary Lead Level
18 Months = Risk
24 Months = Risk + Capillary Lead Level

Annual Risk assessment after 24 months until 5 year

Immigrants = On arrival for anyone between 6 months and 16 years old

If a capillary lead level is positive, what is the next step?

Venous Blood Sample

When do we screen TB in peds?

1 month = Risk
6 month = Risk
12 month = Risk
24 month = Risk

Annual Risk Assessment over 24 months

When should a peds patient start seeing a dentist

12 months

What dental care should be done starting a tooth eruptuon

Topical Fluoride Supplementation
BID brushing

If exclusively breastfeeding in infancy, what supplementation could the infant need

400 IU Vitamin D

What food introductions should be done during infancy

4 months = Rice Cereal / Oatmeal
6 months = Pureed Food

What patient education should be given about infancy food introduction

1 food at a time
Avoid juice

What are some care patient education to give for infants?

Tummy Time
Avoid Digital Media
Put Baby to Bed Awake
Avoid excessive sun exposure

What screenings are done for toddlers?

Autism
Lead
BP
TB

When do we screen BP in peds?

Start annual screening at 3

If patient is risk, start eariler

What food patient education should be given for toddler?

Healthy Foods
16-24oz Whole Milk
Drinking Water
Avoid Juice

What are care patient education should be given for toddler?

Screen time < 1 hour
Toilet Training
Regular Naps and Bedtime

When do peds patients transition to front facing care seat?

Height and Weight gets reach or 2 years

What screenings are done for preschool patients?

Hearing
Vision
BP (Annual)
TB (Annual)
Iron Deficiency (Annual)

What are some risk factors for pediatric hearing loss?

• Speech, language, developmental delay
• FH childhood hearing loss
• NICU stay > 5 days
• NICU stay requiring mechanical ventilation
• Exchange transfusion
• Loop diuretics, chemo
• Congenital/CNS infections
• Congenital head/neck deformities
• Neurodegenerative disorder
• Recurrent otitis media with effusion

What is being assessed for vision screening for peds

Amblyopia
strabismus
acuity

When does the majority of brain become developed

By age 3

What food patient education should we give for preschoolers

Water and Milk
Limit Juice
Let Child Determine Fullness

What care patient education should we give for preschoolers

Screen Time < 1 hr
School Readiness
Helmet with Bikes
Water Safety

When do screen for hearing in peds

3 years
4 year
5 year
6 year
8 year
10 year
11-14 year
15-17 year
18-21 year

When do we screen for vision in peds

3 year
4 year
6 year
7 year
8 year
10 year

What screenings are done for school age children

Vision
Hearing
Lipids
Substance Use
BP (Annual)
TB (annual)

When are lipids screening in peds?

5 year = Start annual risk
9-11 year = Blood Draw

What patient education do we give for school age children

Development
Mental Health
Street Habits
Safety with Adults
Dealing with Bullying
Booster Seat
Dangers of Substance Use

When does a peds patient typically not need a booster seat anymore

8 years

What screenings are done for adolescents

Hearing
Lipids
Substance Use
Depression
HIV
TB (Annual)
BP (annual)

What is screening for substance abuse with peds?

Year 9 = Discussion of Danger
Year 11 = Start annual screening

What is the peds depression screening?

Year 12 = Start screening annually with PHQ-2

What is the peds HIV screening?

15-21 year
Assessment Annual > 21

What are some patient education for adolescenet

Mental Health
Physical Growth and Development
Sexual Health
Risk Reduction
Helmet and Seat Belt Use
Sun Protection
Firearm Safety

What is the leading cause of death in adolescence

Suicide

What are the developmental risks in adolescents

Lack of Connectedness
Substance Use
Academic Issues
MVAs
Homelessness