Pediatric Screenings

what warrants screening?

-substantial morbidity/mortality occurs if disease is untreated

-high prevalence in apparently healthy population

-existence of preclinical phase is detectable by test

-a cost-effective treatment is available

-preclinical detection of disease provides benefit

what makes a good screening test?

-easy to perform

-measure something directly relate to dsiease

-low risk

-highly sensitive and specific

-cost effective

adverse effects of screening

-false positive

-false negative

-cost

-ANXIETY

specificity

how many people do not have the disease and have a negative test

sensitivity

how many people with the disease have a positive test

types of screening

universal and selective (risk based)

anticipatory guidance

-information given by the health care provider to assist parents or guardians in the understanding of the expected growth and development of their children

-promote optimal developmental outcomes and aims to avoid problems in the future

newborn age range

birth to 1 month

infant age range

1 month to 1 year

early childhood age range

1-5

middle/late childhood age range

6-12

adolescence age range

12-17

early adult age range

18-25

what should be assessed for at every pediatric visit?

nutrition

behaviors

growth and development

social determinants of health

anticipatory guidance

what resources are available for those with social determinants of health?

child care

accessing transportation

getting a car seat or crib

financial concerns

food insecurity (SNAP/WIC)

all states test for what conditions in infants? (universal)

phenylketonuria (PKU) and congenital hypothyroidism

other potential tests for infants

bilirubin, congenital heart disease, +/- hearing screening

bilirubin screening

way to assess for jaundice and total serum bilirubin level or transcutaneous bili

-its common in kids cause their hepatobiliary system is not fully developed

where is the best place to look for jaundice on babies with darker skin?

palms/soles, pushing on nose

congenital heart disease screening

use pulse ox on upper and lower extremity to see if there is a difference and physical exam (e.g. murmurs)

with newborn screening, what is important to remember

parent and family heath and well-being, including maternal depression

what is the ideal "way" to feed a baby?

exclusive breastfeeding for at least 6 months

frequency of breastfeeding

8-12 feedings in 24 hours

how do we assess adequacy with breast milk

-we rely on baby to see if they are growing appropriately

-they should be at birth weight by 2 weeks

-how often, how long on each side, do they seem content after

frequency of formula feeding

8 feedings/24 hours

pt education and feeding babies

do NOT prop bottle

do NOT give other fluids

how to perform "cord care"

-air dry by keeping cord below navel

-do NOT give a full bath until cord falls off

other things to remeber with newborn care

-infant capabilities

-calming the baby (never hit/shake the baby)

-illness prevention (immune systems are not really developed)

sleep safety in newborns

sleep on back with nothing else in crib (no stuffed animals, no baby blankets)

newborn car safety

rear-facing car seat

other sleep safety for newborns

-heat stroke prevention (dont need to be swaddled if it hot outside)

-pets

-safe home environment

universal hearing screening guidelines for newborns

all newborns should have a hearing test by one month of age but most are done in the hospital

a hearing deficit should be diagnosed by...

3 months

intervention for a hearing deficit should be done no later than...

6 months

maternal depression should be screened for at...

1,2,4, and 6 month at peds visits

when should a risk assessment for iron deficiency be performed?

4 months

risks for iron deficiency in infants

prematurity (born before 37 weeks gestation), low birth weight, diet (if they have cow milk as source of nutrion before 1 year), low socioeconomic status

when should an infant get an H&H measured?

12 months

after the H&H, risk assessment should be performed for iron deficiency...

at 15, 18, 24, and 30 months

risks for iron deficiency in older infants

socioeconomic, lead exposure, access to food

one should get a capillary lead level measured at what ages?

12 and 24 months

if a capillary screen for lead is positive, confirm with...

venous sample

risk assessment for lead is done...

6,9,12,18,24 months, then annually

are there any safe lead levels?

no so primary prevention critical!

what population should get a lead level measured between the ages of 6 months through 16 y/o?

immigrant, refugee, or international adoptee on arrival

when should fluoride supplementation/tooth brushing begin in infants?

at first tooth eruption (6 mon) and brush teeth twice daily

when should infants start going to the dentist

12 months

when should infants get assessed for risk of tuberculosis?

1, 6, 12, and 24 months

breastmilk/formula should be given to infants for...

12 months

infants that are exclusively breastfeeding should be supplemented with...

400 IU Vitamin D a day via dropper

introduce rice cereal/oatmeal at what age?

around 4 months (when they reach 8 oz of milk)

introduce pureed food at what age?

6 months and one food at a time for three days (first do vegetables, cause fruits taste better so you don't want them to not eat veggies)

what food do you avoid in infants

juice but can do water in sippy cup

what general care is important in infants

-tummy time while awake (need to develop neck muscles and core strength and to prevent head flattening)

-baby proof home

-avoid TV and digital media

-proper water temp/never leave alone in bath

-avoid placing baby in high places

-put baby to bed awake (so they dont have association of nursing and then going to sleep)

-avoid excessive sun exposure

-rear facing care seat

risk assessment for autism spectrum disorder at what age?

18 and 24 months

risk assessment for lead exposure at what age?

24 months

risk assessment for blood pressure at what age?

start annually at age 3, < 3 with risk factors (kidney issues, high BMI, sepsis)

when should TB be assessed for in toddlers?

risk assess annually

proper nutrition for toddlers

self-feeding (around 9 months)

healthy foods (differnt colors so they are less picky)

appropriate snacks

16-24 oz whole milk daily (best for brain development)

drinking water

avoid juice

how much digital media a day should a toddler have?

less than 1 hour

what signs should you look for in a toddler to know if he or she is ready to start potty training?

-when toddler is dry for at least 2 hours (between 2-3 yrs), knows wet/dry, can pull pants up/down, can indicate bowel movement

-does not have to be throughout the night

toddler sleep habits

regular naps and bedtime

other toddler care tips

oral health, appropriate discipline (positive rewarding)

how long are rear-facing car seats recommended?

as long as possible, up to the age of 2 years, depending on height and weight requirements

home safety for toddlers

poisoning (medications, cleaning products), falls, fire safety

when should hearing be screened for in preschoolers?

risk assessment at all well visits annually

risk factors for hearing loss in preschoolers

caregiver concern

evidence of speech, language, developmental delay

FH childhood hearing loss

NICU stay > 5 days

NICU stay requiring mechanical ventilation

exchange transfusion (in utero)

exposure to ototoxic drugs (loop diuretics/chemo)

congenital/CNS infections

congenital head/neck deformities

neurodegenerative disorder

recurrent otitis media with effusion

when does vision screening begin in preschoolers?

3 and 4 years (done with shapes) which detects amblyopia, strabismus, and acuity

what diseases are screened for annually in preschoolers?

TB, lead, iron deficiency anemia

development goals of early childhood

physical, cognitive, socio-economic, language, nutrition and weight

90% of the brain is developed by age..

3

nutrition for preschoolers

healthy foods, water and milk, limit juice, let child determine when full

care and safety with preschool kids

-limit digital media to less than 1 hour/day

-school readiness

-bike helmets

-car seat/booster seat

-water safety

when should vision screening be done in school-aged children?

5,6,8,10,12,15

when should hearing screening be done in school-aged children?

6,7,8,10

when should blood pressure screening be done in school-aged children?

annually

when should lipids be assessed in school-aged children?

once between 9-11, risk assess annually

when should TB be risk assessed in school-aged children?

annually

a booster seat should be used in school-aged children until...

height/weight requirement -- typically around age 8

care and safety for school aged kids

-development and mental health

-teach safe street habits

-teach rules of how to be safe with adults

-dealing with bullying

when should adolescents be screened for hearing?

once between 11-14, 15-17, and 18-21

when should adolescents be screened for blood pressure?

annually

when should adolescents be screened for lipids?

once between 17-21

when should adolescents be screened for tobacco, alcohol, and substance use?

every visit starting at age 11, should discuss dangers starting at 9

how and when should adolescents be screened for depression?

annually starting at 12 using PHQ-2

CRAFFT questionnaire

screening tool for alcohol and substance abuse in adolescents

when should adolescents be screened for HIV?

once between ages 15-21 and risk assess annually

when should adolescents be screened for TB?

risk assess annually

what is the leading cause of death in adolescents?

suicide

crisis lifeline for suicide

988

adolescence developmental key points

-emotional well being

-physical growth and development

-sexual health (infections and pregnancy)

adolescence safety

-risk reduction with sexual, substance use, acoustic trauma

-driving/seat belts

-helmet use

-sun protection

-firearm safety

adolescence risks

-lack of connectedness with family/peers

-substance use especially tobacco/nicotine/vaping

-academic issues/dropping out of school

-motor vehicle accidents

-homelessness