PEDIATRICS 1
Midterm Quiz
“AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE”
BLACK: Slides | BLUE/ITALICS: Audio | RED: EMPHASIZED | VIOLET: OT
PREVENTIVE PEDIATRICS
• Must be given the same importance as the care of sick
children (for me, personally, more importance)
• Both prevention and cure are equally needed to
promote the optimum health of an infant from the time
of conception until adulthood
• Prevention is much cheaper and relatively easier to
undertake
OBJECTIVES
• To provide anticipatory guidance (proper education) to
patients and parents on health maintenance practices in
an ambulatory care setting according to age groups:
o Newborn, infant, childhood and adolescence
• To recommend and administer indicated childhood
vaccinations at various age groups and situations
• To discuss growth and developmental monitoring
MOST IMPORTANT & (monitor stunting and wasting)
• To explain the nutritional requirements according to
age group and aspects of nutrition (prevent
malnutrition) – look into feeding hx.
• To obtain a thorough, adequate and dynamic history
PREVENTIVE PEDIATRIC HEALTH CARE
1. PRIMARY PREVENTION
• Directed at avoiding a disorder before they begin
• Special emphasis on those at increased risk to develop a
condition or disease.
• “Aim of a physician”***
• Examples:
o Chlorination and fluoridation of water
o Immunization (rotavirus and pneumococcal
vaccination)
o Counseling about keeping poisons and drugs out of
reach
2. SECONDARY PREVENTION
• Those in which a condition or its precursor is identified
early (so you can intervene) and effective treatment is
instituted to remedy the condition before progression
or for elimination of the precursor
• Examples:
o Screening programs for blood lead levels
o Screening for adolescent scoliosis (forward bend
test)
o Newborn Screening
o Newborn Hearing Test
3. TERTIARY PREVENTION
• Directed at ameliorating or halting the disabilities from
established disease.
• It’s late because the disease has already ran its course.
5M Preventive Pediatics: Part 1
Dr. Elizabeth Escano-Gallardo | March 21, 2016
• Examples:
o Providing chest physiotherapy for a child with cystic
fibrosis
o Rehabilitation therapy
o Speech therapy
o Behavioral therapy
DIFFERENT PERIODS IN THE LIFE OF A CHILD
• Preconception
• Prenatal and neonatal periods
• Infancy
• Preschool
• School age
• Puberty and adolescence
• Adult
Goal: Reach the healthy adult stage
Prevention starts even before the child is conceived/born so it
starts during the preconception period
PRECONCEPTION
• Thinking about having a baby
• Best time to give preconception counseling for
subsequent babies is right after birth/delivery
• Proper spacing of pregnancies and need to limit the
number of children per family especially in multiparous
mothers.
o Interval between pregnancies for optimum health
of both mother and child is at least 3 years
o Multiparity poses a lot of complications like
premature labor and delivery, higher morbidity
o “It takes a while to go back to pre-pregnancy state;
allow your body to heal”
• Genetic counseling among couples with heredofamilial
diseases
o Hemophilia
o X-linked, autosomal recessive, autosomal dominant
diseases
o Important if there is a history of bad outcome of
previous pregnancies -> Talk to parents
o “Discuss options and implications of getting
pregnant (chances of getting another stillbirth,
preterm delivery or a condition to be avoided)”
PRENATAL AND NEONATAL
• Directed towards preparing prospective parents for
parenthood in order to develop a healthy parent-child
relationship
• Done with the OB Gynecologist
• Prenatal education may be done through a structured
mother’s class or face to face counseling with a health
care professional or worker (ex. Nat’l Buntis Day)
• Education and counseling must include the following
areas of concern:
o Breastfeeding (Advantages & Mother’s concerns)
▪ Discussed during prenatal period
 o Newborn care and procedure
▪ Prime the mother on what to expect during
delivery
▪ Ex. Vaccinations are abhored by some parents
but convince why vaccines are needed and
what are the implications of non-immunization.
o Anticipatory guidance to decrease the risk of injury
and identify risk factors for child maltreatment
▪ Risk for child maltreatment – unwanted
pregnancy, illegitimate child (watch closely)
o Prevention of smoking, alcohol intake and exposure
to teratogens
o Tetanus toxoid immunization for the mother most
specially when not giving birth in a health care
facility.
o Maternal nutrition (to include folic acid
supplementation)
▪ Avoid neural tube defects
BREASTFEEDING
• Nutritional, immunologic and intellectual benefits of
breastfeeding for the infant and mother (no artificial
formula) – should be known by heart
• Psychosocial advantages for both mother and infant
• Potential decrease in risk for future chronic disease
(hypertension, obesity, type 2 diabetes, allergy) in the
child
• Health benefits for the mother
o Reduced post-partum bleeding due to oxytocin
reflex that induces contraction leading to reduced
bleeding post partum
o Delayed return to fertility (exclusive breastfeeding
for 6 months) – contraceptive effect
o Less risk for breast and ovarian malignancies
o Promotes early return to pre-pregnancy weight
• Economic and environment-friendly benefits of
breastfeeding
o Safe, sterile, always available
• Cheap and comes in cute containers
NEWBORN CARE AND PROCEDURES
• Essential Intrapartum And Newborn Care (EINC)
protocol
• Time bound interventions which address the newborn’s
primary needs
o Thermal protection
o Maintenance of homeostatic metabolism
o Protection from infection <>MA
• Involves all deliveries (NSVD or C-section)
FOUR (4) CORE ACTIONS *(visual image on page 5)
• Immediate and thorough drying of the newborn (30-60
st
seconds) – drying for the 1 minute of life
o Prevent loss of heat via evaporation
o Prevent hypothermia
o Initiate first cry
▪ use sterile cloth, do not wipe away vernix caseosa
because it adds warmth, change cloth after wiping
• Early skin to skin contact on mother’s chest (within the
next 30 seconds) and delaying washing/bathing for at
least 6 hours of life
o Facilitates bonding and breastfeeding
o Promote oxytocin reflex when the mother sees the
baby for the first time – milk let down & breastfeed
o Bathing is delayed to prevent infection – what will
colonize the baby is the mother’s flora and not the
hospital’s flora
o Prevents heat loss via convection
• Properly timed cord clamping and cutting between 1-3
minutes of life or until cord pulsations stop
o Prevent anemia and intraventricular hemorrhage
specially in a premature infant
• Non-separation of the newborn and mother for early
breastfeeding (60-90 minutes)
• How long? Keep them together forever! The whole time
the mother is in the delivery/operating room
• TIME BOUND: SHOULD BE DONE IN SEQUENCE!
• Life saving because many of the deaths occur in the first
hour of life.
• Done only in well babies
• Breastfeeding: Oxytocin and Prolactin
• Duration of breastfeeding: 60-90 mins
DIRECT ROOMING-IN
• RA No. 7600 – the rooming in and breast feeding act of
1992
• Adopts rooming in as a national policy to encourage,
protect and support the practice of breastfeeding
• Mandates all hospitals and personnel to room-in all
normal newborns and carry out breastfeeding
advocacy, initiation, and maintenance.
• Practice of placing the newborn in the same room as
the mother right after delivery up to discharge to
facilitate mother-infant bonding and to initiate
breastfeeding
• Normal spontaneous deliveries and c-section
o Latched on to the mother’s breast immediately
after birth
• Should the mother choose not to room in or
breastfeed her newborn, a waiver form releasing the
hospitals from all responsibilities should be
5M PEDIATRICS: Preventive Pediatrics 
documented and signed options for other methods of
feeding shall be outline and appropriate support for her
decision should be provided
• inform of repercussions and try your best to convince
the mother to breastfeed
• Written waiver should be made by the patient herself in
her own words and with her signature
o Normal spontaneous deliveries
▪ mother’s breast immediately afterbirth and
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 roomed in within 30 mins o Organic acid disorders
o Caesarean section o Fatty acid oxidation disorders
▪ Roomed in and breastfed within 3-4 hours after o Disorders of amino acid metabolism
birth • Cost 1500 (available in our setting)

NEWBORN SCREENING NEWBORN HEARING SCREENING

• Republic act no 9288 – newborn screening act of 2004 • Republic act of 9709 – the universal newborn hearing
• An act of promulgating a comprehensive policy and a screening and intervention act of 2009
national system for ensuring newborn screening • Established for prevention and recognition of congenital
• To ensure that every baby born in the Philippines is hearing loss on newborns and infants
offered the opportunity to undergo newborn screening • All infants born in hospital in the Philippines must
• Secondary prevention – bec. condition is already present undergo hearing screen before discharge
• Performance of newborn screening • Infants not born in the hospital should undergo the test
o After 24 hours of life but not later than 3 days after within 3 months after birth
delivery of the newborn
o Newborn in the ICU must undergo newborn NEWBORN EYE SCREENING
screening by 7 days of age • Includes
o refusal: waiver should be secured and written on o Check for steady eyes (nystagmus)
the chart o White, lustrous conjunctiva
• Disorders tested heritable conditions o Clear cornea
o CH - Congenital hypothyroidism o Non-droopy eyelids
o CAH - Congenital adrenal hyperplasia o Pupillary reflex and red-orange reflex (ROR)
o GAL - Galactosemia • specially in premature newborns given oxygen therapy
o PKU - Phenylketonuria causing retinopathy of prematurity who may end up blind
o G6PD deficiency – Highest incidence among • Indications for referral to an ophthalmologist
Filipinos o Jiggly eyes, strabismus
o MSUD - Maple syrup urine disorder o Droopy eyelids, ptosis
o Non-reactive pupil
Disorder Screened Effect if not Effect if screened
screened and managed
o Red eye dry, frothy conjunctivae
CH Severe mental Normal o Opacities
retardation o Absent/ dull or asymmetric red orange reflex
CAH Death Alive and normal
GAL Death or Cataracts Alive and Normal Immunizations with Hepatitis B vaccine and BCG
PKU Severe Mental Normal - Done right after birth
Retardation
G6PD deficiency Severe Anemia, Normal ANTICIPATORY GUIDANCE (Prenatal period)
Kernicterus • Assessment of the child’s future exposure to or
MSUD Death Alive and normal prevention of neglect, maltreatment, and violence
- Results: 7-10 days of life or 10 to 14 days o Parents education
- (+) informed within 10-14 days o Profession
- (-) no news o Attitude regarding the pregnancy
- Official Results: After a month at the hospital where o Planned disciplinary method/ child rearing
woman gave birth approach
• Cost: 550 pesos o Financial security
• Heel prick on filter paper and sent to the national o Family support system
• Inquire about family history of genetic or chromosomal
5M PEDIATRICS: Preventive Pediatrics 

newborn centers for screening

• Once positive, do confirmatory tests in a continuity clinic
for newborns with metabolic disorders
• If not screened, severe mental retardation for
congenital hypothyroidism and other complications
• G6PD (most common): immediately inform parents about
the food that the infant should avoid. (early intervention)
EXPANDED NEWBORN SCREENING
• Includes 22 more disorders (28 all in all)
o Hemoglobinopathies
abnormality and developmental disability
• Discuss about injury prevention and potential exposure
to environment toxicants such as lead
• Should be discussed even before child is born
PREGNANT WOMEN PREVENTION
• Pregnant women must be informed about the
deleterious effects of smoking, alcohol intake and
exposure to known teratogens (infections and drugs)
during pregnancy
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• FDA: determines the potential to become teratogens o caretaker fatigue
Class X : avoid at all costs, inform mother to be careful when
taking in drugs or medications. • WHO child growth standards
o Used as reference standard for weight, height and
TETANUS TOXOID IMMUNIZATION head circumference
• Tetanus toxoid must be started or continued during o Interpretation of growth points are based on Z-
pregnancy scores (standard deviation scores) and not on
percentile scores
DIET o Body mass index (BMI) measurement standards
• Folic acid rich food to prevent neural tube defects enable early detection and prevention of
overweight and obesity problems
DISCHARGE OF HEALTHY TERM NEWBORN o Plot against growth charts that are color coded,
• Optimal time is decided by the physician caring for both beautiful
mother and child o Part of preventive aspect of every patient
• Obstetrician and Pediatrician should collaborate o Developmentalists spend hours with every patient
• For newborns discharged < 48 hours after delivery o Z score 0: normal
(more so if within 24 hours), a follow up must be made
within 48 hours of discharge then at about one month Notetakers:
• NSVD: within 48 hours
• C section: within 72 hours Gayle Francez Monique Tandoc
• More frequent visits required for sick neonates Lethmar Tolentino
(weekly/daily) Erika Monique Ang

INFANCY
• 2nd month of life up to 2 years old
• In order to ensure optimum health, monthly health
visits are recommended during the first year of life and
every other month during the second year
• History and thorough physical examination to assess
the following:
o Care and feeding of infant
o Developmental milestones (at par with age)
o Occurrence of symptoms during the interval
between visits
o Immunizations
o Anthropometric measurements

COMPLEMENTARY FEEDING
• Timely: introduced at 6 months of age
• Breast feeding until 2-3 years old (WHO)
• Adequate: provides sufficient energy, proteins and
micronutrients to sustain growth
• Safe: hygienically prepared and stored
• Properly fed: meal frequency and feeding methods
suitable for age (guide or self-feeding using clean hands,
spoon and fork, cups and bowls) use local fresh and
5M PEDIATRICS: Preventive Pediatrics 

natural foods
• Teach self feeding but know developmental milestone
suitable/appropriate for age

• Provide anticipatory guidance on injury prevention,

behavior and nutrition
• Assess relationship between infant and parents
o Be aware of risk factors for child abuse and neglect
such as prematurity, long hospital stay, presence of
disabilities, stresses in the family, etc.
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5M PEDIATRICS: Preventive Pediatrics 