Peds- Screening And Surveillence

Front 1

surveillance

Back 1

-A continuous process performed by professionals involving skilled observations during pediatric visits.

Front 2

screening

Back 2

-brief testing with a validated tool
-Purpose is to distinguish “normal” from that needing further investigation
-Performed at a certain point in time
-developmental, mental health, vision, hearing, oral health, medical problems, newborn screening

Front 3

anticipatory guidance

Back 3

-Major part of health supervision is anticipatory guidance.
-Provider addresses behavioral issues, development, injury prevention, nutritional issues, school problems and other age appropriate issues.

Front 4

developmental and behavioral assessment

Back 4

-12-26% of American children have developmental or behavioral disorders.
-At each well visit parent should be asked about child’s development and behavior.
-Emotional well-being and parent-child interactions can be observed by clinician.
-use questionnaires and screening tests
-impt to identify abnormalities at a younger age (thru 2yo)

Front 5

growth parameters

Back 5

-Growth charts evaluate child’s body mass index (BMI) for age.
-Height, weight, head circumference (first 2-3 years) plotted at each well visit.

Front 6

blood pressure

Back 6

-screening should be started at 2-3 yo
-HTN diagnosed as systolic or diastolic BP >95 %ile for age and ht/wt
-BP should be checked at each visit in child with renal or cardiovascular abnormality.

Front 7

vision screening

Back 7

-newborn period
-At each visit, parents should be asked about concerns regarding vision, eye alignment, or other eye problems.
-Eyes and eyelids should be inspected at each visit. Movement and alignment evaluated.
-Red reflex evaluated for detection of opacities. Dark exam room.

Front 8

vision testing

Back 8

-visual acuity should be checked at each well-child visit
-age appropriate eye charts (pictures, tumbling E's)
-age appropriate visual acuity:
3-5 20/40 min accepted acuity
6+ 20/30 "

Front 9

hearing eval

Back 9

-Hearing loss can lead to delays in speech, language and cognitive development as well as poor academic performance, personal-social maladjustments, emotional difficulties.

Front 10

risks for hearing loss

Back 10

1. prematurity
2. meds
3. meningitis/mumps/measles
4. OM
5. FH of sensorineural hearing loss
6. in utero infx
7. hyperbilirubinemia
8. mechanical ventilation
9. ear/craniofacial anomalies

Front 11

hearing- expected milestones

Back 11

-Birth – 3 mos: startle to loud noise, awaken to sounds, blinks to noises
-3-4 mos: quiets to mother’s voice, stops playing and listens to new sounds, looks for source of new sound
-6-9 mos: enjoys musical toys, coos and gurgles with inflection, says “mama”

Front 12

hearing- expected milestones cont

Back 12

-12-15 mos: responds to name and “no”, 3-5 word vocabulary, imitates some sounds
-18-24 mos: knows body parts, 2 word phrases (min. 20-50 words), 50% of speech understandable to strangers
-By 36 mos: 4-5 word sentences (500 word vocab.), speech 80% understandable to strangers, understands some verbs

Front 13

hearing evaluation

Back 13

-Evoked Otoacoustic Emissions (OAE’s) Evoked response used at all ages. Seeks evoked electrophysiologic response.
-Audiometry using headphones with child indicating when noise is heard is used in older children.

Front 14

dental screening

Back 14

-children with deciduous "baby" teeth should brush and have dental eval
-may be done as early as 6mo, 6 mo after first tooth erupts
-no late than 12 mos
-fluoride for prevention of caries (Continues until 16 yrs of age or eruption of 2nd perm. molars)
-no nighttime bottles
-sealants

Front 15

iron deficiency screening

Back 15

-most common nutritional deficiency in the US
-Severe deficiency can cause anemia, cognitive and behavioral problems.
-Screening Hb and Hct should be obtained at 9 and 15 months in average risk children.
-Prevention of ID with iron containing formulas and cereals and limiting cow’s milk to 24 oz/day in 1-5 year old children.

Front 16

atherosclerosis in children

Back 16

-athersclerotic process begins in childhood
-lipip filled macrophages within intima of artery
-smooth muscle cells migrate into artery and form fibrous plaque
-that prevalence of these lesions was 70% in young adulthood

Front 17

hypercholesterolemia and hyperlipidemia

Back 17

-AAP recommends that kids with parent with elevated cholesterol (>240 mg/dL) should have total cholesterol measured after 2 yrs of age
-If family history of CV disease before age 55, complete lipoprotein panel (fasting chol, HDL, LDL, trig) is recommended.

Front 18

lead screening

Back 18

-Sources of lead include paint (less common now), soil and dust
-Levels as low as 10 ug/dL can cause behavioral problems and learning disabilities.
-High lead levels (>70 ug/dL) can cause seizures and coma.
-CDC:screening for communities with high % of old houses or high % of kids with lead levels >10ul/dL
-Medicaid recommends children be screened at 1 year and 2 years of age.

Front 19

TB

Back 19

-Well child care should include TB risk assessment and screening depending on risk status.

Front 20

high risk for TV

Back 20

1. contact with person with known or suspected TB
2. sx or radiographic findings suggesting TB
3. birth, residence or travel to high prevalence areas
4. HIV infx
5. Contact with person with HIV/AIDS, prisoner, migrant farm worker, drug user, homeless.

Front 21

Mantoux test

Back 21

-recommended screening test for TB
-can be done as early as 3 mo of age
-repeat annually if risk persists
-previous BCG not C/I to PPD

Front 22

screening of adolescent pts

Back 22

-Hct. For females with heavy menses, weight loss, poor nutrition, athletic activity.
-Adolescents should be asked about sexual activity, STI’s, abuse.
-Sexually active girls should have pelvic exam, pap.

Front 23

Scoliosis screening

Back 23

-Screening with Adam’s Bend Test to note curve of spine.
-Scoliometer used to measure the curve.
-referral: x-ray scoliosis series, ortho

Front 24

newborn screening

Back 24

-in NY newborns vblood issent to lab for various tests including...
Endocrine Disorders- Congenital Hypothyroidism
Hemoglobinopathies – Sickle Cell Disease
Infectious Diseases – HIV Infection
Inborn Errors of Metabolism - Amino Acid Disorders
Inborn Errors of Metabolism - Fatty Acid Oxidation Disorders
Inborn Errors of Metabolism - Organic Acid Disorders
Inborn Errors of Metabolism - Urea Cycle Disorders
Other Genetic Conditions – Cystic Fibrosis