Скачать презентацию Health Maintenance Promotion and Screening Patricia Kuster Ph Скачать презентацию Health Maintenance Promotion and Screening Patricia Kuster Ph

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Health Maintenance, Promotion and Screening Patricia Kuster, Ph. D, RN, CPNP Health Maintenance, Promotion and Screening Patricia Kuster, Ph. D, RN, CPNP

Clinical Guidelines and Preventative Services Evidence –based care guidelines that include: Screening tests Immunizations Clinical Guidelines and Preventative Services Evidence –based care guidelines that include: Screening tests Immunizations Preventative counseling/Anticipatory guidance

 American Academy of Pediatrics(AAP) Bright Futures: National Guidelines for Health Supervision of Infants, American Academy of Pediatrics(AAP) Bright Futures: National Guidelines for Health Supervision of Infants, Children, and Adolescents (U. S. Department of Health and Human Services) Guidelines for Health Supervision

 U. S. Preventative Task Force ◦ A Government-appointed expert panel that developed recommendations U. S. Preventative Task Force ◦ A Government-appointed expert panel that developed recommendations for primary care clinicians on the appropriate content of periodic health examinations ◦ Clinician’s Handbook of Preventative Services

 EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) service ◦ Medicaid’s comprehensive and EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) service ◦ Medicaid’s comprehensive and preventative child health program for individuals under age 21 ◦ aimed at identifying and correcting medical conditions before the conditions become serious and disabling

EPSDT Services (Cont) Includes: ◦ ◦ ◦ Immunizations Developmental/Periodic Screening Vision screening Hearing services EPSDT Services (Cont) Includes: ◦ ◦ ◦ Immunizations Developmental/Periodic Screening Vision screening Hearing services Dental services

Healthy People 2010 A set of health objectives for the Nation to achieve over Healthy People 2010 A set of health objectives for the Nation to achieve over the first decade of the new century. To be used to develop programs to improve health Builds on initiatives pursued in Surgeon General’s Healthy People 2000

Health People 2010 (Cont) Leading Health Indicators ◦ Used to measure the health of Health People 2010 (Cont) Leading Health Indicators ◦ Used to measure the health of the Nation over the next 10 years ◦ Reflect the major health concerns in the U. S. in the first decade of the 21 st century Physical Activity Overweight and Obesity Tobacco Use Substance Abuse Responsible Sexual Behavior Mental Health Injury and Violence Environmental Quality Immunization Access to Health Care

Components of Child Health Maintenance and Promotion Assessment Systematic screening for growth and development Components of Child Health Maintenance and Promotion Assessment Systematic screening for growth and development Periodic health screening Physical exam Immunizations Anticipatory guidance Patient and parent education

Recommended Schedule: Well child Care Newborn to 2 weeks 1, 2, 4, 6, 9, Recommended Schedule: Well child Care Newborn to 2 weeks 1, 2, 4, 6, 9, and 12 months 15 and 18 months 2 -18 years annually Immunizations and Screening incorporated at different time intervals based on guidelines and insurance providers

Assessment/Health History Patient Identifying Information along with relationship of caregiver to patient Chief complaint Assessment/Health History Patient Identifying Information along with relationship of caregiver to patient Chief complaint History of present illness Past medical history (Observe Caregiver/Child Interaction while obtaining health history)

Assessment/Past Medical History Prenatal, postnatal Past illnesses, surgeries, hospitalizations Allergies Accidents Immunization history Nutrition Assessment/Past Medical History Prenatal, postnatal Past illnesses, surgeries, hospitalizations Allergies Accidents Immunization history Nutrition history Growth and Development Review of Systems Family history (genogram? )

Health History/Daily Living Assessment Family composition/Occupations Parenting/Caregiver schedule/time spent Discipline Family stressors/supports/coping Substance Abuse Health History/Daily Living Assessment Family composition/Occupations Parenting/Caregiver schedule/time spent Discipline Family stressors/supports/coping Substance Abuse Nutrition Sleep Elimination Activities at home/outside the home Safety

Screening for Growth and Development Growth Charts Incorporate Developmental Screening onto physical examination forms Screening for Growth and Development Growth Charts Incorporate Developmental Screening onto physical examination forms Denver Developmental Testing (Denver II) Prescreening Developmental Questionnaire(PDQ-II) Ages and Stages questionnaire

Concerns about Developmental Delay Children who fail to progress developmentally or deteriorate developmentally ◦ Concerns about Developmental Delay Children who fail to progress developmentally or deteriorate developmentally ◦ Etiologies CNS dysfunction/ Genetic syndromes Mental health problems, i. e. , depression, ADHD Chronic disease affecting either functional abilities or activity tolerance Child abuse or neglect Maternal/Paternal stress Developmentally inappropriate environment Lack of parent knowledge of development

Referral for developmental delay Base referral on H&P, Developmental testing, hearing and vision screening, Referral for developmental delay Base referral on H&P, Developmental testing, hearing and vision screening, Intervention is based on etiology ◦ ◦ ◦ Parental counseling Educational programs Physical/Occupational/Speech Therapy Neurology Social Services

INFANTS: Key Points Time of rapid growth and development in all areas Basic trust INFANTS: Key Points Time of rapid growth and development in all areas Basic trust with primary caregiver critical ◦ Trust vs. Mistrust

Neonate (0 -28 days) Gestational Age Overall State Color Tone (symmetry) Reflexes Neonate (0 -28 days) Gestational Age Overall State Color Tone (symmetry) Reflexes

Reflexes Rooting Sucking Moro Stepping Tonic Neck Palmar grasp Reflexes Rooting Sucking Moro Stepping Tonic Neck Palmar grasp

Newborn Findings Dysmorphic facies Red reflex Polydactyly Jaundice Heart murmur Weight loss (10% in Newborn Findings Dysmorphic facies Red reflex Polydactyly Jaundice Heart murmur Weight loss (10% in first few days)

Infancy: Physical Changes Weight ◦ 5 -7 oz weekly 1 st 6 months (0. Infancy: Physical Changes Weight ◦ 5 -7 oz weekly 1 st 6 months (0. 5 -1 oz/day) ◦ 3 -5 oz weekly 2 nd 6 months ◦ Birth weight doubles by 4 -6 months, triples by 12 ◦ Average weight of a 1 year old is 10 kg or 21 -22 lbs. Height ◦ 1 inch monthly 1 st 6 months ◦ ½ inch monthly 2 nd 6 months ◦ Birth height increases by 50% by 12 months

Physical Changes cont. Head Circumference ◦ 0. 5 cm per month in first year Physical Changes cont. Head Circumference ◦ 0. 5 cm per month in first year ◦ Posterior fontanel closes by 2 months, AF may begin closure by 9 months, should close by 18 months Teeth ◦ Teething begins around 6 -8 months– 2 lower central incisors

Infancy: Perceptual Hearing ◦ Fully developed at birth (turn to sound or voice) Smell Infancy: Perceptual Hearing ◦ Fully developed at birth (turn to sound or voice) Smell - well developed at birth Vision ◦ Newborn – visual acuity poor ◦ 1 -3 months – follows moving objects ◦ 4 -7 months – color vision, distance vision 20/50

Infancy: Gross Motor Reflexive to conscious behavior Cephalo-caudal development- head to foot Proximo-distal development Infancy: Gross Motor Reflexive to conscious behavior Cephalo-caudal development- head to foot Proximo-distal development – central to peripheral Primitive reflexes disappear by: ◦ Rooting - 4 months ◦ Sucking – 10 -12 months ◦ Moro - 4 months ◦ Stepping – Before walking ◦ Tonic neck – 4 -6 months ◦ Palmer grasp - 4 months ◦ Plantar - 9 -12 months

Infancy: Gross Motor Birth 7 -9 Months 1 -4 months 8 -12 Months 5 Infancy: Gross Motor Birth 7 -9 Months 1 -4 months 8 -12 Months 5 -6 Months ◦ Reflex controlled ◦ Flexed position ◦ Lift head off bed ◦ Head control ◦ Rolls back to side ◦ ◦ Intentional rolling over Supports weight on arms Sits with support Creeping ◦ Sits unsupported ◦ Crawls ◦ Pulls to stand ◦ ◦ Walks with help Cruising May stand alone Can sit down from stand

Infancy: Fine Motor Birth to 1 month ◦ Rakes at objects ◦ Pincer grasp Infancy: Fine Motor Birth to 1 month ◦ Rakes at objects ◦ Pincer grasp ◦ Preference for dominant hand ◦ Grasp and voluntarily let go, will look ◦ Grasp Reflex 1 -4 Months ◦ ◦ Hand to Mouth Plays with hands Reaches, misses Grasps objects 5 -6 Months ◦ Grasp and voluntarily let go, won’t look ◦ Plays with toes ◦ Transfers toys from hand to hand 7 -9 months 8 -12 Months ◦ Finger feeds ◦ Bangs cubes together ◦ Puts objects into a container ◦ Imitates scribbling

Infancy: Psychosocial Development Erikson’s “Trust VS Mistrust” “Can I trust my environment AND Can Infancy: Psychosocial Development Erikson’s “Trust VS Mistrust” “Can I trust my environment AND Can I have an impact on my environment? ”

Infancy: Cognitive Development Piaget’s Sensorimotor Phase - ◦ “Reflexive” 0 -1 month ◦ “Primary Infancy: Cognitive Development Piaget’s Sensorimotor Phase - ◦ “Reflexive” 0 -1 month ◦ “Primary Reactions” 1 -3 months ◦ “Secondary Reactions” 4 -7 months Separation Cause and effect Object permanence – exist even when not in sight

Infancy: Cognitive Development ◦ Curious - finding out how the world works ◦ Goal Infancy: Cognitive Development ◦ Curious - finding out how the world works ◦ Goal directed ◦ Object permanence - separation anxiety & Stranger Anxiety ◦ Name and identify objects ◦ Associate symbols with events

Infancy: Social/Adaptive Play: ◦ Solitary ◦ Interactive – practice play…. ”what will happen if? Infancy: Social/Adaptive Play: ◦ Solitary ◦ Interactive – practice play…. ”what will happen if? ” Imitate sounds and gestures (older infants) Crying and communication

Interventions during assessment: Infants Record weight, length, and head circumference; plot on growth curve Interventions during assessment: Infants Record weight, length, and head circumference; plot on growth curve Apical HR & RR while quiet Exam on flat surface or parent’s lap Distraction is very effective Save invasive exam until last Orient and explain everything to parent Allow parent to use soothing measures to calm infant Provide toys to occupy/distract infant Use a calm voice and gentle, yet firm, handling Screening and immunizations Safety and injury prevention

TODDLERS: Key Points Experience separation anxiety more frequently Limited ability to understand Can become TODDLERS: Key Points Experience separation anxiety more frequently Limited ability to understand Can become easily frustrated because still have limited ability to express themselves Keep contact to a minimum until child is acquainted Allow to handle equipment before use (Safety is always first) Autonomy vs. Shame & Doubt Always offer a choice (acceptable) Lying down position is last

Toddlerhood: Physical Changes ◦ Weight Average weight gain is 4 -6 lbs/year Average weight Toddlerhood: Physical Changes ◦ Weight Average weight gain is 4 -6 lbs/year Average weight of a 2 -year old is 27 lbs Birth weight quadrupled by 2 ½ years ◦ Height Average growth is 3 inches/year Adult height is usually 2 X height at 2 years Average height of a 2 year old is 34 inches

Toddler Physical Growth ◦ Head circumference 1 inch from age 1 -2 ½ inch Toddler Physical Growth ◦ Head circumference 1 inch from age 1 -2 ½ inch from age 2 -3 Anterior Fontanel closed by 18 months ◦ Teeth 16 teeth by 24 months All 20 teeth by 30 months ◦ Bowel and Bladder Control By 30 months may have daytime control

Toddlerhood: Gross Motor 15 months ◦ Walks unassisted – 13 months ◦ Throws ball, Toddlerhood: Gross Motor 15 months ◦ Walks unassisted – 13 months ◦ Throws ball, falls ◦ Stairs, creeping 18 Months ◦ Throws ball w/o falling ◦ Jumps in place 24 Months ◦ Stairs – 1 foot first ◦ Kicks ball forward 30 Months ◦ Stand on one foot ◦ Jumps from step

Toddlerhood: Fine Motor 15 months ◦ Scribbles ◦ Builds tower 2 blocks ◦ Holds Toddlerhood: Fine Motor 15 months ◦ Scribbles ◦ Builds tower 2 blocks ◦ Holds crayon with fist 18 Months ◦ Builds tower 3 -4 blocks ◦ Turns 2 -3 pages of book at a time ◦ Imitates lines when drawing 24 Months ◦ Builds tower 6 -7 cubes ◦ Turns pages of book 30 Months ◦ Builds tower 8 cubes ◦ Holds crayon with fingers, not fist ◦ Imitates more complex lines when drawing

Toddlerhood: Psychosocial Development Erikson’s “ Autonomy vs Doubt and Shame” “Can I gain some Toddlerhood: Psychosocial Development Erikson’s “ Autonomy vs Doubt and Shame” “Can I gain some independence from my parents? ” ◦ ◦ Independence Egocentrism Negativism – part of the quest for autonomy Ritualism

Toddlerhood: Cognitive Development Piaget’s - Sensorimotor Phase “Tertiary Reactions” ◦ ◦ Active experimentation Causal Toddlerhood: Cognitive Development Piaget’s - Sensorimotor Phase “Tertiary Reactions” ◦ ◦ Active experimentation Causal relationships Object classification Object permanence Piaget’s – Preoperational stage (2+) ◦ Egocentrism

Toddlerhood: Social/Adaptive Body image Language development is very rapid Negativism Rituals and limits Play Toddlerhood: Social/Adaptive Body image Language development is very rapid Negativism Rituals and limits Play is: ◦ Parallel play ◦ Imitation

Interventions during Assessment: Toddlers Allow parent to remain as close as possible Communicate mostly Interventions during Assessment: Toddlers Allow parent to remain as close as possible Communicate mostly with parents, use simple language with toddler Use of distraction techniques during exam Screening and immunizations Safety and injury prevention

PRESCHOOLERS: Key Points Preschoolers are very imaginative and like to show off Increased inquisitiveness PRESCHOOLERS: Key Points Preschoolers are very imaginative and like to show off Increased inquisitiveness and questioning ◦ Loves to participate (handle the equipment) MAGICAL THINKING ◦ Fears begin to develop (e. g. the dark, monsters) Keep parent present Leave underpants and socks on

Preschool: Physical Changes Weight ◦ Average wgt gain is 5 lbs/year ◦ Average wgt Preschool: Physical Changes Weight ◦ Average wgt gain is 5 lbs/year ◦ Average wgt of 3 yr old is 32 lbs; ◦ 5 yr old is 41 lbs Height ◦ Grows ~ 2. 5 to 3 inches/year ◦ Average 4 year old is ~ 40. 5 inches ◦ Length at birth doubles by 4 years Teeth ◦ Eruption of permanent teeth may start at end of 5 th year Bowel and Bladder Control ◦ Daytime by 3 years and nighttime by 5

Preschool: Gross Motor 3 years ◦ Rides Tricycle ◦ Stands on 1 foot – Preschool: Gross Motor 3 years ◦ Rides Tricycle ◦ Stands on 1 foot – few seconds ◦ Climbs stairs alternate feet 4 Years ◦ Skips and hops ◦ Throws overhand ◦ Down stairs alternate feet 5 Years ◦ Catches ball ◦ Jumps rope ◦ Balance on 1 foot, eyes closed

Preschool: Fine Motor 3 years ◦ Tower 9 -10 cubes ◦ Copies circle, Circle Preschool: Fine Motor 3 years ◦ Tower 9 -10 cubes ◦ Copies circle, Circle with facial features 4 Years ◦ Scissors ◦ Lace shoes ◦ Copies square, stick figures 5 Years ◦ Ties shoelaces, dresses self ◦ Copies diamond, triangle, makes letters, numbers

Preschool: Psychosocial Development Erikson’s “Initiative vs Guilt” “Can I do everything I want without Preschool: Psychosocial Development Erikson’s “Initiative vs Guilt” “Can I do everything I want without overstepping my bounds? ”

Preschool: Cognitive Development Piaget’s Preoperational Phase “Preconceptual” Switch from egocentric to social awareness Causality Preschool: Cognitive Development Piaget’s Preoperational Phase “Preconceptual” Switch from egocentric to social awareness Causality Time Magical thinking Piaget’s Preoperational Phase “Intuitive Thought”

Preschool: Social/Adaptive Language ◦ By 4 years, using full sentences Body image ◦ Recognize Preschool: Social/Adaptive Language ◦ By 4 years, using full sentences Body image ◦ Recognize differences in others ◦ Body is a whole Play ◦ Cooperative ◦ Imaginary friends

Interventions for Assessment: Preschoolers Explain everything to child (in simple terms). May use dolls Interventions for Assessment: Preschoolers Explain everything to child (in simple terms). May use dolls and puppets Allow child to make some choices Anticipatory guidance Safety and injury prevention

SCHOOL AGE: Key Points Incorporate into history School is the most important activity Likes SCHOOL AGE: Key Points Incorporate into history School is the most important activity Likes explanation of exam Give child a gown to wear A time of “doing” Feeling of mastery, being productive and accomplishments crucial to self-esteem and selfworth More interested in peer group, therefore less anxiety away from parents

School Age: Physical Changes Height ◦ 2 inches/ year ◦ Growth spurt – 10 School Age: Physical Changes Height ◦ 2 inches/ year ◦ Growth spurt – 10 -12 years Weight ◦ Steady weight gain (6 ½ lbs/yr), obesity** Teeth ◦ Lose baby teeth, about 4/year ◦ Molars erupt - 28 teeth by 12 Secondary sex characteristics ◦ May start developing around growth spurt

School-age Child Average weight gain is 4. 5 to 6. 5 lbs/year Grow ~ School-age Child Average weight gain is 4. 5 to 6. 5 lbs/year Grow ~ 2 inches/year Female Growth Spurt = 9. 5 – 14. 5 yrs Male Growth Spurt = 10. 5 – 16 yrs

School Age: Motor Skills Gross Motor ◦ Large muscle activities ◦ More graceful and School Age: Motor Skills Gross Motor ◦ Large muscle activities ◦ More graceful and coordinated Fine Motor ◦ Hand-eye coordination complete ◦ Fine motor control smoother

School Age: Psychosocial Development Erickson’s “Industry vs Inferiority” “What can I accomplish? How good School Age: Psychosocial Development Erickson’s “Industry vs Inferiority” “What can I accomplish? How good am I? ”

School Age: Cognitive Development Piaget’s “Concrete Operations” ◦ Classification ◦ Conservation ◦ Reversibility School Age: Cognitive Development Piaget’s “Concrete Operations” ◦ Classification ◦ Conservation ◦ Reversibility

School Age: Social/Adaptive Self Image ◦ Based on appearance and accomplishments Play ◦ Games School Age: Social/Adaptive Self Image ◦ Based on appearance and accomplishments Play ◦ Games with rules ◦ Clubs ◦ Same sex friends

Interventions for Assessment: School-Age Explain all procedures, what you are doing. Ask child questions, Interventions for Assessment: School-Age Explain all procedures, what you are doing. Ask child questions, involve them Allow for privacy Recognize achievement and praise Healthy lifestyle choices Safety and injury prevention

The Physical Exam * The Physical Exam *

General Appearance Alertness and Cooperation Growth measurements and Vitals Overall state of development (behavior) General Appearance Alertness and Cooperation Growth measurements and Vitals Overall state of development (behavior) Size (nutrition) Hygiene (cleanliness) Parent-child interaction

Key Points Assess for “Red Flags” Developmentally appropriate** Head to toe approach Gain trust Key Points Assess for “Red Flags” Developmentally appropriate** Head to toe approach Gain trust Assure privacy and safety Anticipatory guidance Save invasive until last

Prenatal Visit • • • Important visit before birth of baby Use time to Prenatal Visit • • • Important visit before birth of baby Use time to introduce yourself and discuss issues like family history, circumcision, feeding methods, car seats, home preparation for infant, visit schedules, safety, and etc. Siblings and their preparation

Hospital Visit Newborn exam within first 12 -24 hours of birth Screening-Newborn metabolic Screen Hospital Visit Newborn exam within first 12 -24 hours of birth Screening-Newborn metabolic Screen Review feeding methods Discuss times when parents should call with concerns Discharge planning

Visit 1 -14 Days of Age Physical Exam Screening-Hearing, Vision, & Metabolic Anticipatory Guidance Visit 1 -14 Days of Age Physical Exam Screening-Hearing, Vision, & Metabolic Anticipatory Guidance

1 -14 Days of Age Very Important Visit to begin to establish a long 1 -14 Days of Age Very Important Visit to begin to establish a long relationship with parents and child

Risk factors for neonatal complications High risk pregnancy ◦ Increases risk of Abortion fetal Risk factors for neonatal complications High risk pregnancy ◦ Increases risk of Abortion fetal death premature delivery prior to 37 weeks gestation IUGR congenital malformations mental retardation

 Acquired health problems ◦ In utero exposure to Poor nutrition Alcohol Drugs/Tobacco Viruses Acquired health problems ◦ In utero exposure to Poor nutrition Alcohol Drugs/Tobacco Viruses or Bacteria HTN DM Maternal age <16 or >40

 Genetic Problems ◦ Chromosomal abnormalities ◦ Congenital anomalies ◦ Inborn errors of metabolism Genetic Problems ◦ Chromosomal abnormalities ◦ Congenital anomalies ◦ Inborn errors of metabolism ◦ Mental retardation ◦ Familial diseases

 Perinatal Complications and Injuries ◦ Occur immediately before or during birth Prolonged or Perinatal Complications and Injuries ◦ Occur immediately before or during birth Prolonged or dysfunctional labor Prolonged ROM risk for chorioamnionitis Increase risk of infection for infant Ruptured placenta previa Increases risk of blood loss

 Birth injuries ◦ Mechanical and anoxic trauma incurred by infant in L&D ◦ Birth injuries ◦ Mechanical and anoxic trauma incurred by infant in L&D ◦ 2 -7 per 1, 000 live births ◦ 2 -3% of infant deaths Risk factors ◦ ◦ Macrosomia Prematurity CPD Breech presentation

Common Neonatal Conditions Milia ◦ Multiple, firm, pearly, whitish/yellow papules scattered over the forehead, Common Neonatal Conditions Milia ◦ Multiple, firm, pearly, whitish/yellow papules scattered over the forehead, nose and cheeks Epstein pearls ◦ Single or multiple superficial lesions that are formed by tissues trapped during embryologic growth occur in 80% of newborns, asymptomatic, don’t enlarge, exfoliate within a few weeks

Erythema toxicum neonatorum ◦ Numerous yellow papules and pustules surrounded by large erythematous rings Erythema toxicum neonatorum ◦ Numerous yellow papules and pustules surrounded by large erythematous rings usually on trunk, face and extremities ◦ Develop 24 -48 hours after birth up to the 10 th day of life ◦ Increased eosinophils noted on smear ◦ 50% of infants develop ◦ Fades spontaneously within 5 -7 days

Mongolian Spots ◦ Patchy areas of hyperpigmentation in which the epithelial cells contain increased Mongolian Spots ◦ Patchy areas of hyperpigmentation in which the epithelial cells contain increased amounts of melanin ◦ Most commonly located over the sacrum and buttocks ◦ Fade with time usually to traces by adulthood

Cleft Lip and Palate Cleft lip ◦ Failure of embryonic structures and surrounding the Cleft Lip and Palate Cleft lip ◦ Failure of embryonic structures and surrounding the oral cavity to join Cleft palate ◦ Failure of the palatal shelves to fuse Various degrees of clefts

 Genetic factors influence cleft lip Cleft lip with or without cleft palate occur Genetic factors influence cleft lip Cleft lip with or without cleft palate occur in 1000 births Cleft palate alone occurs in 1 in 2500 births More common in males than females

 Surgical repair is indicated Special nipples and feeding techniques are used until surgery Surgical repair is indicated Special nipples and feeding techniques are used until surgery Speech evaluation and therapy are needed depending on the severity of the cleft Speech evaluation are necessary in later years Dental restoration is often needed

Preauricular sinus tracts and pits Occur anterior to the pinna Result from imperfect fusion Preauricular sinus tracts and pits Occur anterior to the pinna Result from imperfect fusion of the tubercles of the first and second brachial arches during gestational development, Familial More common in females and African Americans Excision if chronically infected

Umbilical hernia Common finding in African American infants, premature infants and congenital thyroid deficiency Umbilical hernia Common finding in African American infants, premature infants and congenital thyroid deficiency Defect of central fascia beneath the umbilicus Require no therapy (attempts to reduce with tape or coins are ineffective) Spontaneous resolution usually occurs in first years of life Surgical repair by 3 -5 years

Rooting Reflex Touch corner of infant cheek and infant turns head and opens mouth Rooting Reflex Touch corner of infant cheek and infant turns head and opens mouth birth to 3 -4 months

Palmar grasp Place index finger into palm from ulnar side, infant demonstrates flexion of Palmar grasp Place index finger into palm from ulnar side, infant demonstrates flexion of fingers to grasp examiner’s index finger Birth to 3 -6 months

Moro or Startle Reflex Support head and then let drop a few cm or Moro or Startle Reflex Support head and then let drop a few cm or loud noise the infants response is symmetrical abduction of the upper extremities and extension of the fingers Birth-3 -5 months

One Month Visit Interview Physical Exam Screening-Review results of Newborn Hearing Tests, vision & One Month Visit Interview Physical Exam Screening-Review results of Newborn Hearing Tests, vision & Metabolic Testing Anticipatory Guidance Immunizations

Two Month Visit Interview Physical Exam Screening Anticipatory Guidance Immunizations Two Month Visit Interview Physical Exam Screening Anticipatory Guidance Immunizations

Four Month Visit Interview Physical Exam Screening- None specific at this visit Anticipatory Guidance Four Month Visit Interview Physical Exam Screening- None specific at this visit Anticipatory Guidance Immunizations

Six Month Visit Interview Physical Exam Screening- Hemoglobin Anticipatory Guidance Immunizations Six Month Visit Interview Physical Exam Screening- Hemoglobin Anticipatory Guidance Immunizations

Nine Month Visit Interview Physical Exam Screening-Assess Lead Risk and TB risk Anticipatory Guidance Nine Month Visit Interview Physical Exam Screening-Assess Lead Risk and TB risk Anticipatory Guidance Immunizations

One Year Visit Interview Physical Exam Screening-lead level, hemoglobin , PPD if risk Anticipatory One Year Visit Interview Physical Exam Screening-lead level, hemoglobin , PPD if risk Anticipatory Guidance Immunizations

Fifteen Month Visit Interview Physical Exam Screening-Assess lead and TB risk Anticipatory Guidance Immunizations Fifteen Month Visit Interview Physical Exam Screening-Assess lead and TB risk Anticipatory Guidance Immunizations

Eighteen Month Visit Interview Physical Exam Screening-Lead & TB Risk Anticipatory Guidance Immunizations Eighteen Month Visit Interview Physical Exam Screening-Lead & TB Risk Anticipatory Guidance Immunizations

Two Year Visit Interview Physical Exam Screening-Lead & TB Risk, Hyperlipidemia risk Anticipatory Guidance Two Year Visit Interview Physical Exam Screening-Lead & TB Risk, Hyperlipidemia risk Anticipatory Guidance Immunizations

Three Year Visit Interview Physical Exam Screening-Lead & TB risk, hyperlipidemia risk, vision and Three Year Visit Interview Physical Exam Screening-Lead & TB risk, hyperlipidemia risk, vision and hearing Anticipatory Guidance Immunizations

Four Year Visit Interview Physical Exam Screening-Lead & TB risk, Hyperlipidemia risk, Vision and Four Year Visit Interview Physical Exam Screening-Lead & TB risk, Hyperlipidemia risk, Vision and Hearing Anticipatory Guidance Immunizations

Five Year visit Interview Physical Exam Screening-Assess Lead & TB Risk, Assess Hyperlipidemia, Vision, Five Year visit Interview Physical Exam Screening-Assess Lead & TB Risk, Assess Hyperlipidemia, Vision, Hearing, Urinalysis Anticipatory Guidance Immunizations

Six Year Visit Interview Physical Exam Screening-Assess lead & TB Risk, Vision, Hearing, Hyperlipidemia, Six Year Visit Interview Physical Exam Screening-Assess lead & TB Risk, Vision, Hearing, Hyperlipidemia, Anticipatory Guidance Immunizations

Screening Recommendations for preventative pediatric health care (AAP) Newborn screening ◦ ◦ ◦ Phenylktonuria Screening Recommendations for preventative pediatric health care (AAP) Newborn screening ◦ ◦ ◦ Phenylktonuria (PKU) Congenital Hypothyroidism (CH) Galactosemia Congenital. Adrenal Hyperplasia(CAH) Sickle Cell Disease Cystic Fibrosis

Screening/Newborn Screening(Cont) Initial newborn screening specimen should be collected from all infants as close Screening/Newborn Screening(Cont) Initial newborn screening specimen should be collected from all infants as close as possible to time of d/c from hospital and not > 6 days If initial specimen collected < 12 hours a 2 nd specimen should be collected before 2 weeks PCP should be identified prior to d/c for appropriate f/u

Newborn Metabolic Screening Completed with heel stick and the filter paper circles should be Newborn Metabolic Screening Completed with heel stick and the filter paper circles should be completely filled with blood Avoid overlapping circles Allow to dry horizontally at least 4 hours before mailing within 24 hrs of collection. Complete all demographic information

Screening/Vision ◦ Normal Visual Developmental Milestones ◦ Visual Acuity Norms ◦ Pediatric Eye Evaluation Screening/Vision ◦ Normal Visual Developmental Milestones ◦ Visual Acuity Norms ◦ Pediatric Eye Evaluation Screening Recommendations

Screening/Hearing Neonatal Risks Affected family member Bilirubin>20 md/dl Congential CMV, herpes, rubella Defects in Screening/Hearing Neonatal Risks Affected family member Bilirubin>20 md/dl Congential CMV, herpes, rubella Defects in ENT structure Birthweight <1500 gm Use of ototoxic medications>5 days(aminoglycosides, furosemide, salicylates, naproxen) ◦ Mechanical ventilation for cardiopulmonary disease>48 hours ◦ Intracranial hemorrhage ◦ ◦ ◦

Screening/Hearing (Cont) Neonatal screening Infant screening 4 -7 months of age 6 -9 months Screening/Hearing (Cont) Neonatal screening Infant screening 4 -7 months of age 6 -9 months of age ◦ Evoked Otoacoustic Emissions (EOAEs) ◦ Brainstem Auditory Evoked Response(BAER) ◦ Open eyes, blink, startle, change sucking or breathing patterns in response to sounds ◦ Look toward sound ◦ Look for decreased verbal output

Infant Hearing Screening 33 infants born a day in US with permanent hearing loss Infant Hearing Screening 33 infants born a day in US with permanent hearing loss Avg. age child with congenital hearing loss identified was 2. 5 to 3 years of age If not identified early may be difficult to obtain fundamental language

Infant Hearing Screening ABR-Auditory Brainstem Response-measures how the brain responds to sounds. OAEs-Otoacoustical Emisions-Measures Infant Hearing Screening ABR-Auditory Brainstem Response-measures how the brain responds to sounds. OAEs-Otoacoustical Emisions-Measures sound waves produced in the inner ear Both tests are quick-5 to 10 minutes and painless Cost $25 -$40

Screening/Cholesterol No universal screening in children Indications Family Hx Premature CAD A Parent with Screening/Cholesterol No universal screening in children Indications Family Hx Premature CAD A Parent with total Cholesterol >240 mg/dl

Screening/Cholesterol (Cont) Optional Indications for screening ◦ ◦ Cigarette smoking Dietary History Sibling with Screening/Cholesterol (Cont) Optional Indications for screening ◦ ◦ Cigarette smoking Dietary History Sibling with elevated serum cholesterol Physical inactivity

Screening/Anemia Iron deficiency is the most prevalent form of nutritional deficiency in U. S. Screening/Anemia Iron deficiency is the most prevalent form of nutritional deficiency in U. S. Risk is highest during infancy and adolescence because of rapid growth ◦ Full term infants iron stores adequate until 4 -6 months

Screening/Anemia (Cont) AAP-recommends Hct or Hgb screening : ◦ All infants 9 -12 months Screening/Anemia (Cont) AAP-recommends Hct or Hgb screening : ◦ All infants 9 -12 months ◦ Adolescent males during routine PE, during growth spurt ◦ Adolescent females during all routine PEs

Screening/Anemia More frequent screening for patients at risk for anemia At High Risk ◦ Screening/Anemia More frequent screening for patients at risk for anemia At High Risk ◦ Infants and children in low income families ◦ Infants and children eligible for WIC (do at 6 mos) ◦ Infants and children who are migrants or refugee

Screening/Anemia (Cont) Risk factors for Iron Deficiency ◦ ◦ Preterm infants and low birth Screening/Anemia (Cont) Risk factors for Iron Deficiency ◦ ◦ Preterm infants and low birth weight infants Infants fed non-iron-fortified infant formula Infants fed cow’s milk before 12 months Breastfed infants who do not receive adequate iron supplemental foods after 6 months

Screening/Anemia (Cont) ◦ Children with special health needs on medications which lower iron absorption Screening/Anemia (Cont) ◦ Children with special health needs on medications which lower iron absorption (antacids, calcium, phosphorus, magnesium), chronic infection or inflammation, restrictive diets, or extensive blood loss ◦ Diet low in iron ◦ Children with limited access to food because of poverty and neglect

Screening/Lead Lead poisoning is the presence of serum lead levels that cause effects on Screening/Lead Lead poisoning is the presence of serum lead levels that cause effects on multiple organ systems Lead has an affinity for calcium binding proteins and may affect any calcium-mediated process Damage includes disruption of Hgb formation and damage to the nervous system secondary to damage to nerve cells and conduction interference Current toxic level 10 micrograms/dl

Screening/Lead (Cont) Risk factors ◦ Living in/regularly visiting home built before 1950 ◦ Living Screening/Lead (Cont) Risk factors ◦ Living in/regularly visiting home built before 1950 ◦ Living in a house built before 1978 undergoing renovation ◦ Living with sibling or housemate with lead >10 mcg/dl ◦ Living with adult whose hobby/job involves lead exposure ◦ Use of lead based pottery or home remedies with lead ◦ Living near industry likely to release lead into atmosphere

Screening/Lead (Cont) Universal Screening ◦ In communities in which risk of lead exposure is Screening/Lead (Cont) Universal Screening ◦ In communities in which risk of lead exposure is widespread Ages 1 and 2 years All children 36 -72 months of age who have not been screened

Screening/Lead (Cont) Targeted screening ◦ Child resides in a geographic area (a specified zip Screening/Lead (Cont) Targeted screening ◦ Child resides in a geographic area (a specified zip code) in which 27% or more housing was built before 1950 ◦ Child receives services from public assistance ◦ Child’s caretaker answers “yes” or “don’t know” to any of the three basic personal-risk questionnaire Ask for all health supervision visits age 6 mo-6 yr

Screening/Urinalysis AAP ◦ Urinalysis should be performed once at 5 years of age ◦ Screening/Urinalysis AAP ◦ Urinalysis should be performed once at 5 years of age ◦ Dipstick leukocyte esterase testing to screen for STDs in adolescence ◦ Annually for sexually active adolescents

Screening/Hypertension AAP ◦ Annual Blood Pressure recordings after age 3 years Normal Blood Pressure Screening/Hypertension AAP ◦ Annual Blood Pressure recordings after age 3 years Normal Blood Pressure <90 th percentile High-normal >90 th and <95 th percentiles Hypertension >95 th percentile (on 3 separate occasions)

Why Vaccinate? Prevention of disease and illness ◦ ◦ Natural and acquired immunity Active Why Vaccinate? Prevention of disease and illness ◦ ◦ Natural and acquired immunity Active immunity Passive immunity Herd immunity Vaccines cost effective

Vaccine Safety Institute of Medicine-Immunization Review Committee Established in 2001 to address specific vaccine Vaccine Safety Institute of Medicine-Immunization Review Committee Established in 2001 to address specific vaccine safety issues Produced independent reports about each issue Reports available at http: //www. iom. edu/CMS/3793/4705. aspx

Vaccine Controversies MMR Vaccine and Autism Thimersol Containing Vaccines and Neurodevelopmental Disorders Multiple Immunizations Vaccine Controversies MMR Vaccine and Autism Thimersol Containing Vaccines and Neurodevelopmental Disorders Multiple Immunizations and Immune Dysfunction Hepatitis B Vaccine and Demyelinating Neurological Disorders SV 40 Contamination of Polio Vaccine and Cancer Vaccinations and Sudden Unexpected Death in Infancy Influenza Vaccines and Neurological Complications New vaccines and complications (e. g. rotateq)

Additional Issues Informed Consent Parental information distributed once with each type of shot Adverse Additional Issues Informed Consent Parental information distributed once with each type of shot Adverse Events

2009 Immunization Schedule Available at: http: //www. cdc. gov/nip/recs/childschedule. htm Changes ◦ ◦ Divided 2009 Immunization Schedule Available at: http: //www. cdc. gov/nip/recs/childschedule. htm Changes ◦ ◦ Divided in to 2 schedules Rotavirus Flu vaccine HPV

Immunization Schedule Summary of Recommendations from the ACIP (Advisory Committee on Immunization Practices) Catch-up Immunization Schedule Summary of Recommendations from the ACIP (Advisory Committee on Immunization Practices) Catch-up Schedule or Delayed Immunization Schedule

Immunization Forms Blue card (California) Yellow Pocket Card California Immunization Registry (CAIR) and Vaccines Immunization Forms Blue card (California) Yellow Pocket Card California Immunization Registry (CAIR) and Vaccines for Children (VFC) Required for Daycare and WIC

Diptheria & Tetanus Toxoids with Pertussis Vaccines DTP is a trivalent vaccine composed of Diptheria & Tetanus Toxoids with Pertussis Vaccines DTP is a trivalent vaccine composed of diphtheria and tetanus toxoids and killed whole-cell pertussis vaccine DTa. P is also composed of diphtheria and tetanus toxoids but has an acellular pertussis vaccine(preferred)

DTP/DTa. P Td Tdap (Tetanus, diptheria, pertussis) ◦ Usual dose 0. 5 ml IM DTP/DTa. P Td Tdap (Tetanus, diptheria, pertussis) ◦ Usual dose 0. 5 ml IM ◦ 2, 4, 6, 15 -18 mos & 4 -6 yrs ◦ Smaller amount of diptheria toxoid given to patients older than 7 years (need less stimulation for antibody production) ◦ First vaccine for adolescents and adults to protect against all 3 illnesses ◦ For 11 -18 yo

DTP/DTa. P Contraindications to DTP or DTa. P ◦ Immediate anaphylactic reaction ◦ Encephalopathy DTP/DTa. P Contraindications to DTP or DTa. P ◦ Immediate anaphylactic reaction ◦ Encephalopathy within 7 days Precautions to further administration ◦ Convulsion with or without fever (within 3 days) ◦ Persistent inconsolable crying 3 or more hours within 48 hours ◦ Collapse or shock like state within 48 hours ◦ Unexplained temperature higher than 104. 9 within 48 hours

DTP/DTa. P Usual reactions ◦ Moderate to high fever ◦ Local reactions Vaccination of DTP/DTa. P Usual reactions ◦ Moderate to high fever ◦ Local reactions Vaccination of febrile or children with developmental delay can confuse the clinical picture ◦ Work up of fever or neurological concern before immunization-Consult pediatrician or ped neurolgist ◦ Minor respiratory illness is not a contraindication

Polio Vaccine Live polio vaccine (OPV)- no longer used Inactivated polio vaccine (IPV) Polio Vaccine Live polio vaccine (OPV)- no longer used Inactivated polio vaccine (IPV)

Polio AAP recommends all IPV schedule for routine childhood immunization 2, 4, 6 -18 Polio AAP recommends all IPV schedule for routine childhood immunization 2, 4, 6 -18 mos & 4 -6 yrs ◦ Give OPV when: Mass vaccination needed to control outbreaks Unvaccinated child is traveling in less than 4 weeks to area polio endemic A parent doesn’t accept recommended # vaccine doses USE OPV for doses 3&4 (Check with 2008 schedule? )

Polio Risks of Polio Vaccine ◦ Cases of vaccine-associated paralytic polio (VAPP) have occurred Polio Risks of Polio Vaccine ◦ Cases of vaccine-associated paralytic polio (VAPP) have occurred ◦ In children the risk is 1 in 1. 5 million doses ◦ In contact 1 in 2. 2 million doses Risk is greater with administration of 1 st dose and when immunocompromised persons are exposed to live polio virus

Haemophilus Influenzae Type B (HIB) Consists of purified bacterial protein joined to a poly- Haemophilus Influenzae Type B (HIB) Consists of purified bacterial protein joined to a poly- or oligosaccharide that is linked to a protein to enhance antibody stimulation ◦ Dose is 0. 5 ml IM ◦ 2, 4, 6* & 12 -15 mos *see immunization schedule ◦ No severe side effects Low-grade fever and local pain reported

Measles-Mumps-Rubella (MMR) MMR is 0. 5 ml (SQ) for either MMR or its singular Measles-Mumps-Rubella (MMR) MMR is 0. 5 ml (SQ) for either MMR or its singular components ◦ Measles (Rubeola) Live attenuated chick-embryo-prepared virus ◦ Adverse reactions to MMR, is usually a result of the measles component ◦ 12 -15 mos & 4 -6 yrs

MMR Measles adverse reactions ◦ ◦ A fever of 103 degrees Transient rashes Encephalopathy MMR Measles adverse reactions ◦ ◦ A fever of 103 degrees Transient rashes Encephalopathy (rare) Febrile seizures

MMR Contraindications: ◦ Pregnancy, women should not become pregnant 3 months after MMR ◦ MMR Contraindications: ◦ Pregnancy, women should not become pregnant 3 months after MMR ◦ Immunodeficiency or therapeutic immunosuppression, may be given 3 months after therapy has stopped ◦ MMR is recommended in symptomatic and asymptomatic HIV patients who are not severely immunocompromised

MMR contraindications (cont) ◦ TB skin test ◦ Allergy to egg or neomycin ◦ MMR contraindications (cont) ◦ TB skin test ◦ Allergy to egg or neomycin ◦ Steroids

MMR Mumps ◦ Live vaccine ◦ Reactions are rare Reactions are: ◦ Febrile seizures, MMR Mumps ◦ Live vaccine ◦ Reactions are rare Reactions are: ◦ Febrile seizures, rash, pruritis, encephalitis, purpura, orchitis reported Contraindications: ◦ Same as measles

MMR Rubella (German Measles) ◦ Live virus Reactions include Fever, lymphadenopathy, rash, -can occur MMR Rubella (German Measles) ◦ Live virus Reactions include Fever, lymphadenopathy, rash, -can occur 5 -12 days after vaccination arthritis, arthralgia, onset 7 -21 days after immunization paresthesia, pain in extremities, morning knee pain Contraindications are the same as measles May be given postpartum, contraindicated in pregnancy

Hepatitis A Inactivated vaccine May be given with other vaccines Contraindicated in those with Hepatitis A Inactivated vaccine May be given with other vaccines Contraindicated in those with anaphylactic rxn to alum or 2 -phenoxyethanol 2 doses b/t 12 & 24 mos (6 months apart)

Hepatitis B Recombinant vaccine ◦ Given IM ◦ Adverse reactions Rare but include, Pain Hepatitis B Recombinant vaccine ◦ Given IM ◦ Adverse reactions Rare but include, Pain and soreness at immunization site 2 -5% of children develop fever 102 F and irritability ◦ Given at birth, 1 -2 months and 6 months Some may used combined vaccines

Rotavirus FDA approved 2006 Oral vaccine Given at 2, 4, & 6 mos Precautions Rotavirus FDA approved 2006 Oral vaccine Given at 2, 4, & 6 mos Precautions ◦ ◦ ◦ Mod to severe illness Acute GE mod to severe Chronic GI disease Intussuusception Immunocompromised Contraindications: Serious allergic reaction to a vaccine component or prior dose

Pneumococcal Vaccine Effective against 7 most common types of pneumococcus Given at 2, 4, Pneumococcal Vaccine Effective against 7 most common types of pneumococcus Given at 2, 4, 6 & 12 -15 mos Reactions: ◦ Local rxn ◦ Fever Research with more types

Varicella Live-attenuated vaccine, Contains neomycin Given at 12 -15 mos and 4 -6 yrs Varicella Live-attenuated vaccine, Contains neomycin Given at 12 -15 mos and 4 -6 yrs Reactions ◦ Local injection site rxn, rash ◦ 3 -5% generalized rash maculopapular not vesicular can occur 5 -26 days after vaccine ◦ Varicella can be given with MMR (different syringe and sites), if not together 4 week interval

Varicella Contraindications: ◦ ◦ ◦ Allergy to neomycin and gelatin Cellular immunodeficiencies Pregnant women Varicella Contraindications: ◦ ◦ ◦ Allergy to neomycin and gelatin Cellular immunodeficiencies Pregnant women Therapeutic immunosuppression Immunocompromised 1 st degree relative May give with MMR (There is a combined vaccine)

Influenza Vaccine A multivalent embryonic egg vaccine, contains inactivated whole virus, with change periodically Influenza Vaccine A multivalent embryonic egg vaccine, contains inactivated whole virus, with change periodically for anticipation of prevalent strains in upcoming flu season December-March Immunize children with risk factors (asthma, cardiac disease, sickle cell disease, HIV and diabetes and those wanting immunity If 8 years or less and not previously exposed need two doses separated by 4 weeks

Influenza Vaccine Side effects Fever 6 -12 hours after immunization in children less that Influenza Vaccine Side effects Fever 6 -12 hours after immunization in children less that 24 months Local reaction in children > 13 years Contraindication Anaphylactic reaction to chickens or egg protein Given yearly from 6 -59 months (see most current recommendations – 2008)

Meningococcal Vaccine A serogroup-specific quadrivalent vaccine against groups A, C, Y, and W-135 ◦ Meningococcal Vaccine A serogroup-specific quadrivalent vaccine against groups A, C, Y, and W-135 ◦ Recommended for college/university students who live in dorms 1 dose required ◦ Recently approved for use in children 2 and older, however still only recommended/required for tweens/teens

Human Papillomavirus Vaccine Protects against cervical cancer Effective in preventing 4 types of HPV Human Papillomavirus Vaccine Protects against cervical cancer Effective in preventing 4 types of HPV Side effects-local pain 3 doses over a 6 months ◦ Given to girls at 11 -12 yrs

NUTRITION and Breastfeeding General concerns ◦ Childhood overweight and obesity ◦ Vegetarian diets ◦ NUTRITION and Breastfeeding General concerns ◦ Childhood overweight and obesity ◦ Vegetarian diets ◦ Food allergy and hypersensitivity

Newborn and Infants Vitamins ◦ Vitamin supplements are usually not necessary for healthy term Newborn and Infants Vitamins ◦ Vitamin supplements are usually not necessary for healthy term infants who are breastfed or formula fed and after 4 -6 months receive mixed feedings of cereal, fruits, vegetables and proteins ◦ Vitamin D supplements for breastfed infants whose mother’s diets are low, or not exposed to sunlight

Newborn and Infants Iron ◦ Iron deficency is the leading cause of anemia in Newborn and Infants Iron ◦ Iron deficency is the leading cause of anemia in children ◦ Term infants who are breastfed have adequate iron supplies until 4 -6 months ◦ Iron-fortified formulas are excellent sources of iron in infants up to 12 months of age ◦ Iron-fortified cereals are excellent sources of iron in infants 6 -12 months of age ◦ Premature infants who are exclusively breastfed beyond 4 -6 months, or infant’s fed cows milk before age 12 months are at high risk of Fe deficiency anemia

Newborn and Infants Fluoride ◦ American Dental Association recommends beginning fluoride treatment at 6 Newborn and Infants Fluoride ◦ American Dental Association recommends beginning fluoride treatment at 6 months of age ◦ See chart in Burns text, pg. 851 Table 33 -2 for fluoride supplementation ◦ Know fluoride information about local water supplies, every county/city different.

Nutrition needs at each age Infants ◦ 110 kcal/kg body weight ◦ Breast milk Nutrition needs at each age Infants ◦ 110 kcal/kg body weight ◦ Breast milk or formula only first 6 months ◦ Solids to be started at 6 months (4 months? ) Toddlers ◦ 100 kcal/kg ◦ 3 meals and 2 snacks/day ◦ Choking hazards

Nutrition needs cont. Preschoolers ◦ Average 1400 -1800 calories/day ◦ Food jags School-age ◦ Nutrition needs cont. Preschoolers ◦ Average 1400 -1800 calories/day ◦ Food jags School-age ◦ Average 1800 -2200 calories/day ◦ Healthy food choices

American Academy of Pediatrics Policy Statement Human milk is preferred feeding for all infants, American Academy of Pediatrics Policy Statement Human milk is preferred feeding for all infants, with rare exceptions. Exclusive breastfeeding 1 st 6 months, then gradually add solid foods. Breastfeeding should continue 1 st year, and as long as mutually desired.

Dental Health Dental Health

Focus on Prevention of dental heath problems should start early PCP should provide education Focus on Prevention of dental heath problems should start early PCP should provide education during well child exams Important to identify dental problems early

Oral Health in America 2000 Good dental health is related to total health Dental Oral Health in America 2000 Good dental health is related to total health Dental problems may be associated with other health problems The mouth reflects the overall health and well being of an individual

Oral Health in America cont Tooth decay is a problem in children esp. in Oral Health in America cont Tooth decay is a problem in children esp. in lower socioeconomic and minority populations

Dental Care First visit by one year Shortage of Pediatric Dentists Those in lower Dental Care First visit by one year Shortage of Pediatric Dentists Those in lower socioeconomic status may not have insurance or the ability to pay

Dental Development Eruption of teeth at 6 - 7 months 20 primary teeth by Dental Development Eruption of teeth at 6 - 7 months 20 primary teeth by age 3 Eruption of permanent teeth at 6 32 teeth by 13 or 14

Dental Caries Role of infection Overgrowth of Strep Mutans Infant may be inoculated from Dental Caries Role of infection Overgrowth of Strep Mutans Infant may be inoculated from the mother or close caregiver Diet high in sugar Improper bottle feeding

Incidence 20% of children b/t 2 and 5 have caries 80% in poor children Incidence 20% of children b/t 2 and 5 have caries 80% in poor children 17 % of children b/t 12 and 15 have caries 36 % of children lack dental insurance

Assessment History Risk Factors Oral Exam Assessment History Risk Factors Oral Exam

Management Strategies Complete a risk assessment for caries Discuss with parents Refer to a Management Strategies Complete a risk assessment for caries Discuss with parents Refer to a pediatric dentist early Provide education and regarding oral hygiene Determine flouride content of water

Other Dental Health Problems Gingivitis Periodontal disease Dental Malocclusions Other Dental Health Problems Gingivitis Periodontal disease Dental Malocclusions