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pediatrics

Healthcare for children from birth through adolescence. Management: - the medical home is the optimal standard of care [6] - general health - physically active children have healthier risk profiles than less-active children [4] - preventive health - vision screening: use risk-assessment approach [11] - oral health: fluoride varnish from age 6 months-5 years - depression screening at ages 11 through 21 years - dyslipidemia screening between ages 9 & 11 years - hematocrit or blood hemoglobin at ages 15 & 30 months to detect iron-deficiency anemia - HIV screening between ages 16 & 18 years - no cervical dysplasia screening for adolescents [11] - avoid plush animals in the waiting area of clinic [18] - window blinds & their cords are a danger to children < 6 years of age [19] - bone health [9] - diet rich in calcium & vitamin D should be encouraged - weight-bearing activities (walking, jumping, dancing) are recommended - supplementation & screening for vitamin D deficiency is not recommended - DEXA screening for children with disorders associated with bone fragility - discourage anorexia nervosa phenotype (low calorie intake, amenorrhea, osteopenia, obsession with thinness) [9] - literacy [8] - counsel parents that reading aloud with their young children on a daily basis can enhance their social & emotional development & help prepare them to learn early language & reading skills - educate parents about developmentally appropriate, enjoyable reading activities for their children - provide at-risk children (low-income families) with developmentally, culturally, & linguistically appropriate books during well visits - offer informational materials to parents to support literacy efforts, including information about programs at public libraries & the AAP's literacy toolkit - administration of medications - oral syringes better than cups for measuring liquid medications (~5-fold fewer dosing errors) [15] - drug use (substance abuse) - CRAFFT screening tool for adolescents - insufficient evidence to recommend behavioral intervention to prevent or reduce drug use in children or adolescents [7] - emergency room setting [5] - dedicated child-friendly, calming environment - pediatric-specific visual pain scales modified for developmental delay - pediatric distraction techniques for minimizing anxiety - child life specialists to coach & calm children - family presence during painful procedures - intranasal, mucosal, oral, transdermal, or inhaled analgesia in place of intravenous or intramuscular administration - use of vibrating devices applied over cold packs or topical anesthetics to reduce pain associated with necessary needle sticks - breastfeeding or 12-25% oral sucrose solution for infants < 6 months of age undergoing minor procedures - topical anesthetics for minor laceration repair, lumbar puncture, & abscess drainage - warmed buffered lidocaine injected slowly with a small-gauge needle for deeper-tissue analgesia - tissue adhesives or steri-strips for low-tension wounds - absorbable sutures for higher-tension lacerations - quality improvement program for reviewing pediatric pain management practices - hospitalization - family-centered rounds improves satisfaction & understanding of care during hospitalization [20] - behavior - gradually delaying infant's bedtime or parents' response to infant's crying improves sleep & is not associated with increased stress or emotional problems [14] - social needs - screening for social needs & providing services results improves parent-reported child health [16] Notes: - a child's performance in drawing a picture of his or her family as part of a well-child visit reflects cognitive, motor, perceptual, attentional, & motivational capacities [9] - integrating behavioral healthcare with medical care in a collaborative primary care setting may improve child & adolescent health [10] - children should not be restrained in a high chair or stroller or strapped onto a caregiver's back for more than an hour at a time [21] - children 1-4 years of age should get at least 180 minutes of physical activity every day [21] - for 3 & 4-yar olds 60 minutes of activity should be of moderate-to-vigorous intensity. - children should get adequate good-quality sleep daily: [21] - 14-17 hours at 0-3 months of age - 12-16 hours at 4-11 months of age - 11-14 hours at 1-2 years of age - 10-13 hours at 3-4 years of age

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health maintenance for infants & children

General

medical specialty

References

  1. Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999.
  2. Prescriber's Letter 13(1): 2006 Dosing of OTC products in the pediatric population Detail-Document#: 220107 (subscription needed) http://www.prescribersletter.com
  3. Paller AS et al. New insights about infant and toddler skin: Implications for sun protection. Pediatrics 2011 128:92102 PMID: 21646256 http://pediatrics.aappublications.org/content/128/1/92
  4. Ekelund U et al Moderate to Vigorous Physical Activity and Sedentary Time and Cardiometabolic Risk Factors in Children and Adolescents JAMA. 2012;307(7):704-712 PMID: 22337681 http://jama.ama-assn.org/content/307/7/704.short
  5. Journal Watch. Dec 11, 2012 Reducing Pediatric Pain and Anxiety During Emergency Care Massachesetts Medical Society http://www.jwatch.org - Fein JA et al. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics 2012 Nov; 130:e1391 PMID: 23109683 - Harrison D et al. Sucrose for procedural pain management in infants. Pediatrics 2012 Nov; 130:918. PMID: 23045554
  6. AAP Principles Concerning Retail-Based Clinics Committee on Practice and Ambulatory Medicine Pediatrics. Feb 24, 2014 PMID: 24567015 http://pediatrics.aappublications.org/content/early/2014/02/18/peds.2013-4080.full.pdf+html
  7. Moyer VA et al Primary Care Behavioral Interventions to Reduce Illicit Drug and Nonmedical Pharmaceutical Use in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 11 March 2014 PMID: 24615535 http://annals.org/article.aspx?articleid=1840850 - Patnode CD et al Primary Care Behavioral Interventions to Prevent or Reduce Illicit Drug Use and Nonmedical Pharmaceutical Use in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. Published online 11 March 2014 PMID: 24615613 http://annals.org/article.aspx?articleid=1840852
  8. Council on Early Child Literacy Promotion: An Essential Component of Primary Care Pediatric Practice. Pediatrics; originally published online June 23, 2014 PMID: 24962987 http://pediatrics.aappublications.org/content/early/2014/06/19/peds.2014-1384.full.pdf+html
  9. Young K, Fairchild DG Pediatrics Group Offers Recommendations on Good Bone Health Physician's First Watch, Sept 30, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Golden NH, Abrams SA, COMMITTEE ON NUTRITION Optimizing Bone Health in Children and Adolescents Pediatrics. September 29, 2014 PMID: 25266429 http://pediatrics.aappublications.org/content/early/2014/09/24/peds.2014-2173.full.pdf+html
  10. Rosenbaum Asarnow J et al Integrated Medical-Behavioral Care Compared With Usual Primary Care for Child and Adolescent Behavioral Health. A Meta-analysis. JAMA Pediatr. Published online August 10, 2015 PMID: 10546978 http://archpedi.jamanetwork.com/article.aspx?articleid=2422331 - Kolko DJ The Effectiveness of Integrated Care on Pediatric Behavioral Health. Outcomes and Opportunities. JAMA Pediatr. Published online August 10, 2015 PMID: 26259063 http://archpedi.jamanetwork.com/article.aspx?articleid=2422330
  11. Simon GR, Baker CN, Barden GA et al for the COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE and, BRIGHT FUTURES PERIODICITY SCHEDULE WORKGROUP. 2016 Recommendations for Preventive Pediatric Health Care. Pediatrics. 2015 Dec 7 PMID: 26644492 http://pediatrics.aappublications.org/content/early/2015/12/07/peds.2015-3908
  12. American Academy of Pediatrics 3rd Edition Guidelines, Pocket Guide, Tool & Resource Kit http://brightfutures.aap.org/3rd_edition_guidelines_and_pocket_guide.html
  13. Choosing Wisely American Academy of Pediatrics Ten Things Physicians and Patients Should Question. http://www.choosingwisely.org/doctor-patient-lists/american-academy-of-pediatrics/
  14. Gradisar M, Jackson K, Spurrier NJ et al Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial Pediatrics May 2016 PMID: 27221288 http://pediatrics.aappublications.org/content/early/recent
  15. Yin HS, Parker RM, Sanders LM et al Liquid Medication Errors and Dosing Tools: A Randomized Controlled Experiment. Pediatrics Sep 2016, e20160357 PMID: 27621414
  16. Gottlieb LM, Hessler D, Long D et al. Effects of social needs screening and in-person service navigation on child health: A randomized clinical trial. JAMA Pediatr 2016 Sep 6; PMID: 27599265
  17. Di Anni B, Eng L, Islam I. An Operational Standard for Transitioning Pediatric Patients to Adult Medicine. NEJM Catalyst. Oct 26, 2016 http://catalyst.nejm.org/operational-standard-pediatric-transition-adult/
  18. Young K, Sadoughi S, Sofair A New Guidance Posted on Infection Control in Pediatric Ambulatory Settings. Physician's First Watch, Oct 23, 2017 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Rathore MH, Jackson MA, COMMITTEE ON INFECTIOUS DISEASES Infection Prevention and Control in Pediatric Ambulatory Settings Pediatrics Oct 2017, e20172857 PMID: 29061869
  19. Onders B, Kim EH, Chounthirath T, Hodges NL, Smith GA Pediatric Injuries Related to Window Blinds, Shades, and Cords. Pediatrics Dec 2017 PMID: 29229682 http://pediatrics.aappublications.org/content/early/2017/12/07/peds.2017-2359
  20. Rea KE, Rao P, Hill E, Saylor KM, Cousino MK. Families' experiences with pediatric family-centered rounds: A systematic review. Pediatrics 2018 Feb 6; PMID: 29437931 http://pediatrics.aappublications.org/content/early/2018/02/02/peds.2017-1883
  21. World Health Organization (WHO). April 24, 2019 To grow up healthy, children need to sit less and play more. New WHO guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. https://www.who.int/news-room/detail/24-04-2019-to-grow-up-healthy-children-need-to-sit-less-and-play-more - World Health Organization (WHO). 2019 GUIDELINES ONPHYSICAL ACTIVITY, SEDENTARY BEHAVIOUR AND SLEEPFOR CHILDREN UNDER 5 YEARS OF AGE https://apps.who.int/iris/bitstream/handle/10665/311664/9789241550536-eng.pdf
  22. Canadian Society for Exercise Physiology 24-Hour Movement Guidelines for Children and Youth http://www.csep.ca/view.asp?x=696