a glimpse of preventive care in pediatrics - akmg

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.



A glimpse of preventive care

in Pediatrics

Abdulla Ghori, MD Chair of Graduate Medical Education

Vice Chair of Pediatrics

Associate Professor of Pediatrics

Case Western Reserve University

MetroHealth Medical Center

Cleveland, OH



Preventive care before delivery

• Ask yourself if there are serious conditions

that run in your family

• Get the name of the condition from a

relative

• Discuss with your OB about the role of

antenatal diagnosis/management

• Many newer tests becoming available



How to pick a delivery center

• Transitioning from uterine life to extra

uterine life is tough

• Pick a center with neonatology support,

just in case…

• Consider basic CPR training



How to pick a pediatrician

• Well recommended

• Culturally matched

• Continuity of care

• An after hours answering service

• Which hospital is he/she affiliated to

• You may even try meeting your

pediatrician before delivery



Preparing for the baby

• Safety approved car seat – check it out

• A digital thermometer

• Bulb suction

• Etc etc



Prepare the siblings

• Prepare before delivery

• Away on excursion

• Bring him after mother is relaxed on bed

• Have a toy for him

• Do not ask “so how do you like your new

sister”



Some things to pay attention to

• Avoid contact with sick visitors

• Take any fever in a newborn seriously

• When in doubt seek help

• Do not try to treat your young infant

yourself



Follow-up visits

• Follow the recommendations of your Pediatrician

• AAP recommends: NB, 1, 2, 4, 6, 9, 12, 18, 24 months, and then yearly

• Vaccination (shots)

• Follow CDC guidelines

• Any side effect of a vaccine is far less than the same symptom occurring with a true infection

• No relationship between Autism and MMR vaccine



Universal Screening

• Newborn period

– State NB screen

– Critical Congenital Heart Disease – using

pulse-oximetry

– Hearing – 0.1-0.3% of well newborns and 2-

4% of NICU babies have hearing defect



Universal Screening

• Developmental screen – 9, 18, and and 30 mo

– Autism screen – 18, 24 months

• Iron Deficiency – routinely at 12 mo.

• Lead screening-

– regulations slightly different from state to state

– in general recommended at 1 and 2 yrs

– CDC – recommends for all immigrants, refugees, adoptees- 6 mo 16 yr old



Universal Screening

• Oral health screening

– Clean teeth twice daily

– Fluoride containing toothpaste - AAP

– A grain sized toothpaste below 3 yrs and pea

sized above 3 yrs

– Assistance to brush until about 8 years

– Topical Fluoride – AAP and USPSTF

recommend topical application 6 mo to 6 yr



Universal Screening

• USPSTF recommends fluoride 0.7mg/L

water

• Oral Fluoride supplementation (AAP)

– Child at risk (risk questionnaire- 13 questions)

– Fluoride vehicles proved to be inadequate

– Family consumes non fluoridated water



Universal Screening

• Screening for latent TB

– Starting at 1 mo, 6, 12, 24 mo and then

annually thereafter

• Lipid Profile

– Dyslipidemia risk assessment – 2,4,6,8,10 yrs

and then annually thereafter

– Lipid profile – 9-11 yrs and 18-21 yrs



Universal Screening

• Vision Screen – 5-10% of preschool

children have vision defect

– Recommended at 3, 4, 5, 6 years and every

other year after 6 yrs

– Any time parent has a concern with vision



Universal Screening

• HIV screening

– USPSTF recommends routine screening 15-

65 yrs

– Targeted screening in other at-risk population

• Alcohol and substance use

– AAP recommends screening starting at age

11 yrs



Universal Screening

• Depression screen

– Nationwide study - ~29% teenagers reported

feeling sad or hopeless every day for

>2weeks



Universal Screening

• Vit D supplementation- AAP

– Infants – 400 IU

– 1-18 yrs – 600 IU

• How much should your child weigh???

• How tall should your child be ????

• Concept of percentiles



Travel

• Region specific requirements on CDC

website

• India

– All travelers – routine vaccines: DTaP, IPV,

MMR, Varicella, Flu

– Most travelers - Hepatitis A and Typhoid

– Some travelers – Malaria, Hepatitis B, Rabies,

Japanese B Encephalitis



A few suggestions to raise

immigrant children

• There is no reason to rock a baby to sleep

• Teach your baby to self soothe and sleep

herself

• It is a good idea to sleep your baby

separately in a crib and not share your bed

• High incidence with SIDS

• Move your baby to another room at age 6

months




immigrant children

• Teach your child to eat by himself- stop

rewarding for eating

• Do not let them graze

• Permit the child to develop some

independence in thinking and activities

• Guide him to learn rather than giving

answers to everything

• Teach reality, do not fake success every

time




immigrant children

• Disciplining

• “SOS Help For Parents” – an excellent

book. Videos also available

• Actions speak louder than words – no

point yelling or screaming




immigrant children

• Provide exposure – “coconut principle”

• What language to speak at home

• Introduce your child – help him develop an identity

• Children have expectations from you

• There is no harm in saying “Thank you” to your child, however old they are…

• Parental Love is the good principles you instill, not just hugs, kisses and gifts



Disclosures

• No financial affiliations

• Co-author of “Dr Spock’s Baby and Child

Care in India”

• This book is being translated to

Malayalam, by DC books, Kottayam

• The proceeds to authors will be distributed

for charity work in Kerala



THANK YOU

[email protected]

a glimpse of preventive care in pediatrics - akmg

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