Transcript Preventive Pediatrics ادخ مان هب Dr. Mehran karimi

‫به نام خدا‬
Preventive Pediatrics
Dr. Mehran karimi
What does mean prevention?
Primary
 Secondary
 Tertiary
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Family
Environment hazards
Smoking
Repeated infections
Violence
Child’s health
Genetic
Malnutrition
Media
Accident
???????
Health supervision visit
Assess
Cognitive development
Social
Family life
 Traditional well child visit
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Principles of health supervision visit
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Health promotion
Health means:
Health is not merely the absence of disease but
includes many dimentions of well-being including
physical’ mental’ social’ environmental and
personal.
Partnership
Continuity and coordination
Media influences behavior
Active or passive smoking
Suggested Periodic health
supervision visit
Teeting
First teeth erupt at 6-8 mo.
 No association between teething and:
fever’ diarrhea’ drooling’ mood
disturbances’ appearance of illness’ sleep
disturbances’ red cheek
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Sleep problems
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Frequent night awakening(1th year of life)
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Night walking’ Night terror’ Night mare’
Restless legs’ Noisy breathing’
Parasomnia’….
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Regular bedtime routine starting with a
quiet interaction (Reading a bedtime
story’..)
Toilet training
Average age of successful toilet training is
35-39 mo.
 Early training (<2 y/o) discouraged
(constipation’ encopresis..)
 Readiness of child is important
 Readiness is present if child communicate
with parents before urine or stool passage
 Positive reinforcement and Regular toilet
time is important
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Temper tantrums
Is a normal part of child development
 May be due to anger ‘ stress’ hunger’
unreasonable demand’ Parental
depression’ Family violence
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Growth & Development monitoring
Malnutrition
Obesity
Underweight
Stunting
Wasting
FTT
 Developmental delay (DQ)
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Parental health needs (Depression ’Disability ’
Addiction’..)
 Reducing cardiovascular diseases:
Obesity: Monitor obesity starting at 2 y/o
Fat: No more than 30% of calories
Saturated fat: less than 10% of total calories
Dietary cholesterol: less than 300 mg/day
BP: In every visit starting at 3 y/o
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Screening test
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Newborn screening:
Metabolic screening: newborn (PKU’Hypothyroidism’Galactosemia’..)
Hemoglobin Electrophoresis: newborn
Hearing evaluation: Before discharge of newborn
Hearing evaluation:’ Speech and language development’
Vision: Evaluation of gross motor
 Anemia: At birth if there is risk factors (such as LBW’..)’ At 9 month
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In healthy child’ Adolescence (Once for boys and yearly for girls)
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Urinalysis: 15 month is the preferred age
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Lead poisoning: 9-12 mo or 24 mo. or both
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Cholesterol:
Random cholesterol if one parent with high blood
cholesterol or family history of premature CVD exist.
Cholesterol > 200 mg/dl → Fasting lipoprotein analysis
Cholesterol 170 to 199 → Borderline →average of two
Cholesterol level assessed
Immunization
Vaccination Eradication:
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Smallpox
Polio
Tetanus
Diphtheria
Rubella
Measles
Pertussis
Mumps
Hib Infection
 Pneumococcal Inf.
 Hepatitis B
 Varicella
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‫نام بيماري‬
‫واكسن‬
‫عالئم اختصاري‬
‫سل‬
‫ب‪.‬ث‪.‬ژ‬
‫‪BCG‬‬
‫ديفتري‪،‬كزاز‪،‬سياه‬
‫سرفه‬
‫سه گانه(ثالث)‬
‫‪DTP‬‬
‫دوگانه خردساالن‬
‫‪DT‬‬
‫دو گانه بزرگساالن‬
‫‪Td‬‬
‫پوليو خوراكي‬
‫‪OPV‬‬
‫پوليو تزريقي‬
‫‪IPV‬‬
‫فلج اطفال‬
‫سرخك‪،‬سرخجه‪،‬‬
‫اوريون‬
‫سرخك‪-‬سرخجه‪-‬اوريون‬
‫‪MMR‬‬
‫كزاز‬
‫توكسوئيد كزاز‬
‫‪TT‬‬
‫هپاتيت ب‬
‫هپاتيت ب‬
‫‪Hep.B‬‬
Vaccination program
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At Birth:
2 Month:
4 Month:
6 Month:
12 Month:
18 Month:
4-6 years old:
14-16 years old:
BCG’ OPV’ Hepatitis B*
DPT’ OPV’ Hepatitis B
DPT’ OPV
DPT’ OPV’ Hepatitis B
MMR
DPT’ OPV
DPT’ OPV’MMR
Td
Immunization
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Active Immunization:
Cellular Immune response
Vaccine
Antibody production
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Passive Immunization
Administration of antibody
Constituents of Immunizing Agents
Vaccine
 Toxoids
 Antitoxins
 Immune globulins
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Preservative
Stabilizer
Antibiotic
 Adjuvant
 Suspending fluid
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Adverse Events Following
Immunization
AEFI
Events or reactions observed following
immunization. Some of these events may be due
to the vaccine, some due to error in the
administration of the vaccine
AEFI Classification
Vaccine reaction
 Program error
 Coincidental events
 Injection reaction
 Unknown
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AEFI
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Mild Reactions:
Pain
Swelling
Fever
Iirritability
Malaise
AEFI
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Severe reactions:
Seizures
Thrombocytopaenia
Hypotonic hyporesponsive episodes
Persistent inconsolable screaming
Anaphylaxis
AEFIs (in some common vaccines)
Vaccine
BCG
Hib
Onset
Interval
2-6 months
1-12 months
1-12 months
Rates per
million doses
100 to 1000
1 to 700
2
0-1 hour
0 to 2
1-6 weeks
5-12 days
15-35 days
0-1 hour
5
333
33
1 to 50
Vaccine associated paralytic polio (VAPP)
Persistent (>3 hrs) inconsolable crying
Seizures
Hypotonic, hyporesponsive episode
Anaphylaxis
Encephalopathy
4-30 days
0 -24 hours
0 - 3 days
0-24 hours
0 - 1 hour
0 - 3 days
Post-vaccination encephalitis
Allergic/anaphylaxis
7-21 days
0-1 hour
1.4 to 3.4
1000 to 60000
570
570
20
0 to 1
400 to 4000
(in infants <6
m)
5 to 20
Reaction
Suppurative lymphadenitis
BCG osteitis
Disseminated BCG-it is
Nil known
Anaphylaxis
Hepatitis B
Guillain-Barrè Syndrome (plasma derived)
Febrile seizures
Thrombocytopaenia
Measles/MMR Anaphylaxis
OPV
DTP
Yellow Fever
General contraindications &
Precaution
contraindications
 Serious allergic reaction after a previous vaccine
dose
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Serious allergic reaction to a vaccine component
Precaution
 Moderate to severe illness
No contraindications
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Mild acute illness regardless of fever
Low grade fever
Convalescent phase of illness
Recent exposure to infectious disease
Mild to moderate local reaction to previous dose
Low grade to moderate fever after previous dose
Current antimicrobial therapy
No contraindications
Premature birth(except Hepatitis B)*
 Malnutrition
 Allergy to penicillin and other
antibiotics(except neomycin & streptomycin)
 Breast feeding
 Egg allergy
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(*Premature birth with BW<2 kg
At birth,1,2,6 mo.)
‫نكات مهم‪:‬‬
‫‪ ‬استفاده از واكسن هاي ويروسي زنده(بجز پوليو وتب زرد) در زنان‬
‫حامله ممنوع است بجز موارديكه خطر ابتال بر عوارض آن غالب باشد‪.‬‬
‫‪ ‬اگر كودكي گاماگلوبولين عضالني و يا محصوالت خوني گرفته باشد ‪3‬‬
‫ماه بعد و اگر گاماگلوبولين وريدي گرفته باشد ‪ 6‬ماه بعد بايد واكسن‬
‫ويروسي زنده (بجز پو ليو)را بگيرد‪.‬‬
‫‪ ‬اگر در كودكي به هر علتي طي ‪ 2‬هفته پس از تزريق واكسن ويروسي‬
‫زنده(بجز پوليو) گاماگلوبولين و يا محصوالت خوني تزريق شده باشد‬
‫الزم است درمورد گاماگلوبولين عضالني و يا محصوالت خوني پس از‬
‫‪ 3‬ماه و گاماگلوبولين وريدي پس از ‪ 6‬ماه واكسن تكرار شود‪.‬‬
‫نكات مهم‬
‫‪ ‬در صورتيكه مابين دوزهاي واكسن فاصله اي بيش از‬
‫مقدار توصيه شده باشد نيازي به شروع مجدد سري‬
‫واكسيناسيون ويا تزريق با دوزهاي باالتر نيست‪.‬‬
Hepatitis B
Contraindication:
Severe allergic reaction after a
previous dose
 Precaution:
Moderate to severe acute illness
Infant weighting <2000 gram
 can be administered:
pregnancy
Autoimmune diseases
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AEFI within 48 hours of DTP
vaccinations
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Redness 1/3
doses
Swelling 2/5
Pain
1/2
Systemic Fever
>=38°C
1/2
Collapse 1/1 750
Convulsions 1/1
750
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Vomiting
1/5
Anorexia
1/5
Persistent,inconsola
ble crying (duration
>=3 hours)
1/100
Fever >= 40.5°C
1/330
Drowsiness 1/3
DTP
Precaution:
Contraindication:
Severe AEFI after a
previous dose
 Encephalopathy after
a previous dose
 Progressive neurologic
disorder
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Moderate to severe
illness
 After previous dose:
Fever > 40.5 c
Collapse
Seizure
Persistent crying
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DTP
Can be administered:
After previous dose
T <40.5 c‘ Mild drowsiness’ Fussiness
 Family Hx of
Seizure’ SIDS’ AEFI
 Stable neurologic condition
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DT ’ Td
Contraindication:
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Severe allergic reaction
after a previous dose
Precaution:
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Guillain-Barre
syndrome after a
previous dose
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Moderate to severe
illness
MMR/MR/R
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Contraindication:
Severely Immunocopromised
Congenital Immunodeficiency
HIV Infection
Leukemia
Aplastic anemia
Generalized malignancy
Antimetabolites Therapy
Large amount of Crticosteroids Therapy
Radiation
MMR
Contraindication:
Severe allergic
reaction after a
previous dose
 Pregnancy
 Severe
Immunodeficiency
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Precaution:
 Recent receipt of
antibody-containing
product
 Hx of
Thrombocytopenia or
Thrombocytopenic
purpura
 Moderate to severe
illness
MMR
Can be administered :
+ PPD
 Simultaneous TB skin testing
 Breast feeding
 Pregnancy of mothers
 Close household contacts
 Allergy to eggs
 Asymptomatic or mildly symptomatic HIV
infection
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Immunization of Immunocompromised
children
BCG Contraindicated in:
HIV/Aids’
Severely Immunocopromised
Asplenia
Renal failure
 MMR/MR/R
Severely Immunocopromised
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‫از توجه شما متشكرم‬