HD016

What is the single most cost effective intervention ever undertaken?

4 ways to obtain an adequate immunization history

Child Immunizations Table

Childhood immunization

1. Request a MIMS printout
2. Take a history from the parent(s)/guardian(s):
3. Speak to the child’s physician
4. Call the public health clinic

[image]

HD019

Perinatal Mortality rate

Neonatal Mortality rate

Post-neonatal mortality rate

 
Outside the first year of life, what is the leading cause of death and hospitalization at all ages?

PMR = (Stillbirths + early neonatal deaths (<7 days) ÷ total births) X 1000

Deaths <28 days per 1000 live births
Indicator of medical care

Deaths between 28 days and 1 year per 1000 live births
Indicator of social determinants

Injury

HD019

5 Positive Factors in Teen Development

Healthy Child Manitoba

1. Parental nurturance
2. Parental monitoring (1+2 -> dec aggressive behaviour)
3. School engagement
4. Peer connectedness
5. Community involvement

Community development approach for the well being of Manitoba's children

Includes:

Baby (Families) First Program

Dec child maltreatment

Healthy Baby Program

Prenatal financial benefit to Mothers <$32,000 family income

Community nutrition and support programs

Triple P - Positive Parenting Program

Positive parenting is the single best predictor of positive development
Train-the-trainer approach

HD010

4 Factors that influence infections in infancy, childhood and adolescence

Infections is Newborns

HD020

1. Age
2. Size
3. Maturation (immune system)
4. Underlying disease

Most common infections are sepsis due to:

1. E. coli
2. Group B strep
3. #3 is Lysteria

Sources of infection:

• Congenital & peripartum (Birth)
• Nosocomial infections (Hospital aquired)
• Community acquired infections

“Early onset” = 1st week of life

“Late Onset” = 7 - 30 days

"Late late" = 30 - 90 days

In general newborns have dec Immunological function

Tutorial all over the place -> Read it...wtf

HD028

Injury Defined

Protective Factors (4)

• A predictable and preventable event which causes bodily harm and results from an interaction between a host, an agent and the environment
• The leading cause of death for Canadians aged 1 to 44 years
• kills more children than all childhood diseases combined
• Manitoba exceeds national avg
  

1. Strong family and community (social capital), parental attachment/bonding, emotional support
2. Employment, socioeconomic stability, education
3. Safe homes, workplaces, communities (physical environment)
4. Safe behaviours: use of protective equipment, rules/compliance, substance use/abuse

HD028

Injury Prevention & Injury Control

Injury Prevention E’s

Injury Prevention Plan (4 steps)

Injury Prevention: Prevention of the occurrence of injury, reducing the severity of an injury

Injury Control: The prevention, treatment, and rehabilitation of injuries. Includes first responder system, emergency room, hospital, rehabilitation, community

Education
Environment/Engineering
Enforcement
Economics

Step 1: Identify the problem (Who, What, When, Where, How and Why of the injury)

Step 2: Identify risk and protective factors

Step 3: Identify injury prevention messages and strategies

Step 4: Consider the “Injury Prevention E’s”, resources and partners

HD028

3 Conceptual Models of Injury Prevention

1. Host-agent-environment and transfer of energy

• Looking at interactions between the host, agent and environment that can lead to injuries
• Energy – mechanical, thermal, chemical, electrical, radiation
• Absence of vital energy source can also result in injury

2. Haddon’s countermeasures

1. Strategies put into place to prevent injuries
2. Prevent creation of the hazard – ban fireworks
3. Reduce amount of the hazard – drug packaging
4. Prevent inappropriate release of the hazard – childproof caps
5. Modify rate or spatial distribution – brakes, bumpers
6. Separate release of the hazard in time or space – bike paths
7. Put a barrier between the hazard and people at risk – helmets
8. Change basic nature of the hazard – round corners
9. Increase resistance of people to the hazard – treat seizures
10. Begin to counter damage already done – first aid
11. Stabilization, definitive care, rehab – timing, quality

3. Haddon’s matrix

• Method of analyzing an injury in terms of the Injury Triangle (host, agent, physical environment, socio-cultural environment) and Injury Life Cycle (pre-event, event, post event)
• Aim is to understand the contributions of various factor and strategize to prevent

HD028

What is the leading cause of injury-related death (D) and injury-related hospitalization (H) in:

Infants, Toddlers, Children (5-9, 10-14), Adolescents

Chronic illness in Adolescence (Generally)

Infants (<1)    D = suffocation & drowning    H = falls
Toddlers (1-4)  D = drowning & submersion    H = falls
Children (5-9)   D = motor vehicle crash    H = falls
Children (10-14)  D = motor vehicle crash    H = falls
Adolescents (15-19) D = motor vehicle crash H = self

• 20-30% of teenagers
• Over 85% of children with congenital or chronic conditions now survive into adolescence
• #s are increasing
• Experience of Dual Crisis - FX of diseases and stress of having a disease

HD036

Challenges for Adolescence w/ Chronic Illness

Coping Stratgies (7)

• Challenges related to everyday life – education, employment, family, etc.
• ↓ independence – challenges in school, finding employment
• Relationship with family – changes in family roles → ↑stress
• Sexuality – ↑concerns about sexuality
• Relationship with peers – ↓time spent with peers → interferes with developmental shift from family to peers
• Mental health – anxiety, fear, sadness, hopelessness
• Body image & sense of self-challenge
• ↑ concerns about death, dying

1. Hoping for the best
2. Having the right attitude
3. Knowing what to expect
4. Making some sense out of a bad situation
5. Taking one day at a time
6. Taking time for yourself
7. Staying connected w/ family and friends

HD036

What adolescents want from caregivers

Elements needed for transfer from Ped to Adult care

• Empathy
• Understanding, hope
• To be treated like a person
• Respond to them as they’re the same person, but
• Special treatment when needed
• Have a sense of humour
• Give them options
• Support
• Don’t give up on the patient
• Competence
• Know what you’re doing

From ppt:

• Future-focused orientation to chronic illness
• Preparation for transition should start early—well before entering adolescence
• Anticipate change and develop a flexible plan
• Transfer should take place when young people are developmentally ready rather than a fixed age
• A preparation period and education program
• Foster personal and medical independence and creative problem solving
• Celebrate transitions as they occur
• A policy on timing of transfer
• Transition arrangements should be evaluated
• A coordinated transfer process

From Notes:

∙ Adolescent support
∙ Family support
∙ Professional and environmental support including an interested and capable adult service, primary care involvement, administrative support, management links
∙ Professional sensitivity to the psychosocial issues of chronic illness
∙ A policy on timing of transfer
∙ A preparation period and education program
∙ A coordinated transfer process→transition map

Try HD035 - good stuff

Try HD053 - Also good stuff

HD033

A child in need of protection (section 17(2) Child & Family Services act 1999)

1. Lacks adequate care, supervision, or control

• < 12 YO left unattended without reasonable provision for supervision & safety

2. In the care, custody, control or charge of a person:

• unable/unwilling to provide adequate care, supervision, or control
• whose conduct endangers or may endanger the well-being of the child
•  who neglects or refuses recommended medical or remedial care

3. Likely to suffer harm/injury due to their environment:

• Abused or is in danger of being abused
• Subject to aggression of sexual harassment
• Subject, or is about to become subject, to an unlawful adoption

HD033

CFS act 1999

Child Abuse

Sexual Abuse

Physical Abuse

Sec 43

An act or omission of any person that results in sexual exploitation of the child, physical injury to the child and/or emotional disability (chronic or permanent nature)

• Act (active) chronic verbal attacks on child’s self-esteem
• Omission (passive) failure to meet child’s needs for nurturing

• non-consensual sex – never legal
• < 12YO never legally able to consent
• 12-<14 yrs – age difference < 2 years
• 14-<16 yrs – age difference < 5 years
• >16 yrs – age is not a factor
• Above that exploitive acts (pornography for example) the individual must be >18

• Active – non-accidental trauma
• Passive – lack of supervision that results in physical injury
• Not OK if in child < 12 months, in child with developmental/emotional or physical disability, using an implement, if harm is > than redness (erythema)

Correct of child by force - no objects or slaps to head, does not cause bodily harm

• Schoolteachers no longer justified

HD033

Incidence of Child Abuse

Bruises & Soft tissue Injury

Conditions mimicking Bruises

• Highest rates in children - birth to 3yrs
• 80% abused by one or both parents

• Common sites – head & facial sites over bony prominences, exploratory surfaces (anterior shins, elbows)
• Uncommon – hands, buttocks, cheeks, forearms, chest, back
• Rare in children who are not “pulling to stand” - <9 months
• Pattern related to mechanism of injury
  
  • Strangulation- facial petechiae
  • Pinch marks
  • Bite marks - animal vs human

• “Normal bruises”
• Mongolian spots
• Bleeding disorders
• Phytophotodermatitis
• Hemangiomas
• Striae - “stretch marks”
• Ehlers-Danlos syndrome
• Folk remedies
  
  • cao gio (coining)
  • quat sha (spooning)
  • scarring
  • cupping
• Erythema multiforme
  
  

HD033

 Burns Incidence and Types

Incidence:

• 28% of all abusive injuries
• 10 - 25 % of pediatric burns are abuse
• Scalds account for 45% of all pediatric burns, accidental or abuse
• Highest incidence - under 5 years of age
• Peak age 13 - 24 months

Superficial (1˚) – epidermis only
Partial thickness (2˚) – blisters at dermis/epi layer
Full thickness (3˚) – epidermis & dermis destroyed
4˚ – involves muscle & bone

Types of burns
Flame - less common in abusive injury
Thermal/scald - Most common burn in abused children

Splash/spill, immersion (child falls into hot liquid), forced immersion

Contact - pattern burn; uniform in severity

HD107

Teratogenic Effects on the Fetus is influenced by...

Prevalence of FASD

What area of the brain does it effect in fetus

• Stage of fetal development
• Differences in maternal metabolism
• Differences in vulnerability and suseptibility
• Synergistic effects with other drugs
• Interactions with environmental variables
• Route of administration: IV/IM >po
• Dose:  large vs small, chronic vs binge (>4 drinks in one short period)

• 1.9 per 1000 world wide
• Canadian prevalence estimated at 9 per 1000
• Rates in specific populations may be considerably higher

There is no safe amount
There is no safe time

All

HD107

Fetal Development Chart (Diagram)

HD107

Fetal Alcohol Spectrum Disorder: 3 Types

1. FAS
2. Partial FAS (PFAS)
3. Alcohol Related Neurodevelopmental Disorder (ARND)

FAS:

• Characteristic dysmorphology
• Classic 3 facial: philtrum, palpebral fissures, thin upper lip
• Growth deficiency (retardation of size)
• Neurodevelopmental disorder
• Sensorimotor
• Attention
• Executive function
• Language
• Cognition
• Academic achievement
• Memory
• Adaptive functioning
• Structural brain abnormalities

Partial FAS:

Same FX on dysmorphology and Neuro, but no growth retardation

Alcohol Related Neurodev Disorder (ARND):

Non-dysmorphic, non-growth retarded. All FX just on the brain.

HD107

Other alcohol related birth defects

Tobacco during Pregnancy

1. Cardiac defects
2. Cleft lip or palate
3. Skeletal defects
4. Renal anomalies
5. Ocular anomalies
6. Hearing impairment

• Most common substance legally used in pregnancy
• 25%  of pregnant women smoke
• Increased risk of:
• Spontaneous abortion
• Stillbirth
• Prematurity
• SIDS
• Mechanisms:  direct toxic effects, fetal hypoxia (CO production or nicotine induced vasospasm)
• Some neurodevelopmental effects described

HD107

Marijuana during Pregnancy

Cocaine during Pregnancy

• Most common substance illegally used  in pregnancy
• THC readily crosses placenta
• May remain in body 30 days before excretion increasing fetal exposure (accumulation risk)
• May slow fetal growth with regular use
• Greater difficulties with state regulation, sleep difficulties
• Neurocognitive effects:  executive function, cognitive application (visual integration, sustained attention, memory)

• Dramatic increase over last 2 decades
• Blocks sympathetic reuptake of neurotransmitters
• Readily crosses placenta
• Mechanisms: Direct neurotoxic effects (monoaminergic pathways (DA, NE, 5HT)) and Vascular mediated damage
• Increased maternal risks:
• stillbirth, SA, abruption, maternal stroke/death
  
• Increased fetal risks:
• Prematurity, fetal distress, low birthweight, congenital infections, cerebral infarcts, necrotizing enterocolitis, SIDS
  
• Poorer neurocognitive outcomes:
• Difficulties with state regulation, irritability, tremor, poorer cognitive outcomes, language and motor difficulties, attention

HD107

Heroin durning Pregnancy

Ecstasy / Meth during Pregnancy

• Increased maternal malnutrition, STIs, hepatitis, pulmonary complications, obstetric cx
• Treatment in pregnancy controversial:
• Methadone:  associated with higher birthweights than seen in heroin
• Methadone also associated with NAS
• Increased maternal complications:
• Increased spontaneous abortion, abruption, chorioamnionitis, premature rupture of membranes
• Increased fetal complications:
• Withdrawal/overdose patterns increase risk of in utero hypoxia
• Prematurity, IUGR, perinatal asphyxia
• Neonatal abstinence syndrome – withdrawal of the baby from drugs

• Dramatic increase in use over last few years
• Fetal complications:
• IUGR (3X increased risk), microcephaly, prematurity
• Cardiac, spinal cord, skeletal abnormalities
• Placental abnormalities
• Neonatal abstinence syndrome
• Neurocognitive outcomes:  verbal and spatial memory, visual motor integration, attention

HD107

Neonatal Abstinence Syndrome (NAS)

• Newborn withdrawal at birth
• Heroin, cocain, amphetamine withdrawal usually occurs within first 48 hours
• Acute phase 5-10 days, but may persist for weeks
• State regulation:
• Difficulties with temperature regulation, flushing/sweating
• Sleep disturbances
• Neurological sx:
• Jitteriness, tremulousness, hypertonicity, seizures
• Irritability/high pitched cry/fist sucking
• Respiratory sx:
• Tachypnea, respiratory distress
• GI sx:
• Vomiting, diarrhea
• Feeding difficulties:  poorly coordinated suck/swallow