pediatrics

Introduction

Healthcare for children from birth through adolescence.

Management

• the medical home is the optimal standard of care
• general health
  • physically active children have healthier risk profiles than less-active children
• preventive health
  • vision screening: use risk-assessment approach
  • 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
  • avoid plush animals in the waiting area of clinic
  • window blinds & their cords are a danger to children < 6 years of age
• bone health
  • 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)
• literacy
  • 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)
• 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
• emergency room setting
  • 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
• behavior
  • gradually delaying infant's bedtime or parents' response to infant's crying improves sleep & is not associated with increased stress or emotional problems
• social needs
  • screening for social needs & providing services results improves parent-reported child health

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
• integrating behavioral healthcare with medical care in a collaborative primary care setting may improve child & adolescent health
• 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
• children 1-4 years of age should get at least 180 minutes of physical activity every day
  • for 3 & 4-yar olds 60 minutes of activity should be of moderate-to-vigorous intensity.
• children should get adequate good-quality sleep daily:
  • 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

More general terms

• medical specialty

Additional terms

• health maintenance for infants & children