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Periodic Health Examination

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Periodic Health Examination

Periodic Health Examination

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  • 1. Periodic Health Examination
  • 2.
    • Is an important way to offer preventive services
    • Preventive services consist of screening, counseling, chemoprophylaxis and immunization
  • 3. Birth – 10 years old
    • Ideal timing for PHE of children is controversial
    • Most visits of young children are centered on vaccination schedules
  • 4. Screening
    • Developmental history:
    • 5% of children entering school have speech delay due to developmental issues
    • Developmental assessment at each visit should be done
    • Early discovery , the doctor is more able to intervene
    • Denver Developmental Screening Test*
  • 5.
    • Ht and Wt:
    • Correlate with child’s overall health
    • In smaller children , ht and wt are essential for assessing growth and development
    • Gender specific growth chart s relate length / ht to wt
    • head circumference should be measured in infancy until 2-3yo
  • 6.
    • BP:
    • Give limited but helpful information in younger children <3yo
    • Elev BP in children – more of secondary HPN
    • AAP, AHA : recommend routine screening of asymptomatic children during well-child visits at 3yo
  • 7.
    • Vision:
    • 5-10% of all preschoolers have some type of visual impairment w/c may lead to educational challenges
    • AAP: ocular hx, gross vision assessment, ocular motility assessment, pupil exam & red reflex exam for children bet birth – 3years, 3 – 5 yo: visual acuity screening
  • 8.
    • Visual acuity screening every 1-2 years throughout childhood
  • 9.
    • Hearing:
    • Mod- severe hearing loss correlates with delayed language development
    • Recurrent otitis media- most common cause of hearing impairment in school-aged children
    • AAP: recommend historical evaluation at all well-child visits & objective screenings at 3, 4, 5, 6, 8 &10 yo
  • 10.
    • Otoacoustic emissions & auditory brainsten response testing – standard screening tools for the newborn
  • 11.
    • Physical Examination:
    • Is a screening tool and sets a baseline for a child
    • Performed during a preventive health visit designed to look for any abnomalities
    • These abnormalities need to be followed/treated and discussed with the parents
  • 12. Newborn Screening
    • AAP&AAFP: routine screening for hemoglobinopathies, PKU, and congenital hypothyroidism by heelstick
    • NBS is a simple procedure to find out if your baby has a congenital metabolic disorder that may lead to mental retardation and even death if left untreated.
  • 13. What are the disorders included in the Newborn Screening Package?
    • 1. Congenital Hypothyroidism
    • results from lack or absence of thyroid hormone, which is essential to growth of the brain and the body. If not detected & hormone replacement is not initiated within (4) weeks, the baby's physical growth will be stunted and even mental retardation.
  • 14.
    • 2. CAH is an endocrine disorder that causes severe salt lose, dehydration and abnormally high levels of male sex hormones in both boys and girls
    • 3. Galactosemia is a condition in which the body is unable to process galactose, the sugar present in milk. Accumulation of excessive galactose in the body can cause many problems, including liver damage, brain damage and cataracts
  • 15.
    • 4. Phenylketonuria is a metabolic disorder in which the body cannot properly use phenylalanine. Excessive accumulation of phenylalanine in the body causes brain damage
    • 5. G6PD deficiency is a condition where the body lacks the enzyme called G6PD. Babies may have hemolytic anemia resulting from exposure to certain drugs, foods and chemicals
    • Ideally done on the 48th hour or at least 24 hours from birth.
  • 16.
    • Anemia:
    • CDC: Hb<11g/dL for children 6mos-5yo
    • Hb<11.5 g/dL for 5yo & 10yo
    • Simple oral iron therapy usually corrects these deficits
  • 17.
    • Lead screening:
    • Elevated blood lead levels >10ug/dL have decreased by up to 88% since removal of lead from gasoline, paint, and food cans
    • Lead exposure: decreases IQ & attention span, behavioral &neurodevelopmental deficits
  • 18.
    • Screen serum lead level at about 12 months of age and at 24 months old
    • Counseling should also be done to reduce exposure of children to lead
  • 19.
    • Screening Urinalysis:
    • Used to screen for DM, renal disease, or bladder disease
    • AAP: recommend a screening urinalysis for all children when they are 5 yo
  • 20.
    • Hyperlipidemia:
    • Complications of arterioslerosis continue to be leading cause of death in US
    • Elevated serum cholesterol level-most important risk factor
    • AAP&AMA: recommend screening for hyperlipidemia in children older than 2yo with grand parent/parent with arteriosclerosis before 55yo, or total chole >240 mg/dl
  • 21.
    • Tuberculosis:
    • Risks:
    • Household/ close contact with known TB
    • Patients with HIV
    • Under served low income populations
    • Residents of long-term care facilities
  • 22.
    • Recommendations:
    • Asymptomatic children high risk for TB should be screened with PPD test annually
  • 23.
    • HIV:
    • Infants born to mothers with HIV or to mothers at high risk for HIV butwith unknown status should be tested for HIV by serum tests immediately after birth
  • 24. Counseling:
    • A large portion of the PHE shuold be spent on counseling
    • FP can make the biggest impact by counseling on a few very specific points at the periodic examination
    • It is useful for doctors to develop counseling schedules to incorporate topics into well-child visits so that important subjects do not get overlooked
  • 25. Injury Prevention:
    • Unintentional injuries from MVA & household injuries are leading cause of death in pediatric age group
    • Many of these accidents can be prevented by implementing simple safety recommendations
    • AAP& AAFP: injury prevention counseling be included in well-child visit
  • 26.
    • Bike related injuries is common in 5-14yo children
    • AAP: recommend the use of properly fitting certified helmets for all rider
    • Smoke detectors and fire-resistant clothing reduce death from residential fires & subsequent burns by 2-3 folds
  • 27.
    • Chemicals and medications must be kept out of reach of children
    • Firearm related deaths accounted for 22.5% of all injury deaths in children
    • AAP: guns to be unloaded & stored in a locked area
  • 28.
    • Falls and drowning are major risks of injury & death to children
    • Restricting child’s access to stairs & water sources (pool) can decrease the risk of injury
    • Automobile accidents: parents should be trained in the proper use of restrains
    • As the child grows, they should help buckle themselves
  • 29.
    • Nutrition:
    • Parents should be counseled that breasmilk has the optimal nutrition for infant development
    • It contains antibodies that prevent allergies & infectious diseases
    • AAFP: recommends doctors to encourage all infants to be breastfed a minimum of 6mos & preferably for a full year
  • 30.
    • Smoke exposure:
    • AAFP: supports the prohibition of the use of tobacco products in all public places
    • Also recommends counseling on parents of harmful effects of second-hand smoke to children
  • 31.
    • Dental care:
    • There is some misconception that care of children’s teeth is not important because their teeth are not permanent
    • Early problems with their teeth can cause abnormalities in their permanent teeth
  • 32.
    • At 3 yo, child can begin brushing his teeth w/ small amount of flouride-containing toothpaste if not swallowed
    • Regular dental check up should start at this age also
    • AAP: infants should be discouraged falling asleep using a bottle w/c can promote decay
  • 33. immunizations
    • Childhood immunization Schedule
  • 34. Chemoprophylaxis
    • Ocular antibiotics for newborns:
    • AAFP : all infants should have erythromycin/ tetracycline antibiotic ointment applied to their eyes within 1hr of birth
    • Vitamin K : single IM dose of vit K should be given within 1hr of birth to prevent HDN
  • 35.
    • Flouride:
    • AAFP: flouride supplementation for children >6mos in area with <0.6 ppmof flouride in the water supply
  • 36. adolescence
    • Is a period of rapid change when individuals take many risks
    • The leading cause of death in this age group are MVA, homicide, suicide, malignant neoplasms and disease of the heart
  • 37.
    • Guidelines for preventive services: annual visits to give adolescents and parents opportunities to have important messages reinforced
    • It is important to include parents in preventative visit giving them anticipatory guidance & encouragement& fostering the parent –child relationship
  • 38.
    • Growth & obesity:
    • Growing problem in US
    • It is a risk factor for stroke, CVD, cancers, arthritis, HPN, & DM
    • AAFP: recommend s screening for obesity by measuring Ht & Wt periodically
  • 39.
    • HPN:
    • AAFP cite insufficient evidence for a recommendation on BP screening for children <18yo
  • 40.
    • Hearing & Vision Problems:
    • Cause difficulty in learning & inhibit social interactions
    • AAFP: subjective hearing screens at every well-child visits & objective hearing screens with whispered voice test, otoacoustic emissions or audiograms for ages 10, 12, 15 & 18
  • 41. Sexually Transmitted Disease
    • 46% of HS students engage in sexual activity
    • Chlamydia trachomatis most common STD in US
    • CDC & ACOG: recommend screening of all sexually active females until the age of 20, then screening those at high risk for chlamydia infection after age 20
  • 42. diabetes
    • ADA: recommends screening in adolescent who are overweight & 2 or more risk factors
    • Risk factors: family Hx DM2, black, or hispanic, HPN
  • 43. Alcohol abuse
    • Adolescents believe that drinking is fun & will not have lasting effects
    • AAFP: recommends annual screening for alcohol use & for promoting the avoidance of alcohol
  • 44. adults
    • HPN: primary test used to screen HPN is measurement with mercury/ calibrated aneroid
    • AAFP: periodic screening for HPN for all adults
  • 45.
    • Diabetes :
    • ADA: screening for diabetes & IFG beginning at age 45 or sooner for patients
  • 46.
    • Osteoporosis :
    • Common disease that primarily affects elderly women
    • WHO: bone mineral density <2.5 SD below that of average women
    • Interventions: modification of fall risk, vit D supplementation & pharmacotherapy
  • 47.
    • Thank you