MA.

CATHERINE DONES,
MD, DPPS PREVENTIVE PEDIATRICS
 • Preventive pediatrics starts with prenatal education and counseling.
This includes the following except:

a. Breastfeeding
b. Newborn Care and Procedures at Birth
c. Tetanus Toxoid Immunization for mothers
d. None of the above
 • Preventive pediatrics starts with prenatal education and counseling.
This includes the following except:

a. Breastfeeding
b. Newborn Care and Procedures at Birth
c. Tetanus Toxoid Immunization for mothers
d. None of the above
PRENATAL EDUCATION

¡ Either thru mothers’ class or face to face counseling with a healthcare professional or social
worker,/ barangay health worker
¡ Includes the following areas of concern
¡ Breastfeeding
¡ Newborn care and procedures at birth
¡ Prevention of smoking, alcohol intake and teratogen exposure
¡ Maternal tetanus toxoid immunization
¡ Maternal nutrition (including folic acid supplementation)
The Essential Intrapartum and Newborn Care (EINC) program , or Unang
Yakap, emphasizes performance of the following four core actions, except

a. Immediate and thorough drying of the newborn

b. Early bathing and foot printing
c. Early skin to skin contact between mother and newborn
d. Properly-timed cord clamping and cutting
The Essential Intrapartum and Newborn Care (EINC) program , or Unang
Yakap, emphasizes performance of the following four core actions, except

a. Immediate and thorough drying of the newborn

b. Early bathing and foot printing
c. Early skin to skin contact between mother and newborn
d. Properly-timed cord clamping and cutting
UNANG YAKAP / ESSENTIAL INTRAPARTUM AND NEWBORN CARE

¡ 4 core actions: ¡ Unnecessary interventions

1. Immediate and in newborn care
thorough drying of the ¡ Routing suctioning
newborn
¡ Early bathing
2. Early skin to skin
contact between ¡ Routine separation from
mother and newborn mother
¡ Foot printing
3. Properly-timed cord
clamping and cutting ¡ Application of substances in
to the cord
4. Non-separation of
newborn and mother ¡ Giving artificial milk
for early breastfeeding formula/breastmilk substitutes
OTHER RECOMMENDED PROCEDURES AT INFANT’S BIRTH

¡ Early rooming-in
¡ Kangaroo mother care
¡ newborn screening
¡ Hearing screening
¡ Immunizations at birth: Hepatitis B and BCG
BREASTFEEDING
What is the perfect first food for the newborn?
 What is the perfect first food for the newborn?
COLOSTRUM

Latching-on and breastfeeding must be done on the first 30 minutes to 1 hour after delivery
What are the benefits /advantages of breastfeeding?

a. Promotes emotional bonding between baby and mother

b. Protects the mother’s health against cancer, obesity and post-partum hemorrhage
c. Contains DHA which enhances brain development and intelligence of the baby
d. All of the above
What are the benefits /advantages of breastfeeding?

a. Promotes emotional bonding between baby and mother

b. Protects the mother’s health against cancer, obesity and post-partum hemorrhage
c. Contains DHA which enhances brain development and intelligence of the baby
d. All of the above
BENEFITS AND ADVANTAGES OF BREASTFEEDING

¡ Safe, sterile, always available

¡ With nutrients to sustain baby’s growth and ¡ Promotes emotional bonding between mother
development from birth to 6 months – and and baby
even after 6 months with adequate ¡ Protect mother from cancer (breast, ovaries
complementary food and uterus), obesity and post-partum
¡ Easily digested and absorbed for baby’s hemorrhage
immature system ¡ Promotes early return to pre-pregnancy weight
¡ Has antibodies as protection against infection ¡ Big financial savings
¡ Has fats (DHA) to enhance brain development
 a. The head, back and hips should be straight, facing the
Which of the breast

following is not a b. Support the breast with the opposite hand in a C-

hold position: thumb above, 4 fingers under the breast
correct c. Stimulate the baby to open his mouth, chin should
breastfeeding touch the breast and lower lip turned inward.
technique? d. Allow baby to suck 15-30 minutes per breast for 8-10
times or more per day
 a. The head, back and hips should be straight, facing the
Which of the breast

following is not a b. Support the breast with the opposite hand in a C-

hold position: thumb above, 4 fingers under the breast
correct c. Stimulate the baby to open his mouth, chin should
breastfeeding touch the breast and lower lip turned inward.
technique? d. Allow baby to suck 15-30 minutes per breast for 8-10
times or more per day
CORRECT BREASTFEEDING TECHNIQUES

¡ Support the baby’s head and the entire body

¡ Infant’s mouth stimulated to open by stroking
throughout feeding. Head, back and hips should
the corner of baby’s lips, chin should touch the
be facing the breast and aligned in a straight
breast and lower lip turned OUTWARD
manner
¡ Allow baby to suck 15 to 30 minutes per breast
¡ Position of the baby: face to face, chest to chest
to extract both foremilk and hindmilk
and tummy to tummy with the mother
¡ Empty the breast around 8 to 10 times or more
¡ Breast should be supported with opposite hand:
a day to ensure adequate milk supply
thumb above and 4 fingers under the breast
A new mother had just come back to work and asked you about her pumped
breastmilk. She is currently storing it on the freezer of their 2-door refrigerator.
How long do you think her stored expressed milk would last?

a. 4 hours
b. 8 days
c. 2 weeks
d. 3 months
A new mother had just come back to work and asked you about her pumped
breastmilk. She is currently storing it on the freezer of their 2-door refrigerator.
How long do you think her stored expressed milk would last?

a. 4 hours
b. 8 days
c. 2 weeks
d. 3 months
RECOMMENDED BREASTMILK STORAGE PERIOD

PLACE OF STORAGE/ TEMPERATURE STORAGE PERIOD

Room temperature (<25C) 4 hours
Room temperature (>25C) 1 hour
Refrigerator (4C) 8 days
Freezer compartment of a 1-door refrigerator 2 weeks
Freezer compartment of a 2-door refrigerator 3 months
Deep freezer with constant temperature (-20C) 6 months
You are an attending
pediatrician to a newborn
born to a 28 year old a. Complicated antepartum, intrapartum and
G2P2 (2002) mother with postpartum courses for both mother and
uneventful prenatal history.
Newborn is born term via newborn
NSD at 38 wks AOG, at b. Vaginal delivery, singleton, completed 36
3kg, with AS 9,9 AGA. On
his 1st day of life, the
weeks, AGA
mother requests you to c. With noted jaundice in the 12th hour of life
discharge her baby. Which
is a criterion for discharge d. Has urinated and passed at least one stool
among newborns before
48 hours?
You are an attending
pediatrician to a newborn
born to a 28 year old a. Complicated antepartum, intrapartum and
G2P2 (2002) mother with postpartum courses for both mother and
uneventful prenatal history.
Newborn is born term via newborn
NSD at 38 wks AOG, at b. Vaginal delivery, singleton, completed 36
3kg, with AS 9,9 AGA. On
his 1st day of life, the
weeks, AGA
mother requests you to c. With noted jaundice in the 12th hour of life
discharge her baby. Which
is a criterion for discharge d. Has urinated and passed at least one stool
among newborns before
48 hours?
 MINIMUM CRITERIA FOR DISCHARGING NEWBORNS <48HRS

¡ Uncomplicated antepartum, intrapartum, and postpartum courses for both mother and newborn
¡ Vaginal delivery, singleton, completed 37 weeks AGA
¡ Normal and stable VS during the preceding 12 hours
¡ Urinated and passed at least one stool
¡ With documented proper latch, milk transfer, swallowing, infant satiety and with no nipple discomfort
¡ Normal physical examination
¡ No significant jaundice in the first 24 hours
¡ Ability of parents to take care of their child
¡ Must follow up within the next 48 hours
Newborns discharged <48 hrs after delivery must have a
follow up consult within 48 hours of discharge
OPTIMAL TIME OF DISCHARGE OF HEALTHY TERM NEWBORN IS ALWAYS DECIDED BY PHYSICIANS
 WHAT ARE FOLLOW UP VISITS FOR?

¡ Assess infant’s general health, hydration, presence of jaundice and weight.

¡ Identify any new problems and obtain evidence of adequate urination and defecation thru history
¡ Reinforce maternal and family education on infant care
¡ Review feeding pattern and technique
¡ Assess mother - infant interaction
¡ Review laboratory results done prior to discharge
¡ Perform screening tests – if not yet done
¡ Encourage compliance to recommended schedule of follow-up and preventive care
NEWBORN SCREENING
A newborn born 36 weeks, weighing 1.8kg is admitted at the NICU. She is septic,
on antibiotics and scheduled to have exchange transfusion. The nurses are asking
when should the newborn screening be done. As her doctor, you would say

a. Can be done before 24 hours from birth; with repeat test at 28th day of life
b. Can be done before 24 hours from birth; no repeat test required
c. Immediately after 24 hours from birth
d. None of the above
A newborn born 36 weeks, weighing 1.8kg is admitted at the NICU. She is septic,
on antibiotics and scheduled to have exchange transfusion. The nurses are asking
when should the newborn screening be done. As her doctor, you would say

a. Can be done before 24 hours from birth; with repeat test at 28th day of life
b. Can be done before 24 hours from birth; no repeat test required
c. Immediately after 24 hours from birth
d. None of the above
OBLIGATION TO INFORM THE
PARENTS OR LEGAL GUARDIAN OF
THE NEWBORN OF THE AVAILABILITY,
NATURE AND BENEFITS OF
NEWBORN SCREENING
ARTICLE 3 SECTION 54 OF THE NEWBORN SCREENING
ACT OF 2004 / REPUBLIC ACT NO. 9288
 NEWBORN SCREENING REFERENCE CENTER
MEMORANDUMS

2014-015 2014-015

¡ Newborn screening should be ideally done ¡ Preterm (<37 weeks), low birthweight (<2kg)
immediately after 24 hours from birth and sick neonates (in NICU) may do NBS
before 24 hours from birth IF blood transfusion
will be done.
¡ Repeat screening should be done at the 28th
day of life
Which of the
a. Alpha Thalassemia
following
b. Galactosemia
disorders can only
c. Congenital Adrenal Hyperplasia
be screened using
d. Glucose -6-Phosphate Dehydrogenase
the expanded Deficiency
newborn
screening?
Which of the
a. Alpha Thalassemia
following
b. Galactosemia
disorders can only
c. Congenital Adrenal Hyperplasia
be screened using
d. Glucose -6-Phosphate Dehydrogenase
the expanded Deficiency
newborn
screening?
NEWBORN SCREENING
¡ Congenital hypothyroidism
¡ Congenital Adrenal Hyperplasia
¡ Phenylketonuria
¡ Galactosemia
¡ Glucose-6-Phosphate Dehydrogenase
Deficiency
¡ Maple Syrup Urine Disease
EXPANDED NEWBORN SCREENING
¡ Congenital hypothryroidism ¡ Methylmalonic Acidemia
¡ Congenital Adrenal Hyperplasia ¡ Multiple Carboxylase Deficiency
¡ Homocystinuria ¡ Proprionic Acidemia
¡ Hypermethioninemia ¡ Citrullinemia
¡ Maple Syrup Urine Disease ¡ Cystic Fibrosis
¡ Phenylketonuria ¡ Alpha / Beta Thalassemia
¡ Tyrosinemia ¡ Hemoglobin C/D/E
¡ Carnitine Palmioyltransferase Deficiency ¡ Biotinidase Deficiency
¡ Carnitine Uptake Deficiency ¡ Galactosemia
¡ Glutaric Acidemia Type II ¡ Glucose-6-Phosphate Dehydrogenase Deficiency
¡ Very Long / Long / Medium / Short Chain Hydroxyacyl-coA
Dehydrogenase Deficiency
¡ 3 – Methylcrotnyl CoA Carboxylase Deficiency
¡ Glutaric Acidemia Type I
¡ Isovaleric Acidemia

***This has been made available since December 2014.

NEONATAL HEARING SCREENING
A 10 day old baby was brought to your clinic for well baby consult. He was born
term, delivered by a midwife at home. When should you schedule the baby for his
newborn hearing screening?

a. Within the first 3 months of life

b. Within the first 4 months of life
c. Within the first 5 months of life
d. Within the first 6 months of life
A 10 day old baby was brought to your clinic for well baby consult. He was born
term, delivered by a midwife at home. When should you schedule the baby for his
newborn hearing screening?

a. Within the first 3 months of life

b. Within the first 4 months of life
c. Within the first 5 months of life
d. Within the first 6 months of life
UNIVERSAL NEWBORN HEARING SCREENING AND INTERVENTION
ACT OF 2009 (RA NO. 9709)

SECTION 5: OBLIGATION TO INFORM

¡ Prior to delivery, the parent / guardian of the newborn shall be informed of the availability,
nature and benefits of hearing loss screening among newborns/ infants 3 months and
below

SECTION 6: OBLIGATION TO PERFORM

¡ All infants born in hospitals are required to undergo newborn hearing loss screening
before discharge
¡ For those who are not born in hospitals, screening should be done within the first 3
months of life
 FOR POSITIVE NEWBORN HEARING LOSS SCREENING RESULT

Audiologic diagnostic evaluation for follow-up, recall and referral for intervention
should be done before 6 months of age
 WELL CHILD CONSULTS
Every well child visit must be an opportunity to evaluate the overall development of the child.
ANTHROPOMETRICS
The height/length,
a. If the child is less than 2 years old, measure the
not just the weight, recumbent length
should always be b. If the child is 2 years old and more, measure the
determined every recumbent length
clinic visit. Which c. If the child is less than 2 years old but cannot/would
statement is true not lie down, just take the standing height and
regarding the WHO subtract 0.7cm to get the length

Child Growth d. If the child is 2 years old or more but cannot / would
not stand, measure the recumbent length and add
Standard 0.7cm to convert it to height
Recommendations?
The height/length,
a. If the child is less than 2 years old, measure the
not just the weight, recumbent length
should always be b. If the child is 2 years old and more, measure the
determined every recumbent length
clinic visit. Which c. If the child is less than 2 years old but cannot/would
statement is true not lie down, just take the standing height and
regarding the WHO subtract 0.7cm to get the length

Child Growth d. If the child is 2 years old or more but cannot / would
not stand, measure the recumbent length and add
Standard 0.7cm to convert it to height
Recommendations?
WHO CHILD GROWTH STANDARDS RECOMMENDATIONS

<2YRS
• Recumbent length
OLD

WILL NOT • standing height

LIE +0.7cm
DOWN
WHO CHILD GROWTH STANDARDS RECOMMENDATIONS

≥ 2YRS • Standing
OLD height

WILL NOT • Recumbent

length -
STAND 0.7cm
WHO CHILD GROWTH STANDARDS RECOMMENDATIONS

WEIGHT FOR LENGTH / HEIGHT

¡ Reliable growth indicator even when age is
¡ Reference standards for weight, height
unknown
and head circumference
¡ Interpretation of growth points
SHOULD BE based on Z scores, NOT
percentile scores BODY MASS INDEX (BMI)
¡ Early detection and prevention of overweight
and obesity problems
VITAL SIGNS
According to the Pediatric Nephrology Society of the Philippines, the blood
pressure of all children should be measured routinely starting at what age?

a. Birth
b. 1 year old
c. 3 years old
d. 5 years old
According to the Pediatric Nephrology Society of the Philippines, the blood
pressure of all children should be measured routinely starting at what age?

a. Birth
b. 1 year old
c. 3 years old
d. 5 years old
WHEN SHOULD BLOOD PRESSURE BE CHECKED AMONG KIDS?

¡ Should be measured at least annually for all children 3 years old and above
¡ Should be determined in every ill consults
¡ Should be done among the following patients:
¡ at risk for obesity
¡ taking medications known to increase BP
¡ have renal disease
¡ with history of aortic obstruction or coarctation
¡ diabetics
 NO AVAILABLE POPULATION- BASED BP LEVELS OF FILIPINO
CHILDREN YET
NORMATIVE BP TABLES HAVE BEEN RECOMMENDED BASED ON AGE, GENDER AND HEIGHT
BP LEVELS INTERPRETATION

1-13 years old >13 years old Recommendations

Normal BP <90th percentile <120/80mmHg Encourage healthy diet , sleep
<120/80 mmHg and exercise
Elevated BP >90th to <95th percentile 120 - 129/ <80mmHg Obese: Counseling on physical
or 120/80mmHg activity and proper diet
Investigate on CKD, DM, heart
failure
Stage 1 hypertension >95th percentile to <95th 130 -139/80- 89mmHg Refer
percentile +12mmHg
OR
130 - 139/ 80 - 89mmHg
Steg 2 hypertension >95 percentile +12 mmHg >140/90mmHg Refer
OR
>140/90 mmHg
A 4 6/12 yo boy, Jin, is
brought to the clinic for a
well child consult. a. Normal
Anthropometrics reveal b. Elevated
weight of 16kg and height
c. Stage 1 hypertension
of 110cm. His blood
pressure is 104/63mmHg. d. Stage II hypertension
How would you interpret
his BP?
A 4 6/12 yo boy, Jin, is
brought to the clinic for a
well child consult. a. Normal
Anthropometrics reveal b. Elevated
weight of 16kg and height
c. Stage 1 hypertension
of 110cm. His blood
pressure is 104/63mmHg. d. Stage II hypertension
How would you interpret
his BP?
 JIN 4 6/12YO BOY
HOW TO USE THE NORMATIVE BP TABLES HT : 110CM – 90th P

2 to 20 years: Boys NAME

Stature-for-age and Weight-for-age percentiles RECORD #

12 13 14 15 16 17 18 19 20
Mother’s Stature Father’s Stature cm in
Date Age Weight Stature BMI*
AGE (YEARS) 76
95
190
74
90
185 S
75
72
180 T
50 70 A
175 T
25 68 U
170 R
10 66
165 E
in cm 3 4 5 6 7 8 9 10 11 5
64
160 160

1. Determine the height percentile of the patient using

62 62
155 155
S 60 60
T 150 150
A 58
145

the US-CDC-NCHS growth chart

T
U 56
140 105 230
R
54
E 135 100 220
52
130 95 95 210
50
125 90 200
90
48 190
120 85
46 180
115 80
75
44 170
110 75
42 160
105 50 70
150 W
40
100 65 140 E
25
38 I
95 60 130 G
10
36 90 5 H
55 120
T
34 85 50 110
32 80 45 100
30
40 90
80 35 35 80
W 70 70
30 30
E 60 60
I 25 25
G 50 50
H 20 20
40 40
T
15 15
30 30
10 10
lb kg AGE (YEARS) kg lb
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Published May 30, 2000 (modified 11/21/00).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
the National Center for Chronic Disease Prevention and Health Promotion (2000).
http://www.cdc.gov/growthcharts
 JIN 4 6/12YO BOY
HT : 110CM – 90th P
HOW TO USE THE NORMATIVE BP TABLES
BP: 104/63 mmHg

1. Determine the height percentile of the patient using

the US-CDC-NCHS growth chart
2. Measure and record the patient’s SBP and DBP
 JIN 4 6/12YO BOY
HT : 110CM – 90th P
HOW TO USE THE NORMATIVE BP TABLES
BP: 104/63 mmHg

1. Determine the height percentile of the patient using

the US-CDC-NCHS growth chart
2. Measure and record the patient’s SBP and DBP
3. Use the correct gender table for SBP and DBP
 JIN 4 6/12YO BOY
HT : 110CM – 90th P
HOW TO USE THE NORMATIVE BP TABLES
BP: 104/63 mmHg
HEIGHT
PERCENTILE
1. Determine the height percentile of the patient using
the US-CDC-NCHS growth chart
2. Measure and record the patient’s SBP and DBP
3. Use the correct gender table for SBP and DBP
4. Find the child’s age on the column at the left side of
the table. Follow the age row horizontally across the
table to intersect with the vertical column of the
child’s height percentile

AGE
 JIN 4 6/12YO BOY
HT : 110CM – 90th P
HOW TO USE THE NORMATIVE BP TABLES
BP: 104/63 mmHg

1. Determine the height percentile of the patient

using the US-CDC-NCHS growth chart
2. Measure and record the patient’s SBP and DBP
3. Use the correct gender table for SBP and DBP
4. Find the child’s age on the column at the left side
of the table. Follow the age row horizontally
across the table to intersect with the vertical
column of the child’s height percentile
 JIN 4 6/12YO BOY
HT : 110CM – 90th P
HOW TO USE THE NORMATIVE BP TABLES
BP: 104/63 mmHg
1. Determine the height percentile of the patient using
the US-CDC-NCHS growth chart
2. Measure and record the patient’s SBP and DBP
3. Use the correct gender table for SBP and DBP
4. Find the child’s age on the column at the left side of
the table. Follow the age row horizontally across
the table to intersect with the vertical column of
the child’s height percentile
5. Find the SBP on the left column of the table and the
DBP on the right column. Find the corresponding
BP percentile on the vertical column to the right of
the age
 JIN 4 6/12YO BOY
HT : 110CM – 90th P
BP LEVELS INTERPRETATION BP: 104/63 mmHg

1-13 years old >13 years old Recommendations

Normal BP <90th percentile <120/80mmHg Encourage healthy diet , sleep
and exercise
Elevated BP >90th to <95th percentile 120 - 129/ <80mmHg Obese: Counseling on physical
or 120/80mmHg activity and proper diet
Investigate on CKD, DM, heart
failure
Stage 1 hypertension >95th percentile to <95th 130 -139/80- 89mmHg Refer
percentile +12mmHg
OR
130 - 139/ 80 - 89mmHg
Steg 2 hypertension >95 percentile +12 mmHg >140/90mmHg Refer
OR
>140/90 mmHg
DEWORMING
Upon history, Jin –at 4 yrs of age - has not been dewormed yet. You tell the mother
that you wanted to give Jin antihelminthics since the DOH recommends deworming
of all children. It is recommended that:

a. Albendazole be given 12-23 months at 200mg single dose every 6 months

b. Albendazole be given for kids 24 months and above with single dose of 400mg every
6 months
c. Mebendazole given orally at 500mg single dose every 6 months for kids 1 year old
and above
d. All of the above
Upon history, Jin –at 4 yrs of age - has not been dewormed yet. You tell the mother
that you wanted to give Jin antihelminthics since the DOH recommends deworming
of all children. It is recommended that:

a. Albendazole be given 12-23 months at 200mg single dose every 6 months

b. Albendazole be given for kids 24 months and above with single dose of 400mg every
6 months
c. Mebendazole given orally at 500mg single dose every 6 months for kids 1 year old
and above
d. All of the above
 DOH ADMINISTRATIVE ORDER 2015-0054
STATED THAT DEWORMING FOR CHILDREN 1-12 YEARS OLD SHOULD BE
GIVEN IN THE FOLLOWING DOSES AND SCHEDULE

ALBENDAZOLE
¡ 12 to 23 months: 200mg single dose MEBENDAZOLE
every 6 months ¡ 12 months and above: 500mg single
¡ 24 months and above: 400mg single dose every 6 months
dose every 6 months

*** SHOULD BE GIVEN ON

FULL STOMACH
Jin’s mother said her son
had 2 episodes of vomiting
last night. At the moment,
Jin is asymptomatic , with a. Yes
normal PE findings on b. No
examination. Would you
still proceed with the
deworming?
Jin’s mother said her son
had 2 episodes of vomiting
last night. At the moment,
Jin is asymptomatic , with a. Yes
normal PE findings on b. No
examination. Would you
still proceed with the
deworming?
CONTRAINDICATIONS ON DEWORMING AMONG CHILDREN:

¡ Severe malnutrition
¡ High grade fever
¡ Profuse diarrhea
¡ Abdominal pain
¡ Serious illness
¡ Previous hypersensitivity to antihelminthic drug
Lisa, a 7 year old girl, came to your clinic with her mother. Their family originally resided at Occidental
Mindoro, but relocated since the father was assigned to Manila. Mother stated that Lisa was given unrecalled
medications as part of the National Filariasis Elimination Program of the DOH. What medications could
have been given to Lisa?

a. Metronidazole and Pyrantel pamoate

b. Ivermectin and Ketoconazole
c. Diethylcarbamazine Citrate (DEC) and Albendazole
d. Praziquantel and Cotrimoxazole
Lisa, a 7 year old girl, came to your clinic with her mother. Their family originally resided at Occidental
Mindoro, but relocated since the father was assigned to Manila. Mother stated that Lisa was given unrecalled
medications as part of the National Filariasis Elimination Program of the DOH. What medications could
have been given to Lisa?

a. Metronidazole and Pyrantel pamoate

b. Ivermectin and Ketoconazole
c. Diethylcarbamazine Citrate (DEC) and Albendazole
d. Praziquantel and Cotrimoxazole
DOH NATIONAL FILARIASIS ELIMINATION PROGRAM

¡ In municipalities endemic for Filariasis

¡ As of April 2019 – Palawan, Sulu, Occidental Mindoro and Sultan Kudarat
¡ Mass treatment, including children 2 years old and above
¡ Meds: Diethylcarbamazine Citrate (DEC) and Albendazole
IRON SUPPLEMENTATION
As a pediatric resident in
training, you have been
assigned to go to a medical a. 0.3 ml once a day for 3 months
mission at a local b. 0.3 ml once a day for 6 months
community. Elemental iron
c. 0.6 ml once a day for 3 months
drops are readily available
d. 0.6 ml once a day for 6 months
at the site. How much
would you prescribe these
iron drops to an 8 month
old boy?
As a pediatric resident in
training, you have been
assigned to go to a medical a. 0.3 ml once a day for 3 months
mission to a local b. 0.3 ml once a day for 6 months
community. Elemental iron
c. 0.6 ml once a day for 3 months
drops are readily available
d. 0.6 ml once a day for 6 months
at the site. How much
would you prescribe these
iron drops to an 8 month
old boy?
IRON SUPPLEMENTATION AS RECOMMENDED BY THE DOH

TARGET POPULATION PREPARATION DOSE / DURATION

Low birth weight 15mg Elemental Iron Drops 0.3ml once a day 2-6 months of age
Infants 6-11months 15mg Elemental Iron Drops 0.6ml once a day for 3 months
Children 1-5 years old 30mg Elemental Iron Syrup 5ml once a day for 3 months
OR
30mg once a week for 6 months
Adolescent 10-19 years old 60mg Elemental Iron with One tablet once a day
400mcg Folic Acid Coated Tablet
Aside from prescribing Elemental Iron drops, you also advise the parents to
do routinely to screen for anemia. Who are usually at risk for anemia?

a. Infants 6 months to less than 1 year old

b. Actively menstruating female adolescents
c. Fad dieters
d. All of the above
Aside from prescribing Elemental Iron drops, you also advise the parents to
do routinely to screen for anemia. Who are usually at risk for anemia?

a. Infants 6 months to less than 1 year old

b. Actively menstruating female adolescents
c. Fad dieters
d. All of the above
PHILIPPINE SOCIETY OF PEDIATRIC HEMATOLOGY
RECOMMENDATION FOR ANEMIA SCREENING

¡ Do a complete blood count at least

once between the following time ¡ At risk
intervals: ¡ Infants 6 months to less than 1 year old

¡ 6-24 months ¡ 12 months to 23 months

¡ Menstruating female adolescents
¡ 2-6 years
¡ Fad dieters
¡ 10-19 years
VITAMIN A SUPPLEMENTATION
You are a part of the City
Health Office. One of your
scheduled programs is the a. 50,000 IU capsule x 1 dose

house-to-house Measles b. 100,000 IU capsule x 1 dose

and Vitamin A drive. Target c. 150,000 IU capsule x 1 dose
population are infants d. 200,000 IU capsule x 1 dose
aged 9-11 months. How
much Vitamin A should
these babies be given?
You are a part of the City
Health Office. One of your
scheduled programs is the a. 50,000 IU capsule x 1 dose

house-to-house Measles b. 100,000 IU capsule x 1 dose

and Vitamin A drive. Target c. 150,000 IU capsule x 1 dose
population are infants aged d. 200,000 IU capsule x 1 dose
9-11 months. How much
Vitamin A should these
babies be given?
VITAMIN A SUPPLEMENTATION AS RECOMMENDED BY THE DOH

TARGET POPULATION PREPARATION DOSE / DURATION

Infants 6-11months 100,000 IU 1 dose only (one capsule anytime
from 6-11months, usually 9months
during measles)
Children 12-59 months old 200,000 IU 1 capsule every 6 months
PREVENTIVE DENTAL CARE
A mother brought her 3year old son, Jeon, to your clinic. She is concerned about his teeth, she has
noticed some discoloration on the upper incisors. No consult with the dentist has been done yet. You
would tell the mother to brush her Jeon’s teeth twice a day with fluoride toothpaste as big as what?

a. Smear, around 2.5mm and 0.125 grams

b. Pea size, around 5mm and 0.25 grams
c. Full length of bristle, around 10-20mm and 0.5 grams
d. None of the above
A mother brought her 3year old son, Jeon, to your clinic. She is concerned about his teeth, she has
noticed some discoloration on the upper incisors. No consult with the dentist has been done yet. You
would tell the mother to brush her Jeon’s teeth twice a day with fluoride toothpaste as big as what?

a. Smear, around 2.5mm and 0.125 grams

b. Pea size, around 5mm and 0.25 grams
c. Full length of bristle, around 10-20mm and 0.5 grams
d. None of the above
USE OF FLUORIDE TOOTHPASTE

AGE FLUORIDE MINIMUM DAILY AMOUNT OF AMOUNT OF

CONCENTRATION USE TOOTHPASTE FLUORIDE
6 mos to less 1000 ppm Twice daily Smear 2 x 0.125 = 0.25mg
than 2yrs old 2.5mm / 0.125g
2 to 6 yrs old 1000 ppm Twice daily Pea size 2 x 0.25 = 0.50mg
5mm / 0.25g
6 years old 1500 ppm Twice daily Full length bristle 2 x 0.5 = 1mg
and above 10-20mm / 0.5g

Twice a day use of fluoride – containing toothpaste is

recommended
Jeon’s mother also
inquired about topical a. 4 weeks
fluoride treatment. She b. 3 months
read in Google that it
c. 6 months
could also be given to
d. 9 months
kids.You will tell her
that it can be applied
every
Jeon’s mother also
inquired about topical a. 4 weeks
fluoride treatment. She b. 3 months
read in Google that it
c. 6 months
could also be given to
d. 9 months
kids.You will tell her
that it can be applied
every
TOPICAL FLUORIDE TREATMENT

¡ Proven to prevent or reverse enamel demineralization

¡ At risk : Recommended receive topical fluoride treatment every 6 months
At the first dental visit, the dentist will assess the child’s oral hygiene, periodontal
health and risk of developing oral disease. He shall provide education on oral health
and optimize fluoride exposure. This visit should be done when?

a. At the time of eruption of the first tooth

b. Later than 12 months of age
c. Both
d. None of the above
At the first dental visit, the dentist will assess the child’s oral hygiene, periodontal
health and risk of developing oral disease. He shall provide education on oral health
and optimize fluoride exposure. This visit should be done when?

a. At the time of eruption of the first tooth

b. Later than 12 months of age
c. Both
d. None of the above
FIRST DENTAL VISIT

¡ Recommended to be done at the time of eruption

of the first tooth
¡ Should be NO later than 12 months of age
¡ On the visit, the dentist shall:
¡ Assess child’s oral hygiene and periodontal health
¡ Evaluate the risk of developing oral disease
¡ Provide education on infant oral health
¡ Optimize fluoride exposure
EYE AND VISION SCREENING
Referral to an
ophthalmologist for
comprehensive eye a. born preterm at 32 weeks AOG
examination is b. diagnosed with Down’s syndrome

warranted among c. with birthweight of 1600 grams

these children with d. with history of squinting

the following criteria,

except:
Referral to an
ophthalmologist for
comprehensive eye a. born preterm at 32 weeks AOG
examination is b. diagnosed with Down’s syndrome

warranted among c. with birthweight of 1600 grams

these children with d. with history of squinting

the following criteria,

except:
 CRITERIA FOR REFERRAL TO OPHTHALMOLOGIST FOR
COMPREHENSIVE EYE EXAM:

¡ With high risk of ROP/ Retinopathy of Prematurity

¡ AOG: 32 wks or less
¡ Birthweight of 1.5kg or less
¡ Older than 32 wks and.or heavier than 1.5kg but with stormy medical course at NICU

¡ Those with metabolic disorders

¡ Those with conditions associated with eye problems (Down’s, NF)
¡ With history of squinting, head tilt or head turn
¡ With visual difficulties and learning problems
The infant was born term at 38 wks, with BW of 2.6kg and was discharged from the
hospital on her 48th hour of life. Family history, however, reveal strabismus on her
older brother. Is an ophthalmology referral warranted?

a. YES
b. NO
The infant was born term at 38 wks, with BW of 2.6kg and was discharged from the
hospital on her 48th hour of life. Family history, however, reveal strabismus on her
older brother. Is an ophthalmology referral warranted?

a. YES
b. NO
 OTHER FACTORS INDICATING OPHTHALMOLOGIC REFERRAL:

¡ Family history of
¡ Strabismus
¡ Amblyopia
¡ Congenital cataract
¡ Congenital glaucoma
¡ Retinoblastoma
¡ Ocular and systemic genetic diseases
Your patient is a 3
year old boy who is
a. Use the Fixes and Follows Test
still unfamiliar with
b. Use the LEA Pictures Chart
letters. How do you c. Use the SLOAN Letter
plan to screen and d. Do nothing, refer to Ophtha ASAP
assess for his visual
acuity?
Your patient is a 3
year old boy who is
a. Use the Fixes and Follows Test
still unfamiliar with
b. Use the LEA Pictures Chart
letters. How do you c. Use the SLOAN Letter
plan to screen and d. Do nothing, refer to Ophtha ASAP
assess for his visual
acuity?
METHODS ON VISUAL ACUITY ASSESSMENT
Infants and Pre-verbal children

¡ FIXES AND FOLLOWS TEST

¡ Fixation behavior is determined using a toy or picture as a target
¡ Done with unoccluded eyes and with one eye occluded
¡ If child fails to fixate and follow an object on each eye--- refer to OPHTHA
METHODS ON VISUAL ACUITY ASSESSMENT
Children who can participate in subjective/ formal visual acuity test

¡ LEA PICTURES CHART

¡ Preschoolers
¡ Not familiar with letters

¡ SLOAN LETTERS/ HOTV CHART

¡ For literate children
METHODS ON VISUAL ACUITY ASSESSMENT
Children who can participate in subjective/ formal visual acuity test

Age Passing mark

3 to 3 11/12 yrs old 20/50 (10/25) or better
4 to 4 11/12 yrs old 20/40 (10/20) or better
5 yrs old and above 20/30 (10/15) or better

** if the kid did not achieve the passing mark, refer to

ophtha
Using an interesting object as a target, the eyes should be able to move
together in all directions of gaze. What type of ocular motility test is this?

a. Version and ductions test

b. Corneal light reflex test
c. Cross over test
d. Alternate cover test
Using an interesting object as a target, the eyes should be able to move
together in all directions of gaze. What type of ocular motility test is this?

a. Version and ductions test

b. Corneal light reflex test
c. Cross over test
d. Alternate cover test
OCULAR MOTILITY ASSESSMENT

¡ VERSIONS AND DUCTIONS

¡ An interesting object or penlight is used as a target
¡ The eyes should be able to move together in all directions of gaze
¡ Limitations or lag in eye movements – REFER!
OCULAR MOTILITY ASSESSMENT

¡ CORNEAL LIGHT REFLEX

¡ A penlight is used as a target
¡ Corneal light reflex should be seen simultaneously at the center of the pupil of each
eye
¡ Corneal light reflex not seen at the center of the pupil– REFER!
OCULAR MOTILITY ASSESSMENT

¡ CROSS OVER TEST / ALTERNATE COVER TEST

¡ Check the presence of ocular misalignment
¡ Done by alternately covering the eyes while patient is fixated at a target
¡ Any movements noted during the test– REFER!
COMPLEMENTARY FOOD
An 8 month old boy
was brought to your a. Pureed food
clinic for well baby b. Finger food
consult. His mother c. Lumpy or chopped food
asks you what food d. Table food
should be given at this
age. What would you
tell the first-time mom?
An 8 month old boy
was brought to your a. Pureed food
clinic for well baby b. Finger food
consult. His mother c. Lumpy or chopped food
asks you what food d. Table food
should be given at this
age. What would you
tell the first-time mom?
COMPLEMENTARY FOOD MUST BE…

¡ Timely introduced--- 6 months of age

¡ Adequate --- provide sufficient energy,
protein and micronutrients (Food Guide
Pyramid, Pinggang Pinoy)
¡ Safe --- hygienically prepared and stored,
feed using clean utensils
¡ Properly fed --- meal frequency and feeding
methods suitable for age
 HOW TO INTRODUCE NEW FOOD

¡ Begin one new food at a time; give it for 3 days

¡ Start with lugaw/ cereals, fruits or vegetables– 1-2 teaspoons a day
¡ Offer a variety of food to improve quality of food intake
¡ Avoid drinks with low nutrient value (sweet beverage)
¡ Do not add salt to diet before 1 year of age
¡ Give supplements of iron, zinc, calcium and vit B12 if diet is mainly plant-based
¡ Feed slowly and patiently, do not force feed
COMPLEMENTARY FOOD

WHAT TO START HOW TO START

Age Type of food Age Frequency
6 months Pureed food 6-8 months 2-3 times a day
8 months Finger food 9-24 months 3-4 times a day
10 months Lumpy or chopped food
12 months Table food

*** snacks may be given 1-2 times a day