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به نام خدا Preventive Pediatrics

به نام خدا Preventive Pediatrics. Dr. Mehran karimi. Millennium Development Goals ، under 5 mortality . under-five mortality. If countinue this conditio n. Global trends in under-five mortality, 1960-2000, with projections to 2015.

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به نام خدا Preventive Pediatrics

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  1. به نام خداPreventive Pediatrics Dr. Mehran karimi

  2. Millennium Development Goals ، under 5 mortality under-five mortality If countinue this condition Global trends in under-five mortality, 1960-2000, with projections to 2015 Source: Data from Ahmad OB, Lopez AD & Inoue M. The decline in child mortality: a reappraisal. Bull WHO, 2000, 70(10), with trend extended through 2015 (in red) and linear trend needed to achieve 2/3 reduction from 1990 levels.

  3. مقایسه مرگ کودکان در جمهوری اسلامی ایران با متوسط جهانی در سالهای 1990 و 2005

  4. درصدمواردمرگ كودكان 1تا59 ماهه دركشور برحسب جنس(سال 1386)

  5. درصدمواردمرگ كودكان 1تا59 ماهه دركشور برحسب محل سكونت (سال 1386)

  6. درصدمواردمحل وقوع مرگ كودكان 1تا59 ماهه دركشور (سال 1386)

  7. درصد علل مرگ كودكان 1تا59 ماهه درکشور(سال 1386)

  8. جدول درصدتوزيع علل مرگ برحسب حوادث وسوانح غيرعمدي درگروه سني 1تا59 ماهه -1386

  9. What does mean prevention? • Primary • Secondary • Tertiary

  10. Smoking Family Environment hazards Repeated infections Violence Child’s health Genetic Malnutrition ??????? Media Accident

  11. Health supervision visit • Assess Cognitive development Social Family life • Traditional well child visit

  12. Principles of health supervision visit • 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

  13. Suggested Periodic health supervision visit

  14. 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

  15. Sleep problems • Frequent night awakening(1th year of life) • Night walking’ Night terror’ Night mare’ Restless legs’ Noisy breathing’ Parasomnia’…. • Regular bedtime routine starting with a quiet interaction (Reading a bedtime story’..)

  16. 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

  17. Temper tantrums • Is a normal part of child development • May be due to anger ‘ stress’ hunger’ unreasonable demand’ Parental depression’ Family violence

  18. Growth & Development monitoring • Malnutrition Obesity Underweight Stunting Wasting FTT • Developmental delay (DQ)

  19. 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

  20. Screening test • 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 In healthy child’ Adolescence (Once for boys and yearly for girls) • Urinalysis:15 month is the preferred age • Lead poisoning:9-12 mo or 24 mo. or both

  21. 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

  22. Immunization

  23. Smallpox Polio Tetanus Diphtheria Rubella Measles Pertussis Mumps Hib Infection Pneumococcal Inf. Hepatitis B Varicella Vaccination Eradication:

  24. Vaccination program • At Birth: BCG’ OPV’ Hepatitis B* • 2 Month: DPT’ OPV’ Hepatitis B • 4 Month: DPT’ OPV • 6 Month: DPT’ OPV’ Hepatitis B • 12 Month: MMR • 18 Month: DPT’ OPV • 4-6 years old: DPT’ OPV’MMR • 14-16 years old: Td

  25. Immunization • Active Immunization: Cellular Immune response Vaccine Antibody production • Passive Immunization Administration of antibody

  26. Vaccine Toxoids Antitoxins Immune globulins Preservative Stabilizer Antibiotic Adjuvant Suspending fluid Constituents of Immunizing Agents

  27. 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

  28. AEFI Classification • Vaccine reaction • Program error • Coincidental events • Injection reaction • Unknown

  29. AEFI • Mild Reactions: Pain Swelling Fever Iirritability Malaise

  30. AEFI • Severe reactions: Seizures Thrombocytopaenia Hypotonic hyporesponsive episodes Persistent inconsolable screaming Anaphylaxis

  31. AEFIs (in some common vaccines)

  32. General contraindications & Precaution contraindications • Serious allergic reaction after a previous vaccine dose • Serious allergic reaction to a vaccine component Precaution • Moderate to severe illness

  33. No contraindications • 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

  34. No contraindications • Premature birth(except Hepatitis B)* • Malnutrition • Allergy to penicillin and other antibiotics(except neomycin & streptomycin) • Breast feeding • Egg allergy (*Premature birth with BW<2 kg At birth,1,2,6 mo.)

  35. نكات مهم: • استفاده از واكسن هاي ويروسي زنده(بجز پوليو وتب زرد) در زنان حامله ممنوع است بجز موارديكه خطر ابتلا بر عوارض آن غالب باشد. • اگر كودكي گاماگلوبولين عضلاني و يا محصولات خوني گرفته باشد 3 ماه بعد و اگر گاماگلوبولين وريدي گرفته باشد 6 ماه بعد بايد واكسن ويروسي زنده (بجز پو ليو)را بگيرد. • اگر در كودكي به هر علتي طي 2 هفته پس از تزريق واكسن ويروسي زنده(بجز پوليو) گاماگلوبولين و يا محصولات خوني تزريق شده باشد لازم است درمورد گاماگلوبولين عضلاني و يا محصولات خوني پس از 3 ماه و گاماگلوبولين وريدي پس از 6 ماه واكسن تكرار شود.

  36. 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 بالاتر نيست.

  37. 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

  38. Redness 1/3 doses Swelling 2/5 Pain 1/2 Systemic Fever >=38°C 1/2 Collapse 1/1 750 Convulsions 1/1 750 Vomiting 1/5 Anorexia 1/5 Persistent,inconsolable crying (duration >=3 hours) 1/100 Fever >= 40.5°C 1/330 Drowsiness 1/3 AEFI within 48 hours of DTP vaccinations

  39. Contraindication: Severe AEFI after a previous dose Encephalopathy after a previous dose Progressive neurologic disorder Precaution: Moderate to severe illness After previous dose: Fever > 40.5 c Collapse Seizure Persistent crying DTP

  40. DTP Can be administered: • After previous dose T <40.5 c‘ Mild drowsiness’ Fussiness • Family Hx of Seizure’ SIDS’ AEFI • Stable neurologic condition

  41. Contraindication: Severe allergic reaction after a previous dose Precaution: Guillain-Barre syndrome after a previous dose Moderate to severe illness DT ’ Td

  42. MMR/MR/R Contraindication: • Severely Immunocopromised • Congenital Immunodeficiency • HIV Infection • Leukemia • Aplastic anemia • Generalized malignancy • Antimetabolites Therapy • Large amount of Crticosteroids Therapy • Radiation

  43. Contraindication: Severe allergic reaction after a previous dose Pregnancy Severe Immunodeficiency Precaution: Recent receipt of antibody-containing product Hx of Thrombocytopenia or Thrombocytopenic purpura Moderate to severe illness MMR

  44. 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

  45. Immunization of Immunocompromised children • BCG Contraindicated in: HIV/Aids’ Severely Immunocopromised Asplenia Renal failure • MMR/MR/R Severely Immunocopromised

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