CORE: Child / Adolescent Preventive Health
Goal: Understand preventive health counseling and vaccines for pediatric populations
Case 1: Infant to 24 mos.
Objectives:
Discuss routine aspects of newborn care
Practice discussing vaccine safety and schedule recommendations
Demonstrate use of AAP Periodicity table in order to guide well child visits
Tiny Tim is a 1 day old male who you delivered by NSVD at 38 weeks 5 days after an uncomplicated pregnancy. He is breastfeeding and has lost about 3% of his birth weight. His bilirubin level was low intermediate risk at 24 hours and he received other routine aspects of care in the newborn nursery including hearing screen, congenital heart disease screening, erythromycin eye ointment, vitamin K shot. Mom feels uncomfortable with the idea of immunization at birth and wants to ask you more questions specifically about the recommendations for Hepatitis B vaccine. Dad asks specifically about ways to avoid SIDS and is interested in buying a cardiorespiratory monitor.
Why is hepatitis B vaccination recommended at birth? What are the specific recommendations?
What are the recommendations for vaccination in family members?
What do you recommend to avoid SIDS?
What aspects of newborn counseling do you provide to the family?
Tiny Timmy is now being seen for a 2-week well child check. He has surpassed his birth weight and continues to breastfeed. Dad asks what to expect for TImmy’s immunizations. They ask if there is any benefit to spacing out the immunizations on a modified schedule. They have particular concerns about seizures, autism, and unsafe ingredients like mercury.
What nutrients would you recommend supplementing for exclusively breastfed infants, and at what age? What if Tiny Tim were formula fed or combination breast and formula?
When can you expect to introduce solid foods?
Are there any foods he should avoid? Mom is particularly concerned about Timmy developing a peanut allergy like his older sister and wonders if he should avoid this.
Where can you find the most up-to-date recommendations on childhood vaccinations?
What safety concerns regarding vaccines might you address with mom?
If it is still flu season during the time of Timmy’s visit, should he receive flu vaccination?
Timmy’s family is nervous about their safety during the COVID pandemic and they skip his 12 and 15 month well child checks due to concern for potential exposures. He arrives in clinic in October for a well child check at 18 months. He has received the following immunizations: PCV13 #1-3, rotavirus #1 and #2, Hep B #1 and #2, DTap #1-3, IPV #1 and #2, Hib #1-3.
What immunizations is he due for today?
Mom worries because his sister has an egg allergy.
She wonders if a history of egg allergy puts her children at unsafe risk for the flu vaccine?
What other aspects of care are recommended at age 12, 15, 18 months? What do these screenings entail? What is the data supporting these screenings?
Resources:
AAP Statements
Periodicity Table
LEAP study resource
CDC website
Case 2: Adolescent
Objectives:
What is the definition of confidentiality how to discuss confidentiality and consent with adolescent patients
Go through the HEADSS assessment for adolescents
Understand adolescent vaccines, including counseling for HPV vaccine
Ang Stee is a 16 year old female who presents for a well-child exam. She has no chronic medical conditions. She is a sophomore in HS and plays soccer on her HS team. Her mother is hoping to have Ang direct this visit as she wants her to become more empowered and independent with her own health but also wants to know what’s going on with her kid’s health.
What can you tell Ang and her mother about patient confidentiality when it pertains to adolescents? About parental consent?
What are the things you want to make sure to ask Ang at this visit? Is there a framework of questions that you can use?
Ang reports that she lives at home with just her mom. She and her mom have a good relationship - she tells her mom everything. She has no contact with her dad, and doesn’t want any in the future - she doesn’t really want to go into detail about this. She has been doing well in school with A/B grades. No school changes or big life changes. She has a set group of friends at school as well as her soccer teammates. She has an Instagram and Snapchat - no Facebook because that’s so 2019. She doesn’t report any cyber bullying nor any in-person bullying. She doesn’t use any alcohol or drugs. She does have a boyfriend and is thinking about becoming sexually active for the first time. Her mood is good - she doesn’t think she has anxiety or depression.
What specific screening should you make sure to do during this visit?
What immunizations would you want to make sure Ang is up to date with?
Resources:
ePSS, AAP, Bright Futures questionnaires