Vaccines for special groups include meningococcal, typhoid and rabies.
The meningococcal disease is caused by Neisseria meningitidis, or meningococcus which is a gram-negative, biscuit-shaped diplococcus bacteria found only in man. Transmission is from person to person through respiratory droplets. It is not as contagious as the common cold but is transmitted through saliva, and occasionally, prolonged contact with an infected person. The incubation period is from 1 to 10 days. The clinical manifestations include upper respiratory infection with or without bacteremia; bacteremia without sepsis; meningococcemic sepsis without meningitis; meningitis with or without sepsis, meningoencephalitis and focal organ infections. This type of meningitis is the only form of bacterial meningitis known to cause epidemics. It is a serious condition. The more severe disease called meningococcemia is a widespread blood infection with a high rate of mortality. A patient afflicted with this disease can deteriorate within hours. Although a small number of patients die, those who survive incur long term sequelae like deafness and brain damage.
Typhoid or typhoid fever is caused by Salmonella typhi. It is acquired through ingestion of food or water contaminated by fecal material from an infected person. It is characterized by a sustained high fever, profuse sweating, and diarrhea. Occasionally, a rash with flat rose-colored spots may appear. If untreated, typhoid fever can lead to serious complications like intestinal bleeding and perforation, encephalitis, and abscesses and inflammation in other organs including the gallbladder, bones and the heart. Sanitation and good hygiene are critical preventive measures for typhoid.
Rabies is a highly fatal viral encephalomyelitis which is transmitted to man by the bite of a rabid animal. The rabies virus is a bullet-shaped rhabdovirus of the Lyssa group. It can be transmitted in either 2 ways: (1) bite exposure(injection of infectious saliva into abreak in the skin caused by animal's teeth) or (2) non-bite exposure by licking of mucous membranes or scratches, open/healing wounds,abrasions; aerosol; or human to human. The incubation period in man varies from as short as 4 days to as long as 19 years, but is usually between 20-90 days. Ninety five percent of cases develop symptoms within a year from the time of the bite. It tends to be shorter in multiple severe bites or bites on the head and neck areas. The clinical manifestations may range from a prodromal phase characterized by nonspecific constitutional symptoms such as fever, malaise, and body weakness followed by pain or paresthesia at the site of the bite then enters into an acute neurological phase with the characteristic feature of violent and painful spasm of the pharyngeal and laryngeal muscles and eventually death due to a respiratory paralysis.
With the existence of the above disease entities, the use of vaccines for each has been an option in certain areas or conditions.
The meningococcal vaccine is not recommended for routine use. It is recommended only in areas where there is an outbreak as declared by health authorities and for children and adolescents known to be at risk for the disease.
The typhoid vaccine is an active immunization against typhoid fever for adults and children older than 2 years of age. A single dose is recommended for both children and adults. Subjects who remain at risk of typhoid fever should be revaccinated using a single dose of vaccine every 3 - 5 years. This vaccine is also recommended for travelers to areas with a risk of exposure to salmonella typhi or persons infected with Salmonella typhi. There are two vaccines for typhoid - an oral live attenuated and an injectible.
Based on the Anti-rabies Act 2007, pre-exposure prophylaxis for children aged 5 years and above is recommended where there is a high incidence of rabies (>2.5 human rabies/million population). The regions with a high incidence of rabies reported in 2006 are Regions 1,2,3,5,7,8,12 and CAR. Booster is not mandatory but may be given every 3 years depending on continuing risk of exposure. Any exposure regardless of severity after completion of the Primary series should be given rabies vaccines as follows: interval from last dose of 0-6 months needs one booster dose, >6 months - 3 years, needs 2 booster doses(given on days 0, 3) and > 3 years require a full dose of vaccine (days 0,3,7,14,28) without Rabies immunoglobulin.
Thursday, January 14, 2010
Tuesday, January 12, 2010
Childhood and Adolescent Immunization Schedules Approved for 2010
by Laurie Barclay, MD
The 2010 recommended childhood and adolescent immunization schedules have been approved by the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention, and the American Academy of Family Physicians, according to a report posted online January 4 and to be published in the January 2010 issue of Pediatrics.
There are 3 revised schedules describing current guidelines for use of US Food and Drug Administration (FDA)–licensed vaccines: one for children from birth through age 6 years, one for children and adolescents aged 7 through 18 years, and a catch-up immunization schedule for children and adolescents who start late or fall behind with scheduled vaccinations.
Noteworthy changes in the 2010 schedule are a new recommendation for influenza A (H1N1) 2009 monovalent vaccine, a recommendation to revaccinate children who remain at increased risk for meningococcal disease with meningococcal conjugate vaccine (MCV4), recommendations on combination vaccines, and recommendations for the recently licensed bivalent human papillomavirus (HPV) vaccine in girls and the quadrivalent HPV vaccine in boys.
Specific changes from last year's recommendations for vaccination with FDA-approved vaccines include the following:
• A footnote refers to ACIP recommendations regarding use of influenza A (H1N1) 2009 monovalent vaccine.
• Only children 6 months or older should receive trivalent inactivated influenza vaccine (TIV), and only those 2 years or older should receive the live attenuated influenza vaccine (LAIV). Healthy children aged 2 to 6 years may receive either TIV or LAIV. However, children aged 2 to 4 years who have a history of wheezing in the preceding 12 months should not receive LAIV.
• The dose of TIV is 0.25 mL for children aged 6 to 35 months and 0.5 mL for those at least 3 years old. For children younger than 9 years given the influenza vaccine for the first time, 2 doses should be given 4 weeks apart. Children who received a single dose of influenza vaccine the previous season should be given 2 doses, separated by 4 weeks or more.
• Children who remain at increased risk for meningococcal disease because of persistent complement deficiency, asplenia, or other conditions should be revaccinated with MCV4. Children who received the initial MCV4 dose at ages 2 through 6 years should receive a dose of MCV4 after 3 years. If the first dose was given at age 7 years or older, children should be revaccinated after 5 years. These children should then be revaccinated with MCV4 every 5 years.
• Children not previously vaccinated with MCV4 should be given this vaccine at age 11 or 12 years or between ages 13 and 18 years. College freshmen living in a dormitory who have not previously received MCV4 should be given this vaccine.
• Combination vaccines are usually preferred to separate injections of the equivalent component vaccines. Updated recommendations regarding the inactivated poliovirus vaccine series are that the final dose should be given on or after the fourth birthday and at least 6 months after the previous dose. Children receiving 4 doses before age 4 years should receive an additional (fifth) dose at ages 4 through 6 years.
• Updated recommendations describe use of the recently licensed bivalent HPV vaccine in girls and the quadrivalent HPV vaccine in boys. Girls not previously vaccinated against HPV should receive the bivalent HPV series at ages 13 through 18 years. For catch-up, the second and third HPV dose should be given at 1 to 2 months and at 6 months after the first dose. The minimal interval for vaccination is 4 weeks between the first and second doses, 12 weeks between the second and third doses, and 24 weeks or more between the first dose and third dose.
The 2010 recommended childhood and adolescent immunization schedules have been approved by the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention, and the American Academy of Family Physicians, according to a report posted online January 4 and to be published in the January 2010 issue of Pediatrics.
There are 3 revised schedules describing current guidelines for use of US Food and Drug Administration (FDA)–licensed vaccines: one for children from birth through age 6 years, one for children and adolescents aged 7 through 18 years, and a catch-up immunization schedule for children and adolescents who start late or fall behind with scheduled vaccinations.
Noteworthy changes in the 2010 schedule are a new recommendation for influenza A (H1N1) 2009 monovalent vaccine, a recommendation to revaccinate children who remain at increased risk for meningococcal disease with meningococcal conjugate vaccine (MCV4), recommendations on combination vaccines, and recommendations for the recently licensed bivalent human papillomavirus (HPV) vaccine in girls and the quadrivalent HPV vaccine in boys.
Specific changes from last year's recommendations for vaccination with FDA-approved vaccines include the following:
• A footnote refers to ACIP recommendations regarding use of influenza A (H1N1) 2009 monovalent vaccine.
• Only children 6 months or older should receive trivalent inactivated influenza vaccine (TIV), and only those 2 years or older should receive the live attenuated influenza vaccine (LAIV). Healthy children aged 2 to 6 years may receive either TIV or LAIV. However, children aged 2 to 4 years who have a history of wheezing in the preceding 12 months should not receive LAIV.
• The dose of TIV is 0.25 mL for children aged 6 to 35 months and 0.5 mL for those at least 3 years old. For children younger than 9 years given the influenza vaccine for the first time, 2 doses should be given 4 weeks apart. Children who received a single dose of influenza vaccine the previous season should be given 2 doses, separated by 4 weeks or more.
• Children who remain at increased risk for meningococcal disease because of persistent complement deficiency, asplenia, or other conditions should be revaccinated with MCV4. Children who received the initial MCV4 dose at ages 2 through 6 years should receive a dose of MCV4 after 3 years. If the first dose was given at age 7 years or older, children should be revaccinated after 5 years. These children should then be revaccinated with MCV4 every 5 years.
• Children not previously vaccinated with MCV4 should be given this vaccine at age 11 or 12 years or between ages 13 and 18 years. College freshmen living in a dormitory who have not previously received MCV4 should be given this vaccine.
• Combination vaccines are usually preferred to separate injections of the equivalent component vaccines. Updated recommendations regarding the inactivated poliovirus vaccine series are that the final dose should be given on or after the fourth birthday and at least 6 months after the previous dose. Children receiving 4 doses before age 4 years should receive an additional (fifth) dose at ages 4 through 6 years.
• Updated recommendations describe use of the recently licensed bivalent HPV vaccine in girls and the quadrivalent HPV vaccine in boys. Girls not previously vaccinated against HPV should receive the bivalent HPV series at ages 13 through 18 years. For catch-up, the second and third HPV dose should be given at 1 to 2 months and at 6 months after the first dose. The minimal interval for vaccination is 4 weeks between the first and second doses, 12 weeks between the second and third doses, and 24 weeks or more between the first dose and third dose.
Saturday, January 2, 2010
Recommended Visits and Schedule of Immunization
The Expanded Program of Immunization (EPI) being administered in local health centers througout the country still covers the primary series consisting of 1 dose of BCG anytime from birth onwards, 3 doses of hepatitis B vaccine at 0,1,6 months and 3 doses each of whole cell DPT and OPV at 6, 10 and 14 weeks and 1 dose of measles at 9 months. This is the routine vaccines given at 0-12 months recommended by the Department of Health or DOH.
The BCG (Bacillus Calmette-Guerin (BCG) vaccine is ideally given at birth . If given beyond 12 months, do PPD (Protein Purified Derivative) or a Tuberculin skin test. If PPD is negative, give BCG. It is immunization against extrapulmonary Tuberculosis and is given as a single dose.
The first dose of Hepatitis B vaccine is ideally given within the 12th hour of life. This may be used as the first dose in a 3-dose primary series at least 4 weeks apart. A fourth dose is needed in the following instances, namely: the third dose is given at less than 6 months of age; no birth dose was given using the EPI schedule of 6, 10, 14 weeks amd for preterm infants less than 2 kgs., due to poor immunogenicity of the vaccine for these infants. For the third condition, the initial dose should not be counted in a 3-dose immunization schedule to complete the series. In infants born to a mother positive for hepatitis B via screening for HBS antigen, hepatitis B Immunoglobulin is ideally given within the first 12 hours of life together with the Hepatitis B vaccine at different injection sites or on alternate thighs intramuscularly.
For the Diptheria, Pertussis, Tetanus (DPT) vaccine, a first booster dose is given at 12-24 months or at least 1 year after the third dose. A second booster shot is administered between 4-6 years of age. For those who did not receive or complete the DPT three series by age 7-16 years, DT (Diptheria & Tetanus) vaccine is recommended at least 4 weeks apart. Booster shots are to be given every 5-10 years after completing the three series.
For the Oral Polio Virus (OPV)vaccine, the first booster is given at 12-24 months or 1 year after the third dose. While the second booster is given at 4-6 years of age.
In case of epidemics, the measles vaccine can be given as early as 6 months of age as a single dose instead of the EPI recommended schedule at 9-11 months.
The other recommended vaccines are Hib, IPV, MMR, Varicella, Hepatitis A, Pneumococcal, Rotavirus, Influenza and HPV.
The Haemophilus type b conjugate vaccine or Hib is indicated in infants from 2 months, for the prevention of invasive diseases such as meningitis, septicemia, epiglottitis caused by H. influenzae type b. In infants less than 6 months, it is given for 3 doses at intervals of 1 or 2 months followed by a booster injection one year after the third injecton. Between 6 and 12 months, 2 doses at an interval 1-2 months is given followed by a booster at 15-18 months of age. For children from 1 to 5 years, a single doses is given if no shot has been received earlier.
Another preparation of the polio vaccine is IPV which is an inactivated poliomyelitis virus vaccine. It is usually given with the other vaccines like Acellular DPT and Hib as combination vaccines so the interval between doses can be at least 1 or 2 months.
MMR (Measles, Mumps, Rubella) vaccine is given as early as 1 year of age with a booster shot between ages 5 - 12 years old. Although some authors recommend that the first dose be given at 15 months.
The first dose of Varicella vaccine is recommended at 12-15 months whereas the second dose may be given at 4-6 years but may be administered earlier provided the interval between the first and second is 3 months. The second dose is recommended for children, adolescents, and adults who received only 1 dose. All indiviuals aged 13 years and up, without previous evidence of immunity should receive 2 doses of varicella at least 4 weeks apart.
Hepatitis A vaccine can be given as early as 1 y/o with a second dose to be given within 6 - 24 months after the first dose or at 0, 1, 6 months schedule depending on the type of hepatitis A vaccine to be administered.
The pneumococcal vaccine or IPD can be given as early as 1 & 1/2 months or 6 weeks with a minimum interval of 4 weeks apart for 3 doses. The pneumococcal polysaccharide vaccine (PPV) is recommended for certain high risk groups in addition to PCV at 2-19 years of age. For healthy children, no additional doses needed if PCV series is completed.
The rotavirus vaccine (RV) is available in two preparations. One is a monovalent human Rotavirus vaccine which would require 2 doses: first dose at 6-14 weeks of age, and the second dose between 14-24 weeks of age. The interval should not be less than 4 weeks and the second dose should be given by age 24 weeks. Whereas the pentavalent human-bovine reassortant Rotavirus vaccine would need a 3 dose series: first dose between 6-12 weeks of age, subsequent doses should be administered at 4-10 weeks intervals and the final dose should not be given later than 32 weeks of age. The RV may be given with OPV or given 2 weeks apart. if give, concommitantly with OPV, 2 doses of monovalent human RV or 3 doses of pentavalent RV should be completed to overcome interference of OPV with RV immune response. This should be given at least 2 weeks apart from OPV.
Influenza vaccine is recommended in children 6 months to five years and those with high risk like congenital heart disease, vascular disease, chronic lung disease like asthma, chronic metabolic disorders, renal disorders and hemoglobinopathies and those children on long term (Aspirin) ASA therapy. Children aged 6 month to 8 years receiving influenza vaccine for the first time need 2 doses given at least 4 weeks apart. Those who received only 1 dose in the first year should receive 2 doses the following year. Children recommended for vaccination who are in their 3rd or more year of being vaccinated and who received only 1 dose in each of the first 2 years of being vaccinated should continue receiving a singlke annual dose. Vaccination should be given once a year preferably between February to June to cover the expected increase in influenza activity from June to October. Healthy children more than 5 years of age who wants to be protected against influenza can also be given the vaccine. Contraindications to vaccine administration are hypersensitivity to any constituent, acute febrile illness,prebious history of Guillen barresyndrome within the last 6 weeks.
Human papilloma virus (HPV) vaccine is available as a bivalent HPV vaccine and a quadrivalent HPV vaccine. The bivalent vaccine (cervarix) is recommended for ages 10-55 years at 0,1,6 months schedule. The second dose may be given 1 - 2.5 months after the first dose if flexibility is needed. Whereas the quadrivalent type (gardasil) is recommended for ages 10-26 years at 0,2,6 months schedule. If flexibility is needed, the second dose should be given at least 1 month after the first dose and the third dose at least 3 months after the second dose.
Other immunization schedule is recommended for the combination vaccine like 6-in-1 combinations (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Polio virus, H. influenzae type B, hepatitis B virus); 5-in-1 Immunization (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Poliomyelitis virus, H. influenzae type b) or 4-in-1 Immunization (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Poliomyelitis virus or H. influenzae type b virus). The age of administration may vary between brands but the first dose is usually given at least 2 months of age and the 3-dose series is completed at interval of 1-2 months.
The BCG (Bacillus Calmette-Guerin (BCG) vaccine is ideally given at birth . If given beyond 12 months, do PPD (Protein Purified Derivative) or a Tuberculin skin test. If PPD is negative, give BCG. It is immunization against extrapulmonary Tuberculosis and is given as a single dose.
The first dose of Hepatitis B vaccine is ideally given within the 12th hour of life. This may be used as the first dose in a 3-dose primary series at least 4 weeks apart. A fourth dose is needed in the following instances, namely: the third dose is given at less than 6 months of age; no birth dose was given using the EPI schedule of 6, 10, 14 weeks amd for preterm infants less than 2 kgs., due to poor immunogenicity of the vaccine for these infants. For the third condition, the initial dose should not be counted in a 3-dose immunization schedule to complete the series. In infants born to a mother positive for hepatitis B via screening for HBS antigen, hepatitis B Immunoglobulin is ideally given within the first 12 hours of life together with the Hepatitis B vaccine at different injection sites or on alternate thighs intramuscularly.
For the Diptheria, Pertussis, Tetanus (DPT) vaccine, a first booster dose is given at 12-24 months or at least 1 year after the third dose. A second booster shot is administered between 4-6 years of age. For those who did not receive or complete the DPT three series by age 7-16 years, DT (Diptheria & Tetanus) vaccine is recommended at least 4 weeks apart. Booster shots are to be given every 5-10 years after completing the three series.
For the Oral Polio Virus (OPV)vaccine, the first booster is given at 12-24 months or 1 year after the third dose. While the second booster is given at 4-6 years of age.
In case of epidemics, the measles vaccine can be given as early as 6 months of age as a single dose instead of the EPI recommended schedule at 9-11 months.
The other recommended vaccines are Hib, IPV, MMR, Varicella, Hepatitis A, Pneumococcal, Rotavirus, Influenza and HPV.
The Haemophilus type b conjugate vaccine or Hib is indicated in infants from 2 months, for the prevention of invasive diseases such as meningitis, septicemia, epiglottitis caused by H. influenzae type b. In infants less than 6 months, it is given for 3 doses at intervals of 1 or 2 months followed by a booster injection one year after the third injecton. Between 6 and 12 months, 2 doses at an interval 1-2 months is given followed by a booster at 15-18 months of age. For children from 1 to 5 years, a single doses is given if no shot has been received earlier.
Another preparation of the polio vaccine is IPV which is an inactivated poliomyelitis virus vaccine. It is usually given with the other vaccines like Acellular DPT and Hib as combination vaccines so the interval between doses can be at least 1 or 2 months.
MMR (Measles, Mumps, Rubella) vaccine is given as early as 1 year of age with a booster shot between ages 5 - 12 years old. Although some authors recommend that the first dose be given at 15 months.
The first dose of Varicella vaccine is recommended at 12-15 months whereas the second dose may be given at 4-6 years but may be administered earlier provided the interval between the first and second is 3 months. The second dose is recommended for children, adolescents, and adults who received only 1 dose. All indiviuals aged 13 years and up, without previous evidence of immunity should receive 2 doses of varicella at least 4 weeks apart.
Hepatitis A vaccine can be given as early as 1 y/o with a second dose to be given within 6 - 24 months after the first dose or at 0, 1, 6 months schedule depending on the type of hepatitis A vaccine to be administered.
The pneumococcal vaccine or IPD can be given as early as 1 & 1/2 months or 6 weeks with a minimum interval of 4 weeks apart for 3 doses. The pneumococcal polysaccharide vaccine (PPV) is recommended for certain high risk groups in addition to PCV at 2-19 years of age. For healthy children, no additional doses needed if PCV series is completed.
The rotavirus vaccine (RV) is available in two preparations. One is a monovalent human Rotavirus vaccine which would require 2 doses: first dose at 6-14 weeks of age, and the second dose between 14-24 weeks of age. The interval should not be less than 4 weeks and the second dose should be given by age 24 weeks. Whereas the pentavalent human-bovine reassortant Rotavirus vaccine would need a 3 dose series: first dose between 6-12 weeks of age, subsequent doses should be administered at 4-10 weeks intervals and the final dose should not be given later than 32 weeks of age. The RV may be given with OPV or given 2 weeks apart. if give, concommitantly with OPV, 2 doses of monovalent human RV or 3 doses of pentavalent RV should be completed to overcome interference of OPV with RV immune response. This should be given at least 2 weeks apart from OPV.
Influenza vaccine is recommended in children 6 months to five years and those with high risk like congenital heart disease, vascular disease, chronic lung disease like asthma, chronic metabolic disorders, renal disorders and hemoglobinopathies and those children on long term (Aspirin) ASA therapy. Children aged 6 month to 8 years receiving influenza vaccine for the first time need 2 doses given at least 4 weeks apart. Those who received only 1 dose in the first year should receive 2 doses the following year. Children recommended for vaccination who are in their 3rd or more year of being vaccinated and who received only 1 dose in each of the first 2 years of being vaccinated should continue receiving a singlke annual dose. Vaccination should be given once a year preferably between February to June to cover the expected increase in influenza activity from June to October. Healthy children more than 5 years of age who wants to be protected against influenza can also be given the vaccine. Contraindications to vaccine administration are hypersensitivity to any constituent, acute febrile illness,prebious history of Guillen barresyndrome within the last 6 weeks.
Human papilloma virus (HPV) vaccine is available as a bivalent HPV vaccine and a quadrivalent HPV vaccine. The bivalent vaccine (cervarix) is recommended for ages 10-55 years at 0,1,6 months schedule. The second dose may be given 1 - 2.5 months after the first dose if flexibility is needed. Whereas the quadrivalent type (gardasil) is recommended for ages 10-26 years at 0,2,6 months schedule. If flexibility is needed, the second dose should be given at least 1 month after the first dose and the third dose at least 3 months after the second dose.
Other immunization schedule is recommended for the combination vaccine like 6-in-1 combinations (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Polio virus, H. influenzae type B, hepatitis B virus); 5-in-1 Immunization (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Poliomyelitis virus, H. influenzae type b) or 4-in-1 Immunization (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Poliomyelitis virus or H. influenzae type b virus). The age of administration may vary between brands but the first dose is usually given at least 2 months of age and the 3-dose series is completed at interval of 1-2 months.
Friday, October 2, 2009
A CRY FROM WITHIN
My first article a few months back was regarding the newborn. I've decided to skip the ages in between and jump right into the adolescence age group. I felt the need to reach out to all teenagers out there who are not yet adults although some may look like one physically, but are still immature in other aspects of their personalities.
In a few days , it will be the first year death anniversary of a young man who won't be able to follow his father's footsteps, that of being a soldier. For still unknown reasons, he chose to end his life through a shot in the head. If some wielded a gun to kill others, he opted to use his father's firearm and ammunition to kill himself. It still baffles us all what could have driven him to the edge.
He was a well-behaved and friendly teenager who was always ready to lend a helping hand. He looked after his younger sisters by preparing their food, giving them a bath and sending them to and picking them up from school. He accepted the responsibility of being the man of the house in the absence of his father who was usually assigned elsewhere to carry out his duties as defender of the state. Was his a case of growing old too soon?
Everyday, an adolescent is confronted by problems both real and imagined. They find themselves struggling between choices in the various aspects of life,i.e. from fashion to food and even career. Most parents find it hard to understand them because they refuse to talk or even listen. These teens speak a language that is even alien to some. They walk in ways that are not the norm. Sometimes, they don clothes that others find repulsive but peers adore and even follow.
What lies behind the mask they show to the world? What are the fears that continuously haunt them?
Now, is the time to make yourself heard! If you need someone to lend you an ear without judgment or censure, I open this site to everyone. I am calling on every adolescent who has something to say or who has something in mind no matter how trivial or how quaint it may be. I fervently hope that through this column, I can prevent another death.
I want to know YOUR CRY FROM WITHIN!
In a few days , it will be the first year death anniversary of a young man who won't be able to follow his father's footsteps, that of being a soldier. For still unknown reasons, he chose to end his life through a shot in the head. If some wielded a gun to kill others, he opted to use his father's firearm and ammunition to kill himself. It still baffles us all what could have driven him to the edge.
He was a well-behaved and friendly teenager who was always ready to lend a helping hand. He looked after his younger sisters by preparing their food, giving them a bath and sending them to and picking them up from school. He accepted the responsibility of being the man of the house in the absence of his father who was usually assigned elsewhere to carry out his duties as defender of the state. Was his a case of growing old too soon?
Everyday, an adolescent is confronted by problems both real and imagined. They find themselves struggling between choices in the various aspects of life,i.e. from fashion to food and even career. Most parents find it hard to understand them because they refuse to talk or even listen. These teens speak a language that is even alien to some. They walk in ways that are not the norm. Sometimes, they don clothes that others find repulsive but peers adore and even follow.
What lies behind the mask they show to the world? What are the fears that continuously haunt them?
Now, is the time to make yourself heard! If you need someone to lend you an ear without judgment or censure, I open this site to everyone. I am calling on every adolescent who has something to say or who has something in mind no matter how trivial or how quaint it may be. I fervently hope that through this column, I can prevent another death.
I want to know YOUR CRY FROM WITHIN!
Sunday, June 21, 2009
INTRODUCTION
Hello, everyone!
I’m your friendly neighborhood pediatrician. You can just call me Tita Doc for short, which I got from one of my patients, JM. He fondly greets me “ Good morning, Tita Doc.” Or “Hello, Tita Doc, ” during each visit to my clinic so the name stuck. I will tackle various topics involving the different aspects of growth and development from infancy to adolescence. My wisdom will be derived from four decades of experiences as well as scientific researches and expert opinions of well-meaning friends and colleagues. Likewise, safety tips and advice on how to raise healthy kids in today's fast paced and high technology laden world will also be addressed. So, read on and feel free to leave a comment on my blog.
Just me,
Tita Doc
I’m your friendly neighborhood pediatrician. You can just call me Tita Doc for short, which I got from one of my patients, JM. He fondly greets me “ Good morning, Tita Doc.” Or “Hello, Tita Doc, ” during each visit to my clinic so the name stuck. I will tackle various topics involving the different aspects of growth and development from infancy to adolescence. My wisdom will be derived from four decades of experiences as well as scientific researches and expert opinions of well-meaning friends and colleagues. Likewise, safety tips and advice on how to raise healthy kids in today's fast paced and high technology laden world will also be addressed. So, read on and feel free to leave a comment on my blog.
Just me,
Tita Doc
Wednesday, May 27, 2009
NEO in the Matrix of Life
Who would ever forget “NEO”, the role reprised by Keanu Reeves in The Matrix Series? He signifies the birth of a new age. In the same manner, the term neonate was derived from the Greek word "neo" and Latin word "natus" which means “new” and “born”, respectively. Once a baby is born, he will face a lot of trials and complexities in life and will eventually create his own niche after coming out from the matrix or the mother’s womb.
What is a normal newborn? Pediatricians define a normal neonate as one who is term, about 37 to 42 weeks of age based on the Ballard’s scoring, with birth weight which is appropriate for gestational age, cephalic in presentation and born via spontaneous vaginal delivery with no history of maternal infection or disease.
The so-called Ballard's scoring or pediatric aging is a scoring system that sums up the physical and neuromuscular maturity rating of a newborn to determine whether the baby is term or mature.
We coined the phrase ”PLS BEG” for the physical maturity rating, i.e.: P for plantar crease, L for lanugo, S for skin, B for breast, E for ear and G for genitalia. The more lines there are on the sole, less fine hair and vernix on the back, the less transparent the skin on the abdomen, the bigger the breast bud, the firmer and well formed the ear lobe and the more rugae on the scrotal sac in the male or the less prominent the clitoris in the female, the more mature or term the baby is.
The neuromuscular maturity refers to certain maneuvers performed on the baby within 12 to 36 hours of life which will be added to the physical maturity score. The acronym to use is SHArP, S for square window and scarf sign, H for heel to ear, Ar for arm recoil, P for posture and popliteal angle. A mature newborn has a flexed posture, with good flexion of wrist joint, good muscle tone and with resistance to extension of the extremities while eliciting the heel to ear, popliteal angle, scarf sign and arm recoil.
The normal birth weight of a term neonate which is appropriate for age (AGA) is between 2500 grams to less than 4000 grams.
The presence of maternal infection or any disease, an abnormal presentation like face or breech, as well as a delivery that entails the use of forceps or caesarian section puts a neonate at risk to develop problems or other complications.
An infant from birth to 28 days is considered a newborn, although some authors extend the age to cover 2 months of life.
Lest I be accused of becoming technical in my definition of terms, I will introduce some acronyms or simple words to help parents or any caretaker understand a normal neonate. Regardless of the manner or place of delivery, everyone who attends to childbirth should be equipped with basic skills and knowledge on what to watch out for.
The APGAR score is a practical guide to assess the well being of a newborn immediately after birth. It was coined by Virginia Apgar in 1952 and stands for A – appearance, P – pulse, G – grimace , A – activity and R – respiration. It is taken at 1 minute and repeated after 5 minutes. The one minute APGAR reflects the need for immediate resuscitation, whereas, the five minute APGAR signifies the probable neurological outcome in one year. A pink baby, with a heart rate of more than 100 beats per minute, with good cry and activity and regular respiration is a normal baby with a perfect score of 10 at 2 points each for every parameter. A score of 7 and up means the baby is not asphyxiated or depressed.
Inspect the child from head to toe. Note for the color of the skin, nail beds, lips and tongue or the mucosal membranes. It should be pink, not pale, blue or red. Is the head round or irregular in shape due to molding, cephalhematoma or caput? Look at the eyes and check for asymmetry, extra folds, redness, and discharge or yellowish discoloration. Check the ear if it is low set and with intact hearing. Are the nostrils patent? Is there alar flaring? Look for cleft palate, high arch, and tongue-tie. Is the neck short or webbed? Are there symmetrical movements of the extremities? Is there chest lag? What is the shape of the thorax? Is the breathing deep, shallow, or absent? Does the baby grunt? Where is the heartbeat located? Is the abdomen globular? Do you feel any masses? Are the pulses full and supple? Count the fingers and the toes, hands, arms, legs and feet. Look at the palms and soles and check for a Simian crease, hypoplastic middle phalanx of the fifth digit and wide gapped toes. Check for the following reflexes: Moro, sucking, rooting and grasp reflex.
After the baby has been stabilized and checked, routine newborn care is provided. It entails giving prophylaxis like Vitamin K1 and eye ointment. The World Health Organization and the Department of Health recommend hepatitis vaccine and BCG at birth. The newborn screening is done after 24 hours of life once with adequate milk intake. Daily bath and cord care are also done in a sterile condition.
Breastfeeding is highly recommended and encouraged unless with contraindications. The benefits derived from it far outweigh the risk of using milk formula feeding. It is BEST for babies up to 2 years and beyond. BEST being B- Bonds the mother and the child; E – Economical in terms of time, money and convenience, S – Safe for it prevents diarrhea and other diseases, allergies and provides antibodies against infection and necessary nutrients in the proper quality and quantity and T – Tried and Tested for years with the right Temperature and contraceptive effect. However, the MRS CANT absolutely breastfeed in six maternal conditions like Mental disorders, Retardation and Seizure disorders, Cardiac diseases, Advanced Nephritis, open Tuberculosis and Thyrotoxicosis. Temporary contraindications to breastfeeding are intake of drugs like anticoagulants, antibiotics, toxic substances like mercury and benzene and mechanical problems like retracted and oversized nipples.
Taking care of a newborn is no easy task, especially for first time parents or caretakers. Babies put their absolute trust in whoever provides them their basic needs. A simple touch and a peek from their dads and moms on a daily basis may spell a difference so every neonate will not be deprived of TLC (Tender loving care).
Enjoy every single moment you spend with that cute little being who was temporarily loaned to you from up above. Don’t be afraid of the responsibility it entails to be a parent. Trust in your instincts and pray for guidance. If you were not sure of what you’re doing, it wouldn’t hurt to ask.
What is a normal newborn? Pediatricians define a normal neonate as one who is term, about 37 to 42 weeks of age based on the Ballard’s scoring, with birth weight which is appropriate for gestational age, cephalic in presentation and born via spontaneous vaginal delivery with no history of maternal infection or disease.
The so-called Ballard's scoring or pediatric aging is a scoring system that sums up the physical and neuromuscular maturity rating of a newborn to determine whether the baby is term or mature.
We coined the phrase ”PLS BEG” for the physical maturity rating, i.e.: P for plantar crease, L for lanugo, S for skin, B for breast, E for ear and G for genitalia. The more lines there are on the sole, less fine hair and vernix on the back, the less transparent the skin on the abdomen, the bigger the breast bud, the firmer and well formed the ear lobe and the more rugae on the scrotal sac in the male or the less prominent the clitoris in the female, the more mature or term the baby is.
The neuromuscular maturity refers to certain maneuvers performed on the baby within 12 to 36 hours of life which will be added to the physical maturity score. The acronym to use is SHArP, S for square window and scarf sign, H for heel to ear, Ar for arm recoil, P for posture and popliteal angle. A mature newborn has a flexed posture, with good flexion of wrist joint, good muscle tone and with resistance to extension of the extremities while eliciting the heel to ear, popliteal angle, scarf sign and arm recoil.
The normal birth weight of a term neonate which is appropriate for age (AGA) is between 2500 grams to less than 4000 grams.
The presence of maternal infection or any disease, an abnormal presentation like face or breech, as well as a delivery that entails the use of forceps or caesarian section puts a neonate at risk to develop problems or other complications.
An infant from birth to 28 days is considered a newborn, although some authors extend the age to cover 2 months of life.
Lest I be accused of becoming technical in my definition of terms, I will introduce some acronyms or simple words to help parents or any caretaker understand a normal neonate. Regardless of the manner or place of delivery, everyone who attends to childbirth should be equipped with basic skills and knowledge on what to watch out for.
The APGAR score is a practical guide to assess the well being of a newborn immediately after birth. It was coined by Virginia Apgar in 1952 and stands for A – appearance, P – pulse, G – grimace , A – activity and R – respiration. It is taken at 1 minute and repeated after 5 minutes. The one minute APGAR reflects the need for immediate resuscitation, whereas, the five minute APGAR signifies the probable neurological outcome in one year. A pink baby, with a heart rate of more than 100 beats per minute, with good cry and activity and regular respiration is a normal baby with a perfect score of 10 at 2 points each for every parameter. A score of 7 and up means the baby is not asphyxiated or depressed.
Inspect the child from head to toe. Note for the color of the skin, nail beds, lips and tongue or the mucosal membranes. It should be pink, not pale, blue or red. Is the head round or irregular in shape due to molding, cephalhematoma or caput? Look at the eyes and check for asymmetry, extra folds, redness, and discharge or yellowish discoloration. Check the ear if it is low set and with intact hearing. Are the nostrils patent? Is there alar flaring? Look for cleft palate, high arch, and tongue-tie. Is the neck short or webbed? Are there symmetrical movements of the extremities? Is there chest lag? What is the shape of the thorax? Is the breathing deep, shallow, or absent? Does the baby grunt? Where is the heartbeat located? Is the abdomen globular? Do you feel any masses? Are the pulses full and supple? Count the fingers and the toes, hands, arms, legs and feet. Look at the palms and soles and check for a Simian crease, hypoplastic middle phalanx of the fifth digit and wide gapped toes. Check for the following reflexes: Moro, sucking, rooting and grasp reflex.
After the baby has been stabilized and checked, routine newborn care is provided. It entails giving prophylaxis like Vitamin K1 and eye ointment. The World Health Organization and the Department of Health recommend hepatitis vaccine and BCG at birth. The newborn screening is done after 24 hours of life once with adequate milk intake. Daily bath and cord care are also done in a sterile condition.
Breastfeeding is highly recommended and encouraged unless with contraindications. The benefits derived from it far outweigh the risk of using milk formula feeding. It is BEST for babies up to 2 years and beyond. BEST being B- Bonds the mother and the child; E – Economical in terms of time, money and convenience, S – Safe for it prevents diarrhea and other diseases, allergies and provides antibodies against infection and necessary nutrients in the proper quality and quantity and T – Tried and Tested for years with the right Temperature and contraceptive effect. However, the MRS CANT absolutely breastfeed in six maternal conditions like Mental disorders, Retardation and Seizure disorders, Cardiac diseases, Advanced Nephritis, open Tuberculosis and Thyrotoxicosis. Temporary contraindications to breastfeeding are intake of drugs like anticoagulants, antibiotics, toxic substances like mercury and benzene and mechanical problems like retracted and oversized nipples.
Taking care of a newborn is no easy task, especially for first time parents or caretakers. Babies put their absolute trust in whoever provides them their basic needs. A simple touch and a peek from their dads and moms on a daily basis may spell a difference so every neonate will not be deprived of TLC (Tender loving care).
Enjoy every single moment you spend with that cute little being who was temporarily loaned to you from up above. Don’t be afraid of the responsibility it entails to be a parent. Trust in your instincts and pray for guidance. If you were not sure of what you’re doing, it wouldn’t hurt to ask.
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