Guide to Health Maintenance and Disease Prevention: What You Need to Know. Why You Should Ask Your Doctor

GUIDE TO HEALTH

MAINTENANCE AND

DISEASE PREVENTION

What You Need to Know.

Why You Should Ask Your Doctor

Ijindah Marcus Uriri, MD, MPH&TM, MPH

Copyright © 2009 by Ijindah Marcus Uriri, MD, MPH&TM, MPH.

Library of Congress Control Number: 2008912208

ISBN: Hardcover 978-1-4415-0051-9

Softcover 978-1-4415-0050-2

eBook 9781462824175

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Contents

DEDICATION

ACKNOWLEDGEMENTS

HEALTH MAINTENANCE AND DISEASE PREVENTION

CHAPTER ONE

CHAPTER TWO

CHAPTER THREE

CHAPTER FOUR

CHAPTER FIVE

CHAPTER SIX

CHAPTER SEVEN

CHAPTER EIGHT

CHAPTER NINE

CHAPTER TEN

CHAPTER ELEVEN

CHAPTER TWELVE

CHAPTER THIRTEEN

CHAPTER FOURTEEN

CHAPTER FIFTEEN

CHAPTER SIXTEEN

CHAPTER SEVENTEEN

CHAPTER EIGHTEEN

CHAPTER NINETEEN

CHAPTER TWENTY

CHAPTER TWENTY-ONE

CHAPTER TWENTY-TWO

CHAPTER TWENTY-THREE

CHAPTER TWENTY-FOUR

CHAPTER TWENTY-FIVE

CHAPTER TWENTY-SIX

CHAPTER TWENTY-SEVEN

CHAPTER TWENTY-EIGHT

CHAPTER TWENTY-NINE

CHAPTER THIRTY

CHAPTER THIRTY-ONE

CHAPTER THIRTY-TWO

CHAPTER THIRTY-THREE

CHAPTER THIRTY-FOUR

CHAPTER THIRTY-FIVE

CHAPTER THIRTY-SIX

CHAPTER THIRTY-SEVEN

CHAPTER THIRTY-EIGHT

CHAPTER THIRTY-NINE

CHAPTER FORTY

CHAPTER FORTY-ONE

CHAPTER FORTY-TWO

DEDICATION

I dedicate this book to my mother, Mrs. Christiana Uriri and my deceased father, Chief Marcus Ichegbo Uriri, for instilling the value of education in me.

To my wife, Mrs. Omegbhai Uriri and children, Chimele, Chilesi, Chizenum and Akelachi for all their support and sacrifices during the writing of this book.

Lastly, this book is dedicated to my brothers, Nyemaekile (Bob), Ayinwe, Chikwudi, Nkasiobi and my sisters, Mamma (Florence), Ndalu (Faith), Nnwere, Nnwoburuoma (Peace), Chigonum, Nkechi, Weleonu,Nnwoma, as well as my deceased brother, Ndamerukele Uriri.

ACKNOWLEDGEMENTS

I thank God almighty for guiding me through the writing of this book. I thank Dr. Olayinka Onadeko and Dr. Henry Douglas for their review of the pediatric section. My special thanks to Mrs. Katrena Johnson and Ms. Theresa Anderson for their support, especially with the cover.

HEALTH MAINTENANCE AND DISEASE PREVENTION

What you need to know. Why you should ask your doctor.

Health maintenance and disease prevention has a primary objective of preventing or delaying the onset of certain medical conditions, health promotions, and maintaining a good quality of life. The benefits of disease prevention have become apparent in the last fifty years as most commonly debilitating illnesses have tremendously declined in incidence. The incidence of most vaccine preventable infectious diseases has declined in the developed countries, and a record decrease has been noted also in developing countries. The incidence of invasive cervical cancer is also declining as a result of cervical cancer screening using Papanicolaou test. Early detection and control of blood pressure has resulted in a decrease in morbidity and mortality secondary to stroke. Early control and management of diabetes has reduced the morbidity associated with visual loss, heart disease, and kidney failure. However, changing personal health behaviors of individuals such as smoking cessation, abstaining from illicit drug use, drinking alcohol to moderation, safe sexual practice, regular exercise and low saturated fat, low cholesterol diet, and so on will lead to a significant reduction in health-related conditions respectively. In the face of an increasing healthcare costs and lack of adequate or nonexistent health insurance coverage for all Americans, health promotion and disease prevention are the keys in reducing morbidity and mortality. Majority of medical conditions are preventable. Additional benefit of health maintenance is reduction in health costs for the individuals and the public in general.

Majorities of the people are unaware of health preventive measures that are available to them. Due to chronic nature of some medical conditions, some of which are asymptomatic, certain individuals may not realize the importance of prevention until when it is too late. Some other medical conditions may result from unhealthy lifestyles with individuals continually abusing their bodies. Such abuse could be in form of eating unhealthy foods without restriction, smoking, alcohol and substance abuse, inactivity, indiscriminate sexual activity without protection, or engaging in other behaviors that are self-destructive.

Oftentimes, due to time constraint, providers are unable to adequately educate patients about preventive measures. Knowledge about health maintenance and disease prevention by the patients prior to office visit will greatly facilitate and improve healthcare delivery. Equipped with such knowledge, patients can act as clinical reminders to their healthcare providers about existing preventive measures.

Most individuals do not seek healthcare services until they are actually sick. Others do so because they lack health insurance and are at risk of frequent emergency room visits. Majorities are unaware about the importance of asymptomatic diseases such as hypertension until they end up with a stroke or heart attack. Individuals ought to be reminded that humans could be compared to cars. No one drives a car, no matter how brand-new all year round without a preventive maintenance. Regularly, such maintenance is required to keep the car functional at all times; otherwise lack of such maintenance may result in inconveniences and costs associated with unexpected breakdowns. Just because your car is running does not mean there is nothing wrong with it. Same situation is applicable to humans. There are several dead men walking. Individuals should be aware of preventive measures and lifestyle changes to maintain a good quality of life. Knowledge about the chronic nature of some medical conditions and the need for long-term management and prevention will go a long way in preventing complications and improving quality of life. Individuals oftentimes downplay the importance of their risky behaviors and associated health consequences. Some are simply in denial of becoming a victim of their own actions. Yet others are simply unaware of such consequences associated with their actions or inactions. The end result may be poor health outcome with resultant frequent hospitalizations, financial distress, poor quality of life, depression, emotional distress on friends and family, and ultimately an untimely death. Good health is not just the absence of disease but a state of physical, mental, and emotional health.

Reference:

1. Carolyn DiGuiseppi, MD, MPH. Guide to Clinical Preventive Services, Second Edition.

2. Centers for Disease Control and Prevention. General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 1994; 43(RR-l): 1-38.

3. McGinni J. M., Foege W. H. Actual Causes of Death in the United States. JAMA. 1993; 270:2207-2212.

4. Centers for Disease Control and Prevention. Public Health Focus: Physical Activity and the Prevention of Coronary Heart Disease. MMWR 1993; 42:669-672.

5. Garraway W. M., Whisnant J. P. The changing pattern of hypertension and the declining incidence of stroke. JAMA. 1987; 258:214-217.

SECTION A

PREVENTIVE HEALTH SERVICES

CHAPTER ONE

Preventive Services

for Newborns and Infants

Main objectives are the following:

 Growth and development of the newborn child

 Newborn prophylaxis

 Screening for the presence of inherited disorders

 Newborn hearing screening

 Injury prevention

 Adequate nutrition

 Dental caries

 Screening for anemia

 Screening for blood lead levels

 Childhood immunizations

Growth and Development: An essential aspect of a well-child visit is monitoring for adequacy of growth and development. Serial growth measurements may lead to detection of important metabolic, infectious, or other disorders affecting growth. It will also assist in detecting presence of nutritional inadequacies as well as child abuse or neglect affecting growth. Benefits of growth measurement include detection of abnormal growth patterns or delayed growth. It is estimated that about 12 percent-16 percent of American children have developmental or behavioral disorders. Early identification of children with developmental delays will result in early intervention.

Your child needs regular weight, length, and head circumference measurements to assess for normal growth and to detect abnormal or delayed growth.

Newborn Prophylaxis:

conjunctivitis—An eye infection that may be caused by bacteria may occur in the newborn period. Some bacteria such as Chlamydia trachomatis (most common) and Neisseria gonorrhea have been associated with this infection. Newborns may acquire infection at the time of delivery. Currently, newborns are prophylaxed against these infections by applying either of the following eye ointments at the time of delivery: 0.5 percent Erythromycin ointment, 1 percent Tetracycline ointment, or 1 percent Silver nitrate. This may prevent progression of the infection.

Your newborn needs prophylaxis against conjunctivitis soon after delivery.

hemorrhagic disease of the newborn—A bleeding disorder in the newborn period is caused by a temporary lack of vitamin K-dependent clotting factors. Vitamin K is therefore given as a muscular injection soon after delivery to prevent bleeding.

Your newborn needs vitamin K prophylaxis against bleeding after delivery.

Screening for Metabolic Disorders:

Many metabolic disorders may present in the newborn period. These disorders may be due to lack of certain enzymes necessary for metabolism and may present no symptoms early in life. Therefore, early detection may lead to early treatment and decreased morbidity and mortality. Such metabolic disorders may include galactosemia, congenital hypothyroidism leading to mental retardation, phenylketonuria, congenital adrenal hyperplasia, sickle-cell anemia, and other hemoglobinopathies, cystic fibrosis, maple syrup urine disease, homocystinuria, and a host of others. There are racial or ethnic predispositions to some of these disorders while others are without predilection. The type screened is also dependent on individual states.

You should be certain that your newborn is screened for metabolic disorders as applicable. In addition, there may be need for a repeat testing after discharge from the hospital. Ascertain if your child needs repeat testing.

Screening for Hearing:

Hearing screening of all newborns is the standard of care across the United States. Some newborns may present with hearing loss after delivery. Screening tests are available for permanent childhood hearing impairment. Newborn hearing screening may lead to earlier identification and treatment of infants with hearing loss. Universal newborn screening for hearing loss is required by law in several states in the United States. Risk factors for sensorineural hearing loss (SNHL) in newborns include as follows:

 Newborn intensive care unit (NICU) admission for two days or more

 Syndromes known to include hearing loss such as Usher’s syndrome, Waardenburg’s syndrome, etc.

 Family history of childhood SNHL

 Congenital infections such as Toxoplasmosis, bacterial meningitis, syphilis, rubella, cytomegalovirus, herpes virus

 Craniofacial abnormalities

Signs of possible loss of hearing include as follows:

 Poor response to noise or voice

 Slow language and speech development

 Abnormal sounding speech

You should have your newborn screened for any possible hearing impairment.

Injury Prevention:

Children in their developmental years are inadvertently exposed to injuries. These injuries can be prevented if caregivers are consciously aware of their children’s environment and consequently adopting safety measures and recommendations. The following are some of the safety tips that each parent is required to know.

 Approved child safety seat according to manufactures’ instructions and child size.

 Child safety seat starts with the first ride home from the hospital.

 Rear facing infant seats should not be placed in the front seat of a car but in the middle center of the rear seat.

 Smoke detectors should be installed in appropriate locations and tested periodically.

 Smokers should not smoke around children. There is danger of secondhand smoke.

 Hot water heaters should be set less than 120°F to avoid scalding from hot tap water.

 Have a bottle of syrup of ipecac at home.

 Display phone numbers of local poison control center at home.

 Place all medications, toxic substances, and matches in child resistant containers.

 Store all products and medications out of reach of children.

 Cosleeping discouraged in breast-fed or formula-fed infants.

 Shaking of child is discouraged.

 Childproof your home and take measures to prevent against fall.

 Do not leave infants in bathtub without constant adult supervision.

 Place infants on back while sleeping. This position reduces the risk of sudden infant death syndrome.

 Avoid soft surfaces, pillows and quilts in infants’ sleeping crib.

 Individuals who own swimming pools should install a four-sided fencing to decrease the risk of drowning. Fences should be at least four feet high, and no opening under the fence or between uprights should be more than four inches. Gates should be self-latching and self-closing and checked often to ensure good working order and safety.

 Do not leave children unattended. Inadequate supervision frequently results in severe and fatal injuries to children.

 Never leave children alone or in the care of another young child while in bathtubs, pools, spas, wading pools, or near irrigation ditches or open standing water.

 Full attention should be focused on the child. Avoid other distracting activities, such as talking on the phone, socializing or other activities.

 Swimming pool owners should learn cardiopulmonary resuscitation (CPR) as well as keep a telephone and equipment approved by U.S. Coast Guard at poolside.

 Other general safety measures such as protection from choking hazards, electrical cords, safety latches on cabinets, stair guards etc.

You should know these safety tips and more from your doctor for optimum child protection and injury prevention.

Adequate Nutrition:

Every child needs adequate nutrition for optimum growth and development. Nutrition is particularly important in the first year of life for normal brain development. By five to six months of life, a newborn is required to double his/her birth weight and to triple it by one year of age. Parents, especially first time mothers and teenage mothers often run into difficulty in nursing their newborn. Consequently, the child is either under—or overfed, leading to failure to thrive or early childhood obesity respectively. The caregiver is required to know the following:

 The benefits of breast-feeding versus formula feeding. Infants who are breast-fed, especially in the first six months of life have a significantly decreased risk of developing ear infections, lung infections, allergic disease, brain infections, diarrhea, and the number of hospital admissions.

 Infants not breast-fed in the first six months of life needs infant formula fortified with iron.

 After six months of age, foods rich in vitamin C should be given to enhance Iron absorption.

 How often and the amount of calories the child needs daily. Your child’s healthcare provider will assist you in achieving this goal.

 Proper method of feeding especially in breast-fed infants.

 When solid food should be added and other supplements introduced.

 Sources of nutritional assistance rather than rationing the food to last for days.

 When to seek professional assistance if child is not adequately gaining weight.

You should receive adequate nutritional counseling from your provider, benefits of breast-feeding versus formula feeding, and when to seek professional help if child is not gaining weight or is overweight.

Dental Caries: Dental caries may occur if water supply in your area has inadequate fluoride concentration. Early childhood caries can be a devastating disease with a lasting detrimental impact on the dentition and systemic health issues. Major benefits of early intervention include analysis of fluoride exposure and feeding practices and oral hygiene counseling. It can be prevented by the following measures:

 Asking your provider if your child needs extra fluoride supplementation, depending on fluoride concentration in your water supply.

 Regularly brush your child’s teeth.

 Avoid putting child to bed with a bottle.

 Scheduling a dental visit for preventive care.

You should be familiar with your child’s oral hygiene for healthy teeth.

Screening for Anemia:

Iron deficiency anemia is common in the first year of life. It is an anemia caused by lack of/or insufficient iron in the body. Iron deficiency anemia affects an estimated 20 percent-25 percent of infants worldwide. Breast-fed infants acquire iron from the breast milk in the first six months of life. Greater than six months, they need additional iron supplement. Infants who are not breast-fed needs iron fortified formula. Iron deficiency anemia may lead to poor growth and development and abnormal behavior. Babies fed cow’s milk have a higher incidence of iron deficiency anemia. Premature infants have an increased risk from iron deficiency. Be informed on the following:

 When to supplement iron to your infant’s feeding. Generally, use of iron fortified infant cereals is required after six months of age.

 Inform your provider if you are going to breast-feed or formula-feed your newborn.

 Know at what age your infant will need to be screened for anemia. Usually it is between nine and twelve months of age, but recommendations may vary.

You should be aware of iron deficiency anemia, especially if you are at a high risk such as infants born to African-Americans, immigrants from developing countries, infants living in poverty, Native Americans, preterm and low-birth weight infants, and infants not fed with iron-fortified formula.

Screening for Blood Lead Levels:

A high blood lead level poses a grave danger to the growing child. Those at risk include children living in large metropolitan areas, poor or living in old dilapidated houses. Lead can be present in dust and can be ingested by children when they put hands and toys in their mouth. Other sources of lead include paint, soil. Lead crosses the placenta and can affect the unborn child. Lead plumbing may contaminate drinking water. Complications include slow growth, seizures, and brain damage leading to a decline in intelligence quotient or cognitive impairment. Tests available include checking for blood lead level and free erythrocyte protoporphyrin levels to determine lead exposure. Targeted screening is recommended in the first twelve months of life.

You should be aware of the possibility of lead exposure to your child, dangers associated with such exposure, and the need to follow up with your provider. Counseling is required to reduce lead exposure.

Childhood Immunizations:

Immunization is a very important aspect of prevention with a remarkable reduction in vaccine-preventable diseases. Oftentimes, parents/guardians are so busy that they tend to forget to have their children vaccinated. Complete immunization coverage will greatly reduce the incidence of these preventable diseases. There are about four series of immunizations that a child should receive by the time the child attains twelve years of age. First series starts from birth till six months of age. Second series starts from twelve months until about twenty-four months of age. Third series begins from four to six years of age, and fourth series from ten to twelve years of age. The following vaccinations (shots) would have been taken before one year of age (first series):

1. Hepatitis B vaccine is given as follows: first shot at birth, second shot given one to two months from the time first shot was given, third shot given five to six months from the time the first shot was given. TOTAL = three shots

2. Shots at two months of age are DTaP, IPV, HIB, PREVNAR, HepB, and Rotateq Oral vaccine. TOTAL = six shots

3. Shots at four months of age are DTaP, IPV, HIB, PREVNAR, and RotaTeq. TOTAL = five shots

4. Shots at 6 months of age are DTaP, IPV, HIB, PREVNAR, HepB, and RotaTeq TOTAL = six shots

What You Need to Know

DTaP = Diphtheria, Tetanus (Lockjaw), Pertussis (Whooping Cough)

Need for vaccination. Diphtheria, tetanus, and pertussis are very dangerous diseases caused by bacteria. While diphtheria and pertussis are spread from person to person, tetanus enters the body through cuts or wounds.

diphtheria—Leads to a covering in the back of the throat (pseudomembrane) that can lead to breathing problems, paralysis, heart failure and death.

tetanus or lockjaw—Leads to painful muscle cramps, locking of the jaw with difficulty opening mouth and swallowing and may lead to death.

Pertussis or whooping cough—Causes severe coughing spells such that the infant finds it difficult to breathe or have anything by mouth. Complications may include seizures, brain damage, pneumonia, and death.

DTaP vaccine will help prevent the spread of these infectious diseases.

Caution: If your child had any adverse reaction to the vaccine such as very high fever, seizures, life-threatening allergic reaction, or any serious medical condition, inform your doctor immediately who can make other arrangements with you.

IPV—A polio vaccine that prevents polio disease. It is usually given in the leg or arm. Polio is a disease caused by a virus that enters the body through the mouth. Complications include paralysis and death.

Need for vaccination Vaccination against polio can prevent the disease.

Caution: Anyone who had a severe allergic reaction to a polio shot or a life-threatening allergic reaction to the following antibiotics neomycin, polymyxin B, or streptomycin should consult with your provider immediately.

HIB—A Haemophilus influenza type b vaccine that prevents Haemophilus influenza type b disease, which is caused by bacteria. It usually attacks children less than five years old. It is spread from person to person. Complications of the disease include meningitis, which is an infection of the brain and spinal cord and may lead to lasting brain damage and deafness. It can also cause pneumonia, swelling in the throat, making it hard to breathe, blood, joint, bone and heart infections, as well as death.

Need for vaccination Hib vaccine can prevent hemophilus influenza.

Caution: As with other vaccines, in the presence of a severe allergic reaction, consult your provider immediately. Children less than six weeks of age should not get Hib vaccine.

PREVNAR—A pneumococcal conjugate vaccine that prevents infection caused by streptococcus pneumonia bacteria. These bacteria can cause serious illness in children including pneumonia, ear infections and deafness, meningitis, and death especially in children less than five years. Children who are less than two years old are at highest risk for serious disease. It is spread from person to person through close contact.

Need for vaccination Prevnar can prevent pneumococcal infection. Four doses of the vaccine are given between two months and twelve to fifteen months of age. However, the vaccine is also recommended for children between two and five years old who have not already received the vaccine and are at high risk of serious pneumococcal disease. This includes children who have the following:

 Sickle-cell disease

 Damaged or no spleen

 Diseases that affect the immune system such as diabetes, cancer, or liver disease

 HIV/AIDS

 Been taking medications that affect the immune system such as steroids or chemotherapy

 Chronic heart or lung disease

Caution: Like all other vaccines, if severe allergic reaction develops, as a result of taking the vaccine, inform your provider immediately.

hepatitis B vaccine—A vaccine that prevents hepatitis B infection. This is a virus that destroys liver cells and can cause a chronic liver infection leading to liver cancer.

Need for vaccination Vaccination can prevent the infection. It is usually given at birth, then at one to two months and the third dose at five to six months.

Caution: As with other vaccines, if serious allergic reaction develops, notify your provider.

RotaTeq Oral Vaccine—A vaccine that prevents against rotavirus infection. Rotavirus is a viral infection that is most commonly associated with gastroenteritis in infants and young children. First dose is given by twelve weeks of age and additional two doses are given by thirty-two weeks of age.

influenza vaccine—Annual influenza immunization is recommended for all children with high-risk conditions who are six months of age or older and young healthy children six to twenty-four months or older. This is particularly important in children with risk factors such as asthma, heart disease, sickle-cell disease, HIV, immunosuppressive disorders, diabetes, and other serious medical conditions.

Reference:

1. Celia I. Kaye, MD, PhD, and Committee on Genetics. Newborn Screening Fact Sheets. Pediatrics 2006; 1 18:3/ e934-e963.

2. Lisa Stellwagen, MD, and Eyla Boies, MD, Care of the Well Newborn. Pediatrics in Review 2006; 27:89-98

3. Advisory Committee on Immunization Practices (ACIP). Recommended Childhood and Adolescent Immunization Schedule, United States, 2006.

4. Bradford L. Therrell, PhD, Alissa Johnson, MA., Donna Williams, BS Status of Newborn Screening Programs in the United States. Pediatrics Vol. 117 No.5. May 2006, pp. S212-S252.

5. Prevention of Rotavirus Gastroenteritis Among Infants and Children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2006/Vol.55/No. RR-12.

6. Preventive Services Guidelines. CareFirst BlueCross BlueShield. April 2006.

7. 2006 Primary Preventive Service Recommendations. 2006 Blue Cross and Blue Shield of Montana. Accessed online at www.bcbsmt.com on 11/10/2006.

8. Preventive Health Care Guideline. Unity Health Insurance. Fit for Life. Accessed online at www.unityhealth.com on 11/12/2006.

9. Lead Exposure in Children: Prevention, Detection, and Management. Pediatrics Vol. 116 No.4 2005 pp. 1036-1046.

10. A Comprehensive Immunization Strategy to Eliminate Transmission of HepB Virus Infection in the United States. Recommendations of the Advisory Committee on Immunization Practices. Part I: Immunization of Infants, Children and Adolescents. MMWR 2005154(RRI6)1-23.

11. U.S. Preventive Services Task Force. The Guide to Clinical Preventive Services 2005.

12. Committee on Infectious Diseases. Recommendations for Influenza Immunization of Children. Pediatrics Vol. 113 no.5 May 2004 pp. 1441-1447.

13. The Pocket Guide to Good Health for Children. U.S. Dept. of Health and Human Services. Agency for Healthcare Research and Quality. No. 04-1P004-A. Oct 2004.

14. Standards for Child and Adolescent Immunization Practices. CDC 2003.

15. Committee on Injury, Violence, and Poison Prevention. Prevention of Drowning in Infants, Children, and Adolescents. Pediatrics Vol. 112 No.2. 2003, pp. 437-439.

16. Ruth A. Brenner, MD, MPH, and Committee on Injury, Violence, and Poison Prevention. Prevention of Drowning in Infants, Children, and Adolescents. Pediatrics Vol. 112 No. 2 2003, pp. 440-445.

17. Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance, and Oral Treatment for Children. Clinical guidelines, Revised 2003.

18. Betsy Lozoff, MD, Isidora De Andraca, PhD, et al. Behavioral and Developmental Effects of Preventing Iron Deficiency Anemia in Healthy Full-Term Infants. Pediatrics vol. 112. No. 4. Oct 2003, pp 846-854.

19. Helfand M., Thompson D. C., Davis, R.L., McPhillips H., Lieu T. A., Homer, C. J. Newborn hearing screening. A summary of the evidence for the U.S. preventive services task force, Rockville (MD): Agency for Healthcare Research and Quality, 2001.

20. Committee on Children with Disabilities. American Academy of Pediatrics: Developmental Surveillance and Screening of Infants and Young Children. Pediatrics vol. 108 No. 1. 2001, pp. 192-195.

21. Newborn Hearing Screening: Recommendations and Rationale. U.S. Preventive Services Task Force. AAFP. Dec. 15, 2001, vol. 64.

22. CDC. Morbidity and Mortality Weekly Report. General Recommendations on Immunization. February 8, 2002/ Vol. 51 / No. RR-2.

23. American Academy of Pediatrics, Recommendations for Preventive Pediatric Health Care. Pediatrics March 2000;! 05:645-646.

24. Dan Brewer, MD, Jon Parham, DO, MPH, Mark Johnson, MD. Preventive Care for Newborns and Infants. Clinics in Family Practice. Vol. 2. Numb. 2. June 2000.

25. Thompson DC, McPhillips H, Davis RL, Lieu T. A., Homer C. J., and Helfand M. Universal Newborn Screening: A Summary of the evidence. JAMA 2001 Oct 24/3 1; 286: 2000-10.

26. Year 2000. Position Statement: Principles and Guidelines for early hearing detection and intervention programs. Joint Committee on Infant Hearing, American Academy of Audiology, American Academy of Pediatrics, American Speech-Language-Hearing Association and directors of Speech and Hearing programs in State Health and Welfare Agencies. Pediatrics 2000; 106: 798-8 17.

27. American Academy of Pediatrics: Screening for Elevated Blood Lead Levels. Pediatrics vol. 101. No. 6. 1998, pp. 1072-1078.

28. U.S. Preventive Services Task Force. Guide to Clinical preventive Services. 2nd ed. Baltimore. Williams and Wilkins, 1996.

CHAPTER TWO

Preventive Services

Ages One Year to Five Years

Main objectives are the following:

 Growth and development

 Injury prevention

 Nutrition

 Screening for Lead Exposure

 Screening for Anemia

 Screening for Blood pressure

 Screening for vision

 Screening for cholesterol

 Dental caries

 Immunization

Growth and Development: Monitoring for growth and development that began in infancy is continued to assess for normal growth and to detect for any signs of abnormal or stunted growth. A serial growth measurement on each well-child visit is continued with the assessment of weight, height, or length and head circumference. Probable causes of abnormal growth such as chronic disease, parental deprivation, endocrine, and infectious diseases may be detected. Growth delay may be genetically determined or may simply be normal or due to chromosomal abnormalities.