Promote Healthy Eating Habits in children

Canadian Paediatric Society, 2305 St. Laurent Blvd., Ottawa, Ont. K1G 4J8
Caring for Kids article

Mealtime means different things for babies, preschoolers and older children. Breastfeeding is best for babies and is the only food babies need until they are six months old. Solid foods are added to children's diets starting at 6 months of age. Preschoolers have special nutrition requirements. As children get older, their nutritional needs become more in line with those of adults.

Bottle-fed babies should be begin learning to drink from a training cup or glass at 12 to 15 months of age. Babies should not be put to bed with a bottle, because the liquid stays in the mouth and can cause tooth decay.

Ensure that infants and toddlers are always supervised during feeding.

What are some tips for developing good eating habits in children?
How can parents introduce children of all ages to a variety of foods?
What are other important tips to remember?

What are some tips for developing good eating habits in children?
While your children are young, they need to develop good eating habits that will last their lifetimes. Mealtime is the ideal opportunity to set an example by creating a positive atmosphere in which healthy food attitudes can be developed.

Canada's Food Guide to Healthy Eating contains basic nutrition messages. The guidelines show how to:

• Enjoy a variety of foods.
• Emphasize cereals, breads, and other grain products, vegetables and fruits.
• Choose lower-fat dairy products, lean meats, and foods prepared with little or no fat.
• Achieve and maintain a healthy body weight by enjoying regular physical activity and healthy eating.
• Limit salt, alcohol and caffeine.

Some tips include:

• Serve your child well-balanced meals. These meals are healthy and they offer a wide variety of tastes and textures that your child will find enjoyable.
• Use nutritional information to guide you in the introduction of new foods and average amounts required.
• Offer a variety of nutritional foods prepared in a variety of ways. Become familiar with Canada's Food Guide to Healthy Eating.
• Ask an older child to help you do the shopping; this may spark an interest in food. The child can also help serve the food.

How can parents introduce children of all ages to a variety of foods?

• Introduce only one food at a time.
• Serve the new food with familiar foods.
• Encourage the child to taste a new food but do not coax the child to eat it. If the new food is rejected, accept the refusal calmly and try again in a few weeks. As new foods and new taste experiences become more familiar, children become more adventurous.
• Let children explore. The more they know about a food, such as where it grows and how to prepare it, the more they will enjoy eating it.
• Be a role model for children. If they see adults enjoying foods, they are more likely to try them.
• Hard small, and round, smooth and sticky foods are not recommended because they may cause choking and aspiration.

What are other important tips to remember?

• Never use food as a reward or punishment.
• When preparing food, always wash your hands, fresh fruits and vegetables, food containers, clean counters and utensils.
• When storing foods use clean containers, refrigerate foods, and never return partly used food to a container.

Source: Adapted from Well Beings, 1999.

Last updated March 2005

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This information should not be used as a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.

Canadian Paediatric Society, 2305 St. Laurent Blvd., Ottawa, Ont. K1G 4J8
Phone: 613-526-9397, fax: 613-526-3332

Foreign bodies in Ear Nose Throat

Am Fam Physician. 2007;76:1185-1189.

Clinical Context

Most patients presenting with foreign bodies in the ear, nose, or throat are children and adults who are intellectually challenged or mentally ill, and successful removal depends on location, type of object, whether the object is graspable, clinician dexterity, and patient cooperation. Foreign bodies in the ear often are lodged at the bony cartilaginous junction and attempts at removal may result in pushing the object farther into the auditory canal or damage to the tympanic membrane. Nasal foreign bodies tend to be lodged below the inferior turbinate or in the upper nasal fossa anterior to the middle turbinate. Pharyngeal foreign bodies may be lodged in the pharynx or hypopharynx.

This is a review of presentations of foreign bodies in the ear, nose, and throat and management strategies that are appropriate for removal.

Study Highlights

• Foreign bodies in the ear:
  • 75% occur in children younger than 8 years.
  • These objects are usually asymptomatic and are often an incidental finding in children.
  • The most common foreign bodies are beads, plastic toys, pebbles, and popcorn kernels; insects are more common in children older than 10 years.
  • In 30% of children younger than 7 years, the object requires removal with the child under general anesthesia.
  • Graspable foreign bodies (foam rubber, paper) have higher rates of success for removal under direct visualization.
  • Options for removal include water irrigation, forceps, cerumen loops, right-angle ball hooks, and suction catheters.
  • Live insects can be rapidly killed before removal by instilling alcohol, 2% lidocaine, or mineral oil into the ear canal, but this should not be done if the tympanic membrane is perforated.
  • Irrigation should be avoided in patients with button batteries because of the risk for liquefaction tissue necrosis.
  • Acetone may be used to dissolve Styrofoam foreign bodies or to loosen cyanoacrylate (eg, Super Glue adhesive).
  • After the first failed attempt at removal, complications increase and success rate falls.
  • Otolaryngologic referral should be made for patients requiring general anesthesia.
  • After removal of a foreign body, all orifices should be examined for other objects.
  • Otic antibiotic drops are required for concurrent otitis externa or when trauma is present.
• Foreign bodies in the nose:
  • Nasal foreign bodies tend to be located on the floor of the nasal passage, and most can easily be removed in the office or emergency department.
  • Patients often present with foul-smelling unilateral nasal discharge.
  • Before removal, 0.5% phenylephrine should be used to reduce edema, and topical lidocaine should be used to provide analgesia.
  • Techniques include forceps, curved hooks, cerumen loops, or suction catheters.
  • In addition, a thin, lubricated, balloon-tip catheter (5- or 6-French Foley) can be passed past the foreign body, the balloon inflated, and removal completed by pulling the inflated catheter balloon forward.
  • Button batteries must be removed from the nose immediately because of the danger of liquefaction necrosis of the surrounding tissue.
  • Sedation is discouraged for removal because of the risk for increased complications from reducing the gag and cough reflex.
  • Patients may be able to expel the foreign body by blowing their nose while blocking the other nostril.
  • If this fails in a young child, positive pressure ventilation can be delivered through the child's mouth, with the rare potential complication of barotraumas to the ear.
  • Appropriate infection control should be exercised as the foreign body will be expelled through the cheek.
• Foreign bodies in the throat:
  • All pharyngeal foreign bodies are medical emergencies that require airway protection.
  • Common obstructing objects in children include balloons, soft plastic, and food particles or boluses.
  • Patients with nonobstructing or partially obstructing foreign bodies present with choking, dysphagia, odynophagia, or dysphonia, whereas those with complete airway obstruction present with immediate respiratory distress, and emergency intervention is essential.
  • Other presentations include undiagnosed coughing, stridor, or hoarseness.
  • Clinicians must have a high index of suspicion in patients with unexplained upper airway symptoms, especially in children with a history of choking.
  • Early consultation with an otolaryngologist is advisable because foreign bodies are difficult to visualize without endoscopy.
  • Sedation is required for endoscopic removal.

Pearls for Practice

• Foreign bodies in the ear, nose, or throat are most likely to present in children. Foreign bodies in the ear tend to be asymptomatic, nasal foreign bodies present with unilateral foul-smelling discharge, and pharyngeal foreign bodies show symptoms and signs of complete or partial obstruction.
• Obstructing pharyngeal foreign bodies are a medical emergency, whereas attempts at removal of foreign bodies from the ear and nose depend on location, type of object, whether the object is graspable, clinician dexterity, and patient cooperation.

Healthy Foods for Healthy Kids

Dr. Harvey Fineberg, President of the Institute of Medicine

(article from Medscape Pediatrics Oct 2007).

More than one third of children and adolescents are overweight or obese, and the problem is getting worse every year. In schools, the number of vending machines, snack bars, and other food options has increased strikingly in recent years. When kids eat at school, traditional breakfast and lunch programs are often less appealing than a soda and a bag of chips.

Many children's diets consist of foods that are high in fat and sugar. It is up to us to improve the nutritional value of our children's meals and snacks.

In its report Nutrition Standards for Foods in Schools: Leading the Way Toward Healthier Youth (http://www.iom.edu/CMS/3788/30181/42502.aspx),^[1] the Institute of Medicine recommends limiting food options that are not part of the school's healthy breakfast and lunch programs. When these other foods are available, they should follow a high nutrition standard.

For example:

The best foods for establishing healthy eating habits in children are fruits, vegetables, whole grains, and healthy dairy products. Snacks, foods, and beverages available to students should have limited calories from fats or sugars. Lowfat and nonfat milk and 100% juice should be chosen over beverages with nonnutritive sweeteners, like sugar substitutes. These sweeteners are not proven weight management tools. Plain, unflavored water should be more readily available than carbonated or fortified waters. After-school and fundraising activities should apply these nutritional standards, rather than relying on candy; other high-sugar foods; and carbonated, caffeinated beverages.

By replacing unhealthy foods in our schools with nutritional alternatives, we will help children to meet nutrition standards, lose weight, encourage better eating habits, and lead healthier lives. Speak out in your local school district about changing their food options today.

That's my opinion. I'm Dr. Harvey Fineberg, President of the Institute of Medicine.

Baby Healthcare Reference for Parents & Medics

Congratulations, You're a Mum & Dad is a compilation of all the reference material collected over 20 years of training medical students and doctors preparing for their postgraduate pediatric exams. It is currently used by nursing trainees & medical students as a locally relevant pediatric textbook.

Written in simple English, (272pages) the book provides new parents and grandparents accurate medical information on how their newborn should feed, grow and develop, on vaccinations and the diseases they help prevent, on breast feeding and formulae options, and daily nutritional requirements. You will also learn about thermometers, which ones to buy, how to deal with fever, cough, diarrhea and many of the common conditions that affect kids as they grow.

The 2nd edition (2007)book is on sale throughout Malaysia (distributed by University Book Distributors - check out the book shop nearest to you ) and S'pore. It retails at Rm45/-

You may order by emailing drtanpohtin@gmail.com or phone 082 572020 or 082 573020 (tel/fx) during clinic hours. Postage will be added to cost.
If u are a book retailer or ordering for medical or nursing students in bulk, a special rate can be negotiated.

Monday, Wed 830 - 12, 200 - 400, 7 - 830pm
Tues, Thurs 930 - 12, 200 - 400, 7-830pm
Fri - Sat 830 - 12, 230 - 430 pm closed nights
Sun 7 - 830 pm only


The following are comments on the first edition (2004)

…The good doctor has given much of her time to training and educating and this book is meant to help parents optimize the use of doctors. In fact this is just the sort of book that should share pride of place next to the first aid box. Dr Tan used to train medical personnel for a living. Here she puts that very same experience to print. It wouldn’t surprise me if even doctors find this book a helpful reference source - Book review by Yahya M Iskandar Sarawak Tribune (6 March 2006)

It is indeed timely to receive your book as my eldest daughter is giving birth to her first child in a few months time. The book will certainly be very useful to her. My heartiest congratulations to you for your noble contribution towards the medical field. YB Datuk Lee Kim Shin, Assistant Minister of Infrastructure, Development and Communications , Sarawak (22 April 2005)

Well done, I am sure it will benefit the doctors and other medical professionals and the parents as well. Please keep it up. You have done a lot for the medical profession and the public in many of your endeavors. I will forward a copy to our Health Minister. YB Dr Soon Choon Teck, Assistant Minister of Housing, Sarawak (12 April 2005)

It is indeed a very informative and useful book. I definitely will find time to read it and share with others as well. YB Lily Yong Lee Lee, Dewan Undangan Negeri Sarawak (26 April 2005)

….. a valuable source of health and medical references – sincerest appreciation and gratitude for gift. YABhg Toh Puan Datuk Patinggi Hajah Norkiah, Astana, Sarawak (26 April 2005)

Congratulations on the second edition of your book. Personally I wish to recommend all newly weds and young parents to have a copy! I have known Dr Tan since my youngest daughter Farah was a few years old. She was the doctor responsible for detecting and curing her of ITP. I cherish all that she had done. My family is forever grateful to a very caring, hardworking and dedicated doctor, our family doctor. This book is the proof of her credibility, total dedication and much experience. Happy reading! YB Datuk Hajjah Rohani bte Hj Abdul Karim, Parliamentary Secretary to the Ministry of Agriculture and Agrobased Industries, Malaysia (20 March 2007)

Pediatric Flu Vaccine Works Despite Strain Mismatch

Pediatric Flu Vaccine Works Despite Strain Mismatch


NEW YORK (Reuters Health) Mar 14 - Despite not being a good match for circulating influenza strains, flu vaccination still provides a considerable degree of protection in many young children, researchers report in the March issue of Pediatrics.

"The results of our investigation," Dr. Carrie M. Shuler told Reuters Health, "support recommendations for influenza vaccination of children and strengthen the evidence of the vaccine's ability to reduce substantially the burden of disease among children."

Dr. Shuler of the Georgia Department of Public Health, Atlanta and colleagues came to this conclusion after conducting a study of 290 children attending a single pediatric practice in the 2003 to 2004 flu season.

During this season, there was a less than ideal match between the vaccine and the predominantly influenza A (H3N2) viruses. Only 25% of the circulating viruses were similar antigenically to the vaccine strain in use.

To investigate what consequences this might have had, the children, all of whom had laboratory-confirmed influenza and were between 6 and 59 months old, were matched 1:2 with controls.

Compared with unvaccinated children, the efficacy of the vaccine in fully vaccinated children was 49%. Partially vaccinated children under the age of 23 months had no significant reduction in influenza. However, older partially vaccinated children showed a 65% reduction.

Thus, concluded Dr. Shuler, "we found that influenza vaccination provided protection against medically attended children who were aged 6 to 59 months during a season with a suboptimal match between vaccine and circulating strains."

Pediatrics 2007;119:e587-e595.

HPV vaccine Protects against Cervical Cancer

ACIP Recommends Quadrivalent HPV Vaccine
News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD

March 23, 2007 — The Advisory Committee on Immunization Practices (ACIP) recommends quadrivalent human papillomavirus (HPV) vaccine for girls and women aged 9 to 26 years, according to guidelines published in the March 12 Early Release issue of the Morbidity and Mortality Weekly Report.

"Genital HPV is the most common sexually transmitted infection in the United States; an estimated 6.2 million persons are newly infected every year," write Lauri E. Markowitz, MD, from the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (proposed), and colleagues. "Although the majority of infections cause no clinical symptoms and are self-limited, persistent infection with oncogenic types can cause cervical cancer in women.... Cervical cancer rates have decreased in the United States because of widespread use of Papanicolaou testing, which can detect precancerous lesions of the cervix before they develop into cancer; nevertheless, during 2007, an estimated 11,100 new cases will be diagnosed and approximately 3,700 women will die from cervical cancer."

The guidelines represent the first ACIP statement on the use of a quadrivalent HPV vaccine licensed by the US Food and Drug Administration on June 8, 2006. This report reviews the epidemiology of HPV and associated diseases, the licensed HPV vaccine, and recommendations for vaccination among girls and women aged 9 to 26 years in the United States.

The licensed HPV vaccine is composed of HPV L1, the major capsid protein of HPV. The quadrivalent HPV vaccine is a mixture of 4 HPV type-specific noninfectious virus-like particles prepared from the L1 proteins of HPV 6, 11, 16, and 18 combined with an aluminum adjuvant.

In clinical trials, the vaccine was highly effective in preventing persistent HPV infection, cervical cancer precursor lesions, vaginal and vulvar cancer precursor lesions, and genital warts caused by HPV types 6, 11, 16, or 18 among girls and women who had not already been infected with the respective HPV type. Although there is no evidence of protection against disease caused by HPV types with which girls and women are infected at the time of vaccination, girls and women infected with one or more vaccine HPV types before vaccination would be protected against disease caused by the other vaccine HPV types.

In clinical trials, systemic clinical adverse events were reported by a similar proportion of HPV vaccine and placebo recipients, and the maximum intensity rating of systemic clinical adverse events was mild or moderate. Vaccine-related serious adverse events occurred in less than 0.1% of persons, and included bronchospasm, gastroenteritis, headache/hypertension, vaginal hemorrhage, and injection site pain/movement impairment.

In the overall safety evaluation, 10 persons in the group that received quadrivalent HPV vaccine and 7 persons in the placebo group died during the course of the trials, but none of the deaths were considered to be vaccine related.

Quadrivalent HPV vaccine is not recommended for use in pregnancy.

Quadrivalent HPV vaccine is available as a sterile suspension for injection in a single-dose vial or a prefilled syringe, and it is administered intramuscularly as 3 separate 0.5-mL doses. The second dose should be administered 2 months after the first dose and the third dose 6 months after the first dose.

The recommended age for vaccination of girls is 11 to 12 years during the established young adolescent healthcare visit at age 11 to 12 years as recommended by several professional organizations when other vaccines are also recommended.

The HPV vaccine can be given as young as age 9 years, and catch-up vaccination is recommended for teens and women aged 13 to 26 years who were not previously vaccinated. It is not possible for a clinician to assess the extent to which sexually active persons would benefit from vaccination, and the risk for HPV infection might continue as long as persons are sexually active. At any age, Papanicolaou testing and screening for HPV DNA or HPV antibody are not recommended before vaccination.

The guidelines caution that vaccination is not a substitute for routine cervical cancer screening and girls and women who have received vaccination should have cervical cancer screening according to the recommended protocol.

After reviewing available data on the epidemiology and natural history of HPV, vaccine acceptability, and sexual behavior in the United States, the ACIP also considered economic and cost-effectiveness analyses presented during meetings in June 2005, October 2005, and February 2006. The ACIP HPV vaccine workgroup developed recommendation options based on the above, as well as on expert opinion of the workgroup members.

The final recommendations were presented to ACIP at the June 2006 ACIP meeting and approved at the June 2006 meeting. The guidelines also recommend long-term follow-up studies to determine duration of protection. Additional data available in the near future from clinical trials and any new information on epidemiology of HPV will be reviewed by ACIP as they become available, and recommendations will be updated as needed.

"The recommendation for routine vaccination of females aged 11 to 12 years is based on several considerations, including studies suggesting that quadrivalent HPV vaccine among adolescents will be safe and effective; high antibody titers achieved after vaccination at age 11 - 12 years; data on HPV epidemiology and age of sexual debut in the United States; and the high probability of HPV acquisition within several years of sexual debut," the authors write. "Ideally, HPV vaccine should be administered before sexual debut, and duration of protection should extend for many years, providing protection when exposure through sexual activity might occur. The vaccine has been demonstrated to provide protection for at least 5 years without evidence of waning protection."

Morbid Mortal Wkly Rep Early Release. 2007;56:1-24.

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr56e312a1.htm
Clinical Context

The most common sexually transmitted infection in the United States is genital HPV. In the January-February 2004 issue of the Perspectives on Sexual and Reproductive Health, Weinstock and colleagues noted that the US annual HPV incidence is about 6.2 million for persons aged 14 to 44 years, with 74% occurring in ages 15 to 24 years. According to the US Cancer Statistics Working Group, in 2003, the incidence of cervical cancer in the United States was 8.1 per 100,000 or about 11,820 cases. In the February 6, 2003, issue of The New England Journal of Medicine, Munoz and colleagues reported that persistent infection with high-risk HPV types was associated with cervical cancer, low- and high-grade cervical cancer precursors, and anogenital cancer. HPV types 16 and 18 cause about 70% of cervical cancers, according to Bosch and de Sanjose in the 2003 issue of the Journal of the National Cancer Institute: Monographs.

Persistent infection with low-risk HPV types 6 and 11 has been linked to benign or low-grade cervical cancer cell changes, genital warts, and respiratory papillomatosis. A quadrivalent HPV vaccine was licensed in the United States in June 2006 for girls and women aged 9 to 26 years to prevent HPV type 6-, 11-, 16-, and 18-related cervical cancer, precursors to cervical cancer and vaginal and vulvar cancer, and anogenital warts.

In 2004, the ACIP HPV vaccine workgroup started to review published and unpublished data from HPV vaccine clinical trials, HPV epidemiology, vaccine acceptability, and sexual behavior. ACIP approved the final recommendations in June 2006. Subsequent modifications were made after the Centers for Disease Control and Prevention review. This is the first ACIP statement to summarize HPV epidemiology, the HPV quadrivalent vaccine licensed for use in the United States, and HPV vaccine recommendations for use in girls and women aged 9 to 26 years.
Study Highlights

* Genital HPV infection is usually transmitted by sexual intercourse with greater risk linked to increased number of sex partners.
* In the United States, 3.7% of girls reported sexual activity by age 13 years and 24% by age 15 years.
* Most significant risk factor for cervical cancer precursors and cervical cancer is persistent infection with high-risk HPV types, especially type 16.
* HPV is also associated with most vaginal intraepithelial neoplasias III (VaIN III) and vaginal cancers (especially type 16), 76% vulvar intraepithelial neoplasia (VIN) and 42% vulvar carcinoma (types 16 or 18), 90% anal squamous cell cancer, all anogenital warts (90% from types 6 and 11), and juvenile onset recurrent respiratory papillomatosis.
* HPV-related lesion treatments do not appear to affect infectiousness.
* HPV prevention methods include abstinence, monogamy with uninfected partner, and possibly condom use, but not routine HPV infection surveillance or partner treatment.
* Each 0.5-mL dose contains 20 µg of HPV 6 L1 protein, 40 µg of HPV 11 L1 protein, 40 µg of HPV 16 L1 protein, 20 µg of HPV 18 L1 protein, and 225 µg of amorphous aluminum hydroxyphosphate sulfate and also includes sodium chloride, L-histidine, polysorbate 80, sodium borate, and water.
* Vaccine efficacy is 89.5% for persistent HPV 6, 11, 16, or 18 infection; 100% for HPV 16- or 18-related cervical intraepithelial neoplasia (CIN) 2/3; 95.2% to 100% for any grade CIN; 98.9% for HPV-6, 11-, 16-, or 18-related external genital warts; and 100% for HPV 16- or 18-related VIN 2/3 or VaIN 2/3.
* If HPV vaccine-type is seropositive or HPV DNA is positive, efficacy for CIN 2/3 prevention was unclear.
* Women who received at least 1 vaccine dose and any follow-up showed efficacy of 39% for type 16- or 18-related CIN 2/3 or adenocarcinoma in situ; 46.4% for any vaccine type-related CIN; 69.1% for vaccine type-related VIN 2/3 and VaIN 2/3; and 68.5% for vaccine type-related genital warts.
* Seropositivity for all ages was 99% for HPV types 6, 11, 16, and 18.
* Serious adverse events were similar for vaccine and placebo groups (< 0.1%); 10 deaths in vaccine group were not vaccine related.
* Most common local adverse event in vaccinated subjects was pain (84%).
* The second most common adverse event from the vaccine was syncope according to the Vaccine Adverse Event Reporting System; observation for 15 minutes postvaccination should be considered.
* Special situations:
o Vaccine is not effective for existing HPV infection, cervical lesions, or genital warts.
o Breast-fed infants of 500 women who received vaccine during lactation had no events.
o Immunosuppressed girls and women can receive vaccine but might have decreased immune response and efficacy.
o Vaccine is not recommended during pregnancy, but no intervention is necessary if received (Category B classification); 1244 vaccinated women who became pregnant had no increase in spontaneous loss or congenital anomalies.
* Contraindications include moderate or severe illnesses and history of immediate hypersensitivity to yeast or any vaccine component.
* Second and third doses should be given 2 months (minimum 4 weeks) and 6 months (minimum 12 weeks) after first dose; interrupted vaccine series does not need to be restarted.
* Papanicolaou test and HPV DNA or HPV antibody testing are not needed prior to vaccination.
* Vaccine can be administered with other age-appropriate vaccines, but only data for hepatitis B vaccine exist.
* Cervical cancer screening should continue in vaccinated patients.
* HPV vaccine is not licensed for girls younger than 9 years or women older than 26 years or for boys and men.

Pearls for Practice

* Quadrivalent HPV vaccine is highly efficacious in the prevention of persistent HPV infection, cervical cancer precursor lesions, vaginal and vulvar cancer precursor lesions, and genital warts due to HPV types 6, 11, 16, or 18 in girls and women who are not infected. The most common local adverse event is pain.
* Three-dose series of the quadrivalent HPV vaccine is recommended routinely for girls and women aged 11 to 12 years, but can be given to those aged 9 to 26 years; girls and women who have received vaccination should continue to undergo recommended cervical cancer screening.


1. Which of the following statements about quadrivalent HPV vaccine is most accurate? (Required for credit)
The most common local adverse event is erythema
It is effective in prevention of cervical cancer precursor lesions
It is effective in prevention of cervical cancer precursor lesions but not genital warts
It is effective in prevention of vaginal and vulvar cancer precursor lesions but not cervical cancer precursor lesions
It is effective in prevention of genital warts but not vaginal and vulvar cancer precursor lesions

2. An 11-year-old girl receives her first quadrivalent HPV vaccine today. Which of the following statements is most accurate? (Required for credit)
The second dose of HPV vaccine is due in 6 months
If she misses the next scheduled dose, she will need to restart the vaccine series
After she receives all 3 doses, she will not need cervical cancer screening in the future
Her 9-year-old sister could receive the vaccine today


Medscape Medical News 2007. ©2007 Medscape

Influenza Vaccination Recommendations for Children

The American Academy of Pediatrics recommends annual influenza immunization (April 2007)for

(1) children with high-risk conditions who are 6 months and older;
(2) healthy children 6 through 59 months of age;
(3) household contacts and out-of-home caregivers of children with high-risk conditions and all healthy children younger than 5 years; and
(4) health care professionals,

Other children, adolescents, and adults can be immunized to decrease the impact of influenza as indicated in the Red Book: 2006 Report of the Committee on Infectious Diseases.

Vaccination also recommended for older child or adolescents with underlying medical conditions eg:-
asthma or other chronic pulmonary diseases;
hemodynamically significant cardiac disease;
immunosuppressive disorders or therapy;
HIV infection;
sickle cell anemia and other hemoglobinopathies;
diseases requiring long-term salicylate therapy;
chronic renal dysfunction;
chronic metabolic disease, such as diabetes mellitus;
and any condition that can compromise respiratory function or handling of secretions or can increase the risk for aspiration.

Joseph A. Bocchini, Jr., MD,
Chairperson of the 2006-2007 Committee on Infectious Diseases