Erena S.

Kasahara
UP.PGll

Pediatrics

Ltconre no. f22715

OFFICIAL PUBLICATION OF THE

PHILIPPINE PEDNTRrc SOCIETY

,a::

a.

:?
i:

ry

PEDIATRIC
HEAUTH GARE

!::

coMMlrTEE 2010-2012
Maria Teresa S. Llorin-Belleza, MD, MPH
Erlinda Susana S. Guisia-Gruz, MD
Leonila F. Dans, MD
Janice Stephanie V. Gimenez-Mendoza, MD
Ma. Eva l. Jopson, MD
Eufrosina Marina A. Melendres, MD
Mary Antonette G. Madrid, MD

Ghristian T. Galigagan, MD
Vice Ghair

Maria Rosario S. Cruz, MD

Ghair

Miguel L. Noche, Jr., MD

Loida T. Villanueva, MD, MPH
Advisers

TABLE OF CONTENTS
...............
Message from the Committee Adviser......

TABLE
.........

Message from the PPS President

Foreword

Abbreviations
Annotations
List of

Appendix 1.
Appendix

2.

Discharge and Follow-up

Appendix 3. Adolescent Health

.'...........'..5

Counseling

PrenatalVisit, Education and

of

"""".."14

Healthy Term Newborns ............15

Care

....'.....'..'16

.........17
Screening
....'.....'..'.........19
Appendix 5. Screening for EyeA/isual Defects
.--.".22
Appendix 6. Preventive Dental Care...........
...--.--23
Appendix 7. Breastfeeding and Complementary Feeding
--.....25
Appendix 8. Child Maltreatment.................
.""'.-----.".."..".27
Appendix 9. "7 Steps to Protect Children".....
.......31
Figure 1. Windows of Achievement .............

Appendix

4.

Developmental Surveillance and

Figure

2.

Figure

3. Z-Score lnterpretation

Developmental Milestones of Early

Literacy.'........'.......'..".""."32
....'.33

.....----.'.' 34
Girls....".
..........35
Figure5. WeightforAgeforGirls: Birthto2years........
Figure 6. Length forAge for Girls: Birth to 2years
'......---........36
Figure 7. Weight for Length for Girls: Birth to 2years
'.'..........-37
Figure 8. BMI forAge for Girls: Birth to 2 years
'.......'...........'..38
.."..................39
Periodicity Table ..........
..-.-....'............"41
Figure 9. Weight for Age for Girls: 2 to 5 years
Figure 10. Height forAge for Girls: 2 to 5 years
'..'..----....'.'."""42
Figure

4.

Head Circumference forAge for

years
Figure 12. BMI forAge for Girls: 2 to 5 years.
Figure 13. Weight for Age for Girls: 5 to 10 years ..........
Figure 14. Height forAge for Girls: 5 to 19 years...........
Figure 15. BMlforAge for Girls: 5 to 19 years...........
Figure 16. Head Circumference forAge for Boys.......
Figure 17. Weight forAge for Boys: Birth to 2years
Figure 18. Length forAge for Boys: Birth to 2 years........
Figure 11. Weight for Height for Girls: 2 to 5

-.. -. ' ' '. 2

....".."'.'

OF COilITENTS
..................43
......44
...........45
...........46
..............47
...............48
.................49
..........50

Figure 19. Weight for Length for Boys: Birth to 2 years.................................51

years........
.............52
Figure 21 . Weight for Age for Boys: 2 to 5 years.
......................53
Figure 22. Height forAge for Boys: 2 to 5 years
.......................54
Figure 23. Weight for Height for Boys: 2 to 5 years.
..................55
Figure 24.BMl forAge for Boys: 2 to 5 years.
......56
Figure 25. Weight forAge for Boys: 5 to 10 years...........
..........57
Figure 26. Height forAge for Boys: 5 to 19 years...........
...........58
Figure 27.BMl forAge for Boys: 5 to 19 years...........
..............59
Figure 28. US CDC-NCHS Growth Chart for Boys............
........60
Figure 29. US CDC-NCHS Growth Chart for Gir|s............
........61
Figure 20. BMlforAge for Boys: Birth to 2

Figure 30. BP Levels for Boys byAge and Height Percenti|e........................62

Figure 31. BP Levels for Girls by Age and Height Percenti|e........................64

Annotations
Figure 32. lmmunization Table 2012...........
Figure 33. Food Pyramid...........................
Bibliography
lmmunization

.................66
..........7O

............71
..................72

MESSAGE
MESSAGE
he preventive aspect of pediatric health care is
an often neglected area in the care for children.
Aside from immunization and nutrition, which
pediatricians are allaware of, there is actually much more to be
done is this area of advocacy. ln a country like us where the
cost of health care is beyond the reach of the majority, a child
getting sick often leads to catastrophic outcomes due to lack of
iOequate health care. Thus, preventing rather than curing
these diseases will be an excellent and practical approach'

we pediatricians and those involved in the care of newborns,

infants, older children and adolescents must take part in this

very significant aspect of health care delivery, that is preventive
pediatrlc health care. This is the reason why our_Sggiety takes
all effort in bringing this updated handbook to all. Much labor
went into the rbvision of this 2012 edition and for this, my
sincere thanks to the Committee on Preventive Health Care
members through its Chair, Dr' Maria Rosario Cruz. To them,
my gratitude and aPPreciation.
May this handbook be of use to all child advocates.

0u.",.-

"*

nesis C. Rivera, MD, FPPS

resident
Philippine Pediatric SocietY

based data to

et me congratulate the indefatigable group of pediatricians, the

members of the Committee on Preventive Pediatric Health Care
led by the dynamic Chairperson Dr. Maria Rosario S. Cruz, for
their untiring efforts to continuously search for local evidenceprovide us comprehensive updates on preventive health care

appropriate for the Filipino child.

This handbook has no grandiose plans. lt's mission is simple: to put

together relevant recommendations to guide us, pediatricians, in our health
supervision encounters with the well child, which is the core to the care of the
infant, child and adolescent. The concept of preventive health care approach is
inevitable because the science of pediatrics is concerned with health and growth
. To achieve optimal health of the developing child , health care for
this vulnerable population should provide regular scheduled visits to assure a
structured primary prevention strategy - adequate nutrition , early detection of
and development

common illnesses, immunization against preventable infectious diseases,

anticipatory guidance, and monitoring the child's growth and development.

Nutritional evaluation, assessment of growth and development,

anticipatory guidance, and vaccination remain to be the essential components
of the well child supervision visits. ln the recent years, however , with the discovery
of new health problems, this handbook in the future, should address these
concerns and other components may be incorporated to the contents of the
recommendation for well baby visits.
I fervently wish good luck to the Committee , for them to continue that
enthusiasm to strive hard as a team, to gather local evidence-based researches in
an effort to provide us, clinicians, an updated recommendations for preventive
health care that are truly for Filipino children. Likewise, I exhort everyone -- the

educators, child advocates, experts

in

child health,

and

leaders

of

training

programs, to focus not only on curative aspects of health care for the developing
child, but on primary prevention as well. Using this handbook routinely as a guide
on the latter aspect of child health supervision, will surely assure youthatyou
are providing a comprehensive care for every patient that you see in your practice.
Let me end with this timeless words from Mother Teresa of Calcuta: "We
are not called to do great things. We are only called to do small things, but with great
love". The Committee on Preventive Pediatric Health Care, once again, has
produced this 6th edition of the handbook, I am sure, with great love. To the
members of the Committee, thankyou forsharing this great love.

/*yt g^t*/'
MIGUELL. NOCHE JR, MD, FPPS, FPSAAI
Adviser
Committee on Preventive Pediatric Health Care

LIST OF ABBREVIATIONS

FOREWORD
he Committee on Preventive Pediatric Health Care

is

honoured to present its sixth edition of the 'Handbook of

Preventive Pediatric Health Care', covering the most recent

updates in the prevention and screening of pediatric
infections and developmental disorders' Similarly, this
involved
edition was the result of the committee's meticulous work, which
and
societies
subspecialty
various
with
consultations
and
research
extensive
on
organizations on new recommendations and guidelines. Thus, we embarked
updates:
following
the
incorporating
tnii seemingly impossibte task of

PPS Policy Statement on Zinc Supplements in Children which

cites the beneficial role of Zinc supplementation in the prevention

of pneumonia and diarrhea
OetaiteO recommended use of fluoride toothpaste in children

FpS, ptOSp and PFV 2012 recommendations for-childhood

immunization including the recent incorporation of rotavirus

BMI

CP
DOH
DBP
DSWD
HEADSSS

LVH

MR
PASOO

vaccine in the DOH-EPlschedule

Developmental Milestones of Early Literacy from Reach Out and
Read, lnc. of Boston, Massachusetts

PEP
SBP
TIPP
UPCHK

age

UP PGH

WHO'CnifO Growth Standards for children above five years of

'
'

5TU PPD
AAPD

Targetedscreeningfortuberculosis
Contraindications to deworming.

I would like to extend my sincerest gratitude to the

committee

mention
members for their indefatigable and selfless contributions. special
B.T.
Loida
Dr.
Jr.
and
Noche,
L.
Miguet
Dr.
adri'rsers,
;;; t; ori

5 Tuberculin U nits Purified Protein Derivative

American Academy of Pediatric Dentistry
Body Mass lndex

CerebralPalsy
Departmentof Health
Diastolic Blood Pressure
Department of Social Welfare and Development
Home, Education/Employment, Activities, Drugs,
Sexuality,
Suicide, Safety/Spirituality
Left Ventricular Hypertrophy
Mental Retardation
Philippine Association for the Study of Overuueight and
Obesity
Pre-Exposure Prophylaxis
Systolic Blood Pressure
The lnjury Prevention Program
University of the Philippines - College of Human
Kinetics
University of the Philippines - Philippine General
Hospital

for

Disease Control and

US CDC-NCHS

United States Center

WHO

Prevention - National Centerfor Health Statistics

World Health Organization

"=t""r"d
only for their invaluable input but also for inculcating in us the
VifLnu"u", not
passion to be committed advocates of preventive health care'

lndeed, it is the fervent hope of the committee that this Handbook will
for
continue to assist pediatricians as well as other health professionals caring
promotion
of wellness
the
espouse
to
students
medical
encourage
and
children
and prevention of disease among Filipino children'

-il*&'t/4

Maria Rosario S. Q/ud, MD, FPPS

Chairman (J

Committee on PreGntrve Pediatric Health Care

DISCLAIMER
"The recommendations contained in this document are intended to GUIDE
practitioners in the conduct of anticipatory care/guidance and periodic health
examinations of infants, children and adolescents. ln no way should the

recommendations be regarded as absolute rules, since nuances and peculiarities in

individual cases or particular conrmunities may entail differences in the specific
approach. ln the end, the recommendations should supplement and not replace
sound clinicaljudgment made on a case to case basis."

ANNOTATIONS

ANNOTATIONS
1.

Prenatal education maY be done

through a structured mothers'class or

face to face counseling with a health
care professional or worker. Education
and counseling must include the
following areas of concern (Appendix

5,

lf a child comes under care for the

first time at any point on the schedule,

or if any items are not accomplished at

Breastfeeding (AppendixT)
Newborn Care and Procedures at
Birth

Anticipatory Guidance

to

decrease the risk of injury and identify

risk factors for child maltreatment

.
.

Prevention

of

smoking, alcohol

intake and exposure to teratogens

Tetanus Toxoid lmmunization for

the mother

do to support their children's emergent

Circumference for Age for Girls, Weight

literacy behaviors (Figure 2)."

care services should be brought up to

date atthe earliest possible time.

8.

for Age for Girls (Birth to 2 years),

Length for Age for Girls (Birth to 2

6.

Risk assessment and screening

of a

using the HEADSSS format is part

complete history-taking of adolescent

patients (131). (ApPendix 3)

7.

Every well child visit must be an

opportunity

for the health care

professional to evaluate the over-all

development of a child. History taking,

the child and doing a

Maternal nutrition (to include folic

observing

acid supplementation)

thorough physical examination remain

to be the most powerful instruments

to the Pediatrician

2. Every infant must be totallY

available

appraised at birth and monitored daily

untildischarge.
Colostrum is the perfect first food

monitoring or referral (Appendix 4).

identifying concerns that may

the following should be

the subspecialist(s) when warranted:

.
.
.
.

Latching-on and

Standards include 'Windows of

breastfeeding must be initiated during

the first 30 minutes to one hour after

Achievement' which describe the range

delivery of the infant (3,6,7).

development milestones (Figure 1).

3. The optimal time of discharge

of a healthy term newborn is decided
by the physicians caring for both
mother and child (40). For newborns
discharged <48 hours after delivery a
definitive appointment must be made
for the infant to be examined within

48

hours of discharge (37). (Appendix

2)

4.

Developmental, psychosocial,

and chronic disease issues for children

and adolescents may require frequent

counseling and treatment visits

separate from routine preventive care
visits.

These motor development milestones

must be interpreted in the light of other
neurodevelopmental findings in a child.

"The Philippine

AmbulatorY

Pediatrics Association, lnc. strongly

recommends that pediatricians advise

parents about the imPortance of

reading aloud to their children during
the first years of life. Research shows
this helps them develop language and

literacy skills, thus making children

ready to learn and read in school. The
Developmental Milestones of Early
Literacyfrom Reach Outand Read, lnc.
in Boston, Massachusetts, describe the

motor and cognitive skills of

closely

monitored, investigated or referred to

in
need

and time lines for six keY motor

Red Flag signs for Atopy from the

Philippine Society of Allergy, Asthma,

and lmmunology: Any child with a
family history of atopy (asthma, atopic
dermatitis, allergic rhinitis, drug i food
allergy) who presents with recurrent/
persistent symptoms of 1 or more of

The WHO Child Growth

for the newborn.

3 27 show the following: Zscore interpretation, Head

Figures

the suggested age, the Preventive

1):

.
.

children from 6 months to 5 years of

age, and inform parents what they can

gastrointestinal symptoms colic,

diarrhea, vomiting, bleeding
skin rash

ocular manifestations bluish,

years), Weight for Length for Girls (Birth

to 2 years), BMI for Age for Girls (Birth
to 2years), WeightforAge for Girls (2to
5 years), Height for Age for Girls (2 to 5
years), Weight for Height for Girls (2 to
5 years), BMI for Age for Girls (2 to 5
years), Weight for Age for Girls (5 to 1 0
years), Height for Age for Girls (5 to 1 I
years), BMI for Age for Girls (5 to 19
years), Head Circumference forAge for
Boys, Weight for Age for Boys (Birth to
2 years), Length for Age for Boys (Birth
to 2 years), Weight for Length for Boys
(Birlh to 2 years), BMI for Age for Boys

brownish discoloration around

both eyes, puffiness under the

(Birlh to 2 years), Weight for Age for

Boys (2 to 5 years), Height for Age for
Boys (2 to 5 years), Weight for Height

eyes, red and teary eyes

for Boys (2 to

nasal symptoms rhinorrhea,

Boys (2 to 5 years), Weight for Age for

Boys (5 to 1 0 years), Height for Age for
Boys (5 to 19 years), BMI for Age for

itchiness, sneezing, stuffiness

coughing with orwithoutwheezing

9.

Approach to a thorough physical

examination and interpretation of

- appropriate.
Respect for an older child's privacy and
minimizing the child's discomfort are
basic in pediatric physical examination.
Additional procedures to be performed
foradolescentpatients are mentioned
in Appendix 3.
findings must be
be age

10. The WHO Child Growth Standards

are used as reference standard for

weight, height and head

circumference. lnterpretation of growth
poirits are based on Z-scores (standard
deviation scores) and not on percentile
scores.

5 years), BMI

forAge for

Boys (5 to 1 9 years).

The following excerpts were lifted

from the WHO Child Growth Standards
recommendations (42):
"lf a child is less than 2 years old,
measure the recumbent length. lf a
child is age 2 years or more and able to

stand, measure the standing height. ln

general, standing height is - 0.7 cm
less than recumbent length. lf a child
less than 2 years old will not lie down for
measurement of length, measure

standing height and add 0.7 cm to

convert itto length. lf a child 2 years old

or more cannot stand,

measuro
recumbent length and subtract 0.7 cm
to convert itto height.

ANNOTATIONS

ANNOTATIONS
Weight-for-length/height

is

reliable growth indicator even when the

age is not known.

Body Mass lndex

(BMl)

How to use the BP Tables:

Determine the height Percentile
a.

and obesity problems."

The WHO cautions the health care

workers about edema associated with

b.

kwashiorkor which can hide the fact

that a child has very low weight. When
plotting the weight of the child with
edema it is imPortant to note on the

c.
d.

blood pressure Percentile tables

(Annotation 11), the US CDC-NCHS
growth charts are also included
(Figures28 31).

blood pressure measurement for

children starting 3 Years of age.
However, it must be done on all ill
patients and all Patients at risk
(those with a history or conditions
that can predispose to hypertension,
or in the presence of PhYsical
examination findings suggestive of a
possible renal or vascular involvement)
regardless of age.
The National High Blood Pressure
Education Program of the National
Heart, Lung and Blood lnstitute crafted
blood pressure percentile tables based
on age, gender and height percentile
(46). Figures 30 and 31 are tables that
showthe blood pressure levels for boys
and girls respectively. Until we have
our own PoPulation - based blood
pressure levels of Filipino children,
these tables may be used to interpret

the blood pressure levels of

our

of the patient using the US CDCNCHS growth charts (Figures 28

and 29)
Measure and record the Patient's

SBP and DBP.

Use the correct gender tablefor
SBP and DBP(Figure30or31).
Find the child's age on the column
at the left side of the table. Follow

the age row horizontally across

the table to intersect with the
vertical column of the child's

growth chartthatthe child has edema.

To be consistentwith the use of the

Nephrology Society
routine
recommends
of the Philippines

the

subspecialist will be prudent.

measurement standards enable early

detection and prevention of overweight

11. The Pediatric

lf in doubt, a referral to

patients.

f.

height percentile.
Find the SBP on the left columns
of the table and the DBP on the
right columns.
Find the corresPonding BP
percentile on the vertical column
to the rightof the age column.

A child is normotensive if the

BP is < 90* percentile for age, gender
and height percentile. Encourage
healthy diet, sleep and physical activity
for children with normal blood pressure.

Prehypertension

in

children

is

as average SBP or DBP

levels that are equal to or greater
than the 90* but <95* percentile.

defined

Adolescents with BP levels equal to

or greater

than 120/80 mm Hg should

be considered Pre-hYPertensive.
on physical activity, diet
management and weight

Hypertension is defined as
average SBP and/or DBP equal to or
greater than the 95* percentile on 3 or
more occasions. Hypertensive patients
must be referred to the subspecialist for
further investigation and management.

12. General Procedures may be

modified depending upon entry point
into schedule and individual need.
13. Article

No. 9288) states "Oblrgation to Inform.

Any health practitioner who delivers, or
assists in the delivery of a newborn in
the Philippines shall, prior to delivery,
inform the parents.or legal guardian of
the newborn of the availability, nature
and benefits of newborn screening."
Section 6 states "Pertormance of

Newborn Screening. Newborn

be performed after
twenty-four hours of life but not later
than three (3) days from complete
screening shall

delivery of the newborn. A newborn that

must be placed in intensive care in

order to ensure survival may be
exempted from the 3-day requirement
but must be tested by (7) seven days of
age. lt shall be the joint responsibility of
the parent(s) and the practitioner or
other persons delivering the newborn
to ensure that newborn screening is
performed" (28):

Health professionals

Counseling

management if obese must be done.

Medical investigation for the presence

of factors that might

need

3 Section 5 of the Newborn

Screening Act of 2004 (Republic Act

are

encouraged to organize and participate

in

failure or LVH) must likewise be done.

for

all

newborns whether high risk or non-high

risk (31). Pertinent sections of Republic
Act No. 9709 (The Universal Newborn
Hearing Screening and lnterventionAct
of 2009) include the following:
Section 5; "Obligation to lnform. Any health practitioner who delivers, or
assists in the delivery, of a newborn in
the Philippines shall, prior to delivery,
inform the parents or legal guardian of
the newborn of the availability, nature
and benefits of hearing loss screening
among newborns or children three
months old and below."
Section 6: "Obligation to Perform
Newborn Hearing Loss Screening and
Audiologic Diagnostic Evaluation All

in hospitals in the
Philippines shall be made to undergo
infants born

newborn hearing loss screening before

discharge, unless the parents or legal

guardians of the newborn object to the
screening subject to Section 7 of this

Act. lnfants who are not born in

hospitals should be screened within the
first three (3) months after birth.
ln the event of a positive newborn

hearing loss screening result, the

newborn shall undergo audiologic
diagnostic evaluation in a timely
manner to allow appropriate follow-up,
recall and referral for intervention
before the age of six (6) months:

Provided, That audiologic diagnostic

evaluation shall be performed by
Newborn Hearing Screening Centers
duly certified by DOH." (3a)

continuing medical education

activities on newborn screening, and to

be model advocates as well (28).

pharmacologic therapy (chronic kidney

disease, diabetes mellitus, heart

recommends screening

14. The PPS Policy Statement on

"Neonatal Hearing Screening"

15. At birth, eye screening includes

the following: checking for steady
eyes,'white lustrous conjunctiva',
clear cornea, non-droopy eyelids,
pupillary reflex and the red orange

A N N O TAT IO N S

ANNOT'ATIONS
18. Vitamin

reflex (ROR). Referral to the

ophthalmologist or pediatric ophthalmologist is prudent with a finding of
any of the following: poorresponseor
asymmetry, jiggly and misaligned eyes,
droopy eyelid, presence of discharge,
non-reactive PuPil, red eYe or dry
frothy conjunctiva, oPacities, and

absent/dull

or

asYmmetric ROR

Rabies Act

of 2007

mandates
the creation of a National Rabies
Prevention and Control Program.
One of the proPosed activities of

The PhilipPine Pediatric SocietY

12 months and above: 500 mg,

Either drug shall be taken

the program is the Provision of

free routine immunization or Pre

1 dose only
(One capsule
is given anytime between
6-11 months
but usually
given at 9
months of age
during the
measles
irnmunization)

Exposure ProPhYlaxis (PEP) for

schoolchildren aged five (5) to
fourteen (14) Years. (52)

17. lron SupPlementation as

recommended by the DOH (5a):

Deworming must

Retinoblastoma" recommends routine

eye examination of infants and

children for earlY detection of
leukocoria and strabismus, the most
common Presenting signs of

Previous hypersensitivity to
The DOH has a National Filariasis

0.3m1 once a

day to start at
two months of
age until 6
months when
complementary
foods are given

immunization.

Figure 32 summarizes the 2012

recommendations for immunization of
infants, children and adolescents from

the Philippine Pediatric Society, the

Pediatric lnfectious Disease Society of
Philippines and the Philippine
Foundation for Vaccination.
Rotavirus is now Part oI the 2O12
DOH EPI(Figure)
lmmunization recommendations
for adolescents are mentioned i n

the

Appendix 3.
Republic Act no. 9482, the Anti

The PPS Policy Statement on

"Zinc Supplements in Children" cites

day lor 5

months

1 tsp once a
day for 3
months or 30mg
once a week for
6 months with

supervised
administration

Elimination Program implemented in

municipalities endemic for filariasis.

the beneficial role of zinc

Mass treatment with Diethylcarbamazine Citrate (DEC) and

supplementation in the prevention of

Albendazole includes children from 2

pneumonia and diarrhea. The

years old and above (62).

recommended dose and dose interval

though have yet to be set. (58)

20.

19. The Department of Health

Administrative Order 2010-0023:
Guidelines on Deworming Drug

21. The Philippine Pediatric

0.6 ml once a

retinoblastoma (36).

16. Every visit should be an

opportunity to uPdate a child's

in

antihelminthic drug

subsequent

of children at high risk for

blindness are keY stePs in the
prevention of blindness in Filipino
children (49). The Clinical Practice
Guideline on "The Routine EYe
Examination as a Screening Tool for

not be done

children with (59):

a
severe malnutrition
a
high-grade fever
a
profuse diarrhea
I
abdominal pain
Serious illness

zation, routine pediatric eye evaluation

referral

ON

FULLSTOMACH.

Screening" asserts that proper dietary

supplementation, measles immuni-

for all patients, and

Mebendazole
single dose every 6 months

(Appendix 5).

Policy Statement on "Pediatric

Blindness Prevention and Vision

supplementation as

recommended bythe DOH (54):

Age-appropriate discussion and

counseling should be an integral part
ofeach visit.
Dental

Administration and the Management of

Adverse Events Following Deworming

Society, lnc. endorses the

recommendations of the American

(AEFD) recommends deworming for

Academy of Pediatric Dentistry (AAPD)

and the American Dental Association
pertinent to preventive dental care
(Appendix 6).

all children aged 12 months to 14 years

(59). The WHO and the DOH both

recommend the use of either

or mebendazole in the
following doses and schedule (59,
albendazole

61):
Albendazole

12 months to 24 months:
200 mg, single dose every 6
months

24 months and above: 400

single dose every 6 months

mg,

The first dental visit

is

recommended to be done at the time of

eruption of the first tooth andnolater

thanl2monthsof age. During the first
dental visit, the dentistwill assess:
. the child's general health, growth
and behavior
. the child's oral hygiene and
periodontal health and,

ANNOTATIONS
.

the risk for

develoPing oral

ANNOTATIONIS

Gastroenterology and Nutrition

is

disease. The dentist will likewise

provide education on infant oral health

guide for physicians and parents in

providing daily healthY diets for

and evaluate and optimize fluoride

children (Figure 33).

exposure (118).

PPS Policy
Fluorides in

the

Statement on

Prevention of Dental

Caries in Children cites ways on how to

prevent early childhood caries such as

involving the Parents, dentists,

physicians and the government in
promoting good oral health, as well as

recommendations
fluoride varnish

(1

on the use

of

7).

Health care Professionals and

parents must be aware that exposure of
children to media food advertising
especially commercials for convenient
foods, processed foods or sweetened
drinks may influence children's choices

toward higher-fat
administrators

breastfeeding that was started during

the prenatal period must be continued

23.

beYond.

Safe, adequate, timely and properly fed

complementary feeding using fresh,
natural and indigenous food shall begin
at six (6) months to meet the evolving

nutritional

requirements of

infants

1). The Philippine Society

Pediatric Gastroenterology and

(6,7,8,7O,7

of

Nutrition issued guidelines on

breastfeeding and comPlementarY

feeding (AppendixT).
Early on, children must be taught

the value of eating healthy foods in

a balanced diet as well as avoiding
unhealthy foods (75,76). Giving of
foods that are too sweet (sweetened
beverages, candies), too salty (chips,

curls) or too oily (gravies, dressings)

should be avoided (70,76,77).
It is imperative that hand hYgiene
be practiced at alltimes.
The food pyramid crafted bY the

Philippine SocietY of Pediatric

in

promoting school-

based nutrition programs to ensure that

children are provided with healthy food

in school(74).

on up to two (2) years and

higher-energy

Physicians may work with school

22. Counseling regarding

during well child visits. Mothers must be
encouraged to exclusively breastfeed
up to six (6) months and continued

or

foods (78).

mendations for schools, physicians

and parents on how to encourage

The WHO listed factors that increase

regular physical activity in children (84).

maltreatment as well as factors that

may offer protective effect (Appendix

24. The following are Policy

Statements of the Philippine Pediatric

8).

the

principle

television, movies, music, music

videos, video games, computer games

and the internet. The Philippine

Pediatric Society Policy Statement on
"Effects of Media Sex and Violence on
Children and adolescents" advocates

Watusi Poisoning, Backpacks and

Children, Noise in the Environment,
Recreational Noise, Fetal and

minimization of media exposure for

Filipino youth and urges parents to
create a healthier and friendlier

and

to

93, 94, 95, 96, 97, 98, 99, 100, 101,

Anticipatory Guidance for

in Appendix

adolescents is contained

children and adolescents will be carried

into adulthood and reduce health
problems related to inactivity (87).
Physical activity can be in the form

3.

of sportsand games, dance, PhYsical

for pediatricians to counsel parents and

children about adopting behaviors to

recreational activities, household

chores and other lifestyle related

physical

activities (89).
Age-approPriate PhYsical

activities for children and adolescents

for 60 minutes daily (PASOO) or on
most days of the week (UPCHK) are

the current recommendations (89).

Health care professionals must
educate parents and discourage

children from prolonged periods of

sedentary activity (TV viewing and

computer games) for periods greater
than two hours Per daY. These
messages are similarly incorporated in
the Philippine Pediatric Society Policy
Statement on "Physical Activity for
Schoolchildren" which lists recom-

environment for their children to

reduce the negative effects of media

102,103).

physically active lifestyle among

influence

adolescence

(1

(11

6).

The lmplementing Rules and

Regulations of Republic Act 7610

The lnjury Prevention Program

(TIPP) of the American Academy of
Pediatrics similarly provide guidelines

prevent injuries from birth

Unit

Children learn behaviors and

Poisoning, Medicinal Poisoning and

healthy living (84,85). A

The Child Protection

have their value systems shaped by

Fireworks Related lnjuries. (90, 91, 92,

Physical activity, along with a wellbalanced healthy diet, is a major

child to

to Protect Children" (110) (Appendix 9).

Vehicles, Child Pedestrian lnjury

Prevention, Child Helmet Use,
Drowning Prevention, Burn lnjury
Prevention, Household Products

to Noise

of a

Network, lnc. enumerated the "7 Steps

Society: Child Safety in Private Motor

Vehicles, Child Safety in Public Motor

Neonatal Exposure

susceptibility

(Anti Child Abuse Law) Section 4 states

that "The head of any public or private

hospital, medical clinic and similar

institution, as well as the attending

physician and nurse, shall report,

to

either orally or in writing, to

Department of Social Welfare and
Development (DSWD) the

07).

25. The World Health

Organization
defines child maltreatment as "all forms

examination and/or treatment of a child

who appears to have suffered abuse

of physical and/or emotional illtreatment, sexual abuse, neglect or

wlthin 48 hours from knowledge of the

same." Clinicians should maintain a

high index of suspicion for past and

negligent treatment or commercial or

other exploitation, resulting in actual or

present incidence of domestic violence

potential harm to the child's health,

(1 1 5).

survival, development or dignity in the

context of a relationship of

26. Lead is an ubiquitous

responsibility,trust and powef' (108).

There is NO one risk factor that
is predictive of child maltreatment and
there is NO one characteristic that
defines resiliency of a child to traumatic

environmental toxicant that can

attack many different organ systems.
Among children, the best studied
effect of lead exposure is cognitive
impairment (64). The Philippine

experiences

Pediatric Society Policy Statement

(1

08,1 1 3).
12

APPENDIX

ANNOTATIONS
"Lead Poisoning in Children" presents
background information on lead

in children, several lead

exposure prevention strategies and

iroisoning

recommendations for the prevention

of lead poisoning

in

children (64).

27- lron deficiency anemia

associated with cognitive and

psychomotor abnormalities in children.

Poor
nutritional history and those with a

At risk are those with

past orfamily history of anemia'

The Philippine SocietY

of

Hematology and Blood Transfusion

comPlete blood count

at least once between the following

time intervals for those at risk: 6-24
months, 2-6 years and 10-19 Years.

Actively menstruating female

adolescents and fad dieters are
likewise

at risk. The

SocietY of

Adolescent Medicine of the Philippines,

lnc recommends a comPlete blood
countat each stage of adolescence.

28. The Society of Adolescent

Medicine of the PhiliPPines, lnc
recommends screening urinalysis on

first encounter with an adolescent

patient (Appendix 3). Urinalysis must
likewise be done for all patients with

signs and symPtoms referable to a

possible renal disease regardless of
age.

29.

As indicated inAppendix 3, annual

health screening for sexually active

females includes vaginal wet mount
and PAP smear. Sexually-active males
must undergo serologic test for syphilis
while both male and female sexually-

active adolescents should have

annual non-culture test for gonorrhea
and Chlamydia.

Appendix

is

targeted among individuals who are at

risk for developing the disease (139 ).
Using 5 TTU PPD or 2TU-RT23
test read al 48-72 hrs, regardless of

BCG status, an induration (not

of > 5 mm is considered
positive in the presence of any or all
of the following: history of close contact
with a known or susPected case of TB,
clinical findings suggestive of TB,
chest x-ray suggestive of TB, and
immunosuppressed condition. ln the
erythema)

is

recommends

30. Screening for tuberculosis

absence of the above factors, an

induration >10 mm is considered

1.

Prenatal Visit, Education and Counseling

Education and counseling regarding breastfeeding must begin during
the prenatal period (3,6,8,9). Prospective mothers, fathers, families and other
caregivers must be informed of the:
nutritional, immunologic and intellectual benefits of breastfeeding for
the infant
psychosocial advantages both for mother and infant
potential decrease risk for future chronic diseases (hypertension,
obesity, type 2 diabetes, allergy)in the child
health benefits for the mother (reduced post partum bleeding, delays
the return to fertility, less risk for breast and ovarian malignancies) and

.
.
.
.

economic and environment-friendly benefits

of

breastfeeding.

(4,8,12,13)

positive (140).

Aside from this, mothers must be informed of the recommended period

of early initiation of breastfeeding, exclusive breastfeeding up to 6 months and
continued breastfeeding after introduction of complementary foods (6,7) .
Other recommended procedures done during the infant's birth may be
explained during the prenatal visits. These include rooming-in, newborn
screening, hearing screen and immunization with Hepatitis B vaccine and BCG

(50,51).
It is during the prenatal visits when the health care professional may

elicit information regarding the parent's education, profession, attitude

regarding the pregnancy, planned disciplinary method/child rearing approach,

financial security, family support system and such other factors that are

vital

in the assessment for the child's future exposure to or prevention of

neglect, maltreatment or violence (108). Similarly, the prenatal visit is a good

opportunity

to inquire about a family history of genetic or

chromosomal

abnormality and development disability. The health care professional must

monitor, counsel and refer whenever necessary to give the infant the best
possible start in life (19).
Discussion regarding injury prevention and potential exposure of the
mother and child to environmental toxicants such as lead may begin during the

prenatalvisits (64).
Pregnant women must be informed about the deleterious effects of
smoking, alcohol intake and exposure to known teratogens during pregnancy
(1,23).Theymustlikewise beadvised and encouraged to take folic acidrich foods and supplements on top of the recommended healthy diet for a
pregnant woman (20,21 ,22). Tetanus Toxoid immunization must be started or
continued during pregnancy (50).
Pediatricians, obstetricians, midwives, nurses and other health care
professionals/workers must work together to promote the welfare of the
mother and the unborn child both in normal and high-risk pregnancies.
14

APPENDlX

APPENDIX

Appendix 2.
Discharge and Follow-up of Healthy Term Newborns

Appendix 3.
Adolescent Health Care

The Philippine Society of Newborn Medicine lists the

following

minimum criteria for discharging newborns before 48 hours (37,39):

r
.
.
.
.
.
.
.
.

uhcolnplicated antepartum, intrapartum and postpartum courses for

both motherand newborn
Vaginaldelivery,singleton,completed3Tweeks,AGA

Normal and stable vital signs during the preceding 12hours(RR

<60/min, CR 1OO-160/min, axillary temperature 36.5"C - 37-4'C
properly clothed in an open crib)
Has urinated and passed at least one stool
Has documented proper latch, milk transfer, swallowing, infant satiety
and absence of nipple discomfort. lf not breastfed, has tolerated at
least two feedings with documented coordinated sucking, swallowing
and breathing while feeding
Normal physical examination
No evidence of significant jaundice in the first 24 hours of life
Educability and ability of the parents to care for their child (recognize
signs of illness, care of the umbilical cord/skin/genitalia, maternal
confidence in feeding her infant and parents' understanding of the
importance of follow-up visit or emergency consultation)
Must follow-up within the next 48 hours

The purposeofthefollow-up visit

is to (39):

Assess the infant's general health, hydration,

and presence/ degree

of jaundice; weigh the patient; identify any new problems; and

obtain historical evidence of adequate urination and defecation

patterns for the infant

Review feeding pattern and

particularly

breastfeeding for adequacy qf position, latch-on, and swallowing.

Complete history-taking and risk assessmenVscreening (HEADSSS

format).
Screening should include psychosocial problems involving
the family, education, eating habits, lifestyle and other risky behaviors
such as smoking, alcohol drinking, substance abuse, sexual
development and activities, violence and safety concerns, depression
and suicidal tendencies.
Physical Examination
This should be done in privacy and preferably by a health care
providerthat is of the same gender as the teen patient. ln addition to the
routine physical examination, the following should be done:
Tanner Staging/Sexual Maturity Rating
Breast examination
Examination of the spine and shoulders. Check for scoliosis and
kyphosis.
lnspection of the genitals and anus. A more thorough
examination is warranted in symptomatic patients.

2.2
2.3
2.4

LaboratoryTests

3.1

behavior.

3.2

3.3
3.4

Complete Blood Count (or at least Hemoglobin/Hematocrit) at

every stage of adolescence
Urinalysis on first encounter
Vaginal wet mount, PAP smearfor sexually active females
Serologic test for syphilis for sexually active males

Review the outstanding results of laboratory tests performed before

Non-culture test for gonorrhea and Chlamydia for both males

discharge.

and females who are sexually-active

Perform screening tests(seesectionon General Procedures) ifnot

yet done and other tests that may be clinically indicated, such as

1.

tepMique, including observation of

Assess quality of mothei-infant interaction and details of infant

should undergo the following:

Reinforce maternal or family education in

regarding infant feeding.

The Society of Adolescent Medicine of the Philippines, lnc., cognizant

of the rapid physical, cognitive and psychosocial changes occurring in each
adolescent patient, recommends an annual health screening and preventive
services for this special population. During the annual visit, the adolescent

serum bilirubin.

Suggest and encourage compliance to recommended schedule of

periodic follow-up and preventivecare.
15

lmmunization Update:
Td, MMR and HepatitisA, Hepatitis B, HPV lnfluenza
Second dose of Varicella if notyetgiven

'16

APPENDIX

APPENDIX
LANGUAGE DELAY

Anticipatory Guidance and Counseling

5.1 Self breast examination forfemales

5.2
5.3
5.4

Healthy Lifestyle: physical activity, diet, avoidance of alcohol,

smoking, drug use
Sexual behaviorand the riskof acquiring STDs including HIV
lnjury and accident prevention: use of sports protective gear'

seat belts, no driving under the influence of alcohol, no

.
.
.
.
.

Does notturn to sound by 6 months

Does not babble or use gestures by 12 months
No single word utterances by 16 months
No 2-word phrases by 2 years
No 3-word sentences by 3 years

smoking in bed, no hand gun use.

confidentiality is a major issue in attending to adolescent patients.

ln addition, guidance and counseling is now directed to the patient with

diminishing participation of the parenVguardian'

PSYCHOSOCIAL DELAY

.
.
.
.
.

No socialsmile by 3 months
Not laughing in playful situation by 6 months

Hard to console, stiffens when approached by

year

ln constant motion, resists discipline

Does not play with other children at 3 years

Appendix 4.
Developmental Surveillance and Screening

The Philippine Society for Developmental and Behavioral Pediatrics states

that developmental surveillance is a flexible. continuous and cumulative
process. At every well child visit, the process has five components(141):
1. eliciting and attending to the parent's concerns about their child's

2.
3.
4.
5.

development
maintaining a developmental history
making accurate and informed observations of the child
identifying the presence of risk and protective factors
documenting the process and findings

The following are RED FLAGS in each area of development

MOTOR DELAY

.
.
.
.
.

Poor head control by 3 months

Hands stillfisted by4 months
Unable to hold objects bY 7 months
Does notsitindependently by 10 months

Cannotstandononelegby 3years

COGNITIVE DELAY

.
.
.
.
'
'
'
'
'

2 months
6 months

Notalertto mother
Not searching for dropped objects

12 months

No object permanence
No interest in cause-and-effect games

18 months

2years
3 Years

4ltyears
5 Years

Sl"years

Does not categorize similarities

Does not knowfull name
Cannot count sequentially
Does not know letters or colors
Does not know own birthday or address

SCHOOLAGE CHILDREN
Slowto rememberfacts
Slowto learn newskills, relies heavilyon memorization
Poor coordination, unaware of physical surroundings and prone to
accidents
May be awkward and clumsy, and has trouble with fine motor skills

APPENDIX

APPENDIX

ln addition, the following are to be checked in detail during specified ages:

READING SKILLS (Forschool age children)

Slow in learning connection between letters and sounds
Confuses basicwords
Makes consistent reading errors:

letterreversals - b-d, P-q

letterinversion - m-w
transpositions - feltleft
word reversals - was-saw

I
a

I
a

number reversals - 14-41

Repeats, omits or adds words
Does not read fluently
Does not like reading at all
Avoids reading aloud
Uses fingers to follow a line of print when reading

Appendix

5.

Screening for Eye/Visual Defects'

The Philippine Society of Pediatric Ophthalmology and Strabismus
recommends comprehensive ophthalmologic examination for the following :
premature infants at risk for Retinopathy of Prematurity (ROP)
Age of Gestation (< 32 wks)
low birth weight (<1500 g)
lnfants weighing 1500 to 2000 g with a stormy medical

o
o
o

I
I

.
.
I
I

course
infants with metabolic disorders
family history of retinoblastoma
family history of congenital cataracts
history of maternal infection (rubella) or genitourinary infection
(STDs)
history of "squinting"
history of visual difficulties
vitamin A Deficiency or history of night blindness
children with other impairments (CP, Down's, MR, hearing
impairment etc.)

6 mos,

Msual Response: Response to

light; should be able to fix and
follow by 3 mos.
lnspection:
Clean, non-droopy eyelid
"White conjunctiva"
Clear eornea
Ocular Motility:
Steady and aligned eyes
Pupils reactive to light
Ophthalmosocpy: Red orange
reflex (Bruckner toet)

Non-reactive pupil
Absent 1Dull/ asymmetric
ROR; leukocoria

VisudlResponse: Fixes & Follows

Blank stare

lnspection:
White" lustrous conjunctlva
Clear cornea
Ocular Motility:
Equal/central corneal reflexes
(Hirschberg test)
Steady and aligned eyes
Ophthalmoscopy: Red orange
reflex (Bruckner test)
Vision Test LEA Symbols-at least
20t40 (0.5)
lnspection:
White shiny conjunctiva
Clear cornea
Ocular Motility:
Alternate cover test or
/central corneat reflex
Steady and aligned eyes
Ophthalmoscopy: Red Orange
Reflex

Vision Test: LEA Symbols at least

20/32 (0.63) or Snellen 20/40
lnspection:
White shiny conj unctiva
Clear cornea

Poor response or

asymmetric
Droopy/ discharge
Red eye
Opacities

Jiggly and misaligned eyes

Dry or "sudsy' conjunctiva

Opacities
Non-central/ unequal
corneal reflex
Jiggly eyes and misaligned
eyes
Absent / dull asymmetric
ROR: leukocoria
LEA < 20/40 (0.5) or > 1
difference between eyes
Dry / frothy conjunctiva
Opacities
Any eye movement on
alternate cover test or
Unequal/ non-central
corneal reflex
Jiggly eyes and misaligned
eyes
AbsenU Dull I asymmetric
ROR; leukocoria

LEA<2Q!32 (0.63) or
Snellen <20140 oi >1 line
difference between eyes
Dry or frothy conjunctiva
Opacities

APPENDIX
Ocular Motility:
Alternate cover test or Symmetricall
/central corneal reflex
I
Steady and aligned eyes
I
Ophthalmoscopy: Red Orange I
Reflex; Normal Fundus
I

APPENDIX
Appendix 6.
Preventive Dental Gare

nny eye movement on

alternate cover test or
Asymmetric / non-central
corneal reflex
Jiggly eyes
AbsenU Dulll asymmetric
ROR; leukocoria

The vision testing using LEA Chart or its equivalent is preferably done at
distance and near starting 3 years of age. The vision testing procedure
s as follows:

.
.
.
.
r
.

a
a

a
a
a
O

Distance visual acuity should be tested at 6 meters (20 ft) or 3 meters

(10 ft) and at reading distance of 34-40 cm (14-16 inches) from child
under good illumination
Establish
method of communication i.e. naming or pointing
(matching). Decide with child which means will be used to identify
symbols.
"Let's play a game"
Start with both eyes open to acquaint child with the "game".
Point briefly at each of the 4 symbols (circle, house, apple, square) on
the lowest line, observe the baseline responses for comprehension,
speed and accuracy.
can be played with 1 eye
Demonstrate to child that the
occluded.
Cover the top line with a white card and ask the child to identify only the
1"'symbol on the line belowthe covering card.
Repeat procedure for the each lower line moving quickly down (to
avoid tiring the child) until the child hesitates or misidentifies a symbol.
Upon reaching the misidentified symbol, move back up 1 line and ask
the child to identify all the symbols on that line.
lf the child skips a symbol, askthe child to tryagain.
Visual Acuity is recorded as the last line on which at least 4 of the 5
symbols are read correctly. (Ex. lf up to 10'n line VA=20l40 or 0.5).
Always test until this threshold line. lf only 3 out of 5 are read correctly,
record the result: visual acuity of the previous line (+e;.
Repeat testwith the other eye occluded.
lf the child wears glasses, they should be worn.
Watch out for peekers.
Frustration or disinterest often indicates that the child no longer
recognizes a symbol.
Pointing at the line to be read is preferable over pointing at a specific
symbol.
lf results are inconclusive, repeat or refer.

21

Use of Fluoride Toothpaste. Twice daily use of fluoride-containing

toothpaste is recommended as a primary preventive measure. Parents
and caregivers must ensure that the recommended amount of fluoride
toothpaste is used. Young children must always be supervised while
brushing and should be taught to spit out the toothpaste and to avoid
rinsing after brushing.
Recommended Use of Fluoride Toothpaste in Children

6 months
to less than
2 years old

10-20mm
0.5 - 1.0g

Topical Fluoride Treatment. Professionally applied topical fluoride

has been proven to prevent or reverse enamel demineralization. The
American Academy of Pediatric Dentristy (AAPD) recommends that
children at moderate caries risk should receive a professional fluoride
treatment at least every 6 months; those with high caries risk should
receive topically-applied fluoride more frequenlly (11 8,121).

OtherAnticipatory Measures. Anticipatory care includes guidance

on oral hygiene and proper diet. Cleansing the infant's teeth as soon
as they erupt with either washcloth or soft brush will help reduce
bacterial colonization. The use of dental floss is important to reduce
interproximal caries.

The education of parents includes the cariogenicity of some foods and

beverages, dental caries and its relationship with prolonged bottle feeding
or bottle feeding while asleep, and the maintenance of good oral hygiene in the
mother that has a significant impact on the child's caries rate (117 ,118,123).

APPENDIX

APPENDIX
Appendix 7.
Breastfeeding and Gomplementary Feeding

4.

Philippine Society of Pediatric Gastroenterology and Nutrition

A.

Breastfeeding
Benefits of Breastmilk
Safe, sterile and always available
with perfect nutrients to fully sustain the growth and development
of the baby from birth to six months of age; after 6 months, still a

'.

good source

.
.

of

5.

Easily digested and absorbed; efficiently used by the baby's

immature system

B.

Contains fats (DHA) which enhance brain development and

intelligence of the babY

2.

Store in sterile polypropylene (cloudy hard plastic)containers, properly

or by using a breast pump when

breastmilk supply is abundant and when the mother is planning to go
backtowork.

Recommended Breastmilk Storage period

. Room temperature (<25"C):
. Room temperature (>25"C):
Refrigerator (4"C):
Freezer compartment of a 1-door refrigerator:
Freezer compartment of a 2-door refrigerator:
Deep freezer with constant temperature (-20'C):

Diet of a Lactating Mother

Rice
Fruits (vitamin C rich; different varieties)
Vegetables (green leafy and yellow)
Meat, fish, poultry, seafoods

.
.
.
.

Advantages of Breastfeeding
a
Promotes emotional bonding between baby and mother
T

Protects the mother's health against cancer (breast, uterus,

ovaries), obesity and post-partum hemorrhage

Promotes early return to pre-pregnancy weight
Gives the family big financial savings

3.

Express breastmilk by hand

.
.
.
.

complementary foods

against infection

labeled with the date and time of breastmilkcollection.

nutrients when given with adequate

Contains antibodies and substances which protect the babY

Breastmilk Expression and Storage

'

"chesttochest, and "tummytotummy" with the mother.

Support the breast with the hand of the opposite arm in a C-hold
position: thumb above, 4 fingers underthe breast.
Stimulate the infant to open the mouth wide by stroking the corner
of the baby's lips; check that the chin touches the breast and
thelower lip is turned outward.
Ensure thatthe baby grasps the entire nipple plus once inch of the
surrounding areola.
Allow the baby to suck 15 to 30 minutes per breast to extract both
foremilkand hindmilk.

Empty the breast aroundS

adequate milk suPPlY.

tol0timesor moreadaytoensure

Mongo, beans, taho

hour

8 days
2 weeks

3 months
6 months

6 cups

4 pieces
1 Tzcups
5 pieces
(matchbox
size for meat), or
2 cups cut into
small pieces
4 pieces a week
1 Tz cups 3x a

week
Mitk
Fats (olive oil, corn oil, butter)
Fluids

Correct BreastfeedingTechniques
Support the baby's head and the entire body throughout the
feeding; the head, back and hips should be facing the breast and
aligned in a straight manner.
Maintain the position of the baby in such a way he is "face to face",

Egg

4 hours

2 glasses
7 teaspoons
7 glasses water;
1 glass fresh fruit

juice

C.

Complementary Food

Timely introduced at6 monthssf sgs

Adequate provides sufficient energy, protein and micronutrients

to sustain growth: use PSPGN Dietary Prescription Food Guide
Pyramid as a tool
Safe hygienically prepared and stored; feed using clean utensils,
NOT bottles and nipples
Properly fed meal frequency and feeding methods suitable for age
(guide or self-feeding using dean hands, spoon and fork, cups
and bowls; using locally fresh and naturalfoods)
Howto introduce:
Begin with one new food at

time to be given for 3 days.

APPENDIX

APPENDIX
Start with lugaw or cereals, fruits or vegetables in any order,
givingoneto two teasPoons a daY.
Stutt"*itn pureed foods at 6 months of age' lntroduce "finger
foods" around 8 months of age; lumpy or chopped foods at
l0months of age; table food at '12 months of age'
Feed 6 8 mont-h old infant 2 3 times a day; 9 24 month old

.
'.
.

ln the

for the maltreatment it suffers, but rather that it may be more difficult to parent
because it:

ApPendix 8'
Child Maltreatment

TheWorldHealthorganizationpresentsanecologicalmodel

describinj the risk factors tor cnitO maltreatment. The complex interaction
oi tactori in the individual, social relationships, community and society must
(108)'
be understood to effectively deal with problems of child maltreatment

The risk factors are not themselves diagnostic but in situations where resources
are limited, children and families ldentified as having severa/ of these

factors should have priority for receiving services'

lndividual Factors:*
ln Parent and Caregiver
has difficuity bonding with a newborn child as a result, for example, of
difficult pregnancY
I
was a maltreated child
t
t""t u*"r"ness of child development or has unrealistic expectations
that "prevent understanding of the child's needs and behavior
uses physical punishmentto discipline children
shows lack of self-control when upset or angry
involved in criminal activitY
is depressed
experiences financial d ifficu lty

;;;;r;J;;;r;
World

H ea lth O rg an

izatio n'

needs for instance one who is mentally or

demonstrates personality or temperament traits (such as hyperactivity

orimpulsivity)

is one child out

of a multiple birth which has taxed the parent's ability to

supportthe child

either exhibits or exposed to dangerous behavior problems such as

intimate partnerviolence, criminal behavior, abuse towards animals

Relationship factors
lack of parent-child attachment and failure to bond
a
family breakdown that results in unhappiness, tension, mental ill health
I
violence in the family
I
gender roles or roles in intimate relationships that are disrespectful
I
lack of support networkto assist in stressful situations
I
discrimination against the family because of ethnicity, nationality,
religion
involvement in criminal or violent activities

Community Factors
I
tolerance to violence
a
lack of inadequate housing
I
poverty
I
high levels of unemployment
I

lack of services to support families and institutions and to meet

specialized needs
transient neighborhoods
easy availability of alcohol
local drug trade
harmfuleffects of lead and othertoxins

*rhis is a partial list. fhe complete list of factors is available in the wHo publication "Preventing
of this
ent: A guide-io iixing action and generating evidence-" (108). Contents
6iiin Uint
"t prinua fritn peiniisiii rrom tne wH6 Press, inowtedge Management and sharins'

an infant with high

physically disabled or hasachronicillness

Do not add salt to the infant's diet before one year of age'

children.Feedslowlyandpatiently.DONOTforce-feed;make
feeding a pleasurable experience.

wasanunwantedbaby

is

infants 3 4 times a day. Give additional nutritious snacks once or

twice a day.
offera variety of foods to improve the quality of food intake;
avoid drinks with low nutrient value (sweetbeverages)'
Give supplements of iron, zinc, calcium, and vitamin 812, if diet is
primarilY Plant-based
itractice responsive feeding. Feed infants directly and assist old.er

Child

The presence of these factors does not meanthatthechild isresponsible

Societal Factors
a
socioeconomic inequality or instability
a

I
I

social and cultural norms that promote or glorify violence towardE

others as depicted in the media, popular music, video games
existence of child pornography, child prostitution, child labor
social and cultural norrris that diminish the status of the child in parentchild relationships
social and cultural norms that demand rigid gender roles for maleE and
females

APPENDIX
Protective Factors
Factors that appear to facilitate resilience include:
secure attachment of the infant to the adult family member
high levels of parentalcare during childhood
non-association with delinquent or substance-abusing peers
a warm and supportive relationship with a non-offending parent
a lack of abuse-related stress

t
.
r
r
'

Based on the current understanding of early child development, it is

clear that stable family units can be a powerful source of protection
for children. Good parenting, strong attachment between parents and
children, and positive non-physical disciplinary techniques are likely to
be protective factors."
The WHO further recommends a national child maltreatment prevention
agenda that would bring together contributions of diverse sectors forthe
simultaneous protection of cases and more importantly for the primary
prevention of maltreatment.
Suggested strategies

in this agenda underlie the need to tackle

maitreatment simultaneously
in different social contexts.

at

child
different stages of human development and

step 2. Minimize the opportunity for sexual abuse by eliminating or reducing

one-aduluone-child situations. More than g0% of sexual abuse cases occur in
situations where a child is left alone with an adult or an older youth.
schoolorganizations, clubs, sports teams, faith groups must eliminate
situations of one-adulVone-child.
Talk to your chird when he/she returns from an outing. Notice the

child's behavior and whether the child can tell you with confidence how the
time was spent.
Tell the adults who care for your child that you and your child are
educated about child abuse. Be that direct.
Step 3. Talkaboutit.
Teach your children what parts oftheir bodies others should not touch.

Do not be afraid that you are teaching them

about "sex." you are

protecting them. Mention that the abuser can be a family membel a friend or an
older youth.
Children are afraid to "tell" an abuse. The abuser shames the child,
tells the child that his/her parents will be angry confuses the child about what is
right or wrong, or threatens the child or a family member. Break the barrier by

talking openly about it.

Promising Child Maltreatment Prevention Programs (111):

Early childhood home visiting by health workers
Parent education programs
I
Child sexual abuse prevention programs in schools
a
Hospital-based parent education program to prevent abusive health
trauma (Shaken Baby)

.
.

Appendix 9.

"7 Steps to Protect Children"

Child Protection Unit Network, lnc.
Pediatricians and health care professionals may disseminate this guide and use
it during well child counseling.

gtep {. Learn the facts. Majority of sexual offenders of children are family
members, friends and neighbors people that the child and the child's family
trust.

Boys, in almost the same frequency as girls, are also being sexually
abused.

APPENDIX

Few girls report the abuse but boys tend not toreportat all.

lf a child seems uncomfortable or resistant to being with a particular

adult (an uncle ora ninong) askwhy.
Step

4.

StayAlert.

Learn the signsofsexuar abuse. physical signs are notcommon.

Emotional and behavioral signs are more common such as ,too perfect,,
behavior, withdrawal, depression, unexplained anger or rebellion, running
away, failing in school, unusual interest in or knowledge of sexual matters,
fearofaperson,intense dislike at being leftsomewhere or with someone.
Know the textmates of your child.

step 5. Act on any suspicion of abuse. The future well-being of a child is at

stake.

Have the courage to report suspected abuse. Do not close your eyes
and pretend that it will go away. lt will not go away. lf the child is not
helped, the abuse will continue.

You can bring the child to the child protection Unit of pGH, pcMC and
East Avenue Medical Center.
It is the duty of hospital administrators, doctors, nurses, government

teachers and employees of government agencies to report abuse.

27

28

APPENDIX
Step 6. Learn howto reacttothe knowledgeof abuse.
Offersupport:
. Believe the child and make sure the child knows you believe

in him/her. Very few reports of child abuse are not true.

Thank the child for telling you and for having the courageto
do so.

'.

Encourage the child to talk but don't ask leading questions'

Seek professional help.

Step 7. Get lnvolved

Use your voice and your vote to make your community a safer place for
children. Ask what schools or organizations in your community have child abuse

prevention policies and help with their creation. Demand that the government

]:ut their resources into protecting children from sexual abuse and into
responding to reports of sexual abuse.

You can download educational materials on child sexual abuse prevention for
parents on www.darkness2light.org

FIGURES
1.
2.
3.
4.
5.
6.
7.
8.
9.

Windows of Achievement
Developmental Milestones of Early Literacy
Z Score lnterpretation
Head Circumference forAge for Girls
Weight forAge for Girls: Birth to 2 years
Length for Age for Girls: Birth to 2 years
Weight for Length for Girls: Birth to 2 years
BMI forAge for Girls: Birth to 2 years
Weight forAge for Girls: 2to 5 years
10. Height forAge for Girls: 2to 5 years
11. Weight for Height for Girls: 2to 5 years
12. BMI forAge for Girls: 2 to 5 years
13. Weight forAge for Girls: 5 to 10 years
Height for Age for Girls: 5 to 19 years
15. BMI forAge for Girls: 5 to 19 years
16. Head Circumference forAge for Boys
17. Weight forAge for Boys: Birth to 2years
18. Length forAge for Boys: Birth to 2years
19. Weight for Length for Boys: Birth to 2 years
20. BMI forAge for Boys: Birth to 2 years
21. Weight for Age for Boys: 2 to 5 years
Height for Age for Boys: 2 to 5 years
23. Weight for Height for Boys: 2to 5 years
24. BMI forAge for Boys: 2to 5 years
25. Weight forAge for Boys: 5 to 10 years
Height for Age for Boys: 5 to 19 years
27. BMI forAge for Boys: 5 to 19 years
28. US CDC-NCHS Growth Chart for Boys
29. US CDC-NCHS Growth Chart for Girls
30. BP Levels for Boys by Age and Height Percentile
31. BP Levels for Girls by Age and Height Percentile
32. lmmunizationTable 2012
33. Food Pyramid

14

22

26

W$

*f

sad*ws

r!

(o

&e*n$swryxryxmryx*

@va***rl*

o
.^

o
=
o

o
o

o
d'

o
3
o

c
v
m

ltJ*lo Ci:ild Gr"wtfu StendBlds

"{{
-n

(d'

c
o
N

I
.

r
r
r

reaches for book

book to mouth
sits in lap, head steady
turns pages with adult help

sits without support

may carry book
holds book with help
turns board pages, several at a time

looks at pictures
vocalizes, pats pictures
prefers pictures offaces

hold child comfortably; face{o{ace gaze

follow baby's cues for "more" and "stop"
point and name plctures

no longer mouths right away

points at pictures with one finger

respond to child's prompting to read

let the child control the book
be comfortable with toddlels short attention span
ask "where's the...?" and let child point

may make same sound for particular picture (labels)

points when asked, "where's...?"
turns book right side up
gives book to adult to read

(,
N

a turns board book pages easily, one at a time

e carries book around the house

s may use book

as transitional object

e names familiar pictures

e fills in words in famillar stories

B 'teads" to dolls or stuffed animals

e use books in routines, bedtimes

6 ask "what's that?" and give child time to answer
e pause and let child complete the sentence

e recites parts of well-known stories

a attention span highly variable

r
r

learns to handle paper pages

goes back and forth in
books to find favorite pictures

r
r

r competent book handling

====.4i.r+!,1Tii,;:i
,

tums paperpages one at a time

recites whole phrases, sometimes whole stories

coordinates text with picture
protests when adult gets word wrong in a familiar
story
reads familiar book to self

listens to longer stories

can retell famrliar story
understands what text is
moves finger along text
"writes" name
moves toward letter recognition

r
r
r

r
r

relate books to child's experiences

keep using books in routines

read at bedtime
be willing to read the same story over and over
ask "what's that?"
relate books to child's experiences

ask "what's happening?"

encourage writing and drawing
let the child tell the story

"..,ol"#r*;,i*;Jt;ilji?#EsrH{rlilir*5.l;i$rrh'r".;#,ffii#,lir{j*;sr-*..

ffi@l

o
o
o
1)
3
o
0)

6
=-

o
o
f
o
@
o

m
0,

I
to
0)
o

Io

c
n
m

FIGURES
Figure 3. Z- SCORE INTERPRETATIONo'

Figure 4. Head Circumference forAge for Girls

Compare the points plotted on the child's growth charts with the z-score lines to
determine whether they indicate a growth problem. Measurements in the shaded
boxes are in the normal range.

EE
go
oi!
-N

E
!
c

='E

E8'
GROWTH INDICATORS

>\\
=5

Length/Height
- for - Age
Above 3

See note

Weight - for -Age

Above 2

Weight - for LengthiHeight

BMI-for-Age

Obese

Obese

Overweight

Overweight

Possible risk of
overweight
(See note 3)

Possible risk of
overweight
(See note 3)

@1

Z.SCORE

vr

See note 2

Above'l

tn
J

Below - 2

Stunted
(See note 4)

Underweight

Wasted

Wasted

Below - 3

Severely stunted
(See note 4)

Severely
Underweight
(See note 5)

Severely wasted

Severely wasted

C'l

GI
L
o
rts
I

o
tJ
tr

1.

A child in this range is very tall. Tallness is rarely a problem, unless it is so excessive that it
may indicate an endocrine disorder such as a growth-hormone-producing

tumor, Refer a child

in this range of assessment if you suspect an endocrine disorder (e.9. if parents of normal
height have a child who is excessively tall for his or her age.

o
L
o
qE
.J

2.

J.

A child whose weight-for-age falls in this range may have a growth problem, but this is better
assessed from weighlfor-length/height or BM l-for-age.
A plotted point above 1 shows possible risk. A trend towards the 2 z-score line shows definite
risk.

4.

It is possible for a stunted or severely stunted child to become oveniveight.

This is referred to as very low weight in lMCl training modules. (lntegrated Management of
Childhood lllness, ln-service training. WHO, Geneva,1977.)

u
=
o
I

rJ
L

\,
tto
o
.I

o
o
N

r!

o
rn

o
6

Weight-for-age GIRLS
Birth to 2 years (z-scores)

.TI

@)u';**'l;ell

(6'

-o

(6-

(o

o
o

o
-L
w
J

o
N)

o
o)
a

n
m

WHO Child Growth Standards

Length-for-age GIRLS

r!

@y,tt*'l;rxl

(o
a

to

f,
(o

o
a
o
o

a
=
L

f
J
o

N)

o
o
a

WHO Child

crowth Standards

o
c

v
m

(t

Weight-for-len

th GIRLS

@v,tt*lmtl

l!

(o

c
o
:'r

(E'

o
a
to

f
(o
5

a
:1
n

=
o
l\)

o
0)
a

=n

c)

m
U)

WHO Child Growth Standards

,funs-l"

,rlF-

BM|-for-age GIRLS
Birth to 2 years (z-scores)

_R.

@y,t*g'lsr[l

l1
(o

--o

90

(p

o
(o

o
o

a
-I
w
f5
o
N

o
0)
a

o
e
7
m
(!)

WHO Child

crowth Standards

ra

rt
D

ffi

TTTifitrI

at

birth'

il

,a

TG

il- c :llvr

tIq

-rlTrilrG 'IIil N, il:lEN]EIfiiIi

T
T

F.llli

JFII7F}.

t.

lz-4 l j l2
I

o"u.'l

mo

mos

PRENATALVTSTT&couNsELING C
n

o
ScREENING FORATOPY'

oooooooo

p
It/l

c c c

c
A. SGREENING FORINBORN ERRORS OF METABOLISM,.

c.

SGREENING FOR EYE/ VISUAL DEFECTS

.'

c. PHYsrcALAcnvrtYi--

E.pREVENTToNoFCHTLDMALTREATMENT'tt??????!
OOOOOOOI
rwitoxtcurts"O
ATRISK
I

PROCEDURESFORPATIENTS

c.woRK.upFoRSEXUALLyAcTtvE

ADoLESGENTS*
Pre

****lt**
at

Natal'l birth'

O
<+
.(.-.H

2-4

11

days'l

mo

2T4-T-6-T-il-T-i[

ro" I ror I ro. I ros

I mot

rs

ts-T-Z_-l
|,uo. I tos I mos
I

DONE AT EVERY VISIT OR AT RECOIVIMENDED INTERVALS

FOLLOW-UPS DURING THE 1S'YEAR OF LIFE DONE ON A MONTHLY BASIS
AGE RANGE A PROCEDURE IS DONE AT LEAST ONCE ORAT RECOMMENDED INTERVALE

AGE RANGE A PROCEDURE IS DONE AT LEAST ONCE FOR ALL CHILDREN

THE DOT INDICATES THE PREFERRED AGE

******

ttttt

'I4YT5Y

l 6Y I sY | loY

lsY
I

|,"|lntl

DoNE FoR THosE AT HtcH RtsK oNLY

AGE RANGE A pRocEDURE ts DoNE AT LEAST oNcE FoR THosE AT HlcH RlsK

-Tl

'Weight-for-age GIRLS
2

6'
o

to 5 years (z-scores)

sc

q.

(o
J

(o

o
a
?.

l\)

d)

o
0)
a

fr

(Jl

c
m
V)

Height-for-a e GIRLS
2

to 5 years (z-scores

ll

@u'a:*'l;rll

(o

c
o

9
I

a.

tA

o^

(o

o
o
a

a
N

o
o)
o

=_
L

(tl

m
CA

WHO Child Growth Standards

Weight-for-h
2

ht

l!

GIRLS

@v,t**l;ltn

to 5 years

(o

c
o

:'
3

-/
-/

-?i

=
(o
J
a.

-o

(6'
0

-t

a
a
I

-2

N)

-3

(Jl

-a

o
o)
a

c
v
m

-4
*
&_- "_z
ry %:
ry

ry

BMl-for-age GIRLS

-----------to

5 vears (z-scores)

-r.l

@vag'l;etl

(-'
o
!s

=
o

(o

o
o^

a
?.

o
('l

fr

0)

m
V)

WHo Child Growth Standards

Weight-for-age GIRLS
5

.TI

(6'

c
o

to 1 0 years (z-scores)

P
o

=
(d'
5

o^
a

(o

o
o"

a
=
?.

Ctr

o
o
0)

Height-for-age
5

to

o
C

n
m

-TI

GIRLS

c
d

9 years (z-scores)

I
-o.

(o

fl
0

o
(o

o
o"

o
=
L
(Jl

-3

o)

7
a

/a

FF

'l

aa
d fl
,/

(o

{
2

n
*

0)

@
I

2007 WHO Reference

c
7
m

BMI-for-age GIRLS
5

!-l

to 19 years (z-scores)

@)w,t*l'l;tl*

l!
(o
c

-o

!t

TD

=
o
(o

o
o

a
=
L
('l

o
(o

0)

2o07 WHO Reference

l!

Birth to 5 years (z-scores)

@y,t**'l;erl

(o

c
o

-o
0)

o-

a
o
c
3

o"

-o
f

o
o
o
(o

o
o

TD

(t

WHO Child Growth Standards

c
v

Weight-for-age

.TI

BOYS

(5'
C

o
:

Birth to 2 years (z-scores)

(6'

d
a
(o

o
o

-w
o

I
w

=
=
o

l\)

o
0)

'1'l

fr
ITI

WHO Child Growth Standards

Length-for-age
Birth to 2 years (z-scores)

.TI

BOYS

@v.'tt**r*l

6'
c

-o

90

t--

5
(o
J

o
a
(o

o
o

-@
o
L

5
=

q
o
N)

o
o)
a

WHo child Growth Standards

o
N
m
@

-n

Weight-for-l

@m,mn

o
!o

./

./
2

6'
J
o
a

0
1

ro
(o
=

TD

-3

o
?

w
5
=

"*{-

-# 7
&
-az %
g
{)
/-e
f*

4-4 -&
---

v_

7 ry

o
N
o

--tt'?

A)
a
@

BMl-for-age BOYS
Birth to 2 years (z-scores)

l!

@y,tt*l;esl

(o

c
o

N
I

=
o-'

(o

o
o
-w
o
?.

q
3
J
o

0)
a
U'

WH0 Child Growth Standards

c
7

Weight-for-age
2

BOYS

to 5 years (z-scores)

@)y,tll'lmn

N
j
o.

=
(o
f

(o

o
o

-(F
o
L

1\)

o
('l

o
g)
@

Height-for-age
toE

ears (z-scores)

BOYS

@y,t**l*rl

7
m

";
N

-----

-o

(6'
J

(o

o
o
(D

o
?.

N)

(,l

0)
U'

WHO Child Growth Standards

Weight-for-height
2

BOYS

@u'alg'l;etl

to 5 years (z-scores)

l!
(o

-o

!t

./

o
=
6'
J
2
,l

o'

-a.

(o
5
0

o^

-ID
?.

-2

-3

o
(t
o

-7

a
g4 ry
fr'"'1

7,-,,t

-a
.*F

7
-

0)
Ch

c
fr
m
U,

7;?r
1-::

-11

to

5 years {z-scores)

@y,t*g'lstll

(6'

c
o

l\)

TD

o
(o

o
o"
a

w
o

?.

(Jl

o
0)
a

m
@

WHO Child Growth Standards

Weight-for-age BOYS
5

to

I 0 years (z-scores)

-Tl

World Health
Organization

6'

-o
l\)
I
o

=
(-'

d
(o

o
o

(D

(Jl

o
o
0)
a

Height-for-age
5

to 1 9 years (z-scores)

BOYS

@y,t**'l;lrl

o
c
7
m

f!

(o

-o
N

(d'
o"

(o

o
o
w
o
2

(tl

(o

-(t
0)

2007WHO Reference

o
7
m

FIGURES

FIGURES

US CDC-NCHS Growth Chart for Girls (Sfafure of Age: to be used in

Figure
- 29. locating
Blood Pressure Percentile of children and adolescents)

to 2S years: Girl*
$taturs-for-agG and Weight-for-f, ge percentiles

Blood Pressure Levels for Boys by Age and Height Percentile

nlaME
RECORD

12 13 14 1$ 16 17 ',l$ 19
Mother'$ Slature

*-,,,",,-,-*

Fathet's Stature

20
cm

AGI tYt :ARS}

-*-*-** BMIi

A{

Daie

s0.

80.

-74.

bz

,,/

165

160

s
T
A

99ih

50llr

s
T
A
T

.62

50rh

86 87 89 91 93 94

95

901h

951h

'106

'tc7 109 111 112 114

115

as0

9Slh

113 114 116 118 120 121

122

rs0

501h

90 91 93 95 90 S8

98

-ad

//

90ih
95th

.80-

/,

/.

w '70: -30
-25

,4

-20

4 fr

tb

2g

4 5 87

-5,

30

9Sh

2A

50th

UU

-,/

9$lr

T
90{h

9silr

50rh

*35

901h

*s0 -70

95rh

*45

-30

t.
.GE (YHr IRS
I

40

9&h

sgth

'/

ffi

10

/ A/l//

-10
kd

56

,25

',r'

E
I

50tlr

//

I 10 11 12 13 14 15 16 17 18 19

tublishBd May 30, 2mo (modlliod 1 I /r1 /00).

SOUfiCB OMlopod Iry lh Ndional Cgn&r lor geaffi Slatigics in collabffalsn wilh
lhe Nalional Oonter lor Chronic Ologas prwention and Heaith P.oMion i2000)

tdpr4wwodc,gov/growlhchddi

61

9S1h

*50

50rh

-40

9ftlr

-15
-10
ko
20

90rh

9Sth

ub

100 1c1 103 105 107 108 109

t04 tcs l0/ 109 l0 112 '13
111 112 114 '116 118 119 12'

210

5fth

70

-92

114

111

BO

105 106 108 11N 112 113

109 110 111 113 115 111

180

'34

106

00 220

:85

fi

80 e1 83 85 67 68 B9
$4 95 97 99 100 10? 103
98 SS 101 103 104 106

88 89 91 93 S5 96
102 1c3 1S 107 109 110

50

-36

95th

9Srh

s0th

991h

B
E

5rh 1!th ztih 50rb 751fi 90th

95rh

o5

.64

95rh

-54

lsrcentile ol Helght

84 85 B7 88 90 92 92
97 99 100 1t2 104 t!$ 10s
101 1t2 10,1 106 108 109 110

150

-56

90lh
95lh

5.

-r

Percentile

{Y;'1 *
I
50rh

-74'

170

31ai

tro"

/o'

0iaslolic Bi {mmilg}

$yslofie 8P {mn}{g}

3P

Itr

'tz'

or Wslght (lb)

Figure 30. BP Levels for Boys byAge and Height Percentile

95th
9Slh

tb

ffi

5orh
90th
9Srh

99rh

97
1'11

184 105 106 10$ 110 111 112

108 109 110 11? 114 115 116
115 116 '118 12t t2l 123 123

sl 92 94 ss s$ ss

100

105 1C6 108 110 111 113 l1l

109 1 10 112 aa4 15 117 1a7
'116 117 119 121 123 124 125
1

92 A 95 97 93 100
106 107 1S 111 113 114 115
101

110 111 113 115 111 118 119

117 118 120 122 124 125 '26
9a 95 97 9! {00 102 102
107 1CS 110 112 114 115 11
111 112 a14 115 118 119 128
119 12t 122 123 125 127 121
95 96 S 100 1t2 103 104
109 110 112 114 115 111 118
113 114 116 '118 119 t21 121
120 121 123 125 t21 128 12S
s7 98 100 10? 103 105 106
111 112 114 115 11t 119 119
115 116 117 119 121 122 123
122 1r3 a25 127 128 130 130

Pereenillo ol ilelght

sth 10th 25rh 50th ?i& 90th

39
53
58
66

33 10 41 42 43
54 t5 56 57 58
59 $$ 60 61 e2
66 67 68 6S 70
44 44 45 46 47
59 59 60 01 62
63 S3 64 05 S6
71 7t ?2 73 74
47 48 49 50 51
62 63 64 65 66
66 67 S8 69 l0
74 75 tS 77 78
50 61 S2 53 54
65 6S 6? 6S 69
697Ar72737474
77 78 7S 80 81

44
5$
63
?1
48
03
87
75
5',1
66
71
78
55
S9

35
$0
54
S2

36
51
55
63

3?
52
56
64

05&

38
53
t7
65

34
49
54
61

81

53
68
72
B0

i3
68
72
80

$4
09
13
81

55
70
i4
82

!6
71
7'
83

57
72
76
84

55
7A
74
82

55
i0
t4
82

56
11
15
83

57
i2
16
84

58
73
11
85

59
74
78
B6

56
71
75
83

5?
V2
76
84

58
12
l7
85

59
13
?S
8S

60
14
?9
87

60
75
79
81

57585960e1fi62
72 75 ?4 70 76 76
7E 77 18 79 80 81
n4 85 86 87 88 88

58
i3
77
s5

59
73
78
86

69
14
i9
86

61
75
80
88

61
76
81
88

62
77
81
89

39
54
$8
66
44
59
63
71

48
63
67
75

'2

E7
71

7S
65
70

82
57
72
76
84
59
74
7B

86
61
76
80
B8

77
81

89
63
78
82
90

FIGURES

FIGURES

Figure 31 . BP Levels for Girls by Age and Height Percentile

Slood Pressure Levels for Boys by Age and lleight Pereentils {Continued)
Blood Prcssu$ Levels for Girls by Age and Height Percentile
8P

Aoe Perclntile
(Y"40 t

11

liastollc BP {mnHg}

Systdic 8P {mmHg)

Percentile

oftleight

5rh lorh 25rh 50th Tsth 90th

95th

50rh 99 100 102 104 105 fi7 147

90rh 13 114 115 117 11S ln 121
951h 117 118 119 121 123 124 12'
eerh 124 125 121 129 130 132 132
1

50ilr
90rh

95tl
99th
5oth
90rh

ssrh
50111

90th

9grh
50rh

gfin
95rh
9Sth

50rh

90ll'
951h

ggth
17

90rh
95ih
9gtir

101 102 104 106 10B 109 110

115 116 118 120 121 123 123
119 120 122 123 125 127 127
126 127 129 131 133 134 135
104 105 106 108 110 111 112
117 '118 120 1n 1a 125 126
121 122 124 126 128 129 130
128 '130 131 133 135 136 137
106 197 109 111 113 114 115
120 121 123 125 128 128 128
124 125 127 128 130 132 132
131 132 134 136 138 139 140
109 110 112 113 115 117 117
1?2 124 '125 121 129 130 131
126 127 129 131 133 134 135
134 135 136 138 140 142 142
111 112 114 116 ',118 ',119 ',120
125 126 128 130 13',1 133 134
129 130 132 134 135 137 137
136 137 139 141 143 144 145
114 115 11S 118 120 121 122
127 128 130 132 134 135 136
131 132 134 136 138 139 140
139 140 141 143 145 146 147

Percnlile oi Height

59
't4
78
86
59
74
78
86
60
75
79
81
60
75
80
87
01
76
81
88
63
78
82
g0

60
75
79
81

8B

89

60

61

ot

75

79
87

61
76
80
88
62
77
81
89

61

62

75

76

80

81

76
80
88

77
81

89

77

t6

81

82

89

s0

63

64

7&

79

82

83

S0

91

64

78

79

83

83

90

o1

s5

66

oo

60

80

81

84

85

86

93

g3

62 63
77 78
8',1 82
89 g0

63

78
82
90
64
79
83
91

65
80
84
92
67
82
87
s4

79
83
91
05
80
B4
92
60
81
85
93
58
83
8?
95

79
84
92
66
80
85
93
67
82
86
94

82

$0th

90

95lh
99ih

79

83
91

90rh

85

107

114

111

112,

50lh
901h

95lh

93
50rh

82

90rh

87

95tlr

94

sgih

69

70

50ih

84

84

90rh

88

89

95ilr

97

99rh
501h

90th
951h

9Srh

Downloaded lrom the;

-The
Fourth Report on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents"
PFDIATRICS Vol, 1 14 No, 2 August 2004, 554-573 with ttn permission from
National Hearl, Lung and Blood lnsfitute (NHLBI)

103

s9rh

67

96

100 101 102 104 105 106

108 108 10S 111 1]'2 ',13

90

95ih

90th

81

83 84 85 86 BB 89
9? 97 98 100 101 .02

8B 98 90 91 92 94 94
101 102 103 104 106 '01 108
105 10e 107 108 110 ',11 112

80

66

sSrh

111 111 113 114 115 116

50{h

50rh

S2

5th 10rh 25ah 50$ 75rh 90rh

99ih

95rh

91

B4

951h

90th

OOrh

83

Percentile of Helghl

95 85 87 88 e9 91 91
98 99 100 10'1 103 104 105
102 103 1U 105 107 ',,08 1!9
109 |1t 111 112 114 115 116
86 87 88 89 91 9? 93
100 100 $2 103 104 100 106
104 104 10i 107 108 109 10

50ilr

64
79

Pscentile

50th

OJOJW

77
82
90
63
78
82
90

Ag

(Year)

?8

ubcoc

62

83

92

61
76
80
88

59
74
78
80
60
75
79
87

951h

0iastolie BP

$y$lolie Bp {mmf,lg}

6F

5rh 10th ?5th 50th 75lh 90th

50tlr

00ih
95rh

NATIONAL INSTITUTES OF HEALTH

s9lh

U. S. Deparlment of Health and Human Service$

50lh

gfrh
95ih
9911r

113 114 115 111 4,18

41
55
59
6i
46
61

48
{t2
66
73
50
64
6B
76

B1

53
67
11
18
54
68
72
B0
30
70
74
B1

53
67
7t
7$
55
69
7t
B0
56
70
74
82

54
68
72
79
56
70
74
B1
57
71
75
82

55
69
13
80
56
7t
74
82
5B
72
76
B3

55
69
73
81
5f
11
75
83
58
72
76
84

57
71
75
B'

51
71
75
g2

57
71
75
83

58
72
76
83

59
73
71
81

60
71
73
8i

58
72
76
83

5B
72
76
83

58
7?
7$
84

59
73
tl
84

60
74
78
B5

61
75
79
86

59
73
7V
8{

5s
73
71
84

59
13
71
85

60
74
l8
86

61
75
79
80

62
76
80
87

64
68
76

96

52

'109

bb

113

7A

114 114 116 117 118 ':2A

120

98

54

111

6$

f i5

72

122

80

99

55

93 33 95 98 97 99

106 107 108 109 111 ':12 13

110 111 112 113 115 116 110
117 118 11S ftA 122 "2J 124
s5 9i s6 98 99 100 101
108 109 110 11'1 113 114 114
112 112 1a4 1lS 116 118 118
125
J19 12t 121 122 12
"25
96 97 9S 100 101 ',A2 103
110 11C 112. 113 114 '.,16 11S
114 .1M15 111 118 119 124
121 121 123 124 125 ",21 121
s8 99 100 102 103 i04 105
112 112 114 115 r'16 118 118
110 11t 111 119 120 ':21 122
123 123 125 126 121 ''29 129
1

95rh

39 40 41
53 54 55
57 58 59
65 65 60
44 45 40
58 50 60
626364$65
1A 1A 71
48 49 50
ti? 63 64
e$ 67 68
74 14 75
51 52 52
65 6E 67
E9 7t 71
76 77 f8

38
52
56
64
41
57
6'1
69
41
61
65
73

89 90 S1 93 94 95
103 103 10t 106 107 :09
fi7 10i 1!8 110 111 :12
104 105 106 10S 109 110
108 109 110 111 113
"14
115 11e 11t 11S 120 '21

5th 10th 25rh s0lh 75th Itrh

119

91 92 93 94 96 91

{mnllg}

Percantile of Height

69
73

39
53
57
64
44
58
62
69

72
50
(;1
6B
78
53
67
11
70

42
56
60
67
47
61

72
51

ti5
69
76
54
68
72
79
50
70
14
81

58
72
76
83
59
73
77
B4

6l
?4
7E

86
61

75
79
87
62
76
80
88

FIGURES
Blood Pressure Levels for Girls by Age and Height Percentile {Continued}

Age

Percenlile

tYear)

50lh
90rh
95rh
99ih
50rh
9Oflr

95th

s9rh

l3

50th
90rh

95ih
99th
50ih
90th
9srh
s9ih
15

s0h
90rh
95rh

s9lh
50rh
90rh

9srh
9gth
17

Percentile of tleight

5th 10rh 25th 50th 75th 90th 95th

100 lc1 1{2 103 105 106 10I
114 114 116 111 118 11$ 120
118 118 119 121 1n 123 124
125 12' 126 128 129 130 131
102 103 104 105 107 108 109
116 116 117 119 1m Q1 122
19 120 121 123 124 125 126
127 121 128 130 131 132 133
'104 105 106 107 109 110 110
117 118 119 121 122 123 124
121 122 123 124 126 127 128
128 12S 130 132 133 134 135
10s 106 fi1 109 110 111 112'
1'1S 120 121 122 124 125 125
123 123 125 126 127 129 129
130 131 132 133 135 136 136
101 108 109 110 111 113 113
120 121 122 123 125 126 121
124 125 126 127 12S 130 131
'131 13? 133 134 136 137 130
108 108 110 111 112 114 114
' 121 121 123 124 126 127 118
125 126 127 128 130 131 132
132 133 1U 135 137 ',138 139
108 109 1 10 111 113 114 115
1?2 122 123 125 126 127 ,28
125 1?6 127 129 130 131 132
133 133 134 130 137 138 139

50ih
9Orh

s51h
99rh

* Prconlile ot lleioll t
sth 10th ?5th 50th 75lh 90ih

60
74
78
85
61
75
79
86

02
76
80
87
63
77
8'1
88
64
78
82
83
s4
78
82
s0
64
78
82
s0

63
77
81
e8

ti4

b3

78
82
90
65
79
83
91

79 80
83 84
90 91
66 67
80 81
84 85
91 92

90

oo
80
B4
91

oo
81
85
92

{j5

DO

62

62

76

76

80

80

87

88

78
85
61
75
19

63
77

77

81

81

88

89

04
78
82
83

64
78
82
90

64

65

78

79

82

83

90

65
79
83
s0

95th

62
76
80
87
63
77
81
88
64
78
82
89

8S

74

79
83
91

80
84
91

Philippine EPI Vaccines: Vaccines in the pink

box, enclosed in parenthesis, are vaccines

DTwP)
Given intramuscularly (lM)

lmmunization (EPl) of the Department of Health

61
15
79
87
62
76
80
88
63
77
81
89

60
74
18
86
61
75
79
87

s0

DIPHTHERIA AND TETANUS TOXOIDS AND

ACELLULAR PERTUSSIS VACCINE (DTAP/

given in the Philippine Expanded Program of

oia$tolic BP {mnHg}

Syst0lic BP {rnmHg)
8P

IMMUNIZATION ANNOTATIONS

03

(DOH). Vaccines in the EPI include:

77
81

64

64

78

7B

82

82

89

.q0

65

65

79

70

Other recommended vaccines include:

83

83

90

s1

00

00

Human Papillomavirus (HPV)

lf the 3'o dose in given at age less than 24

weeks

Hepatiiis

A,

Vaccines for Speciai Groups: These are

vaccines not part

81

85

Downloaded

08

81

82

85

Ub

93

93

pr

07

68

81

81

s2

85

85

86

,92

o1

s3

fror

ihe:

Fourth Report on lhe Diagnosis, Evaluation and Treatmert of High Blood Pressure in Children and Adolescents'
PEDIATRICS Vol. 114 No. 2 Augusi 2004, 554-573 wi'th the prmission fmril
National Heart, Lung and Blood lnbtitute {NHLBI)
NATIONAT INSlITUTES OF HEATTH
U. S. Department of Health and Human Services

of the EPI or

Other

Recommended Vaccines but available data

support their use in certain conditions or in
selected populations. These include: Typhoid,
Meningococcal, and Rabies.

93

or

Hepatitis BVaccine
Given lntramuscularly (lM)
The'lst dose is given within the 1" 12 hours of
life, and may be counted as part of the 3-dose
primary series. Subsequent doses may be

vaccine, IPV lnfluenza, MMRV Pneumococcal,

Rotavirus, TdaP, Varicella.

84

67

given at least 4 weeks apart, with the 3* dose

preferably grven not earlier than 24 weeks of
age" A4'ndose is neededforthefollowing:

DTaP,

80

g?

a minimum age of 6 weeks with

minimum interval of 4 weeks. The fourth dose

may be given as early as 12 months provided
there is a minimum interval of 6 months from the
3* dose. The 5'n dose may not be given if the 4'h
dose was administered at age 4 years or older,

Other Recommended Vaccines: Are the

vaccines outside the pink area. These vaccines
are not part ofthe Philippine EPI but, because of
merit, are advocated by the Philippine Pediatric
Society (PPS), Pediatric lnfeciious Diseases
Society of the Philippines (PIDSP), and the
Philippine Foundation for Vaccination (PFV).

89

Philippine EPI Vaccines

BCG
Given lntradermallY (lD).
BCG should be given at the earliest possible age
after birth, preferably within the 1" 2 months of
life. For healthy infants and children >2 months
who are not given the BCG at birth, PPD prior to
BCG vaccination is not necessary. However,
PPD is recommended prior to BCG vaccination
if any of the

,,The

BCG,

Hepatitis B, Measles, Oral Polio Vaccine (OPV),

DTwP, Hib, MMR and Rotavirus (RV).

Given at

'.
.

of close contact to

known or

clinical findings suggestive of TB and/or

chestx-raY suggestive of TB

ln the presence of any of these conditions, an

is

considered positive,

The dose of BCG is 0.05m1 for infants <12

months and 0.1ml for children 212 months of
age.

For patients using the EPI schedule of

birth,6 and 14weeks.

For preterm infants

less than 2kgs,

whose 1"'dosewas given at birth.

For preterm infants born to HBsAg (-)

mothers who are medically stable may be
given the 1"'dose of HBV at 30 days of
chronological age regardless of weigh|
and this can be counted as part of the 3dose primary series.

lf mother is HBsAg (+), administer HBV and

life. lf HBsAg

HBIG (0.5mt) within 12 hours of

status is unknown, administer HBV within 12

hours of life and determine mother's HBsAs as
soon as possible; if HBsAg (+), administer HBIG
no laterthan 7 days of life.
B

coNJUGATE VACCINE (Hib)

suspected infectious cases ofTB

induration of >5mm

HAEMOPHILUS INFLUENZAE TYPE

following are Present:

suspectedcongenitalTB

history

Given intramuscularly (lM)

Given at a minimum age of 6 weeks with a

minimum interval of 4weeks, lf the l"dosewas
given between 7 through 11 months of age, the
2"0 dose should be given at least 4 weeks later

dose at least 8 weeks from the 2'"

booster dose should be given
between 12-15 months with an interval of 6
months from the 3'o dose. One dose of Hib

and the

dose.

3'o

IMMUNIZATION ANNOTATIONS continued

"'

vaccine should be considered for unimmunized

children age 5 years or older who have sickle
celldisease, leukemia, HIV infection, orwho has
splenectomy,

should beadministered atage 4throughto 6

years. lfacombination ofOPV andlPV are

given as part of the series, a total of 4
doses should beadministered, regardless of
the child's cunent age. lf available, IPV is

IMMUNIZATI0N ANNOTATIONS continued ...

vaccine for the first time should receive 2 doses
of the vaccine separated by at least 4

weeks. lf only one dose was administered

prefened.

during the previous influenza season,

MEASLES
Given subcutaneously (SC)

Rotavirus Vaccine (RV)

Given perorem (PO)

recommended using

Children who received a dose of a measles

containing vaccine at less than '12 months

The monovalent human rotavirus

should be given 2 additional doses beginning at

1 2 through 1 5 months of age and separated by
at least 4 weeks, the latter two preferably as
MMR. Measles vaccine may be given as early
as 6 months of age in cases of outbreaks as
declared by public health officers.
Measles Mumps, Rubella (MMR)
Given Subcutaneously (SC)
The minimum age when MMR is administered is

al

age 12 months. The second dose

is

at age 4 through 6 years but

may be administered at an earlier age provided

administer 2 doses ofthe vaccine then one dose

yearly thereafter. ln October 3, 2011, WHO
vaccine

(RVl) is given as a 2-dose series, with the 1"'

dose administered beginning at 6 weeks of age
and the 2"0 dose administered not later than 24
weeks of age. The pentavalent human bovine
rotavirus vaccine (RVS) is given as a 3-dose
series, with the 1"' dose given between 6 weeks

to 14 weeks of age and the 3'o dose

administered not later than 32 weeks of age.
The minimum interval between doses is 4
weeks. There is insufficient data on efficacy
and safety of rotavirus vaccines given in older
age groups.

administered

theinterval between thel'' and 2"0 doseisat

least

4 weeks. Children below 12 months of age

given any measles-containing vaccine

(Measles, MR, MMR) should be given 2
additional doses of MMR. The

1"'

dose is given

at 12 to 15 months of age and should

separated by at least

be

weeks from measles

containing vaccine. The 2"0 dose

is

administered age 4 through 6 years, but may be

given at an earlier age provided the interval
between the 1" and the 2'o dose is at least 4
weeks. Children 12 months or older given any

measles-containing vaccine (Measles, MR,

MMR), should be given one dose of MMR
vaccine, separated by at least 4 weeks from the
1 " measles-containing vaccine.

Given at

a minimum age of 6 weeks with

Recommended Vaccines
HepatitsAVaccine
Given lntramuscularly (lM)
Hepatits A is recommended for all children >12
months. A 2'o dose of the vaccine is given 6 to
12 months

afterthe 1" dose.

minimum interval of 4 weeks. The final dose in

the series should be given on or after the fourth
birthday and at least 6 months after the
previous dose. lf 4 or more doses have been
given prior to age 4 years, an additional dose

influenza
strains in the next yea/s Southern Hemisphere
vaccine. These are the current strains as in the

Northern Hemisphere vaccine. Because the

strains in lhe 2012 influenza vaccine have not

changed from the previous season,

it

is

recommended that children ages 6 months to 8

years old who received at least one dose of the
2011 vaccine will require onlyone dose of the

2012 vaccine. Children who received single

dose of influenza vaccine for 2 consecutive
years should continue receiving single annual
doses. Annual vaccination should preferably be
given between February to June, but may be

Human Papillomavirus Vaccine (H PV)

Given lntramuscularly (lM)
Primary vaccination consists of 3-dose series
administered to females 10-18 years of age.
The recommended schedule is as follows:

Bivalent

HPV: 0, 1, 6 months

*Quadrivalent HPV: 0,2,6 months.

The minimum interval bdtween the 1" and the
2"0 dose is at least one month and the minimum
interval between the 2'o and the 3' dose is at
least3 months.

lnfluenza

Given lntramuscularly

or

Subcutaneously

(rM/sc)

All

children

from 6months to 18 years

Should receive influenza vaccine. Children

6 months

to

8 years receiving influenza

ln children who are fully immunized*, Td booster

doses should

be given every 10 years. A

single dose of Tdap can be given in place of the

due Td dose, and can be administered

regardless of the interval since the last tetanus

and diphtheria toxoid-containing

vaccine.

years of age who

are not fully immunized with DPT vaccine
should be given a single dose of Tdap. The
remaining doses are given as Td. Children and
Children and adolescents

7-1 8

adolescentsTto lSyears of age who have

never been immunized with DPT vaccine
should receive the 3-dose series of tetanus
containing vaccine using the 0,1, 6 months
schedule. A single dose of Tdap is given,
preferably as 1"'dose, The remaining doses are
given as Td.
*Fully
immunized defined as 5 doses of DTaP or 4
doses of DTaP if the 4" dose was administered on or
after

th e

fou rlh bi rlh d ay.

VARICELLAVACCINE

MEASLES, MUMPS, RUBELLA, VARICELLA

Given subcutaneously (SC)

(MMRV)

The 1" dose of the vaccine is administered from

Given subcutaneously (SC)

Combination MMRV may

be given as

an

alternative to separately administered MMR and

varicella vaccine for healthy children 12 months

of Quadrivalent HPV in males 1 0-1 I years of age

for the prevention of anogenital wafts is optional .
a

given throughout the year.

*lJse

POLrOvlRUS vAcclNE (lPV/oPV)

OPV given perorem (PO)
IPV given intramuscularly (lM)

the same

TETANUS AND DIPTHERIATOXOIDS (Td) and

ACELLUALR PERTUSSIS (Tdap)
Given lntramuscularly (lM)

to 12 years of age. A

2no

dose of MMRV is

administered at 4-6 years old or at an earlier age

proyided the interval between the 1 " and the 2'o
dose is at least 3 months.
PNEUMOCOCCAL VACCINES (PCV/PPV)
Given intramuscularly (l M)
The minimum age for Pneumococcal Conjugate
weeks and for the
Vaccine (PCV) is
Pneumococcal Polysaccharide Vaccine (PPV)

is 2

years.

A single dose of PCV

is

recommended for all healthy children ages 2 to 5

years with any incomplete PCV schedule. For
healthy children, no additional doses of PPV are
needed if the PCV series is completed. PPV is
recommended for high risk children >2 years of

age in addition

to

PCV. PPV should

administered at least 8 weeks after PCV.

be

age 12

to 15 months.

The 2"0 dose

is

administered at 4-6 years or at an earlier age

provided the interval between the 1"'and the 2'o

dose is at least 3 months. A 2'd dose of the

is recommended for children,

adolescents, and adults who previously
received only one dose of the vaccine. All
individual >13 years and without previous
vaccine

evidence of immunity should receive 2 doses of

varicella vaccine at least4 weeks apart.
Vaccines For Special Groups
TYPHOID
Given intramuscularly (lM)

Recommended for travelers to areas where

there is risk of exposure to S. typhi and for
outbreak situations as declared by public health
officials. A single dose may be given as early as
2 years of age with revaccination every 2 to 3
years ifthere is continued exposure to S. typhi,

Figure 32. lmmunization fabJe 2012

f'"H-e'

Childhood lmmunization Schedule 2012

AGE

IN

BcG

MONTHS

WEEKS

BIRTH

YEARS
i:l

t0 i2 14 16 18 20 22,o

14 16 18 20 2 q

e 10 n

8 10 12

13-1

-l
tiiit

__-]

TI Dr*P/
or"p*

I ra"p

ll

DTwP/DTaP
I

r"*-_-]
rev.

OPV/IPV

[4
t-il]

",ll

F=-il]
[-r-t-*-l

@
l=ffi4

::al

PCV

tt

tt
Ir

,,.1

[".*"ilf

['"r^ -lI
f-*-'
f=

EptVaccines
inside box

Range of Recommended Age

i+,],'ljili+.ilti

catch Up Immunization

Influenza Yearly

varicella

Hep A Series

ForHigh RiskGroup

* Primary doses are given at least 4 weeks apart

_t
IMMUNIZATION ANNOTATIONS continued

"'

MENINGOCOCCALVACCINE

RABIES
Given lntramuscularly (lM) or lntradermally (lD)
Anti Rabies Act 2007 recommended routine

Tetravalent meningococcal (ACYW-135)

rabies pre-exposure prophylaxis (PreP) for

conjugate vaccine (MCV4) given intramuscular

childrenaged 5- l4years in areas wherethere

is high incidence of rabies and animal bites

(tMy

Meningococcal polysaccharide vaccine

(MPSV4) given subcutaneous (SC), or
Bivalent meningococcal polysaccharide A and C
vaccine given intramuscular (lM)/ subcutaneous
(SC)

For individuals at high risk (ex, Anatomic or

functional asplenia, compliment or factor
deficiencies, HIV):

Children ages 2-18 years should receive a

2-dose primary series of MCV4 given at 2
months apart.

o lf MPSV4 or bivalent meningococcal

vaccine were used
as the 1"'dose, a 2"0 dose using MCV4
should be given, with minimum interval of 2
polysaccharide A and

monthsfromthe 1"'dose
Reactivation with MCV4 is recommended
3 to 5 years following completion of the

(defined

as more than twice the

average). There are

national

two (2)

recommended
regimens for pre-exposure prophylaxis:

r
.

lntramuscular dose: PVRV 0.5m1 of

PCEVC

lmlon days0,7,21 0128.

lntradermal dose: PVRV or PCECV 0.1m|

given on days 0, 7, and2l or 28.

Rabies vaccine should never be given in the

is

gluteal area because absorption

unpredictable. Forthe intradermal (lD) regimen,

a repeat dose should be given if vaccine

is

inadvertently given subcutaneously. After

completion of 3 doses of rabies pre-exposure
prophylaxis, subsequent exposures, regardless
of interval between re-exposure and last dose

of

the vaccine , will require only booster dose on

primary series, to those who remain at high

risk
ln outbreak situations, meningococcal vaccines

day0and3. Booster doses may begivenlM

(preferably MCV4) may be given to those <2

immune globulin. Periodic booster doses in the

absence of exposure are not recommended for
the general population.

years of age (minimum age of 3 months using 2

doses 3 months apart.

(0.5,1 PVRV or

.0ml PCEC) or lD (0.1m| PVRV

rabies

or PCEC). There is no need to give

i
i

Flgure 33. Food Pyramid

Reproduced with the permission from the Phi

Society of Pediatric Gastroenterology and Nutrition.

-!

LOGARITHMIC VISUAT ACUTTY CHART

foR rEsTtl{c ar 10cM (16 ll{c[Es]
0.1 LOc Ut{tTS

LETTER

SIZE

6.3

DECIMAL

SIZE lllGREllEliTS

C?fro

-Oet

soM.os{'O
{.oM

o.'o

t.2M

0.12

2.5M

0.16

tr

t.ouo.2o
.6 M 0.25
25M 0.32

.OM

M
t3M
50 M
tou
t2M
!5M
20 M
80

O.'n
0.50

0.63

A80
1.oo
1.25

SNELLEN DISTANCE
EQUIVALENT

C]

()

()

O
O

()

000acr

troc?0a
O()OOO

oooo0
00000
oodoo
oooo0
ooo00

MSTER FOO'

6t95

20/32A

6nstu2&

6,60

2ot2oo

6/48 nn60
6t3a

20n25

6t30

20t100

6/24

mt80

6t19

20t63

6/15
6t12

20t50
20t40

61s.5 mt32

47.5 ml25

6/6

20tm

6t4.8 mtr6

r.60

61s.8 m112.5

2.OO

6/3

20t10

-\
LETTEF aEcrrrAr

f,T
tmrEsnrcAT{ct(r0[El[sl

srzE

Slll

lilGnEICxIS =

ooo00
1,6M

ot

l.OG

UilrS

00000

0.32

16ooool
F-o o , ol

1.0

0.40

foooool

.80

O50

toooo"l

.63

0.63

Foml

.50

O80

F@-l

.40M

1.OO

F;.;;;l

6i-fi"1

1.25

(!@

E@l

Eotlv lEMt

IlEtEB FOO|

0.25

1.25M

.32

SNEILEN DISTANCE

nh.d^rrcGAemilnUSUAI-ACUfIYCll

lfr

lfi;;;l
t6;6El

ol

6ns an*

6t12

Nto

6ts.s

2ots2

6/7.5 nt25

v6

ml20

6r'4-a 201t6