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 OFFICIAL PUBLICATION OF THE
PHILIPPINE PEDIATRIC SOCIETY

PREVENTIVE
PEDIATRIC
HEALTH CAR
HANDBOOK 2016
COMMITTEE 2014-2016

Erlinda Susana S. Cuisia-Cruz, MD

Leonila F. Dans, MD
Janice Stephanie V. Gimenez-Mendoza, MD
Ma. Eva I. Jopson, MD
Eufrosina Marina A. Melendres, MD
Michael M. Resurrecion, MD

Mary Antonette C. Madrid, MD

Christian T. Caligagan, MD
Vice Chair

Maria Rosario S. Cruz, MD

Chair

Miguel L. Noche, Jr., MD

Loida T. Villanueva, MD, MPH
Advisers

The Committee wishes to thank the following institutions, officials, societies and friends for
their most valuable contribution:
PHILIPPINE PEDIATRIC SOCIETY, INC.
BOARD OF TRUSTEES
OFFICERS 2014-2016
Milagros S. Bautista, MD
President
Alexander O. Tuazon, MD
Vice President
Salvacion R. Gatchalian, MD
Secretary
Edwin V. Rodriguez, MD
Assistant Secretary
Joselyn A. Eusebio, MD
Treasurer
Jose B. Salazar, MD
Assistant Treasurer
Melinda M. Atienza, MD
Immediate Past President
Board of Trustees
Cynthia P. Daniel, MD
Rhodora D. Diaz, MD
Benjamin T. Lim, MD
Renie M. Maguinsay, MD
May B. Montellano, MD
Cesar M. Ong, MD
FIorentina U. Ty, MD
COUNCIL ON RESEARCH AND PUBLICATIONS
Directors
Florentina U. Ty, MD
Edwin V. Rodriguez, MD
Renie M. Maguinsay, MD
Advisers
Mary N. Chua, MD
Luis M. Mabilangan, MD
Estrella B. Paje-Villar, MD
Carmelo A. Alfller, MD
ACKNOWLEDGEMENT
1. WHO (Permissions)
Knowledge Management and Sharing
WORLD HEALTH ORGANIZATION
For giving us the permission to print excerpts from the publication "Preventing Child
Maltreatment: A Guide to Taking Action and Generating Evidence"
2. National Heart, Lung and Blood Institute (NHLBI)
NATIONAL INSTITUTES OF HEALTH
U. S. Department of Health and Human Services
For giving us the permission to print the Blood Pressure Percentile Table for Boys
and Girls published in the document "The Fourth Report on the Diagnosis,
Evaluation and Treatment of High Blood Pressure in Children and Adolescents."
3. NationaICenterforDisease Prevention and Control
Department of Health
4. Child Protection Unit Network Inc.
UP-Philippine General Hospital
5. AnthonyP. Calibo, MD, DPPS
Medical Specialist - IV
Department of Health
6. DeanRonualdoU. Dizer
College of Human Kinetics
University of the Philippines, Diliman
7. Pediatric Infectious Disease Society of the Philippines, Inc.
Pediatric Nephrology Society of the Philippines
PhilippineAmbulatory PediatricAssociation
Philippine Association for the Study of Overweight and Obesity
Philippine Obstetrical and Gynecological Society
Philippine Pediatric Dental Society, Inc
Philippine Society of Adolescent Medicine Specialists
Philippine Society of Asthma, Allergy and Immunology
Philippine Society of Developmental and Behavioral Pediatrics
Philippine Society of Newborn Medicine
Philippine Society of Pediatric Gastroenterology and Nutrition
Philippine Society of Pediatric Hematology
Philippine Society of Pediatric Metabolism and Endocrinology
Philippine Society of Pediatric Ophthalmology and Strabismus
 C O N T E N T S TA B L E OF C O N T E N T S
TA B L ~ E OF:

1 Figure 11. Weight for Height for Girls: 2 to 5 years ......................................4 3

Message from the PPS President ............................................................
2 Figure 12. BMI forAge for Girls: 2 to 5 years ...............................................4 4
Message from the Committee Adviser ......................................................
3 Figure 13. Weight forAge for Girls: 5 to 10 years .........................................45
Foreword ............................................................................................
4 46
Figure 14. Height forAge for Girls: 5 to 19 years ..........................................
List of Abbreviations .............................................................................
5 Figure 15. BMI forAge for Girls: 5 to 19 years .............................................4 7
Annotations ............................................................................................
14 48
Figure 16. Head Circumference for Age for Boys ..........................................
Appendix 1. Prenatal Visit, Education and Counseling ................................
15 Figure 17. Weight forAge for Boys: Birth to 2 years .....................................4 9
Appendix 2. Discharge and Follow-up of Healthy Term Newborns .............
16 50
Figure 18. Length forAge for Boys: Birth to 2 years ......................................
Appendix 3. Adolescent Health Care ........................................................
17 51
Figure 19. Weight for Length for Boys: Birth to 2 years .................................
Appendix 4. Developmental Surveillance and Screening .............................
19 Figure 20. BMI forAge for Boys: Birth to 2 years .........................................5 2
Appendix 5. Screening for EyeNisual Defects ...........................................
22 53
Figure 21. Weight for Age for Boys: 2 to 5 years ...........................................
Appendix 6. Preventive Dental Care ........................................................
24 Figure 22. Height forAge for Boys: 2 to 5 years ...........................................5 4
Appendix 7. Breast'feeding and Complementary Feeding ............................
55
Figure 23. Weight for Height for Boys: 2 to 5 years .......................................
26
Appendix 8. Child Maltreatment ..............................................................
28 Figure 24. BMI forAge for Boys: 2 to 5 years ...............................................5 6
Appendix 9. "7 Steps to Protect Children". ................................................
57
Figure 25. Weight for Age for Boys: 5 to 10 years .........................................
31
Figure 1. Windows of Achievement .........................................................
58
Figure 26. Height forAge for Boys: 5 to 19 years ..........................................
32
Figure 2. Developmental Milestones of Early Literacy ...............................
33 Figure 27. BMI forAge for Boys: 5 to 19 years .............................................5 9
Figure 3. Z-Score Interpretation ................................................................
60
Figure 28. US CDC-NCHS Growth Chart for Boys ........................................
34
Figure 4. Head Circumference for Age for Girls ........................................
61
Figure 29. US CDC-NCHS Growth Chart for Girls ........................................
35
Figure 5. Weight for Age for Girls: Birth to 2 years ....................................
62
Figure 30. BP Levels for Boys by Age and Height Percentile ........................
36
Figure 6. Length for Age for Girls: Birth to 2 years ......................................
Figure 31. BP Levels for Girls byAge and Height Percentile ........................6 4
37
Figure 7. Weight for Length for Girls: Birth to 2 years ..................................
Figure 32. Food Pyramid ................................................................' .............6 6
38
Figure 8. BMI forAge for Girls: Birth to 2 years ...........................................
67
Figure 33. Immunization Table 2014 .............................................................
39
Periodicity Table ............................................................................................
68
Immunization Annotations ............................................................................
41
Figure 9. Weight forAge for Girls: 2 to 5 years ............................................
42
Figure 10. Height forAge for Girls: 2 to 5 years ............................................ I 72
Figure 34. Immunization for Teens and Pre-Teens .......................................
73
Bibliography ..................................................................................................

MESSAGE
he Philippine Pediatric Society Inc. as the frontline organization of
Filipino child healthcare advocates nationwide is firmly committed to
promote ways and means not only to cure childhood illnesses but more
importantly prevent them. This is the essence of effective child rearing
"preventing the predictable and controlling the preventable."
As part of its vital publications in the past two decades, the 2016 edition of the "Preventive
Pediatric Healthcare Handbook" is an addition to every pediatrician's quick and easy
reference in the "practical, timely and appropriate" continuing care of children and
adolescents. The succinct and abridged items with their corresponding explanations and
evidences make this handbook a truly pragmatic guide in daily pediatric practice.
It is heartwarming to share that this handbook has been included as one of the pertinent
reading materials and guides in various medical schools nationwide. This is a recognition of
the handbook's value as a tool which can facilitate active learning of preventive pediatrics,
imbue medical learners with a deep understanding of anticipatory guidance in children and
foster a better appreciation of child healthcare in the local setting hinged on globally
accepted underpinnings.
The PPS salutes the hardworking and ever reliable members of the Committee on
Preventive Pediatric Healthcare led by Dr. Maria Rosario S. Cruz who took the helm and
continued the tradition of excellence began by two deeply committed advocates of
preventive pediatrics, Drs. Miguel L. Noche Jr and Loida B. T. Villanueva, former Committee
chairpersons who painstakingly laid down the structural framework of this handbook. Their
trailblazing inspiration and pioneering endeavors have remained intact, indelible and
enshrined up to this latest edition.
As the PPS joins the global bandwagon to information modernization and advancement,
through web-based teaching learning, it continuously reminds the Filipino pediatrician that
fundamental concepts of child health care, although dynamic remain universal cornerstones
that defy the boundaries of time, technology and tradition.
May every Filipino pediatrician make this tool as useful as it has been envisioned and
realized.
MabuhayangPPS!
President
MESSAGE
reetings!Allow me to remind you all, Fellow Physicians, that our vision in
the practice of medicine is to provide optimum health and public safety
for the Filipino people. This vision is to be achieved with the highest
professional skills/competence and ethical standards. The mission of the
Committee on Preventive Health Care of the Philippine Pediatric Society (PPS) is for
preservation of optimum health through primary preventive strategies --- that is, prevention
of common illnesses for high risk patients. This entails no grandiose plan, but needs
grandiosework.
The 2016 edition of the handbook published by the Committee is it's 7th updated
version of primary health care prevention strategies for infants, children and adolescents.
The Committee's recommendations started with simple beginnings, utilizing a number of
foreign data in its first edition in 2000, which we know may not be appropriate for Filipino
children that can result to adverse outcomes. From the initial discussions, the primary goal
of the Committee is to collate local evidence-based studies and come up with relevant
recommendations. Hence, subsequent editions of the handbook, incorporated
recommendations derived from more and more local evidence-based studies. These are
evident in this edition. With this untiring efforts of the Committee, clinicians including
seasoned pediatricians became more confident for its safety in implementing the
recommendations contained in this handbook. This has resulted to the increase in the
utilization of the handbook suggesting the increasing trend of clinicians to include primary
prevention in their clinical practice.
Hence, it can be said that the PPS, through this Committee, has provided the
Filipino physicians an effective and inexpensive tool for promoting optimum health and
safety to our children. Congratulations!
To the Committee of Pediatric Preventive Health Care, kudos to the success of
your endeavors, for you are now starting to see the fruits of your talent, dedication and
commitment. These achievements could only be possible with hard work, and, from Mother
Teresa of Calcutta's word of wisdom, done with "great love". More power to all of you and
may the Lord bless you.
MIGUEL L. NOCHE, JR., MD, FPPS, FPSAAI
Adviser
Committee of Pediatric Preventive Health Care
 F O R E W O R D
LIST OF A B B R E V I AT I O N S

T he Committee on Preventive Pediatric Health Care Handbook has

5TU PPD 5 Tuberculin Units Purified Protein Derivative
through the years continuously devised strategies to transmit the AAPD American Academy of Pediatric Dentistry
message of preventive pediatrics to all pediatric medicine practitioners.
BCPC (Local) Barangay Council for the Protection of
This publication started by our esteemed predecessors Dr. Miguel L.
Children
Noche Jr. and Dr. Loida T. Villanueva was intended to provide every pediatrician
BMI Body Mass Index
with a "quick, user-friendly and easy to use" guide for childhood wellness
encompassing growth and development, immunizations, anticipatory guidance, CIU Crisis Intervention Unit
injury control and health surveillance. CP Cerebral Palsy
DOH Department of Health
As it has been the practice in the past, the Committee has conducted a considerable DBP Diastolic Blood Pressure
amount of time in active discussion, collaborative exchanges of knowledge and DSWD Department of Social Welfare and Development
constructive integration of recommendations and evidences regarded as "vital EINC Essential Intrapartum and Newborn Care
and essential" for the frontline pediatrician. Invaluable contributions from well- HEEADSSS Home, Education/Employment, Eating, Activities, Drugs,
respected members of different pediatric disciplines provided the expert opinion Sexuality, Suicidality, Safety/Spirituality
duly supported by existing guidelines and best practices. LVH Left Ventricular Hypertrophy
MR Mental Retardation
In the 2016 edition, the Committee is proud to include updates and developments PASOO Philippine Association for the Study of Overweight
in the following areas: and Obesity
Newborn screening PEP Pre-Exposure Prophylaxis
Eye and vision screening PPS Philippine Pediatric Society
Deworming ROP Retinopathy of Prematurity
Screening for iron deficiency anemia
ROR Red Orange Reflex
Additional references for "essential intrapartum and newborn care
(EINC or "Unang Yakap") and breastfeeding SBP Systolic Blood Pressure
Annual screening for adolescents TIPP The Injury Prevention Program
Immunization UPCHK University of the Philippines - College of Human
Milestones of Early Literacy Development Kinetics
University of the Philippines - Philippine General
Allow me to thank the members of the Committee on Preventive Pediatric Health Hospital
Care Handbook for their incomparable dedication and commitment to make this US CDC-NCHS- United States Center for Disease Control and
contribution a continuing legacy to the Filipino child. Prevention National Center for Health Statistics
WCPDs Philippine National Police Women and Child
Likewise, let me commend the Philippine Pediatric Society Inc. for continuing to Protection Desks
be an active conduit in providing timely and time-tested learning to its members World Health Organization
nationwide. Its willingness to be an active part in information dissemination has
equipped, enabled and empowered every Filipino pediatrician to be a competent
healthcare provider, educator, researcher, manager and social mobilizer. DISCLAIMER

Let this latest edition be another humble contribution to the betterment and
furtherance of the Filipino child in an era where wellness and prevention should be
the rules rather than the exceptions.
Maria Rosario S.~r~/z, MD, FPPS
Chair, Committeel~a~Preventive Pediatric Health Care Handbook
"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. In no way should the
recommendations be regarded as absolute rules, since nuances and peculiarities
in individual cases or particular communities may entail differences in the specific
approach. In the end, the recommendations should supplement and not replace
sound clinical judgment made on a case to case basis."
 A N N O T A T I O N S
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
1):
Breastfeeding (Appendix 7)
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 Immunization for
the mother
Maternal nutrition (to include folic
acid supplementation)
2. Every infant must be totally
appraised at birth and monitored daily
until discharge.
Colostrum is the perfect first food
for the newborn. Latching-on and
breastfeeding must be initiated during
the first 30 minutes to one hour after
delivery of the infant (1, 8, 11, 12)
3. The optimal time of discharge of
a healthy term newborn is decided by
the physicians caring for both mother
and child. For newborns discharged
<48 hours after delivery, a definitive
appointment must be made for the
infant to be examined within 48 hours
of discharge (52, 54). (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.
5. If a child comes under care for the
first time at any point on the schedule,
or if any items are not accomplished
at the suggested age, the preventive
care services should be brought up to
date at the earliest possible time.
6. Risk assessment and screening
using the HEEADSSS format is part of
a complete history-taking of adolescent
patients (157). (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, observing the child and doing a
thorough physical examination remain
to be the most powerful instruments
available to the pediatrician in
identifying concerns that may need
monitoring or referral (Appendix 4).
The WHO Child Growth
Standards include 'Windows of
Achievement' which describe the
range and time lines for six key motor
development milestones (Figure 1).
These motor development milestones
must be interpreted in the light of other
neurodevelopmental findings in a
child.
"The Philippine Ambulatory
Pediatrics Association, Inc. 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 Literacy from Reach Out and
Read, Inc. in Boston, Massachusetts,
describe the motor and cognitive skills
of children from 6 months to 5 years of
A N N O T A T I O N S
age, and inform parents what they can
do to support their children's emergent
literacy behaviors (Figure 2). "
8. Red Flag signs for Atopy from the
Philippine Society of Allergy, Asthma,
and Immunology: Any child with a
family history of atopy (asthma, atopic
dermatitis, allergic rhinitis, drug / food
allergy) who presents with recurrent/
persistent symptoms of 1 or more
of the following should be closely
monitored, investigated or referred to
the subspecialist(s) when warranted:
Respiratory symptoms: chronic
cough with or without wheezing,
shortness of breath, chest
tightness, trouble sleeping due to
coughing, fatigue, problems with
feeding or grunting during infancy
Nasal symptoms: frequent
sneezing, rhinorrhea, itchiness,
nasal congestion
Ocular symptoms: bluish,
brownish discoloration around
both eyes, puffiness under the
eyes, redness and tearing,
itchiness
Skin symptoms: dryness and
itchiness
Gastrointestinal symptoms:
itchiness of the roof of the mouth
and throat, colic, vomiting,
stomach cramps, diarrhea and
bloody stools
9. Approach to a thorough physical
examination and interpretation of
findings must be age - 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 for adolescent patients
are mentioned in Appendix 3.
10. The WHO Child Growth Standards
are used as reference standard for
weight, height and head circumference.
Interpretation of growth points are
based on Z-scores (standard deviation
scores) and not on percentile scores.
Figures 3-27 show the following:
Z-score interpretation, Head
Circumference for Age for Girls,
Weight for Age 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 for Age
for Girls (Birth to 2 years), Weight for
Age for Girls (2 to5 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 10 years), Height
for Age for Girls (5 to 19 years), BMI
forage for Girls (5 to 19 years), Head
Circumference for Age 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
(Birth to 2 years), BMI for Age for Boys
(Birth to 2 years), Weight for Age for
Boys (2 to 5 years); Height forAge for
Boys (2 to 5 years), Weight for Height
for Boys (2 to 5 years), BMI forAge for
Boys (2 to 5 years), Weight forAge for
Boys (5 to 10 years), Height forAge for
Boys (5 to 19 years), BMI for Age for
Boys (5 to 19 years).
The following excerpts were lifted
from the WHO Child Growth Standards
recommendations (57):
"If a child is less than 2 years old,
measure the recumbent length. If a
child is age 2 years or more and able
to stand, measure the standing height.
In general, standing height is ~ 0.7 cm
less than recumbent length. If a child
less than 2 years old will not lie down
 A N N O T A T I O N S
for measurement of length, measure
standing height and add 0.7 cm to
convert it to length. If a child 2 years
old or more cannot stand, measure
recumbent length and subtract 0.7 cm
to convert it to height.
Weight-for-length/height is a
reliable growth indicator even when
the age is not known.
Body Mass Index (BMI)
measurement standards enable early
detection and prevention of overweight
and obesity problems."
The WHO cautions the health
care workers about edema associated
with 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 growth chart that the child has
edema.
To be consistent with the use of
the blood pressure percentile tables
(Annotation 11), the US CDC-NCHS
grow charts are also included (Figures
28-31).
11, The Pediatric Nephrology Society
of the Philippines recommends
routine 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 or
vascular involvement) regardless of
age.
The National High Blood Pressure
Education Program of the National
Heart, Lung and Blood Institute crafted
blood pressure percentile tables based
on age, gender and height percentile
(61). Figures 30 and 31 are tables that
show the 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
patients.
How to use the BP Tables:
a. Determine the height percentile
of the patient using the US CDC-
NCHS growth charts (Figure 28
and 29)
b . Measure and record the patient's
SBP and DBP.
c . Use the correct gender table for
SBP and DBP (Figure 30 and 31)
d. 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
height percentile.
e. Find the SBP on the left columns
of the table and the DBP on the
right columns.
f. Find the corresponding BP
percentile on the vertical column
to the right of the age column.
A child is normotensive if the BP
is <90th percentile for age, gender and
height percentile. Encourage healthy
diet, sleep and physical activity for
children with normal blood pressure.
Prehypertension in children is
defined as average SBP or DBP
levels that are equal to or greater than
90th but <95th percentile. Adolescents
with BP levels equal to or greater than
120/80mm HG should be considered
pre-hypertensive. Counseling on
physical activity, diet management
if obese must be done. Medical
investigation for the presence of
factors that might need pharmacologic
therapy (chronic kidney disease,
diabetes mellitus, heart failure of LHV)
A N N O T A T I O N S
must likewise be done. If in doubt, a
referral to the subspecialist will be
prudent.
H y p e r t e n s i o n i s d e fi n e d a s
average SBP and/or DBP equal to or
greater than 95th percentile on 3 or
more occasions. Hypertensive patients
must be referred to the subspecialist for
further investigation and management.
t2. General Procedures may be
modified depending upon entry point
into schedule and individual need.
13, Article 3 Section 54 of the Newborn
Screening Act of 2004 (Republic Act
No. 9288) states "Obligation 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.
Health professionals are
encourage to organize and participate
in continuing medical education
activities on newborn screening, and
to be model advocates as well (40).
Newborn Screening Reference
Center Memorandum 2014-015
regarding the protocol on collecting
blood sample states that "newborn
screening should be ideally done
immediately after 24 hours from birth".
(44)
Expanded newborn screening has
been made available since December
2014. (43)
14, The PPS Policy Statement
on "Neonatal Hearing Screening"
recommends screening f o r a l l
Newborns whether high risk or non-
high risk (47). Pertinent sections of
Republic Act No. 9709 (The Universal
Newborn Hearing Screening and
Intervention Act of 2009) include the
following:
Section 5: "Obligation 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 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 infants born in hospitals in the
Philippines shall be made to undergo
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. Infants who are not born in
hospitals should be screened within
the first three (3) months after birth.
In 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." (49)
15. The Philippine Society of Pediatric
Ophthalmology and Strabismus
(PSPOS) and the Philippine Academy
of Ophthalmology (PAO) recommend
the regular eye and vision screening
examination of children from infancy
until maturity of their visual system.
The single most effective way of
determining a child's eye health is
through a non-invasive and simple Eye
and Vision Screening Test (Appendix 5).
 A N N O T A T I O N S
The Philippine Pediatric Society
Policy Statement on "Pediatric
Blindness Prevention and Vision
Screening" asserts that proper
dietary supplementation, measles
immunization, routine pediatric
eye evaluation for all patients, and
subsequent referral of children at high
risk for blindness are key steps in the
prevention of blindness in Filipino
children (68). The Clinical Practice
Guideline on "The Routine Eye
Examination as a Screening Tool for
Retinoblastoma" recommends routine
eye examination of infants and children
for early detection of leukocoria and
strabismus, the most presenting signs
of retinoblastoma (51).
16. Everyvisitshould bean opportunity
to update a child's immunization.
Figure 33 and 34 summarize the
recommendations for immunization of
infants, children and adolescents from
the Philippine Pediatric Society, the
Pediatric Infectious Disease Society
of the Philippines and the Philippine
Foundation for Vaccination.
Immunization recommendations
for adolescents are summarized
in Figure 34.
Republic Act no. 9482 the Anti
Rabies Act of 2007 mandates
the creation of a National Rabies
Prevention and Control Program.
One of the proposed activities of
the program is the provision of
free routine immunization or Pre
Exposure Prophylaxis (PEP) for
schoolchildren aged five (5) to
fourteen (14) years. (72)
A N N O T A T I O N S
17. Iron Supplementation as 18. Vitamin A supplementation as Mebendazole
recommended by the DOH (74): recommended by the DOH (74): 12 months and above: 500 rag,
single dose every 6 months
Either drug shall be taken ON FULL
STOMACH.
Drops; 15rag Deworming must not be done in
eemental the children with (82):
iron/0.6ml severe malnutrition
high-grade fever
profuse diarrhea
abdominal pain
foodsaregiven serious illness
previous hypersensitivity to
6-11 / containing antihelminthic drug
I day for 3
months ~ 15ml
t months The DOH has a National Filariasis
' : /elemental /' ~ " Elimination Program implemented
1 .
iron/06ml
1 The PPS Policy Statement on "Zinc in municipalities endemic for
Supplements in Children" cites the filariasis. Mass treatement with
Children Syrup ' 1 tsp once a day beneficial role of zinc supplementation Diethylcarbamazine Citrate (DEC)
.1-5 yrs old containing. 'for 3 months or in the prevention of pneumonia and and Albendazole includes children
. '30mgoncea
30rag ' diarrhea. The recommended dose and
week for 6 from 2 years old and above (85).
: elemental
ron/5ml .months with dose interval though have yet to be
supen/ised set. (79) 20. Age-appropriate discussion and
~ administration counseling should be an integral part
, ~ , , 19. The Department of Health of each visit.
Administrative Order 2015-0054:
Ad
Girls
- tl f O. 0tonce Revised Guidelines on Mass Drug
Administration and the Management of
21. The Philippine
Dental Society, Inc. endorses the
Pediatric
I containing
(o-19yrs.)1,mgement6O ar1t a day Adverse Events Following Deworming recommendations of the American
I ir~ witff | ' (AEFD) and Serious Adverse Events Academy of Pediatric Dentistry (AAPD)
I 4oomc fol ! (SAE) recommends deworming for all and the American Dental Association
.... } acid(coated) / , children aged 1 to 12 years (81). pertinent to preventive dental care
The WHO and the DOH both (Appendix 6).
recommend the use of either T h e fi r s t d e n t a l v i s i t i s
albendazole or mebendazole in the recommended to be done at the time
following doses and schedule (81, 82, of eruption of the first tooth and no
84): later than 12 months of age. During the
first dental visit, the dentist will assess:
Albendazole the child's general health, growth
12 months to 23 months: 200 rag, and behavior
single dose every 6 months the child's oral hygiene and
24 months and above: 400 mg, periodontal health and,
single dose every 6 months the risk for developing oral
disease. The dentist will likewise

A N N O T A T I O N S
provide education on infant oral
health and evaluate and optimize
fluoride exposure (141).
PPS Policy Statement on Fluorides
in the 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
on the use of fluoride varnish (140).
22. Counseling regarding breasffeeding
that was started during the prenatal
period must be continued during
well child visits. Mothers must be
encouraged to exclusively breastfeed
up to six (6) months and continued
on up to two (2) years and 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 (11, 12, 13, 95). The Philippine
Society of Pediatric Gastroenterology
and Nutrition issued guidelines on
breasffeeding and complementary
feeding (Appendix 7).
Early on, children must be taught
the value of eating healthy foods in
a balanced diet as well as avoiding
unhealthy foods (99, 100). Giving of
foods that are too sweet (sweetened
beverages, candies), too salty (chips,
curls) or too oily (gravies, dressings)
should be avoided (95, 100, 101)
It is imperative that hand hygiene
be practiced at all times.
The food pyramid crafted by
the Philippine Society of Pediatric
Gastroenterology and Nutrition is
a guide for physicians and parents
in providing daily healthy diets for
children (Figure 32).
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 or higher-energy
foods (102)
Physicians may work with school
administrators in promoting school-
based nutrition programs to ensure
that children are provided with healthy
food in school (98).
23, Physical activity, along with a
well-balanced healthy diet, is a major
principle to healthy living (96, 107).
A physically active lifestyle among
children and adolescents will be
carried into adulthood and reduce
health problems related to inactivity
(108). Physical activity can be in the
form of sports and games, dance,
physical recreational activities,
household chores and other lifestyle
related physical activities (111)
Age-appropriate physical activities
for children and adolescents for 60
minutes daily (PASO0) or on most
days of the week (UPCHK) are the
current recommendations (111). 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 recommendations for schools,
physicians regular physical activity in
children (107).
A N N O T A T I O N S
24. The following are Policy
Statements of the Philippine Pediatric
Society: Child Safety in Private Motor
Vehicles, Child Safety in Public
Motor Vehicles, Child Pedestrian
Injury Prevention, Child Helmet Use,
Drowning Prevention, Burn Injury
Prevention, Household Products
Poisoning, Medicinal Poisoning and
Watusi Poisoning, Backpacks and
Children, Noise in the Environment,
Recreational Noise, Fetal and
Neonatal Exposure to Noise and
Fireworks Related Injuries. (113, 114,
115, 116, 117, 118, 119, 120, 121,122,
123, 124, 125, 126)
Anticipatory Guidance for
adolescents is contained in Appendix
3.
The Injury Prevention Program
(TIPP) of the American Academy of
Pediatrics similarly provide guidelines
for pediatricians to counsel parents
and children about adopting behaviors
to prevent injuries from birth to
adolescence (129).
25. The World Health Organization
defines child maltreatment as "all
forms of physical and/or emotional ill-
treatment, sexual abuse, neglect or
negligent treatment or commercial or
other exploitation, resulting in actual
or potential harm to the child's health,
survival, development or dignity
in the context of a relationship of
responsibility, trust and power" (130).
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
experiences (130, 131,134, 135).
The WHO listed factors that
increase the susceptibility of a child
to maltreatment as well as factors that
may offer protective effect (Appendix 8).
The Child Protection Unit Network,
Inc. enumerated the "7 Steps to Protect
Children" (131,134) (Appendix 9).
Children learn behaviors and
have. their value systems shaped
by 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
minimization of media exposure for
Filipino youth and urges parents
to create a healthier and friendlier
environment for their children to
reduce the negative effects of media
influence (142)
The Implementing Rules and
Regulations of Republic Act 7610 (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,
either orally or in writing, to Department
of Social Welfare and Development
(DSWD) the examination and/or
treatment of a child who appears to
have suffered abuse within 48 hours
from knowledge of the same." They
may also report suspected cases to
the Local Barangay Council for the
Protection of Children (BCPC), Local
Government Unit (City/ Municipal/
District) Social Welfare Office, Crisis
Intervention Unit (CIU) - DSWD-NCR
and Philippine National Police Women
and Child Protection Desks (WCPDs).
Clinicians should maintain a high
index of suspicion for past and present
incidence of domestic violence (136,
138, 139)
 A N N O T A T I O N S
26. Lead is an ubiquitous
environmental toxicant that can attack
many different organ systems. Among
children, the best studied effect of lead
exposure is cognitive impairment. The
Philippine Pediatric Society Policy
Statement =Lead Poisoning in Children"
presents background information on
lead poisoning in children, several lead
exposure prevention strategies and
recommendations for the prevention of
lead poisoning in children (87).
2 7 . I r o n d e fi c i e n c y a n e m i a i s
associated with cognitive and
psychomotor abnormalities in children.
At risk are those with poor nutritional
history and those with a past or family
history of anemia.
The Philippine Society of Pediatric
Hematology recommends a 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. Special attention should
be given to infants 6 months to less
than 12 months, and 12 months to 23
months (80). Actively menstruating
female adolescents and fad dieters are
likewise at risk. The Philippine Society
of Adolescent Medicine Specialists
recommends a complete blood count
at each stage of adolescence.
28. The Philippine Society of
Adolescent Medicine Specialists
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 in Appendix 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.
30. Screening for tuberculosis is
targeted among individuals who are at
risk for developing the disease (168).
Using 5 TTU PPD or 2TU-RT23
test read at 48-72 hrs, regardless
of BCG status, an induration (not
erythema) 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.
In the absence of the above factors,
an induration > 10 mm is considered
positive (169).
A P P E N D I X
Appendix 1.
Prenatal Visit, Education and Counseling
Education and counseling on Essential Intrapartum and Newborn Care
(EINC or Unang Yakap) and breastfeeding must begin during the prenatal period
(2, 8, 11, 13, 14). The recommended EINC practice for immediate care of the
normal newborn are a series of time-bound interventions at the time of birth that
can be enforced immediately in all health care settings. It emphasizes the step-by-
step performance of a sequence offourcore actions which are: (1)
(1) immediate and thorough drying ofthe newbom,
(2) early skin-to-skin contact between mother and newbom,
(3) properly-timed cord clamping and cutting, and
(4) non-separation ofnewbom and mother for early breastfeeding.
These time-sensitive interventions should not be pre-empted nor undermined by
other interventions. Unnecessary interventions in newborn care include routine
suctioning, early bathing, routine separation from the mother, foot printing,
application of various substances to the cord, and giving pre-lacteals or artificial
milk formula or other breast milk substitutes.
Aside from this, to promote, protect, and support breastfeeding, mothers
must be informed of the recommended period of early initiation of breastfeeding,
exclusive breastfeeding up to 6 months and continued breastfeeding up to two
years and beyond after introduction of complementary foods (11, 12, 19, 20).
Other recommended procedures done during the infant's birth may be
explained during the prenatal visits. These include early rooming-in, Kangaroo
Mother Care, newbom screening, hearing screen and immunizations with Hepatitis
B vaccine and BCG (1, 69, 70).
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
(130). 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 (25).
Discussion regarding injury prevention and potential exposure of the
mother and child to environmental toxicants such as lead may begin during the
prenatal visits (87).
Pregnant women must be informed about the deleterious effects of
smoking, alcohol intake and exposure to known teratogens during pregnancy (6,
32). They must likewise be advised and encouraged to take folic acid-rich foods
and supplements on top of the recommended healthy diet for a pregnant woman
(29, 30, 31). Tetanus Toxoid immunization must be started or continued during
pregnancy (69).
 A P P E N D I X A P P E N D I X

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. Appendix 3
Adolescent Health Care

Appendix 2. The Philippine Society of Adolescent Medicine Specialists, cognizant

Discharge and Follow-up of Healthy Term Newborns 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 should
The Philippine Society of Newborn Medicine lists the following minimum criteria
undergo the following:
for discharging newborns before 48 hours (52, 54):
Uncomplicated antepartum, intrapartum and postpartum courses for
1. Complete history-taking to screen for risks and protective factors using
both mother and newborn
Vaginal delivery, singleton, completed 37 weeks, AGA the tool HEEADSSS (27, 28) which means: H-home, E-education/
Normal and stable vital signs during the preceding 12hours(RR employment, E-eating, A-activities, including media and internet
exposure, D-drugs (alcohol, tobacco, and other drugs), S-sexuality,
<60/min, CR 100-160/min, axillary temperature 36.5°C - 37.4°C
properly clothed in an open crib) S-suicidality/depression, S-safety. It is recommended to add another S,
Has urinated and passed at least one stool which screens for strength/spirituality.
Has documented proper latch, milk transfer, swallowing, infant satiety
and absence of nipple discomfort 2. Physical Examination
Normal physical examination
No evidence of significant jaundice in the first 24 hours of life This should be done in privacy and preferably by a health care provider
Educability and ability of the parents to care for their child (recognize that is of the same gender as the teen patient. In addition to the routine
signs of illness, care of the umbilical cord/skin/genitalia, maternal physical examination, the following should be done:
confidence in feeding her infant and parents' understanding of the 2.1 Tanner Staging/Sexual Maturity Rating
importance of follow-up visit or emergency consultation) 2.2 Breast examination
Must follow-up within the next 48 hours 2.3 Examination of the spine and shoulders. Check for scoliosis and
kyphosis.
The purposeofthefollow-up visit is to(54): 2.4 Inspection of the genitals and anus.Amore thorough examination
Assess the infant's general health, hydration, and presence/degree is warranted in symptomatic patients.
of jaundice; weigh the patient; identify any new problems; and obtain
historical evidence of adequate urination and defecation patterns for 3. Laboratory Tests
the infant.
Reinforce maternal or family education in infant care, particularly 3.1 Complete Blood Count (or at least Hemoglobin/Hematocrit) at
regarding infant feeding. every stage of adolescence
Review feeding pattern and technique, including observation of 3.2 Urinalysis on firstencounter
breastfeeding for adequacy of position, latch-on, and swallowing. 3.3 Vaginal wet mount, PAP smear for sexually active females
Assess quality of mother-infant interaction and details of infant 3.4 Serologic testfor syphilis for sexually active males Non-culture
behavior. test for gonorrhea and Chlamydia for both male and females
Review the outstanding results of laboratory tests performed before who are sexually-active
discharge.
Perform screening tests (see section on General Procedures) if not 4. Immunization Update:
yet done and other tests that may be clinically indicated, such as
serum bilirubin. Please refer to Figure 34. Summary Table: Immunization of Teens and
Suggest and encourage compliance to recommended schedule of Pre-teens 2016 (7 to 18 yrs old)
periodic follow-up and preventive care.
 A P P E N D I X A P P E N D I X

5. Anticipatory Guidance and Counseling The following are RED FLAGS in each area of development:
SOCIAL-EMOTIONAL RED FLAGS/1711
5.1 Self breast examination for females
5.2 Healthy Lifestyle: physical activity, diet, avoidance of alcohol, AGE RED FLAG
smoking, drug use 6 months Lack of smiles or other joyful expressions
5.3 Sexual behavior and the riskofacquiring STDs including HIV Lack of reciprocal (back-and-forth sharing of)
9 months
5.4 Injury and accident prevention: use of sports protective gear,
vocalizations, smiles, or other facial expressions
seat belts, no driving under the influence of alcohol, no smoking
in bed, no hand gun use. 12 months Failure to respond to name when called
Absence of babbling
Confidentiality is a major issue in attending to adolescent patients. In Lack of reciprocal gestures (showing, reaching, waving)
addition, guidance and counseling is now directed to the patient with 15 months Lack of proto-declarative pointing or other showing gestures
diminishing participation of the parent/guardian. Lack of single words
18 months Lack of simple pretend play
Lack of spoken language/gesture combinations
24 months Lack of two-word meaningful phrases
Appendix 4.
(without imitating or repeating)
Developmental Surveillance and Screening
Any age Loss of previously acquired babbling, speech, or social skills
The Philippine Society for Developmental and Behavioral Pediatrics
(PSDBP) recommends that developmental surveillance be done at every well
child visit. Developmental surveillance is a process by which the health care MOTOR RED FLAGS (172)
professional recognizes the children who may be at risk of developmental
AGE RED FLAG
delays. At every well child visit, developmental surveillance has 5 components:
4 months Lack of steady head control while sitting
1. Eliciting and attending to the parent's concerns about their child's 9 months Inability to sit
development 18 months Inability to walk independently
2. Maintainingadevetopmentalhistory
3. Making accurate and informed observations of the child
4. Identifying the presence of risk and protective factors RECEPTIVE LANGUAGE 173.1~4~
5. Documenting the process and findings
AGE RED FLAG
Furthermore, the PSDBP recommends that developmental screening 2 months Does not alert or quiet to sound
be done at specified ages particularly at 9, 18 and 30 months and every year 6 months Does not turn to the source of sound
thereafter. Developmental screening is the process of administering a 10 months Does not respond to own name
standardized tool designed to identify children who are at risk of developmental 12 months Does not follow verbal routines/games
disorders. It is also done when surveillance activities detect risks and anytime 15 months Does not understand simple questions
when parents express concerns about their child's development. (170) Does not stop when told "NO"
Does not understand at least 3 different words
18 months Does not point to 3 body parts
Does not follow simple commands
30 months Does not follow 2 part commands
36 months Answers simple questions
 A P P E N D I X A P P E N D I X
%

EXPRESSIVE LANGUAGE (173,174)

AGE RED FLAG

6 months Does not coo
10 months Does not babble
12 months Absence of nonverbal purposeful messages (show objects)
14 months Absence of pointing
16 months Does not say 3 different spontaneous words
24 months Vocabulary of not more than 35-50 words
Does not produce 2-word phrases
36 months No simple sentences
42 months Intelligibility to unfamiliar adult at <50%
54 months Not able to tell or retell a familiar story
60 months Not fully intelligible to an unfamiliar adult
>72 months Not fully mature speech sounds

Appendix 5.
COMPONENTS OF EYE AND VISION SCREENING
AND SUMMARY OF RECOMMENDATIONS
A P P E N D I X A P P E N D I X

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
is as follows:

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 a 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.
Demonstrate to child that the "game" can be played with 1 eye
occluded.
Cover the top line with a white card and ask the child to identify only the
l"t symbol on the line below the 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.
If the child skips a symbol, ask the child to try again.
Visual Acuity is recorded as the last line on which at least 4 of the 5
symbols are read correctly. (Ex. If up to 10" line VA=20/40 or 0.5).
Always test until this threshold line. If only 3 out of 5 are read correctly,
record the result: visual acuity of the previous line (+3).
Repeat test with the other eye occluded.
If 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.
If results are inconclusive, repeat or refer.

Appendix 6.
Preventive Dental Care

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
 A P P E N D I X A P P E N D I X

Appendix 7.
brushing and should be taught to spit out the toothpaste and to avoid
Breasffeeding and Complementary Feeding
rinsing after brushing.
/ Philippine Society of Pediatric Gastroenterology and Nutrition
Recommended Use of Fluoride Toothpaste in Children
A. Breasffeeding

1. Benefits of Breastmilk
Safe, sterile and always available
With perfect nutrients to fully sustain the growth and development
6 months 1000 ppm Twice daily Smear 2 x 0.125 = of the baby from birth to six months of age; after 6 months, still a
to less than 2.5mm 0.25mg
good source of nutrients when given with adequate
2 years old 0.125g complementary foods
Easily digested and absorbed; efficiently used by the baby's
2to 6 1000 ppm Twice daily Pea size 2 x 0.25 =
immature system
years old 5mm 0.50mg
Contains antibodies and substances which protect the baby
0.259 against infection
6 months 1000 ppm Twice daily Smear 2 x 0.125 = Contains fats (DHA) which enhance brain development and
to less than 2.5mm 0.25mg intelligence of the baby
2 years old 0.125g
Full length 2. Advantages of Breasffeeding
6 years old 1500 ppm Twice daily of bristle 2 x 0.50 = Promotes emotional bonding between baby and mother
and above 10-20mm 1.0mg Protects the mother's health against cancer (breast, uterus,
0.5 1.0g ovaries), obesity and post-partum hemorrhage
Promotes early return to pre-pregnancy weight
Topical Fluoride Treatment. Professionally applied topical fluoride Gives the family big financial savings
has been proven to prevent or reverse enamel demineralization. The
American Academy of Pediatric Dentristy (AAPD) recommends that 3. Correct Breastfeeding Techniques
children at moderate caries risk should receive a professional fluoride Support the baby's head and the entire body throughout the
treatment at least every 6 months; those with high caries risk should feeding; the head, back and hips should be facing the breast and
receive topically-applied fluoride more frequently (145, 148). aligned in a straight manner.
Maintain the position of the baby in such a way he is "face to face",
OtherAnticipatory Measures. Anticipatory care includes guidance "chest to chest, and "tummy to tummy" with the mother.
on oral hygiene and proper diet. Cleansing the infant's teeth as soon Support the breast with the hand of the opposite arm in a C-hold
as they erupt with either washcloth or soft brush will help reduce position: thumb above, 4 fingers under the breast.
bacterial colonization. The use of dental floss is important to reduce Stimulate the infant to open the mouth wide by stroking the corner
interproximal caries. of the baby's lips; check that the chin touches the breast and the
lower lip is turned outward.
The education of parents includes the cariogenicity of some foods and Ensure that the baby grasps the entire nipple plus once inch of the
beverages, dental caries and its relationship with prolonged bottle feeding or surrounding areola.
bottle feeding while asleep, and the maintenance of good oral hygiene in the Allow the baby to suck 15 to 30 minutes per breast to extract both
mother that has a significant impact on the child's caries rate (144, 145, 150). foremilk and hindmilk.
Empty the breast around 8 to 10 times or more a day to ensure
adequate milk supply.
 A P P E N D I X A P P E N D I X

Appendix 7.
brushing and should be taught to spit out the toothpaste and to avoid Breastfeeding and Complementary Feeding
rinsing after brushing. Philippine Society of Pediatric Gastroenterology and Nutrition
i

Recommended Use of Fluoride Toothpaste in Children

A. Breastfeeding

Benefits of Breastmilk
Safe, sterile and always available
With perfect nutrients to fully sustain the growth and development
6 months 1000 ppm Twice daily Smear 2 x 0.125 = of the baby from birth to six months of age; after 6 months, still a
to less than 2.5mm 0.25mg good source of nutrients when given with adequate
2 years old 0.125g complementary foods
Easily digested and absorbed; efficiently used by the baby's
2to 6 1000 ppm Twice daily Pea size 2 x 0.25 = immature system
years old 5mm 0.50mg Contains antibodies and substances which protect the baby
0.259 against infection
6 months 1000 ppm Twice daily Smear 2 x 0.125 = Contains fats (DHA) which enhance brain development and
to less than 2.5mm 0.25mg intelligence of the baby
2 years old 0.125g
Full length Advantages of Breastfeeding
6 years old 1500 ppm Twice daily of bristle 2 x 0.50 = Promotes emotional bonding between baby and mother
and above 10-20mm 1.0mg Protects the mother's health against cancer (breast, uterus,
0.5 1.0g ovaries), obesity and post-partum hemorrhage
Promotes early return to pre-pregnancy weight
Topical Fluoride Treatment. Professionally applied topical fluoride Gives the family big financial savings
has been proven to prevent or reverse enamel demineralization. The
American Academy of Pediatric Dentristy (AAPD) recommends that Correct Breastfeeding Techniques
children at moderate caries risk should receive a professional fluoride Support the baby's head and the entire body throughout the
treatment at least every 6 months; those with high caries risk should feeding; the head, back and hips should be facing the breast and
receive topically-applied fluoride more frequently (145, 148). aligned in a straight manner.
Maintain the position of the baby in such a way he is "face to face",
Other Anticipatory Measures. Anticipatory care includes guidance "chest to chest, and "tummytotummy" with the mother.
on oral hygiene and proper diet. Cleansing the infant's teeth as soon Support the breast with the hand of the opposite arm in a C-hold
as they erupt with either washcloth or soft brush will help reduce position: thumb above, 4 fingers under the breast.
bacterial colonization. The use of dental floss is important to reduce Stimulate the infant to open the mouth wide by stroking the corner
interproximal caries. of the baby's lips; check that the chin touches the breast and the
lower lip is turned outward.
The education of parents includes the cariogenicity of some foods and Ensure that the baby grasps the entire nipple plus once inch of the
beverages, dental caries and its relationship with prolonged bottle feeding or surrounding areola.
bottle feeding while asleep, and the maintenance of good oral hygiene in the Allow the baby to suck 15 to 30 minutes per breast to extract both
mother that has a significant impact on the child's caries rate (144, 145, 150). foremilk and hindmilk.
Empty the breast around 8 to 10 times or more a day to ensure
adequate milk supply.
 A P P E N D I X A P P E N D I X

Breastmilk Expression and Storage How to introduce:

Express breastmilk by hand or by using a breast pump when Begin with one new food at a time to be given for 3 days.
breastmilk supply is abundant and when the mother is planning to go Start with lugaw or cereals, fruits or vegetables in any order,
back to work. giving one to two teaspoons a day.
Store in sterile polypropylene (cloudy hard plastic) containers, properly Start with pureed foods at 6 months of age. Introduce"finger
labeled with the date and time of breastmilk collection. foods" around 8 months of age; lumpy or chopped foods at 10
months of age; table food at 12 months of age.
Feed 6-8 month old infant 2-3 times a day; 9-24 month old infants
5. Recommended Breastmilk Storage Period 3-4 times a day. Give additional nutritious snacks once or twice a
Room temperature (<25°C): 4 hours day.
Room temperature (>25°C): 1 hour Offera variety of foods to improve the quality of food intake;
Refrigerator (4°C): 8 days avoid drinks with low nutrient Value (sweet beverages).
Freezer compartment of a 1-door refrigerator: 2 weeks Do not add salt to the infant's diet before one year of age.
Freezer compartment of a 2-door refrigerator: 3 months Give supplements of iron, zinc, calcium, and vitamin B12, if diet is
Deep freezer with constant temperature (-20°C): 6 months primarily plant-based
Diet of a Lactating Mother Practice responsive feeding. Feed infants directly and assist older
Rice 6 cups children. Feed slowly and patiently. DO NOT force-feed; make
Fruits (vitamin C rich; different varieties) 4 pieces feeding a pleasurable experience.
Vegetables (green leafy and yellow) 1 ½ cups
Meat, fish, poultry, seafoods 5 pieces Appendix 8.
(matchbox Child Maltreatment
size for meat), or
2 cups cut into The World Health Organization presents an ecological model
small pieces describing the risk factors for child maltreatment. The complex interaction
Egg 4 pieces a week of factors in the individual, social relationships, community and society must
Mongo, beans, taho 1 ½ cups 3x a be understood to effectively deal with problems of child maltreatment (130).
week The risk factors are not themselves diagnostic but in situations where
Milk 2 glasses resources are limited, children and families identified as having several of
Fats (olive oil, corn oil, butter) 7 teaspoons these factors should have priority for receiving services.
Fluids 7 glasses water;
1 glass fresh fruit It is important for pediatricians to recognize and report on going child
juice maltreatment (republic Act No. 7610). Suspected child abuse cases may be
reported to the following:
Complementary Food Local Barangay Council for the protection of Children (BCPC)
Must be: = Local Government Unit (City/Municipal District) Social Welfare Office
Timely-introduced at 6 months of age Cdsis Intervention Unit (CIU)- DSWD-NCR (24 hours):
Adequate - provides sufficient energy, protein and micronutrients to Contact No. 734-8635 (NCR cases only)
sustain growth: use PSPGN Dietary Prescription Food Guide Pyramid Philippine National Police Women and Child Protection Desks
as a tool (WCPDs)
Safe - hygienically prepared and stored; feed using clean utensils,
NOT bottles and nipples All hospitals should have a protocol in the handling of women and child
Properly fed - meal frequency and feeding methods suitable for age abuse cases. The Department of Health Administrative Order No. 2013-0011
(guide or self-feeding using clean hands, spoon and fork, cups and on the establishment of women and child protection in all government hospitals
bowls; using locally fresh and natural foods) can be downloaded from:
http://www.doh.gov.ph/content/women-and-childrer~-protection-program html
26
 A P P E N D I X A P P E N D I X

Recommended Anticipatory Guidance Topics for Prevention of Suggested strategies in this agenda underlie the need to tackle child
Violence Against Children (MAC) maltreatment simultaneously at different stages of human development and in
different social contexts.
Promising Child Maltreatment Prevention Programs (133):
Early childhood home visiting by health workers
Parent education programs
Child sexual abuse prevention programs in schools
Hospital-based parent education program to prevent abusive health
trauma (Shaken Baby)
Positive discipline
Appendix 9.
"7 Steps to Protect Children"
other people
Child Protection Unit Network, Inc.
Normal sexual
behavior Pediatricians and health care professionals may disseminate this
Good touch/ guide and use it during well child counseling.
bad touch
Bullying Learn the facts. Majority of sexual offenders of children are family
members, friends and neighbors people that the child and the child's family
Mobile phone trust. Boys, in almost the same frequency as girls, are also being sexually
and intemet abused. Few gids report the abuse but boys tend not toreportat all.
safety
Alcohol and Minimize the opportunity for sexual abuse by eliminating or reducing
substance abuse one-ac/u/t/one-child situations. More than 80% of sexual abuse cases occur in
Dating violence situations where a child is left alone with an adult or an older youth.
School organizations, clubs, sports teams, faith groups must eliminate
Protective Factors situations of one-adult/one-child.
Factors that appear to facilitate resilience include: Talk to your child when he/she returns from an outing. Notice the child's
secure attachment of the infant to the adult family member behavior and whether the child can tell you with confidence how the time was
high levels of parental care during childhood spent.
non-association with delinquent or substance-abusing peers Tell the adults who care for your child that you and your child are
a warm and supportive relationship with a non-offending parent educated aboutchild abuse. Be thatdirect.
a lack of abuse-related stress
Based on the current understanding of early child development, it is clear that St~_p_3. Talk about it. Teach your children what parts of their bodies others
stable family units can be a powerful source of protection for children. should not touch. Do not be afraid that you are teaching them about "sex." You
Good parenting, strong attachment between parents and children, and are protecting them. Mention that the abuser can be a family member, a friend or
positive non-physical disciplinary techniques are likely to be protective an olderyouth.
factors." 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
The WHO further recommends a national child maltreatment prevention
or wrong, or threatens the child or a family member. Break the barrier by talking
agenda that would bring together contributions of diverse sectors for the
openly about it.
simultaneous protection of cases and more importantly for the primary
prevention of maltreatment. If a child seems uncomfortable or resistant to being with a particular
adult (an uncle or a ninong) ask why.
 APPENDIX

Step_~. Stay Alert. Learn the signs of sexual abuse. Physical signs are not FIGURES
common. Emotional and behavioral signs are more common such as "too
perfect" behavior, withdrawal, depression, unexplained anger or rebellion, 1. Windows of Achievement
running away, failing in school, unusual interest in or knowledge of sexual 2. Developmental Milestones of Early Literacy
matters, fear of a person, intense dislike at being left somewhere or with 3. Z Score Interpretation
someone. Know the textmates of your child.
4. Head Circumference for Age for Girls
SteLS. Act on any Suspicion of Abuse. The future well-being of a child is at 5. Weight forAge for Girls: Birth to 2 years
stake. Have the courage to report suspected abuse. Do not close your eyes 6. Length for Age for Girls: Birth to 2 years
and pretend that it will go away. It will not go away. If the child is not helped, the 7. Weight for Length for Girls: Birth to 2 years
abuse will continue.
8. BMI for Age for Girls: Birth to 2 years
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, 9. Weight forAge for Girls: 2 to 5 years
nurses, government teachers and employees of government agencies to report 10. Height for Age for Girls: 2 to 5 years
abuse. 11. Weight for Height for Girls: 2 to 5 years
12. BMI for Age for Girls: 2 to 5 years
Learn How to React to the Knowledge of Abuse. Offer support:
Believe thechild and make sure the child knowsyou believe in 13. Weight for Age for Girls: 5 to 10 years
him/her. Very few reports of child abuse are not true. 14. Height for Age for Girls: 5to 19years
Thank the child for telling you and for having the courage to do 15. BMI for Age for Girls: 5 to 19 years
SO.
Encourage the child to talk but don't ask leading questions. 16. Head Circumference for Age for Boys
Seek professional help. 17. Weight for Age for Boys: Birth to 2 years
18. Length forAge for Boys: Birth to 2 years
Get Involved. Use your voice and your vote to make your 19. Weight for Length for Boys: Birth to 2 years
community a saferplace forchildren. Ask what schools or organizations in
your community have child abuse prevention policies and help with their 20. BMI for Age for Boys: Birth to 2 years
creation. Demand that the government put their resources into protecting 21. Weight forAge for Boys: 2 to 5 years
children from sexual abuse and into responding to reports of sexual 22. Height for Age for Boys: 2 to 5 years
abuse. 23. Weight for Height for Boys: 2 to 5 years
You can download educational materials on child sexual abuse
prevention for parents on W ww.darkr~ess_2_light.org 24. BMI for Age for Boys: 2 to 5 years
25. Weight for Age for Boys: 5 to 10 years
26. Height forAge for Boys: 5 to 19 years
27. BMI for Age 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 byAge and Height Percentile
32. Food Pyramid
33. Immunization Table 2016
34. Immunization of Teens and Pre-Teens
 FIGURES FIGURES

Figure 1. Windows of Achievement Figure 2. Developmental Milestones of Early Literacy

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32
 F I G U R E S F I G U R E S

Figure 3. Z- SCORE INTERPRETATION+2 Figure 4. Head Circumference for Age 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.

GROWTH INDICATORS
Z-SCORE
Length/Height Weight - for - Age Weight - for - BMI - for - Age
- for - Age Length/Height

Above 3 See note 1 Obese Obese

Above 2 Overweight Overweight

See note 2
Possible risk of Possible risk of
Above 1 overweight overweight
(See note 3)
, , I
( S=e e n o t e 3 ) I
=
0 (Median) i
| i =
Below- 1
.+--

Below - 2 Stunted Underweight Wasted Wasted

(See note 4)

Below - 3 Severely stunted Severely Severely wasted Severely wasted

(See note 4) Underweight -T
(See note 5)
.+.-

Notes: J_
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.g. if parents of normal I-

height have a child who is excessively tall for his or her age.
Illl
A child whose weight-for-age falls in this range may have a growth problem, but this is better II
assessed from weight-for-length/height or BMI-for-age. I
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 overweight.

5. This is referred to as very low weight in IMCI training modules. (Integrated Management of
Childhood Illness, In-service training. WHO, Geneva,1977.)
 F I G U R E S
F I G U R E S

Figure 6. Length forAge for Girls: Birth to 2 years

Figure 5. Weight for Age for Girls: Birth to 2 years
 +
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EARLY ,~ MIDDLE , A~OLESCENCE'
I I N F A N C y4 .~J~.~HQQD_~,~CHILDHOOD ~ EARLY MIDDLE . _ |
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I i 14Y 15Y 16Y F~7Y 18Y 19Y/
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D.MANTOUXTEST~ 5Y 8Y IOY 11Y 12Y 13Y 14Y 15Y 16Y 17Y 18Y 19Y
Pre at 2-4 1 2 4 6 9 ~|[11 15 18 24 3Y 4Y 6Y
NatalI birth~ days~ mo mos mos mos mos nfCs mos mos mos

DONE AT EVERY VISIT ORAT RECOMMENDED INTERVALS

FOLLOW-UPS DURING THE 1~T YEAR OF LIFE DONE ON A MONTHLY BASIS
DONE FOR THOSE AT HIGH RISK ONLY
-~ ~ AGE RANGE A PROCEDURE IS DONE AT LEAST ONCE OR AT RECOMMENDED INTERVALS
AGE RANGE A PROCEDURE IS DONE AT LEAST ONCE FOR THOSE AT HIGH RISK
AGE RANGE A PROCEDURE IS DONE AT LEAST ONCE FOR ALL CHILDREN
THE DOT INDICATES THE PREFERRED AGE

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 F I G U R E S
F I G U R E S

Figure 10. Height forAge for Girls: 2 to 5 years

Figure 9. Weight forAge for Girls: 2 to 5 years

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 F I G U R E S F I G U R E S

Figure 11. Weight for Height for Girls: 2 to 5 years Figure 12. BMI forAge for Girls: 2 to 5 years
 F I G U R E S
F I G U R E S

Figure 13. Weight for Age for Girls: 5 to 10 years Figure 14. Height forAge for Girls: 5 to 19 years

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Figure 15. BMI forAge for Girls: 5 to 19 years Figure 16. Head Circumference for Age for Boys
 F I G U R E S F I G U R E S

Figure 17. Weight forAge for Boys: Birth to 2 years

Figure 18. Length forAge for Boys: Birth to 2 years

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Figure 21. Weight forAge for Boys: 2 to 5 years Figure 22. Height forAge for Boys: 2 to 5 years
 F I G U R E S F I G U R E S

Figure 23. Weight for Height for Boys: 2 to 5 years Figure 24. BMI forAge for Boys: 2 to 5 years

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Figure 25. Weight forAge for Boys: 5 to 10 years Figure 26. Height forAge for Boys: 5 to 19 years

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Figure 27. BMI forAge for Boys: 5 to 19 years Figure 28. US CDC-NCHS Gro~h Cha~ for Boys (Stature of Age: to be used in
locating Blood Pressure Percentile of children and adolescents)

2 tO 20 years: Boys NAME

Stature-for-age and Weight-for-age percentiles RECORD #

12 13 14 15 t6 17 t8 19 20
M o t h e r ' s S ~ b . ~ e . . . . . . . . . . . Father's Stature .......... ----
76-
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 F I G U R E S F I G U R E S

Figure 29. US CDC-NCHS Growth Chart for Girls (Stature of Age: to be used in Figure 30. BP Levels for Boys by Age and Height Percentile
locating Blood Pressure Percentile of children and adolescents)

2 to 20 years: Girls NAME ....................................................................... Blood Pressure Levels for Boys by Age and Height Percentile
Stature-for-age and Weight-for-age percentiles RECORD # ...........................
sy~o,cBp(mH~l oi=~o,csp(m.~g)
12 13 14 15 16 17 1 8 1 9 2 0 BP
Mother s St~re ....................... Father E, Stature (" P~tentil~, of Height ") (" Percentile of He~ht
Age percentile
0t.r) S t ~ t ~ h 2 5 / h S S t h 7 5 t h 9 0 fi t ~ ~ t h 1 0 t h 2 , ~ h ~ 7 5 t h 9 ~ n 9 5 t h
-74q 1 50th 80 81 83 85 87 88 89 34 35 36 37 38 39 39

90th 94 95 97 99 100 102 103 49 50 51 52 53 53 54

S
~72-{ 57 58 58
T 951h 98 99 10t 103 104 1=06 106 54 54 55 56
-704 A 105 106 t08 110 112 113 114 61 62 63 64 65 66 66
99th
T
-68-I 2 50th 84 85 87 88 90 92 92 39 40 41 42 43 44 44
U
R 90th 97 99 100 102 104 105 106 54 55 56 57 58 58 59
-66-I E 62 63 63
95th 101 102 104 108 108 169 110 59 59 60 6t
-644
99~ 109 110 111 113 115 117 117 66 67 68 69 70 71 71

50th 88 87 89 91 93 94 95 44 44 45 n6 47 48 48

90th 100 101 103 105 107 1~ 109 59 59 60 61 62 63 63

95~ 104 105 107 109 110 112 113 63 63 64 65 66 67 67

111 112 114 116 118 119 120 71 71 72 73 74 75 75

501~ 88 89 91 93 95 96 97 47 48 49 50 51 5t 52
90~ 102 103 1C5 107 109 110 111 62 63 64 65 66 66 67
95th 106 107 109 11t 112 t14 115 68 67 68 69 70 71 71
991h 113 114 116 t18 120 121 122 74 75 76 77 78 78 79

50th 90 91 93 95 96 98 98 50 51 52 53 54 55 55
90th 104. 105 106 108 110 11t 112 65 66 67 68 69 69 70
-1804 95th ~08 109 110 112 114 t15 116 69 70 7t 72 73 74 74
,1704 9gth 115 116 118 120 121 123 123 77 78 79 80 81 81 82
-1604 91 92 94 96 98 99 100 53 53 54 55 56 57 5Z

-1504 W 90th 105 t66 108 110 tll 113 113 68 68 69 70 71 72 72

E 95th 109 110 112 114 t15 117 117 ?2 72 73 74 75 76 76

I 99th 116 117 119 t21 123 124 125 80 80 81 82 83 84 84
G
50th 92 94 95 97 99 100 101 55 55 56 57 58 59 59
4204 H
T 90th 106 107 109 111 113 114 115 70 70 71 72 73 74 74
1104 77 78 78
95th 110 111 113 115 117 118 119 74 74 75 76
-1004 99th 117 118 120 122 124 125 126 82 82 83 84 85 86 86

8 50th 94 95 97 ~9 100 102 102 56 57 58 59 60 60 61

9061 107 169 110 112 114 115 116 71 72 72 73 74 75 76
99h tll 112 114 116 118 119 120 75 76 77 78 79 79 80

991h 1t9 120 122 123 125 127 127 83 84 85 86 87 87 88

9 50th ~ ~ 100 102 103 104 57 58 59 60 61 61 62

90th 109 1t0 112 114 115 t17 118 72 73 74 75 76 76 77
95th 113 114 116 1t8 t19 121 121 76 77 78 79 80 81 81
99th 120 121 123 125 127 128 129 64 85 86 87 88 88 89
AGE 10 50th 97 98 100 102 103 t05 106 58 59 60 6t 61 62 63
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 90~ 111 112 114 115 117 119 119 73 73 74 75 76 77 78
Pi~hed May 30, 2000 imc~f~ed ~ 1,2~ O0) 77 80 81 82
116 117 119 121 122 123 78 79 81
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t{~e Nat pop,at C~'~ter fO~ Ch~'~r~iC O~4zse pt¢-ver~tiot~ and Hea~ P~ot{~ {2000} -=za 99h
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 F I G U R E S F I G U R E S

Figure 31. BP Levels for Girls byAge and Height Percentile

Blood Pressure Levels for Boys by Age and Height Percentile (Continued)

Systolic BP {nmlHg) Dia~,~lic BP (mmHg)

Blood Pressure Levels for Girls by Age and Height Percentile
BP
4[- Percentile of Height ") (" Percentile of Height ") Diastolic BP (mmHg)
Age Percentile Systolic BP (mmHg)
BP
(Yem @ 5~h 10th 25t~ 501h 75th 90th 95th 5th t0th 25th 50th 75th 90th 95th
(" Percentile of Height ")' ~" Percentile of Height ~1.
Age Percsmiie
50th 99 100 102 t04 105 107 107 59 59 60 61 62 63 63
(Year) 5th 10th 25th 50th 751h 90th 951h 51h t0th 251h 50th 75th 90ttl 951h
90~ 113 114 t15 117 119 120 121 74 74 75 76 77 78 ?8 41 42
50th 83 84 85 8{~ 88 89 90 38 39 39 40 41
95~ 117 118 119 121 123 124 125 78 78 79 80 81 82 82
90th 97 97 98 100 10'} 102 ,}03 52 53 53 54 55 55 56
99~ 124 125 t27 129 130 132 132 86 86 87 88 89 gO 90 t00 101 ,}62 104 105 106 107 56 57 57 58 59 5g 80
951h
12 50~ 101 102 t04 166 108 109 110 59 60 61 62 63 63 64 99~h 1138 108 109 111 112 113 114 84 64 85 65 66 67 67
£Oth 115 116 118 120 121 123 123 74 75 75 76 77 78 79 5£~h 85 85 87 88 89 91 91 43 44 44 45 46 46 47
951h 119 120 122 123 125 127 127 78 79 80 8t 82 82 83 90th 98 ~ ,}0O 101 108 104 105 57 58 58 59 60 81 61
99~ 126 127 129 131 133 134 135 86 87 88 89 90 90 9t 951h 102 103 ,}04 105 107 108 t09 6,} 82 82 63 64 65 65
104 105 t08 110 111 112 66 60 81 62 64 64 99~h 109 t10 1tl 112 I14 115 ,}18 89 69 70 70 71 72 72
13 50~ 106 ~
117 118 120 122 124 125 126 75 75 78 77 78 79 79 50th 86 87 88 89 91 92 93 47 48 48 49 50 50 51

122 124 126 128 12g 130 79 79 80 81 82 83 83 9Oth 190 ,}00 102 1Q3 104 106 106 61 62 82 63 64 64 85
95~ 121
90 91 9t 951h ,}04 104 ,}05 ,}07 I08 109 110 65 86 86 67 68 88 69
991h 128 130 131 133 135 136 137 87 87 88 89
991h 111 111 113 114 115 116 t17 73 73 N 74 75 76 76
14 5(~ 106 107 t09 111 113 114 119 60 61 82 63 64 65 85
4 58th 88 88 98 91 92 94 94 50 50 5,} 52 52 53 54
9Oth 120 121 t23 125 126 128 128 75 76 77 78 79 79 80
90th 101 102 103 104 106 107 108 ~4 64 85 66 67 67 68
95~ 124 125 127 128 130 132 132 80 80 81 82 83 84 84
95th 105 1~ 107 108 110 111 112 88 68 69 70 71 7,} 12
99~ 131 132 t34 138 138 139 140 87 88 89 90 91 92 92
~h 112 113 114 115 117 118 119 76 78 76 77 78 7~ 79
18 5Cth 109 110 112 113 115 117 117 61 62 63 64 65 66 66
5 50th 89 90 91 93 94 95 96 52 53 53 54 55 55 56
~th 12"2 124 125 127 129 130 131 76 77 78 79 80 80 81
96~h 103 103 ,}05 I06 !07 i09 t09 66 67 67 68 69 69 70
95~ 126 127 129 I31 133 134 135 81~ 81 82 83 84 85 85
95th 107 107 108 1,}0 111 112 H3 70 71 7! 72 73 ?3 74
991h 134 135 136 138 140 142 142 88 89 90 91 92 93 93
99th t14 114 118 117 118 120 120 78 78 79 79 80 81 81
16 5Oth 111 112 114 116 118 119 120 63 63 84 65 66 67 67
6 50th 91 92 93 94 86 87 98 54 54 55 56 56 57 58
125 126 128 130 131 133 134 78 78 79 80 8t 82 82
90th 104 ,}C~ !06 i08 109 ,},}0 111 68 68 89 70 70 7,} 72
951h 129 i30 132 134 135 137 137 82 83 83 84 85 86 87 74 74 75 78
95th t0~ 1~ ,}10 111 113 !,}4 115 72 72 13
13~ 137 t39 141 143 144 145 90 90 91 92 ~3 94 94 80 83 83
99th 1% !16 ,}17 ,}19 120 t2,} 1~ 80 80 81 82
17 50th 114 ii5 118 118 120 121 122 65 66 66 67 68 6g 70
7 50th 93 £3 95 96 97 99 99 55 58 56 57 58 58 59
90th 127 128 130 132 134 135 136 80 80 81 82 83 84 84 90th 107 108 1£9 111 ,}12 113 ~9 7g 70 71 72 72 73
106
95~ 131 132 134 138 138 t39 140 84 85 88 87 87 88 89 981h 110 111 !t2 113 115 116 116 73 74 74 75 76 76 77
99~ 139 140 i41 t43 145 146 147 92 93 93 94 95 96 97 ~h 117 !18 119 129 122 123 124 81 8! 82 82 83 84 84
8 5('Jrh 95 95 96 98 99 100 101 57 57 57 58 59 60 60
90th 108 109 110 111; 11 3 I 1 4 11 4 71 7t 71 72 73 74 74
~th 112 1,}2 114 115 11 6 11 8 11 8 75 75 75 76 77 78 78

991h 119 ~20 121 122 !23 125 125 82 82 83 83 84 85 88

Downloaded f~rn the:
50th 96 97 98 100 t81 1~ 103 58 58 58 59 60 61 61
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PEDIATRICS VoL t14 No, 2 August 2004. 554=573 with the permission from £0th 110 110 112 113 1,}4 116 118 72 72 72 73 74 78 75
National Heart, Lu~ and Blood Institute (NHLBI) 95,}h 114 114 115 117 118 1!9 120 76 76 76 77 78 79 ?9
NATIONAL INSTLTUTES OF HEALTH 127 83 84 84 85 86 87
99th 121 121 123 124 125 127 83
U. S Department of Health and Human Ser,.4ces
10 50th 98 99 i09 102 103 ,}04 105 59 89 59 60 61 62 62
£Oth 112 112 114 115 ~16 118 118 73 73 73 74 75 78 76
95th t16 118 117 118 120 121 122 77 77 77 78 79 80 89
99th 123 123 125 126 127 i29 129 84 84 85 86 8~ 87 88
 Figure 32. Food Pyramid
F I G U R E S

Blood Pressure Levels for Girls ;by Age and Height Percentile (Continued)

Systolic BP ImmHg) Diastolic 8P (mmHg)

BP
(" Percentile of Height ")' (" Percentile of Height ")
Age Percentile

501h
5th
100
10th 25th 5Oth 75th 90th gSth
101 102 103 105 106 107
5th t0th 25th 50th 75~ g0th gSth

60 60 60 61 62 63 63
m iii ~iIti ilIi~ii
m I ~ e m e u l Food Guld,
gOlb 114 114 116 117 1t8 119 120 74 74 74 75 76 77 77 t,,,~, wA,~, 0-t|~JP I S7
95t1~ t18 118 119 121 122 !23 124 78 78 78 79 80 81 81
99tt~ t25 t25 126 128 I28 !30 131 85 85 86 87 87 88 89
50th t02 103 104 105 107 108 109 61 61 61 62 63 64 64
90th 116 t16 117 119 120 121 122 75 75 75 76 77 78 78
119 120 121 123 124 125 126 79 79 79 ~3 81 82 82
99U~ t27 127 128 130 I31 !32 133 88 86 87 88 88 89 £8

13 50th t04 t05 1~ 107 109 t!0 110 62 62 62 63 64 65 65

£0th t17 t18 119 121 122 123 124 76 76 76 77 78 79 79
9511~ I2t 122 123 124 126 127 128 88 80 80 81 82 83 83
9£th t28 129 130 132 133 134 135 87 87 88 89 89 90 91

14 ~ t06 106 107 109 110 tll 112 63 63 63 £4 65 65 65

90th t1£ 120 121 122 124 t25 125 77 77 77 78 79 80 80
95th t23 123 125 126 127 129 129 81 81 81 82 83 84 84
9£th t30 13t 132 133 135 136 136 88 88 89 93 90 91 82
1(~3 110 111 t13 64 64 65 66 87 67 ~t(Peedlng l~eastfeedng IBr~zstlr~e~ng
15 56~ t07 108 113 64
exclusli (8-t:2K = day) (8-12x zt day)
9C~h t2~ 121 122 123 125 126 127 78 78 78 79 80 81 81 t,,~',=,,,,,,,~ ¢vt
95th t24 t25 126 127 129 130 131 82 82 82 83 84 85 85 =,,-=,,,,-1 =Z~,=I
991h t31 t32 133 134 136 137 138 89 89 90 91 91 92 83
16 5O& t08 108 110 111 112 114 114 64 64 65 66 66 67 68
121 122 123 124 125 127 128 78 78 79 80 81 81 82
t25 126 127 128 130 131 132 82 82 83 84 85 85 86
99~ 132 133 134 135 137 138 139 90 80 00 91 92 93 93
17 5Cih 188 109 110 111 I13 114 115 84 65 65 66 87 67 68
90th 122 122 123 125 125 127 128 78 78 79 80 81 81 82
951h 125 126 127 129 130 131 132 82 83 83 84 85 85 86
991h 133 133 134 136 137 I38 t39 90 ££ 91 9t 92 93 83

Ce~y~'ight @ 20(}8 Philippiee ~ of Pediat~

[~ovTnloaded from the:
"The Fourth Report on the Diagnosis. Evaluation and Treatment o1 High Blood Pressure in Child ren and Adolescents"
PEDIATRICS VoI, 114 No 2 August 2004, 554-573 with the pennission ftorn
National Heart, Lung and Blood institute (NHLB)
NA'110NAL INSTITUTES OF HEALTH
U, S. Depar'~nerlt 01 Health and Human Services

Reproduced with the permission from the Philippine :S

Figure 32. Food Pyramid

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m e t ~ ~ ~ A d u d t

Reproduced with the permission from the Philippine :Society of Pediatric Gastroenterology and Nutrition.
Figure 33. Immunization Table 2016

~
r cina~ion

..... Childhood Immunization Schedule2016

AGE IN BIRTH WEEKS MONTHS YEARS

6 8 10 12 14 16 18 2O 22 0 12 14 16 4 6 8 10 12 14

I
(DTwP - HiB -
Hep B*)
and other
(Sep B*) :
(Hep B*)
I
I Tdapi(Td)
DTaP (DTwP*)/DTIIP*
combinations
I I
(HIB*) DTaP, IPV- HiB

I PV/O PV*

(OPV~)/IPV

PCV* I I I I
I
RV* (RV $erle|*)

I n fl u e n z a

Measles

JE Vaccine

MMR*

Varicella .......... : :~:~ ) ": ) ))L~Jr~ )) ) )))):

m
m

HepA
:: :: ::: : :::

HPV
~/i/ ti'i! J
m m i i
m m m m m m m m m m m m m m ~ m m
Range of Recommended Age Catch Up Immunization i * Primary doses are given at least 4 weeks apart

DISCLAIMER:
The Childhood Immunization Schedule presents recommendations for immunization for children and adolescent~ based on the knowledge, experience and premises current at the time of publication. The schedule represents a
consensus with which physicians may at times disagree. No claim is made for infallibifity, and the PPS, PIDSP an PFV acknowledge that individual circumstances may warrant a decision differing from the recommendations given here.
The recommendations are not absolute. Physicians must regularly update their knowledge about specific vaccines and their use because information about safety and efficacy of vaccines and recommendations relative to their
administration continue to develop after a vaccine is licensed. 1

i'
 IMMUNIZATION ANNOTATIONS
The National Immunization Program (NIP)
consists of the following antigens: BCG,
Monovalent Hepatitis B, DPT-Hib-Hep B
vaccine, Oral Polio vaccine (OPV).
tion Schedule 2016
MONTHS
0 YEARS
KALUlU~AN A school based immunization program to
provide catch-up doses for school children and
adolescents has been established. Measles-
Rubella (MR) vaccine and Tetanus-Diptheria
8 10 12 14 16 18 20 10 12 14 (Td) vaccines are administered to Grade 1 and
Grade 7 students enrolled in public schools.
Human Papillomavirus Vaccine (HPV) shall be
given to female children 9-10 years old at
health facilities in pdority provinces.
I
Quadrivalent HPV 2 doses are given at 0, 0
months.
BACILLUS-CALMETTE GUARIN (BCG)
Given intradermaliy (ID): live attenuated
The dose of BCG is 0.05 ml for children < 12
months of age and 0.1 ml for children >t2
months of age.
Given at the earliest possible age after birth,
preferably within the first 2 months of age
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 following are present:
Suspected congenital TB
History of close contact of TB to known or
suspected infectious cases
. Clinical findings suggestive of TB and/or
chest x-ray suggestive of TB
In the presence of any of these conditions, an
~.................~,.. induration of > 5 mm is considered positive.
HEPATITIS B VACCINE (HPV)
Given intramuscularly (IM)
The first dose should be given at birth or within
1~:~ .... ..... the first 12 hours of life. The minimum interval
between doses is 4 weeks. The final dose is
administered not earlier than age 24 weeks,
Another dose is needed if the last dose was
given at age < 24 weeks.
For preterm infants:
I i i I If born to HBsAg(-) mothers and medically
* Primary doses are given at least 4 weeks apart stable, the 1~t dose of HBV may be given at
30 days of chronological age regardless of
weight and this can be counted as part of the
based on the knowledge, experience and premises current at the time of publication. The schedule represents a 3-dose primary series.
:V acknowledge that individual circumstances may warrant a decision differing from the recommendations given here.
;s and their use because information about safety and efficacy of vaccines and recommendations relative to their
Another dose of HBV is needed for those < 2
kgs whose 1st dose was received at birth
For infants born to HBsAg(+) mothers,
administer HBV and HBIG (0.5 ml) within 12
hours of life. HBIG should be administered not
later than 7 days of age, if not immediately
available.
For infants born to mothers with unknown HBsAg
status:
. With birth weight _> 2 kgs, administer HBV within
12 hours of birth and determine mother's
HBsAg as soon as possible. If HBsAg(+),
administer HBIG not later than 7 days of age.
With birth weight < 2 kgs, administer HBIG in
addition to HBV within 12 hours of life.
DIPTHERIA AND TETANUS TOXOID AND
PERTUSSlS VACCINE (DTP)
Given intramuscularly (IM)
Given at a minimum age of 6 weeks with a
minimum interval of 4 weeks
The recommended interval between 3~ and 4
dose is 6 months, but a minimum of 4 months is
valid. The 5m dose may not be given if the 4t"
dose was administered at age 4 years or older,
HAEMOPNILUS iNFLUE~ WPE B
CONJUGATE VACCINE (HiB)
Given intramuscularly (IM)
Given as a 3-dose primary series with a minimum
age of 6 weeks and a minimum interval of 4
weeks; a booster dose is given between 12-15
months of age with an interval of 6 months from
the 3rd dose.
Refer to Vaccines for Special Groups for Hib
recommendation in high risk children
POLIOVIRUS VACCINE (OPVflPV)
OPV given per greta (PC): live attenuated
IPV given intramuscularly
Given at a minimum age of 6 weeks with a
minimum interval of 4 weeks; The primary sedes
consists of 3 doses. A booster dose should be
given on or after the 4t" birthday and at least 6
months from the previous dose~
PNEUMOCOCCAL CONJUGATE- VACCINES
(PCV)
Given intramuscularly (IM)
Given at a minimum age of 6 weeks
The primary vaccination of PCV consists of
3 doses with an interval of at least 4 weeks
IMMUNIZATIONANNOTATIONS con't
between doses, plus a booster dose given 6
months after the 3rd dose,
Healthy children 2 to 5 years old who have no
previous PCV vaccination may be given 1 dose
of PCV13 or 2 doses of PCV10 at least 8 weeks
apart. Routine use of PCV is not recommended
for healthy children 5 years and above.
Refer to Vaccines for Special Groups for
Pneumococcal vaccine recommendation in high
risk children.
ROTAVIRUS VACCINE (RV)
Given per orem (PO)
Given at a minimum age of 6 weeks with a
minimum interval of 4 weeks between doses; the
last dose should be administered not later than
32 weeks of age.
The monovalent human rotavirus vaccine (RVl)
is given as a 2-dose series and the pentavalent
human bovine rotavirus vaccine (RV5) is given
as a 3-dose series.
INFLUENZAVACCINE
(TRIVALENTIQUADRIVALENT)
Tnvalent influenza vaccine given intramuscularly
(IM) or subcutaneously (SC)
Quadrivalent influenza vaccine given
intramuscularly (IN)
Given at a minimum age of 6 months
The dose of influenza vaccine is 0.25 ml for
children 6 months to 35 months and 0.5 ml for
children 36 months to 18years.
Children 6 months to 8 years receiving influenza
vaccine for the first time should receive 2 doses
separated by at least 4 weeks. If only 1 dose was
given during the previous influenza season, give
2 doses of the vaccine then 1 dose of vaccine
yearly thereafter.
Children aged 9 to 18 years should receive 1
dose of the vaccine yearly, Annual vaccination
should begin in February but may be given
throughout the year.
MEASLESVACCINE
Live attenuated
Given subcutaneously (SC)
Given at the age of 9 months, but may be given
as early as 6 months of age in cases of
outbreaks as declared by public health
authorities.
69
In lieu of monovabnt measles vaccine, MMR
may be given if recommended by public health
authorities.
JAPANESE ENCEPHALITIS VACCINE (JE)
Given subcutaneously (SC)
Given at a minimum age of 9 months
Children 9 months to 17 years of age should
receive one primary, dose followed by a
booster dose 12-24 months after the primary
dose. Individuals 18 years and older should
receive a single dose only.
MEASLES-MUMPS-RUBELLA(MMR)
Given subcutaneously (SC); live attenuated
Given at a minimum age of 12 months, but
may be given at an earlier age if
recommended by pubIic health authorities.
The minimum interval between doses is at
least 4 weeks.
Two (2) doses of MMR are recommended.
The 2nd dose is usually given from 4 - 6 years
of age but may be given earlier.
Children below 12 months of age given any
measles containing vaccine (Measles, MR,
MMR) should be given 2 additional doses.
VARICELLAVACCINE
Given subcutaneously (SC); live attenuated
Given at a minimum age of 12 months
Two doses of varicella vaccine are
recommended. The 1st dose is given at 12 - 15
months of age. The 2nd dose is usually given
at 4 - 6 years of age.
For children below 13 years old, the
recommended minimum interval between
doses is 3 months. However, if the 2od dose
was administered at least 4 weeks after the
first dose, it can be considered as valid.
, For children 13 years and above, the
recommended minimum interval between
doses is 4 weeks.
MEASLES, MUMPS, RUBELLA, VARICELLA
(MMRV)
Given subcutaneously (SC); live attenuated
Given at a minimum age of 12 months
The maximum age is 12 years.
The minimum interval between doses is 3
months. MMRV may be given as an
alternative to separately administered MMR
and varicella vaccine.
*Fully immunized is defined as 5 doses of D TP or 4 doses of D TP if the 4th dose was given on or after the 4th birthday.
IMMUNIZATIONANNOTATIONS con't
HEPATITIS A VACCINE
Given intramuscularly (IM)
Given at a minimum age d 12 months
Given as a 2-dose series, where the 2.~ dose
is given at least 6 months from the 1st dose
TETANUSAND DIPTHERIATOXOID (Td)/
TETANUSAND DIPHTHERIATOXOIDAND
ACELLULAR PERTUSSlS VACCINE (Tdap)
Given intramuscularly (IM)
For 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.
For fully immunized* pregnant adolescent,
administer one dose 1 dose of Tdap vaccine
anytime after 20 weeks d gestation.
For the unimmunized pregnant adolescent,
give the 3-dose tetanus-diptheria containing
vaccine (TdfTdap) following a 0-1-6 month
schedule. Tdap should replace one dose of Td
given preferably after 20 weeks d gestation.
HUMAN PAPILLOMAVIRUS VACCINE (HPV)
Given intramuscularly (IM)
Primary vaccination consists of 3-dose series
with a minimum age of 9 years
The recommended schedule is as follows:
Bivalent HPV at 0, 1 and 6 months
Quadrivatent HPV at 0, 2 and 6 months
The minimum interval between the 1st and the
2nd is at least 1 month and the minimum
interval between the 2"d and the 3rd dose is at
least 3 months. The 3rd dose should be given
at least 6 months after the Ist dose.
A 2-dose schedule is an option for girls 9 to 14
years of age for both bivalent and quadrivalent
vaccines. The doses are given at least 6
months apart. The quadrivalent HPV can be
given to males 9 to 18 years of age for the
prevention of anogenital warts.
VACCINES FOR HIGH RISK/SPECIAL
GROUPS
RABIES VACCINES
Given intramuscularly (IM) or intradermally
(ID) Recommended regimens for pre-exposure
prophylaxis:
70
Intramuscular regimen: Purified Vero Cell
Rabies Vaccine (PVRV) 0.5 ml or Purified
Chick Embryo Cell Vaccine (PCEVC) tml
given on days 0, 7, 21 or 28.
Intradermal regimen: PVRV or PCECV 0.1 ml
given on days 0, 7, 21 or 28
A repeat dose should be given if the vaccine is
inadvertently given subcutaneously.
Rabies vaccine should never be given in the
gluteal area since absorption is unpredictable.
In the event of subsequent exposures, those who
have completed 3 doses of pre-exposure
prophylaxis regardless of the interval between
exposure and last dose of the vaccine will require
ONLY booster doses given on day 0 and 3.
Booster doses may be given IM (0.5 ml PVRV or
1 ml PCECV) or ID (0.1 ml of PVRV or PCECV).
There is no need to give rabies immune globulin.
TYPHOID VACCINE
Given intramuscularly (IM)
Given at a minimum age of 2 years old with
revaccination every 2-3 years
Recommended for travelers to areas where there
is risk of exposure and for outbreak situations as
declared by public health authorities.
DENGUE VACCINE
Live attenuated
Given subcutaneously (SQ)
Given at a minimum age of 9 years old
The maximum age is 45 years old.
Given as a 3-dose series at 0, 6 and 12 months
CHOLERAVACCINE
Given per orem (PO)
Given at a minimum age of 12 months as a 2-
dose series 2 weeks apart
Recommended for outbreak situations and
natural disasters as declared by health
authorities
MENINGOCOCCALVACCINE
Tetravalent meningococcal (ACYW-135)
conjugate vaccine (MCV4-D, MCV4-TT, MCV4-
CRM) given intramuscularly (IM)
Tetravalent meningococcal polysaccharide
vaccine (MPSV4) given intramuscularly (IM) or
subcutaneously (SC)
Indicated for those at high risk for invasive
disease: persistent complement component
deficiencies, anatomid functional asplenia. HIt,

IMMUNIZATIONANNOTATIONS c0n't
travelers to or residents of areas where
meningococcal disease is hyperendemic or
epidemic, or belonging to a defined risk group
during a community or institutional
meningococcal outbreak
Dosing schedule:
MCV4-D: minimum age is 9 months. For
children 9-23 months, give 2 doses at 3 months
apart. For children 2 years and above, give one
dose.
MCV4-TT: given to children 12 months and
above as single dose.
MVC4-CRM: given to children 2 years and
above as single dose
Revaccinate with MCV4 vaccine every 5 years as
long as the person remains at increased risk of
infection.
MPSV4 given to children 2 years and above as
single dose. If MPSV4 is used for high risk
individuals as the 1st dose, a 2°d dose using
MCV4 should be given 2 months later. Booster
doses d MPSV4 are not recommended.
MCV4-D and PVC13 should be given at least 4
weeks apart,
PNEUMOCOCCAL CONJUGATE VACCINE
(PGV)/PNEUMOCOCCALPOLYSACCHARIDE
VACCINE (PPSV)
Given intramuscularly (IM)
Indication for children with high risk medican
conditions: chronic heart, tung, kidney disease,
DM, CSF leak, cochlear implant, sickle cell
disease and other hemoglobinopathies, anatomic
and functional asplenia, HIV and congenital
immunodeficiency, immunosuppression,
malignancy, and solid organ transplantation.
Children > 2 through 5 years of age:
Give one dose of PCV13 if an incomplete
schedule d 3 doses of any PCV was
administered previously
Give 2 doses of PCV13 at least 8 weeks apart
if unvaccinated or any incomplete schedule of
less than 3 doses of any PCV was
administered previously
. Give supplemental dose of PCV13 if 4 doses
of PVC7 or other age appropriate complete
PCV7 series was given
For children with no history of PPSV vaccination,
give PPSV at least 8 weeks after the most recent
v
Figure 34. Immunization of Teens and Pre-teens 2016
PCV13.
Children 6 through 18 years of age:
Give one dose of PCV13 followed by one
dose of PPSV at least 8 weeks later if with
no prior PCV or PPSV immunization
. Give one dose d PPSV at least 8 weeks
after the most recent PCV13 if with previous
PCV13 but without PPSV immunization
A single dose of PPSV is given at least 8
weeks after the last dose of PCV13 in
children with no history of PPSV
immunization.
A single revaccination with PPSV should be
administered 5 years after the 1st dose d
PPSV to children with high risk medical
conditions.
HAEMPPHILUS INFLUENZAE TYPE B
CONJGATE VACCINE (HIb)
Given intramuscularly (IM)
Indications for children with high conditions:
chemotherapy recipients, anatomid functional
asplenia including sickle cell disease, HIV
infection, immunogtobulin or early complement
deficiency
Children aged 12-59 months:
Unimmunized* or with one dose of Hib
vaccine received before age 12 months,
give 2 additional doses 8 weeks apart
Give > 2 doses of Hib vaccine before age
12 months, give one additional dose
Children < 5 years old who received a Hib
booster dose during or within 14 days d
starting chemotherapy/ radiation treatment
should receive a repeat dose of the vaccine at
least 3 months after completion of therapy.
Chiidren who are hematopoetic stem cell
transplant recipients shouid be reimmunized
with 3 doses of Hib vaccine, 6-12 months after
transplant regardless d vaccination history:
doses should be given 4 weeks apart.
Unimmunized children 15 months and older
undergoing elective sptenectomy, give one
dose of Hib containing vaccine at least 14
days before the procedure
Give one dose of Hib vaccine to unimmunized
children 5-18 years old who have anatomid
functional asplenia (including sickle ceil
disease) and HIV infection.
 F I G U R E S F I G U R E S

Figure 7. Weight for Length for Girls: Birth to 2 years Figure 8. BMI forAge for Girls: Birth to 2 years

II

| I L E I ! I fi l l