Академический Документы
Профессиональный Документы
Культура Документы
Statements
of the
Philippine
Pediatric
Society, Inc.
ii
Child Labor
Infant Walkers
13
17
23
27
Sports Clearance
31
Message
Victor S. Doctor, MD
President
Genesis C. Rivera, MD
Vice President
Melinda M. Atienza, MD
Secretary
Victor S. Doctor, MD
President
Philippine Pediatric Society, Inc.
iii
PREFACE
More than 50% of the population are pediatric in age. The Philippine Pediatric Society remains committed
to protect the Filipino children through its various services by the network of pediatricians throughout the
country. Advocacy remains at the heart of the organization. Child advocacy is worth all the challenges and
difficulties that are experienced, for, in the end, it is ultimately for the benefit of the child. With this fourth
volume of Policy Statements, the Philippine Pediatric Society renews and strengthens its commitment to
the Filipino child.
The PPS policy statements have had a major impact on Philippine Health Policy Development since the
first publication in 2003. A policy statement in the first issue, newborn screening, has been enacted into
Republic Act 9288 or the Newborn Screening Law. The Newborn Screening Law mandates that every
child must be given the opportunity to be offered newborn screening. Today, 2 other policy statements
have been crafted into bills universal newborn hearing screening (Senate Bill No 2390 sponsored by
Senators Miriam Defensor-Santiago, Pilar Juliana Cayetano, Loren Legarda and Manuel Lapid) and orphan
disorders (Senate Bill No. 3087 sponsored by Senator Edgardo Angara). The Department of Health (DOH)
has included folic acid supplementation among its recommendations to women of reproductive age in its
Maternal-Newborn Health And Policy Strategy Framework. It is envisioned that the PPS policy statements
will serve as basis for health policies that will eventually impact on better health for the Filipino child.
With the assistance and support of the PPS Board of Trustees, committee members, the different
subspecialties, and chapters, the committee presents 9 policy statements.
There are policy statements that have been withdrawn from this volume due to further review and information
from expert reviewers still coming in and due to topics that require further investigation and consultation.
Acknowledgement of the panel of expert reviewers is given at the end of each statement. Some policy
statements were also jointly sponsored.
This issue presents policy statements on:
Obesity in Children and Adolescents, jointly sponsored with the Society of Adolescent Medicine
of the Philippines, Inc;, the Philippine Society of Pediatric Metabolism & Endocrinology. Inc; and
the Philippine Society of Pediatric Gastroenterology and Nutrition;
Child Labor;
Infant Walkers;
Caffeine and Children;
Medical Certificate for School Entrants, jointly sponsored with the Philippine School Health
Officers Association, the Philippine Society of Pediatric Cardiology and Department of
Education;
Pre-Operative Evaluaion in Pediatric Patients Undergoing Surgery and Other Major
Therapeutic or Diagnostic Procedures, jointly sponsored with the Philippine Society for
Pediatric Cardiology; the Child Neurology Society of the Philippines; the Philippine Society for
Pediatric Anesthesia; and the Philippine Society of Pediatric Surgeons;
iv
Sports Clearance, jointly sponsored with the Philippine Society of Pediatric Cardiology
The issues that the committee were covered in its four publications are just a few of many issues affecting
our children; hence, a lot of areas need to be covered and a lot of work remains. The committee remains
unfazed and ever more ready to accept these challenges as it continues to research and work towards this
goal in the hopes of protecting the future of Filipino children.
The Editors
vi
BACKGROUND
Being at risk for overweight is defined as a BMI between the
85 th and 95 th percentile for age and gender, and being
overweight is defined as a BMI at or above the 95th percentile
for age and gender. Disadvantages of using BMI include the
inability to distinguish increased fat mass from increase fatfree mass and reference populations derived largely from nonHispanic whites, potentially limiting its applicability to
nonwhite populations.1,2
Weight for length is usually used in the under 2 year age group.
In the United States, being overweight in this age group is
defined as greater than the 95th percentile of the weight for
length. The definition is purely statistical, and the percentile
values are age and gender specific. It is important to measure
head circumference because a very large head may alter
weight-for-length ratio.3
The number of overweight children and adolescents has more
than doubled since the early 1970s. From 1999 to 2000, the
prevalence of overweight (BMI 95th percentile for age and
gender) for children aged 2 to 19 years ranged from 9.9% to
15.5%. The prevalence increased with age and was higher in
racial-ethnic minorities than in non-Hispanic whites. For
example, Mexican American children were significantly more
overweight (23.7%) than non-Hispanic white children (11.8%)
said that children consume more energy when meals are eaten
in restaurants than at home, possibly because restaurants tend
to serve larger portions of energy dense foods.11
Todays youth are considered the most inactive generation in
history. This is caused in part by reductions in school physical
education programs and unavailable or unsafe community
recreational facilities. 12 According to the World Health
Organization, nearly two-thirds of children in both developed
and developing countries are insufficiently active, with serious
implications on their future health.13
In the 1998 Asian Conference on Early and Childhood
Nutrition, the Food and Nutrition Research Institute reported
that the most common leisure activities of Filipino children
aged 8 to 10 were playing computer games, reading, and
watching television.14 Another survey of children aged 8 to
10 years in Manila conducted by FNRI showed that only one
out of four children participated in actual physical exercise
everyday. Three out of four spent their time playing computer
games, watching television, and reading. It was also reported
that children had physical education lessons only once or twice
a week.15
Television viewing is thought to promote weight gain by
increasing energy intake and displacing physical activity.
Children seem to passively consume excessive amounts of
energy-dense foods while watching television. Television
advertising could adversely affect dietary patterns at other
times throughout the day and exposure to commercials
increases the likelihood that children later select an advertised
food when presented with options.11
Being severely overweight in childhood is associated with
relatively rare immediate morbidity from conditions, such as
pseudotumor cerebri, slipped capital femoral epiphysis,
steatohepatitis, cholelithiasis, and sleep apnea. Being overweight
is also associated with a higher prevalence of intermediate
metabolic consequences, such as insulin resistance, elevated blood
lipids, increased blood pressure, and impaired glucose tolerance.
These conditions, which are often asymptomatic, increase the
long-term risk for developing diabetes and heart disease in
adulthood and are associated with persistent obesity into
adulthood. However, the recent emergence of medical conditions
that are new to overweight children, such as type 2 diabetes,
represents the increasing prevalence of more serious, shorter term
morbidity. Perhaps the most significant morbidities for overweight
children and adolescents are psychosocial.3,5
Laboratory investigations directed at identifying co-morbidities
of obesity may include thyroid functions, lipid profile, complete
chemistries and hepatic profile, and fasting glucose and insulin.
An oral glucose tolerance test (OGTT) should be considered to
exclude impaired glucose tolerance or T2DM in individuals at
high risk, e.g. family history of T2DM and/or metabolic
syndrome, after 10 years of age. Determination of serum or
urinary cortisol
1.
2.
3.
4.
5.
Recommendations
6.
1.
2.
7.
8.
4.
5.
6.
7.
8.
Roles of Physicians
1. Physicians should obtain a thorough dietary,
psychosocial and family history on the pediatric patient.
Hypertension, dyslipidemias, tobacco use, and other
conditions that can be cardiovascular risk factors should
be identified and addressed.
2. Physicians should monitor height, weight, and BMI
of children and adolescents at every clinic visit. They
should identify those at risk for overweight and
obesity.
3. Physicians should advocate exclusive breastfeeding for
at least 6 months and onwards; and proper
complementary feeding.
4. Physicians should educate the family on healthy eating
and regular exercise habits early in the childs
development. Useful information may be made
available through brochures or waiting room posters.
5. Physicians should refer to registered nutritionist dietitians for proper dietary management.
6. Physicians should refrain from using food as rewards.
*Lead Reviewer
PANEL OF EXPERT REVIEWERS
Society of Adolescent Medicine of the Philippines, Inc.
Rosa Ma. Nancho, MD
Erlinda Cuisia-Cruz, MD
Alicia Berbano-Tamesis, MD
Philippine Society of Pediatric Metabolism and
Endocrinology, Inc.
Sioksoan Chan-Cua, MD
Susana Campos, MD
Nutrition Foundation of the Philippines
Rodolfo Florentino, MD, PhD
Philippine Society of Pediatric Gastroenterology and
Nutrition
Randy P. Urtula, MD
Juliet Sio-Aguilar, MD
Mary Jean Guno, MD
Grace Battad, MD
Paciencia Macalino, MD
Aurora Genuino, MD
Rebecca Castro, MD
PPS Committee on Nutrition and Promotion of Breastfeeding
Mary Jean Guno, MD
Randy Urtula, MD
PPS Obesity Working Group
Grace Uy, MD
Susan Jimenez, MD
Grace Battad, MD
Sioksoan Chan-Cua, MD
Gemma Dimaano, RD
ACKNOWLEDGEMENTS
Participants of the Round Table Discussion on Obesity in
Children and Adolescents (01 October 2004):
Ma. Theresa Bacud Health Education Promotion Officer
III, Health and Nutrition Center, Department of Education
Jane Mari Cabulisan, MD Medical Specialist II, National
Center for Disease Prevention and Control, Department of
Health
Frances Prescilla Cuevas Chief, Health Program Officer,
National Center for Disease Prevention and Control,
Department of Health
Sioksoan Chan-Cua, MD Director, Philippine Association
for the Study of Overweight and Obesity; President,
Philippine Society of Pediatric Metabolism and
Endocrinology, Inc.
10.
REFERENCES
11.
1.
2.
3.
4.
5.
6.
7.
8.
9.
12.
13.
14.
15.
16.
17.
18.
19.
20.
DISCLAIMER:
The publication of the Policy Statements of the Philippines Pediatric Society is part of an advocacy for the provision
of quality health care to children. The recommendations contained in this publication do not dictate an exclusive
course of procedures to be followed but may be used as a springboard for the creation of additional policies.
Furthermore, information contained in the policies is not intended to be used as substitute for the medical care and
advice of physicians. Nuances and peculiarities in individual cases or particular communities may entail differences
in the specific approach. All information is based on the current state of knowledge. Changes may be made in this
publication at any time.
Child Labor
Philippine Pediatric Society, Inc.
Child labor is very prevalent specially in developing countries like the Philippines. This puts
the children at risk for abuse and exploitation, exposes them to hazardous environments and
also compromises their health. This policy statement discusses the impact of child labor in
children, the various laws that have been enacted to quell this problem and recommendations
for parents, physicians and the government on how to protect our children from child labor
and uphold the rights of a child.
Keywords: child labor, child abuse, exploitation, childrens right
URL: http://www.pps.org.ph/policy_statements/child_labor.pdf
BACKGROUND
The Convention on the Rights of the Child outlines the rights
of every child. Children have the right to life, an adequate
standard of living, parental care and support, social security,
a name, nationality, and identity, information, leisure,
recreation, and cultural activities, opinion, freedom of thought,
conscience, religion, freedom of association, and privacy. In
spite of this, childrens rights continue to be violated in the
form of child labor.1
An estimated 246 million children around the world engage
in child labor, of which roughly three-quarters work in
hazardous situations or conditions, such as mines, working
with chemicals and pesticides in the agricultural sector, or
working with dangerous machinery. They are found in homes
as domestic servants, behind walls of workshops as laborers,
and in plantations. At least 70 percent work in agriculture.
Girls, in particular, are especially vulnerable to exploitation
and abuse, working as domestic servants or unpaid household
help under horrific circumstances. They are either trafficked
(1.2 million), forced into debt bondage or other forms of
slavery (5.7 million), prostitution and pornography (1.8
million), participating in armed conflict (0.3 million), or other
illicit activities (0.6 million). The Asian and Pacific regions
have 127.3 million child laborers, representing 19 percent of
children, the largest in the 5 to 14 age group.2
Child Labor
Child Labor
RECOMMENDATIONS
It is a situation wherein children are compelled to work on a
regular basis. In addition, it refers to work where children are
separated from their families and where children are forced
to lead prematurely adult lives.4 As opposed to child labor,
child work childrens or adolescents participation in economic
activity that does not negatively affect their health and
development or interfere with their education and, in this light,
can be positive and is legal.2
The Philippines has ratified ILOCs 138 and 182. It has
developed and implemented a national program for the
elimination of the worst forms of child labor. The Philippine
Time-Bound Program Against Child Labor, launched in 2002,
emphasizes combining sectoral, thematic, and area-based
approaches in combating child labor. In support of the
Child Labor
6.
EXPERT REVIEWERS
Department of Labor and Employment Bureau of Women
and Young Workers
Chita G. Cilindro (Director)
Department of Health National Center for Disease
Prevention and Control
Yolando E. Oliveros, MD, MPH (Director IV)
Department of Social Welfare and Development
Gemma Gabuya (Social Welfare Officer V)
Round Table Discussion Participants
16 October 2007
10
Child Labor
ACKNOWLEDGEMENTS
The committee would like to acknowledge the following
for their contribution:
Department of Labor and Employment Bureau of Women
and Young Workers - Chita G. Cilindro (Director)
Department of Labor and Employment - Ruby Dimaano
Department of Health National Center for Disease
Prevention and Control - Yolando E. Oliveros, MD, MPH
(Director IV)
Department of Health National Center for Disease
Prevention and Control, Family Health Office Rodolfo
Albornoz, MD (Medical Specialist III)
Department of Social Welfare and Development - Gemma
Gabuya (Social Welfare Officer V)
Department of Social Welfare and Development Nicamil
K. Sanchez (Social Welfare Officer IV)
Liga ng mga Barangay sa Pilipinas Rudenio Eduave
(Director for Organizational Development)
REFERENCES
1.
2.
3.
4.
www.bwyw.dole.gov.ph/CL%20Situation.htm.
Accessed on October 10, 2006.
5. Gomez C. RP has 4 million working children. Visayan
Daily Star. 31 March 2006. Available at http://
w w w. v i s a y a n d a i l y s t a r. c o m / 2 0 0 6 / M a r c h / 3 1 /
topstory7.htm.
6. World Children Organization. Available at http://
world_children.org/WCO%20web%20images/
homepage/phil_cond1.htm.
7. Sardaa MC. Combating Child Labor in the
Philippines. Prepared for Asian Development Bank
Institutes Seminar on Social Protection for the Poor in
Asia and Latin America. 25 October 2002, Manila.
8. ILO Convention No. 138. Available at http://ohchr.org/
english/law/pdf/ageconvention.pdf. Accessed on
September 11, 2007.
9. ILO Convention No. 182. Available at http://
www.ilo.org/public/english/standards/relm/ilc/ilc87/
com-chic.htm. Accessed on September 11, 2007.
10. de Boer J. Sweet Hazards: Child labor on sugarcane
plantations in the Philippines. Terre des Hommes
Netherlands. 2005.
11. Republic Act 9231. An Act Providing for the
Elimination of the Worst Forms of Child Labor and
Affording Stronger Protection for the Working Child,
Amending for this Purpose Republic Act No. 7610. As
Amended, Otherwise Known as the Special Protection
of Children Against Child Abuse, Exploitation, and
Discrimination Act. Available at http://
www.ops.gov.ph/records/ra_no9231.htm. Accessed on
September 11, 2007.
12. Reactions to the Policy Statement Child Labor drafted
by the Philippine Pediatric Society, Inc. Department of
Social Welfare and Development. October 2007.
DISCLAIMER:
The publication of the Policy Statements of the Philippines Pediatric Society is part of an advocacy for the provision
of quality health care to children. The recommendations contained in this publication do not dictate an exclusive
course of procedures to be followed but may be used as a springboard for the creation of additional policies.
Furthermore, information contained in the policies is not intended to be used as substitute for the medical care and
advice of physicians. Nuances and peculiarities in individual cases or particular communities may entail differences
in the specific approach. All information is based on the current state of knowledge. Changes may be made in this
publication at any time.
11
xviii
Infant Walkers
Philippine Pediatric Society, Inc.
Infant walkers are commonly employed by parents nowadays. Recent studies have found
that infant walkers may put children at risk for accidents and minor injuries as well as cause
a delay in motor development. This policy presents the advantages and disadvantages of
infant walker use as well as recommendations for its use.
Keywords: infant walkers, accidents, minor injuries
URL: http://www.pps.org.ph/policy_statements/infant_walkers.pdf
BACKGROUND
Infant walkers are commonly used mobile infant carriers today.
They allow a pre-ambulatory infant to sit in a suspended seat
attached to a circular rim standing on wheels. The device gives
the infant precocious locomotion.1-3 Walkers are sometimes
equipped with a plastic table or hanging toys that keep the
infant entertained while seated. Some are equipped with a
braking mechanism whereas others are foldable and can be
easily stowed.1
Walkers are employed by parents for various reasons: to keep
their infant preoccupied while they are doing other things, to
hold their children during feeding, to keep their children quiet
and happy, to aid the infant in strengthening their legs and to
help infants walk at an earlier age.1,2,4-6 However, recent studies
have shown that infant walkers are not beneficial to children
and are actually a danger to them.
Several studies have shown that contrary to popular belief,
walkers do not aid infants to walk at an earlier age but can
even delay their motor and mental development.1,2-9 One study
showed that walker-experienced infants scored lower on
Bayley scales of mental and motor development compared to
non-walker experienced.1,3 Another study showed that walker
experienced infants had abnormal Denver Developmental
Screening Test Results9 while another study showed that
13
access to the kitchen and other dangerous areas in the house.16Reported burn injuries were contact and scald burns, some
severe enough to require resuscitation and skin grafting. It
has been reported that the incidence of thermal injury
associated with baby walker use remains at high levels despite
increased safety measures.17,18,21
21
14
Infant Walkers
RECOMMENDATIONS
Roles of the Government
1. The government should create guidelines and safety
standards in the manufacture and import of infant walkers,
if not completely ban walkers in the country.
2. The government should launch a media campaign that
informs the public of the disadvantages of infant walkers
and discourages its use.
3. The government should aid in the education of doctors,
midwives and other health personnel on the disadvantages
of infant walker use.
4. The government should ban the use of walkers in hospitals
and approved child care facilities.
5. The government should initiate and support researches
regarding the benefits, disadvantages and safety of infant
walker use in the Philippine setting.
Roles of Physicians and Health Care Personnel
1. Physicians and health care personnel should educate
parents on the hazards of infant walker use.
2. Physicians and health care personnel should conduct
researches that will elucidate further the effects and
disadvantages of infant walker use.
3. Physicians and health care personnel should make sure
that walkers are not used in their clinics and other child
health care facilities.
Roles of Parents
1. Parents should be informed and should read and research
on the hazards of infant walker use.
2. If parents choose to use walkers, they should select a
walker that meets the standards set by the government.
Infant Walkers
EXPERT REVIEWER
Lead reviewer: Joselyn A. Eusebio, MD
expert reviewer: Philippine Pediatric Society Committee on
____
Rommel Crisenio M. Lobo, MD
13.
14.
REFERENCES
1.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
15
Infant Walkers
DISCLAIMER:
The publication of the Policy Statements of the Philippines Pediatric Society is part of an advocacy for the provision
of quality health care to children. The recommendations contained in this publication do not dictate an exclusive
course of procedures to be followed but may be used as a springboard for the creation of additional policies.
Furthermore, information contained in the policies is not intended to be used as substitute for the medical care and
advice of physicians. Nuances and peculiarities in individual cases or particular communities may entail differences
in the specific approach. All information is based on the current state of knowledge. Changes may be made in this
publication at any time.
16
Caffeine is both a naturally occurring substance and an additive in many foods, beverages,
and medicines. It is a known stimulant that mainly influences the central nervous system but
has effects on other body systems. Its consumption is widespread due to its easy accessibility
and availability through sodas, chocolate, and coffee, owing to the spread of coffee
establishments in the area. Its specific effects on children have been relatively less studied.
This policy statement looks into local consumption of caffeine-containing foods and drinks,
its effects, and guidelines that have been set by other countries. The Philippine Pediatric
Society, Inc. recommends limiting caffeine consumption by children.
BACKGROUND
Caffeine has been used as early as the Stone Age when ancient
peoples discovered that chewing seeds, bark, and leaves of certain
plants eased fatigue, stimulated awareness, and elevated mood.1,2
For thousands of years, it has been used in a variety of forms
such as coffee, tea, chocolate, yerba mat, and guarana berries
among others. 3 Caffeine is the most widely consumed
psychoactive substance, its consumption being estimated at
120,000 tons per annum.1 It has also been added to a variety of
carbonated and energy drinks and medicines, such as
decongestants, analgesics, stimulants, and appetite suppressants.4
(See Appendix) Childrens exposure to caffeine is largely via
carbonated drinks, chocolate, tea, and coffee (especially in
urbanized areas) through the deluge of coffee franchises.
In a study on beverage caffeine intake in young children in
Canada and USA, it was determined that American children
consumed more caffeinated beverages at 56% compared to
Canadian children at 36%. Canadian children consumed
approximately half the amount of caffeine (7 vs. 14 mg/day).
It was concluded, however, that caffeine intake from
caffeinated beverages remained well within safe levels for
consumption by young children.5
Caffeine is a xanthine derivative and its effects are mediated
through its action on the cerebral cortex and brain stem of the
17
18
Roles of Physicians
1. Physicians should educate parents and caregivers on the
effects of caffeine, the products that contain them, and
ways in which its intake could be reduced and/or
avoided.
2. Physicians should educate parents and caregivers on food
and beverage products that are energy rich but
nutritionally dense (e.g. fresh fruit juices, milk, etc.) in
place of softdrinks and energy drinks.
3. Physicians should be vigilant in prescribing medications
that have adverse drug interactions with caffeinecontaining food and beverages, especially if their
pediatric patients are consuming diets containing such
items.
Children*
4 - 6 years
7 - 9 years
10 - 12 years
45 mg/day
62.5 mg/day
85 mg/day
RECOMMENDATIONS
Roles of the Government
1. The government should implement laws that mandate
labeling of all food, beverage, and medicines that
contain caffeine and the level of caffeine found in these
products.
2. The government should strengthen and implement
programs to promote healthy diet and alternative
options to intake of caffeine-containing foods and
beverages.
3. Increase awareness of the public, through the Department
of Health and DOH accredited hospitals, including
schools on the effects of caffeine in children.
4. To encourage the coffee selling establishments to include
a warning or caution (posters, signs) on the negative
effects of caffeine on children.
Roles of Food, Beverage, and Medicine Manufacturers
1. Food, beverage, and medicine manufacturers should
properly label their products that contain caffeine and the
levels at which it is found in the product.
Roles of Parents
1. Parents should educate their children on the effects of
caffeine and the products that contain them.
2. Parents should encourage the reduction and/or avoidance
of caffeine in their childrens diets.
3. Parents should encourage their children to consume food
and beverage products that are energy rich but
nutritionally dense (e.g. fresh fruit juices, milk, etc.).
4. Parents should inquire with their childrens primary
physician if any of their childs medications (whether
prescription or over-the-counter) contain caffeine and the
level at which it is found in the medication.
5. Parent should aim to reduce/avoid administering
medication containing caffeine to their children unless
otherwise strongly indicated by their childs pediatrician/
attending physician.
6. Parents should set examples in the moderate intake of
coffee.
19
ACKNOWLEDGEMENTS
The Committee on Policy Statements recognizes the
contribution of the following:
Dr. Mario Capanzana -- Officer in Charge, Food and
Nutrition Research Institutex
REFERENCES
1. Caffeine. Available at http://en.wikipedia.org/wiki/
Caffeine. Accessed on May 7, 2007.
2. Suleman A, Siddiqui NH. Hemodynamic and
cardiovascular effects of caffeine. Available at http://
www.priory.com/pharmol/caffeine.htm. Accessed on
May 7, 2007.
3. National Cancer Institute. Caffeine. National Cancer
Institute Drug Dictionary. National Institutes of Health.
Available at http://www.cancer.gov/Templates/
drugdictionary.aspx?CdrID=40817. Accessed on May
11, 2007.
4. National Cancer Institute. Caffeine. National Cancer
Institute Dictionary of Cancer Terms. National Institutes
of Health. Available at http://www.cancer.gov/
Templates/db_alpha.aspx?CdrID=454809. Accessed on
May 11, 2007.
5. Knight CA, Knight I, Mitchell DC. Abstract. Beverage
caffeine intakes in young children in Canada and the
US. Canadian journal of dietetic practice and research:
a publication of Dietitians of Canada. 2006 Summer.
Vol. 67 No. 2. Pages 96-99.
6. Caffeine. Available at http://www.stanford.edu/
~johnbrks/theCafe/substance/caffeine.html. Accessed
on May 7, 2007.
7. Caffeine Effects: The Effects of Caffeine on the Body.
Available at http://mass-spec.chem.cmu.edu/VMSL/
Caffeine/Caffeine_effects.htm. Accessed on May 11,
2007.
8. Mayo Clinic Staff. Caffeine: How much is too much?
8 March 2007. Available at http://www.mayoclinic.com/
health/caffeine/NU00600. Accessed on May 21, 2007.
9. American Heart Association. Caffeine: AHA
Recommendation.
Available
at
http://
w w w . a m e r i c a n h e a r t . o r g /
presenter.jhtml?identifier=4445. Accessed on May 21,
2007.
10. Jorens PG, Van Hauwaert JM, Selala MI, Schepens PJ.
Abstract. Acute caffeine poisoning in a child.
European journal of pediatrics. October 1991. Vol. 150
No. 12. Page 860.
11. Walsh I, Wasserman GS, Mestad P, Lanman RC.
Abstract. Near-fatal caffeine intoxication treated with
peritoneal dialysis. Pediatric emergency care.
December 1987. Vol. 3 No. 4. Pages 244-249.
20
27.
28.
29.
30.
DISCLAIMER:
The publication of the Policy Statements of the Philippines Pediatric Society is part of an advocacy for the provision
of quality health care to children. The recommendations contained in this publication do not dictate an exclusive
course of procedures to be followed but may be used as a springboard for the creation of additional policies.
Furthermore, information contained in the policies is not intended to be used as substitute for the medical care and
advice of physicians. Nuances and peculiarities in individual cases or particular communities may entail differences
in the specific approach. All information is based on the current state of knowledge. Changes may be made in this
publication at any time.
21
APPENDIX
Item
Mountain Dew
12 ounces
55.0 mg
12 ounces
34.0 mg
Coke Light
12 ounces
45.0 mg
Pepsi
12 ounces
37.0 mg
12 ounces
0 mg
8 ounces
135 mg*
Instant coffee
8 ounces
95 mg*
8 ounces
5 mg*
8 ounces
3 mg*
16 ounces
259 mg
Black tea
8 ounces
40-70 mg*
Green tea
8 ounces
25-40 mg*
8 ounces
4 mg*
12 ounces
26 mg
Dark chocolate
1 ounce
20 mg*
Milk chocolate
1 ounce
6 mg*
Cocoa beverage
5 ounces
4 mg*
8 ounces
5 mg*
22
BACKGROUND
A school entrant is a child, adolescent, or young adult who is
about to enter nursery, Grade 1 of elementary school, Grade 6
of middle school, first year of high school, or first year of
college or a vocational course. In addition, a school entrant
may be a transferee student regardless of the grade or year
level he/she will be entering.
Philippine situation
Schools generally require that their students undergo a physical
examination and medical evaluation upon enrollment. This
medical certification indicates whether the child is fit to enroll
or requires further evaluation. It is issued after a general health
assessment by either the childs primary care physician or the
school physician. In the Philippines, there are no existing
guidelines/protocols or laws mandating this. Not all private
schools require such certification prior to admission. The
pending Magna Carta of Students requires that school
authorities endeavor to provide free annual physical checkups to students.1
International situation
In the USA, schools also require what is known as a school
entrant medical examination, school entry physical, or school
23
Limitations
RECOMMENDATIONS
Recommended elements
The following are the recommended elements of the medical
interview and physical examination prior to issuing a medical
certificate:
The medical interview
1. Medical history attention to physical, emotional, or
family problems that might influence school achievement,
previous participation in preschool experiences, new
medical problems, medications
2. Immunization status dates of previous, updating as
necessary
3. Language, social, and adaptive development changes
in childs developmental and psychosocial status, update
on school progress and problems
The physical examination (should be age appropriate and
performed by a physician)
1. Height and weight
2. Blood pressure and heart rate
3. Teeth, gums, tongue, and throat
4. Reflexes
5. Eyes (to include vision), ears (to include hearing), nose,
and skin
6. Heart, lungs, and abdomen
7. Fine-motor development, such as the ability to pick up
small objects or tie shoes
8. Gross-motor development, such as the ability to walk,
climb stairs or jump
9. Spinal alignment for signs of curvature (scoliosis)
10. Genitalia, confirming a normal level of maturation and
checking for hernia, infection and other possible problems
24
EXPERT REVIEWERS
Private School Health Officers Association, Inc.
Ma. Consuelo Z. Garcia, MD, DPACCD (Immediate Past
President)
Philippine Ambulatory Pediatric Association
Cecilia O. Gan, MD
1.
2.
3.
4.
29 November 2007
Philippine School Health Officers Association - Consuelo Z.
Garcia, MD
Child Neurology Society Philippines, Inc. - Susan Andong,
MD
Philippine Ambulatory Pediatric Association - Cecilia Gan,
MD
5.
6.
ACKNOWLEDGEMENTS
DISCLAIMER:
The publication of the Policy Statements of the Philippines Pediatric Society is part of an advocacy for the provision
of quality health care to children. The recommendations contained in this publication do not dictate an exclusive
course of procedures to be followed but may be used as a springboard for the creation of additional policies.
Furthermore, information contained in the policies is not intended to be used as substitute for the medical care and
advice of physicians. Nuances and peculiarities in individual cases or particular communities may entail differences
in the specific approach. All information is based on the current state of knowledge. Changes may be made in this
publication at any time.
25
xxxii
BACKGROUND
With the rapid advancements in technology, surgical
procedures have become safer, more sophisticated, and less
invasive. Anesthetic procedures have also been improved and
streamlined. Surgical morbidity and mortality have decreased.
However, despite all these advances, the risks and
complications of surgery still can not be eliminated, they can
only be minimized. Pre operative risk assessment and
evaluation is the major methodology in minimizing surgical
complications. Pre operative evaluation is a must for almost
all surgical procedures and medical testing requiring
anesthesia. 1 It is required for all patients undergoing a
diagnostic or therapeutic procedure regardless of the setting
except in the following cases: (1) Healthy patients requiring
nerve blocks, local or topical anesthesia and/or no more than
50% nitrogen oxide, oxygen and no other sedative or analgesic
agents, and (2) Patients receiving sedation analgesia or
conscious sedation.2
It is commonly believed that the greatest risk in adult
surgery is cardiovascular complications, whereas for the
pediatric population, the greatest risks are pulmonary and
airway complications. However, cardiac conditions
together with coagulopathy, anemia, pregnancy and
reactions to anesthesia may increase the risk in the pediatric
population and must also be given due consideration. In
27
28
RECOMMENDATIONS
Role of the Government
1. The government should facilitate the dissemination of
information to all health facilities.
Roles of the Attending Physician
1. The physician must be aware of the policy guideline
prepared by the Philippine Pediatric Society on the preoperative evaluation of the pediatric population.
2. The physician must be updated on the risks and
complications of the contemplated procedure.
3. The physician must inform the parents of the need for a
pre operative evaluation.
4. The physician must be responsible in explaining to the
parents the various components of the evaluation process
as well as the risks of the contemplated procedure.
Role of the Pediatrician
1. The pediatrician must be aware and guided by the policy
guidelines set by the Philippine Pediatric Society.
Roles of Parents
1. The parents should inquire on the contemplated
procedure, risks and possible complications of the
operations that their child will be undergoing.
2. The parents should cooperate with the physicians in the
pre operative evaluation of the patient and should give
truthful answers during the interview and history taking.
ACKNOWLEDGEMENTS
The Committee on Policy Statements recognizes the
contribution of the following:
Philippine Society for Pediatric Cardiology
Child Neurology Society of the Philippines
Philippine Society for Pediatric Anesthesia
Philippine Society of Pediatric Surgeons
REFERENCES
EXPERT REVIEWERS
1.
Philippine Society for Pediatric Cardiology
Ma. Bernadette A. Azcueta, M.D.
2.
Child Neurology Society of the Philippines
Marissa Lukban, M.D.
3.
Philippine Society for Pediatric Anesthesia
Marichu Battad, M.D.
Philippine Society of Pediatric Surgeons
Delfin Cuajunco, M.D.
4.
5.
6.
7.
DISCLAIMER:
The publication of the Policy Statements of the Philippines Pediatric Society is part of an advocacy for the provision
of quality health care to children. The recommendations contained in this publication do not dictate an exclusive
course of procedures to be followed but may be used as a springboard for the creation of additional policies.
Furthermore, information contained in the policies is not intended to be used as substitute for the medical care and
advice of physicians. Nuances and peculiarities in individual cases or particular communities may entail differences
in the specific approach. All information is based on the current state of knowledge. Changes may be made in this
publication at any time.
29
APPENDIX A
Cardiovascular
Unstable coronary syndromes
o Recent* myocardial infarction (MI)
o Unstable or severe angina
*
Recent can mean less than 30 days if post myocardial infarction cardiac risk stratification is completed and patient
determined to be low-risk; 3 to 6 months if formal risk stratification not done.
Non-Cardiovascular
Pulmonary disease, severe or symptomatic (e.g., chronic obstructive pulmonary disease requiring oxygen, respiratory
distress at rest, asthma, cystic fibrosis, etc.)
Poorly controlled symptomatic diabetes (causing symptoms with attendant risk of hypovolemia)
Symptomatic anemia
APPENDIX B
Test
Coagulation Studies
No ECG within last year in patients (regardless of age) with history of diabetes, hypertension,
chest pain, congestive heart failure, smoking, peripheral vascular disease, inability to exercise, or
morbid obesity. At time of preoperative evaluation, testing should occur in patients with any
intercurrent cardiovascular symptoms or with signs and symptoms of new or unstable cardiac
disease.
Hemoglobin
Patient has a known history of coagulation abnormalities or recent history suggesting coagulation
problems or on anticoagulants. Patient needs anticoagulation post-operatively (where a baseline
may be needed).
Potassium
Patient has a history of anemia or history suggesting recent blood loss or anemia.
Chest X-Ray
ECG
30
Sports Clearance
Philippine Pediatric Society, Inc.
Philippine Society of Pediatric Cardiology
Children are encouraged to engage in sports and reap its multiple benefits. However, there
are instances when this involvement could lead to more harm than good. A sports clearance
achieves many goals and may be used to detect life-threatening health conditions, determine
readiness for sports participation and as a venue for counseling, among others. Though it has
limitations, a sports clearance by qualified medical personnel is nonetheless recommended
by the Philippine Pediatric Society, Inc. for all children who are about to engage in sports.
Keywords: sports clearance, preparticipation physical evaluation, athletic screening, sports
participation
URL: http://www.pps.org.ph/policy_statements/sports_clearance.pdf
BACKGROUND
Participation in sports on a regular basis allows a child to
reap the multiple benefits of physical activity.1-4 The possible
physical benefits include improved motor skills, endurance,
cardiovascular fitness, muscular strength, lean body mass, and
peak bone mass.1,2,3,5,6 It also has social, psychological, and
behavioral benefits as well.2,4,5 It may serve as an adjunct
therapy for obesity, diabetes, and asthma.7-12 With all its
benefits, it is but natural that we encourage our children to
engage in sports. Sports participation is even supported by
the state as embodied in Article XIV Section 19 of the 1987
Philippine Constitution, [the] State shall promote physical
education and encourage sports programs, league
competitions, and amateur sports, including training for
international competition, to foster self-discipline, teamwork,
and excellence for the development of a healthy and alert
citizenry.13
2.
3.
4.
5.
31
2.
3.
32
Sports Clearance
2.
3.
2.
3.
4.
Sports Clearance
RECOMMENDATIONS
Children and adolescents who may or may not be athletes are
referred to as children in the following recommendations.
Roles of Government
1. The government should mandate that all children should
undergo a sports clearance prior to sports participation.
2. The government should mandate that sports clearances
be conducted only by qualified medical personnel.
3. The government should mandate that all medical
personnel with an interest to clear children for sports
participation must undergo training or certification to do
so.
Roles of Hospital Administrators
1. Hospital administrators should certify that medical
personnel who conduct sports clearances be qualified to
clear children for sports participation.
2. Hospital administrators should establish training and
certification programs for medical personnel who are
interested in performing sports clearances on children.
Roles of Physicians
1. Physicians who clear children for sports participation
should undergo proper training and acquire certification
33
4.
5.
Sports Clearance
2.
3.
4.
PANEL OF EXPERT REVIEWERS
Philippine Center for Sports Medicine
Raul C. Canlas, MD
Philippine Society for Pediatric Cardiology
Jonas del Rosario, MD
5.
6.
ACKNOWLEDGEMENTS
The Committee on Policy Statements recognizes the
contribution of the following:
Philippine Center for Sports Medicine
Philippine Society for Pediatric Cardiology
Pediatric Orthopaedic Society of the Philippines
PPS School Committee
34
8.
9.
Sports Clearance
20.
21.
22.
23.
24.
25.
26.
27.
28.
35
36
Sports Clearance