Introduction:
Child health include physical, mental and social wellbeing too.Each year more than 10 million children under the age of 5 die .
At least 6.6 million child deaths can be prevented; each year if affordable health interventions are made available to the mothers and children who needs them.
Many diseases and disorders of childhood, adolescence, and adulthood can be prevented or lessened in severity if detected early.
Preventive services are needed for children for many reasons:
Children represent high percentage of population (40% -45%) .
Many causes of mortality & morbidity are avoidable: RTA. Poisoning, burns, falls & drowning.
Vulnerability (liability) of children & their parents.
Routine periodic examination for children:
(At birth) linked with immunization schedule.
every 2 months in the first year.
every 3 months during the 2- 3 year.
every 6 months during 4-5 years.
Child health care services:
Effective preventive care includes providing many kinds of screening, counselling, and immunization services:
These Services includes:
(Complete Physical examination (newborn care, follow up care).
Growth monitoring ( weight , height / length ).
Developmental assessment .
Immunization ( 0 , 2 ,4,6,9,15,18 months,4 years ).
Conducting vision screening regularly.
Vitamin A supplement.
Feeding instructions ( breast feeding & complementary feedings ).
health education (Counselling children and their parents about which foods to eat and which to avoid).
Detection of special cases ( birth defects, genetic diseases, disabilities , allergies..etc. ).
These services can be summarized by GOBI FFF
Growth monitoring.
ORS , ARI and control of diarrhea disease(CDD) ,
Breast feeding.
Immunization against communicable diseases and curative care.
Female health education , Next visit and follow up , using childs card.
Food supplementation.
Counseling including Family planning.
Newborn Care:
We have two medical examinations to be done for every new baby:
1-Immediate newborn care:
Its the responsibility of the birth attendant (doctor or midwife):
To detect abnormalities which need immediate treatment?
Measure birth weight.
Estimation of Apgars score at the 1st and the 5th minute of life after birth.
Apgar score: we have 5 signs, each is given a score of 0, 1or 2 :
Heart rate , Respiratory rate, Muscle tone, Response to catheter in nostril, Color of skin.
If the score is less than or equal to 3 at 5 minutes this means that the infant is at a higher risk of neonatal death, or to have respiratory & cerebral complications during the neonatal period ( neonate intensive care unit).
2-Late newborn care:
This should be done within the 1st 48 hours after birth by a pediatrician, this includes: examination of all systems with much more details than the immediate, all of the finding should be recorded. screening for certain diseases.
Childs development: There are various definitions of periods in a child's development, since each period is a range of individual differences regarding start and ending. Some age-related development periods and examples of defined intervals are:
HYPERLINK "http://en.wikipedia.org/wiki/Newborn" newborn (ages 01 month); HYPERLINK "http://en.wikipedia.org/wiki/Infant" infant (ages 1 month 1 year); HYPERLINK "http://en.wikipedia.org/wiki/Toddler" toddler (ages 13 years); HYPERLINK "http://en.wikipedia.org/wiki/Preschooler" preschooler (ages 46years); HYPERLINK "http://en.wikipedia.org/wiki/Elementary_school" school-aged child (ages 613 years);
HYPERLINK "http://en.wikipedia.org/wiki/Adolescent" adolescent (ages 1320).
Aspects of child development
1 .Physical growth. 2. Motor development. 3. Cognitive/ Intellectual development. HYPERLINK "http://en.wikipedia.org/wiki/Reflex_action" 4. Social-emotional development . HYPERLINK "http://en.wikipedia.org/wiki/Central_nervous_system" 5. Language.
Primitive reflexes : are HYPERLINK "http://en.wikipedia.org/wiki/Reflex_action" reflex actions originating in the HYPERLINK "http://en.wikipedia.org/wiki/Central_nervous_system" central nervous system that are exhibited by normal infants but not neurologically intact adults, in response to particular HYPERLINK "http://en.wikipedia.org/wiki/Stimulus_(physiology)" stimuli.
These primitive reflexes are also called infantile (infant or newborn ) reflexes.These reflexes disappear as a child moves through HYPERLINK "http://en.wikipedia.org/wiki/Child_development" normal child development.
Tonic- neck reflex? , palmer reflex? , sucking reflex ?, Moro reflex?, rooting reflex?
Older children and adults with a HYPERLINK "http://en.wikipedia.org/wiki/Neurology" neurolog HYPERLINK "http://en.wikipedia.org/wiki/Neurology" ical HYPERLINK "http://en.wikipedia.org/wiki/Neurology" HYPERLINK "http://en.wikipedia.org/wiki/Neurology" problemes , may retain these reflexes and primitive reflexes may re-appear in adults because of certain neurological conditions including, but not limited to, HYPERLINK "http://en.wikipedia.org/wiki/Dementia" dementia, traumatic HYPERLINK "http://en.wikipedia.org/wiki/Lesion" lesions, and HYPERLINK "http://en.wikipedia.org/wiki/Stroke" strokes.
MotorDevelopment:
Motordevelopmentisrecordedinthehealthcardinonesimplified chartlinkedwiththevaccinationschedule.
The (nurse) tick the mark ( opposite the motor development if done by the child at the appropriate time.
If there is a motor developmental delay the childis referred to the family doctor for further assessment
Growth Monitoring:
Growth monitoring is an important technique for identifying individuals, groups or communities whose growth is not keeping up with the expected pattern (Introduced in early seventies).
Poor growth as a result of infection, malnutrition or other cause needs to be detected in order that corrective action may be taken.
Its a process of sequential measurements of the weight of Under 5 years children, in order to be able to detect signs of malnutrition (e.g. growth failure) as early as possible & to correct this position.
This process should start soon after birth with the measurement of birth weight & the recording of the Wt. on the growth chart.(wt. for age).
Growth monitoringisdonefor allchildrenof both sexeslessthan 5yearsthroughtheprimaryhealthcare (Familymedicine)centers.
It is done for the healthy child as a part of the Child care services ( follow up visits ) .
Nurses are directed to do growth monitoring every time the child comes to the unit for any reason .
Growth Chart:
A growth chart is used by pediatricians , family physicians and other health care providers to follow a child's growth over time.
The HYPERLINK "http://en.wikipedia.org/wiki/Human_height" height, HYPERLINK "http://en.wikipedia.org/wiki/Weight" weight, and HYPERLINK "http://en.wikipedia.org/w/index.php?title=Head_circumference&action=edit&redlink=1" head circumference of a child can be compared to the expected parameters of children of the same age and sex to determine whether the child is growing
Growth charts are different for boys and girls, due in part to pubertal differences and disparity (inequality) in final adult height.
Growth charts have been constructed by observing the growth of large numbers of normal children over time. Growth charts can also be gathered from a portion of the population considered to have been raised in more or less ideal environments, such as nutrition that conforms to pediatric guidelines, and no maternal smoking. Charts from these sources end up with slightly taller but thinner averages.
Growth charts can also be used to predict the expected adult height and weight of a child because, in general, children maintain a fairly constant growth curve.
When a child deviates from his or her previously established growth curve, investigation into the cause is generally necessary. E.g indicate the onset of a chronic illness such as HYPERLINK "http://en.wikipedia.org/wiki/Inflammatory_bowel_disease" inflammatory bowel disease.
children with diseases such as HYPERLINK "http://en.wikipedia.org/wiki/Down_syndrome" Down syndrome follow distinct growth curves . Due to differences in normal growth rates between breastfed and formula fed babies, there are currently separate charts for breastfed babies which are based on normal growth patterns of exclusively breastfed babies.
we use the growth chart for every individual child, where wt. is the best indicator, as it is affected with anything that affect nutrition, appetite, income, psychological, infection.
The birth weight is used as the 1st reading and wt is measured monthly and plotted on the chart joined by curve (growth curve) , The upper and lower lines on the chart correspond approximately "average" weight of healthy children (WHO "reference" weights). The space between two lines has been called the {Road to Heath}, In normal child --- ---Up going curve., No wt. gain --------- Flat curve., Wt. loss ----------------------- Down going.
Record any immunization received in the appropriate space. When potting the child's weight it is important to plot the weight above correct month of the chart.
Lack of attention to the rising problem of obesity & concentrating mainly on under nutrition.
What Factors Affect a Child's Growth?
Genetics, gender, nutrition, physical activity, health problems, environment, and hormones all influence a child's height and weight.
Children at Risk
Certain risk factors have an influence on child's nutritional state, those children need more care and more frequent follow up visits
These risk factors are related to medical, social, economic and educational conditions and may include:
LBW
Twins or multiple births
Many children in a family, brothers or sisters undernourished
Short spacing {short intervals between births}
Poor growth in early life
Early stopping of breast feeding {i.e. before 6 mothers}
Introduction of complementary food either too early or too late
Many episodes of infection
Poverty- 3 or more children in family died
Children with only one parent
Illiterate mother.