University of Basrah
College of Medicine
Department of Community Medicine Dr. Lamis Aziz Hameed
Child Health Services
Child care aims to ensure that the child, once born, grows satisfactorily
through infant, pre-school, school and adolescent periods to full healthy
adulthood
It seeks to provide all the services necessary for the promotion,
maintenance, protection and restoration of health.
• Services for preschool children
• Services for school children
Services for preschool children
It concerned with curative and preventive services for children between
birth and school entry.
Why special services for preschool children in the developing
countries are needed?
1. Large number of children. Children under five years of age make up
about 20% of the total population
2. Health problems during this period are many and most of these
problems are serious but preventable.
3. A very high mortality among young children in developing countries,
deaths among under five children may constitute up to 50% of total
deaths.
4. Disease among children especially in early age even if cured may leave
disability with its great suffering and their rehabilitation is costly.
Objectives of preschool children services
■ promote the health of children to ensure that they achieve optimal
growth & development both physical and mental.
■ Protect children from major hazards by specific measures
1. Immunization against some infectious diseases.
.
Chemo prophylaxis
.
2.
.
Dietary supplements to prevent malnutrition
.
3
4.Education of the parents about health and nutrition.
■ Treat diseases and disorders with particular emphasis on early
diagnosis.
Main services :
1. Management of simple illnesses.
2. Monitoring and encouraging adequate growth.
Immunization against infectious diseases
.
3
.
Identification of children at risk
.
4
5. Encouragement of family planning
6. Diet supplementation
Malaria prophylaxis
.
7
.
Health education
.
8
Growth monitoring
Physical growth is an important indicator of the well being, health and
nutritional status of the individual child and the population.
* Growth is a product of the continuous and complex interaction of
hereditary and environmental factors
Two main purposes of growth monitoring:
.
To promote adequate growth of children
.
1
.
To pick up those at particular risk
.
2
How to assess the growth of a child?
The growth and development of each child should be carefully monitored
Indicators of growth of children-
Weight measurement is the most important single method of assessing the
growth.
Whether or not a child is growing normally, can be decided on easily by
comparing, the child’s weight to "normal" or "standard" weights of a
healthy reference population (children at the same age or height).
By plotting the weight on the weight chart, this weight chart is called
growth chart (Road to health chart).
Weight measurements are evaluated by comparing them to the median
weight, this comparison is expressed as a percentage of median (centile
system), 97th, 50th, & 30th are the median weight.
When plotting the child's weight it is important to know the
following:
1. The exact position of single weight can be misleading, the direction in
which child's weight curve is moving is most important in assessing the
child nutritional status.
2. The velocity of child's weight gain (rate of gaining wt.) is more
important than his actual weight at any age.
3. If the child is not gaining weight or is losing weight, the curve will be
flat or go down ward such a child need special care.
4. In a child with malnutrition the increase in the rate of wt. gain is the
earliest evidence of recovery.
Standard growth curves
1.Weight for age standard curve: the one most commonly used.
2.Weight for height standard curve: the best way to identify wasted
children.
3. Height for age standard curve: indicate whether a child is stunted
or not.
Mid arm circumference it is a measure of body lean tissue. As
compared to weight, it is not an accurate indicator of malnutrition & can’t
be used to monitor the progress of growth.
Skin fold thickness it is a measurement of subcutaneous fat tissue, it is a
good indicator of the energy reservoir of the body.
Immunization
Each child should be immunized against the common communicable
diseases for which vaccines are available.
Immunization program in Iraq
Age
Vaccine
1
st
24 hours of life Hepatitis B (1
st
dose)
1
st
week BCG, OPV (0 dose)
2 Months OPV (1
st
dose), Rota virus (1
st
dose) , Hexavalent
(1
st
dose) =[ DPT+ Hepatitis B+ Hib+Injectable polio]
4 months OPV (2
nd
dose), Rota virus (2
nd
dose), Pentavalent(1
st
dose)= [ DPT+ Hib+Injectable polio]
6 Months OPV (3
rd
dose),Rota virus (3
rd
dose) , Hexavalent
(2
nd
dose)
9 months Measles
15 months MMR
18 months OPV (1
st
booster dose), Pentavalent(2
nd
dose)
4-6 years OPV (2
nd
booster dose), Pentavalent (3
rd
dose), MMR
(2
nd
dose)
Children at risk
- Low birth weight. - Twins and multiple births.
- Many children in family. - Short interval between births.
- Poor growth in early life. - Early stopping of breast-feeding
before 6 months.
- Many episodes of infections. - Poverty of family
- Children with only one parent. - Children with congenital anomaly.
Chemo prophylaxis & Dietary supplements
In endemic areas of malaria chemo prophylaxis is usually
recommended for the highly susceptible groups including preschool
children.
Dietary supplements is another prophylactic measure to prevent
common nutritional deficiencies such as Vt. A deficiency.
Some developing countries give food supplements to prevent or to treat
malnutrition.
Health education
Should be part of all services of preschool children.
Development clinic
Development is the increase in complexity, it involves both structural
and functional aspects.
Child development is a term that describes, ''the physical, motor,
mental, emotional, and social growth of a baby.''
The Developmental Pediatric Clinic is an opportunity which deals
with child's development.
Three main objectives
1. To promote optimal physical and mental growth of all children.
2. To facilitate the detection of various impairments affecting
development.
Thus, it ensures early diagnosis and effective treatment of
handicapping conditions
3. They provide the opportunity to discuss child development with
the parents.
Development examination is a term applied to a set of procedures which
are used to establish the stage of development of an individual child and
to recognize the deviations from normal.
1.Developmental history
2. Observation of the child’s behaviour
3. Adminstation of various tests
A developmentally handicapped child- a child who has failed to progress
at a normal rate in acquiring certain developmental skills in motor,
adaptive, communicative & social spheres.
Three main categories of handicapping conditions:
1/ Those which are obvious from birth --- gross congenital aomalies
and Down’s syndrome.
2/ Those which must be looked for --- metabolic disorders, congenital
dislocation of the hip
3/ Those which become apparent during the course of development --
- cerebral palsy, mental retardation, squint, language disorders.
How early detection is achieved?
1) the neonatal and six-week examination.
2) follow-up of infants and children who have suffered various forms of
trauma or illness affecting the nervous system.
3) Detection by parents and relatives
4) Detection by health workers--- nursery nurses, health visitors, and
general practitioners.
Main Services
Dev. Evaluation Clinic offers dev. evaluation services for infants,
preschoolers, and school-age children. These services include:
1. Identifying developmental, learning, and social delays
2.Determining the significance of delays and behavior problems
3.Determining the need for further assessment/intervention
4.Recommending participation in educational or therapeutic
programs
Parameters of human development
1. Gross motor --- body posture & large movement like sitting, crawling
2. Vision & fine movements --- visual competence & manipulative skills
3. Hearing & speech
4. Social behaviour & playing
Factors which affect development
-
Genetics & familial factors -Sex
-
Physical impairment ---- deafness, blindness -Nutrition
-
Social, emotional & cultural factors -Enviroment