Healthy Child. Healthy Child. Comprehensive Comprehensive

assessment of the assessment of the health of childrenhealth of children

Mainly the indicator of the effectiveness of Mainly the indicator of the effectiveness of measures to protect children's health is the measures to protect children's health is the health of every child.health of every child.

Health - is not merely the absence of disease Health - is not merely the absence of disease and injury, but also harmonious physical and and injury, but also harmonious physical and neuro-psychological development, normal neuro-psychological development, normal functioning of all organs and systems, lack of functioning of all organs and systems, lack of disease, sufficient ability to adapt to unusual disease, sufficient ability to adapt to unusual environmental conditions, resistance to environmental conditions, resistance to adverse influences.adverse influences.

The healthThe health children investigated by the major criteria to children investigated by the major criteria to

be determined during each routine inspection be determined during each routine inspection decreed age groups.decreed age groups.

Taken into account the following features:Taken into account the following features: 1. Deviations in the ante-, intra-, early 1. Deviations in the ante-, intra-, early

postnatal periods.postnatal periods. 2. Level and harmony of physical and 2. Level and harmony of physical and

neuropsychological development.neuropsychological development. 3. Functional status of major systems3. Functional status of major systems of of

organs.organs. 4. Resistance and reactivity.4. Resistance and reactivity. 5. The presence or absence of chronic 5. The presence or absence of chronic

disorders (including congenital).disorders (including congenital).

Assessment of Assessment of physical developmentphysical development is an important prognostic indicator of health. is an important prognostic indicator of health.

This assessment allows you to select groups This assessment allows you to select groups that are in a state of risk, and this in turn is that are in a state of risk, and this in turn is important for the diagnosis and prevention of important for the diagnosis and prevention of disease.disease.

Often low physical development believes the Often low physical development believes the main cause of disease.main cause of disease.

In turn, chronic disease causes deterioration In turn, chronic disease causes deterioration of physical development.of physical development.

Physical development – is a natural process of Physical development – is a natural process of gradual formation and changes in the forms gradual formation and changes in the forms and functions. On the other hand – it is the and functions. On the other hand – it is the degree of maturation at each life segment.degree of maturation at each life segment.

Two aspects:Two aspects:

Quantity (growth)Quantity (growth) Quality (development)Quality (development)

GrowthGrowth

It is a measure of physical It is a measure of physical development and maturation. development and maturation.

It signifies an increase in size of It signifies an increase in size of the body and its various organs. the body and its various organs. Thus, it can be measured in terms Thus, it can be measured in terms of centimeters and kilograms.of centimeters and kilograms.

DevelopmentDevelopment

It is a measure of functional or It is a measure of functional or physiological maturation. physiological maturation.

It signifies accomplishment of mental It signifies accomplishment of mental (acquisition of skills etc.), emotional (acquisition of skills etc.), emotional (development of attidudes etc.) and (development of attidudes etc.) and social (adaptation to family and social (adaptation to family and society etc.) abilities.society etc.) abilities.

Unlike growth, it is rather difficult to Unlike growth, it is rather difficult to assess development.assess development.

MaturationMaturation

It literally means to ripenIt literally means to ripen It is described as aging or as an It is described as aging or as an

increase in competence and increase in competence and adaptability. It is usually used to adaptability. It is usually used to describe a qualitative change, that is, describe a qualitative change, that is, a change in the complexity of a a change in the complexity of a structure that makes it possible for structure that makes it possible for that structure to begin functioning or that structure to begin functioning or to function at a higher level.to function at a higher level.

Physical developmentPhysical development

is a dynamical process of growth is a dynamical process of growth and biological maturation of a and biological maturation of a child usually referred to as a unit, child usually referred to as a unit, express the sum of the numerous express the sum of the numerous changes that take place during changes that take place during the different periods of childhood.the different periods of childhood.

Factors Influencing Factors Influencing Growth and Growth and DevelopmentDevelopment1.1. GeneticGenetic

2.2. NutritionalNutritional

3.3. Socioeconomic Socioeconomic

4.4. Environmental and seasonalEnvironmental and seasonal

5.5. Chronic diseasesChronic diseases

6.6. Growth potentialsGrowth potentials

7.7. Prenatal and intrauterinePrenatal and intrauterine

8.8. Emotional Emotional

The main criteria for The main criteria for assessmentassessmentof physical development of physical development (growth)(growth) weight;weight; height (stature, head-to-heel height (stature, head-to-heel

length);length); head circumference (HC);head circumference (HC); chest circumference;chest circumference; proportionality of these proportionality of these

measurements.measurements.

Measurements of a Measurements of a newborn childnewborn child At birth weight is more variable than At birth weight is more variable than

height and to a greater extent is a height and to a greater extent is a reflection of the intrauterine reflection of the intrauterine environment. environment.

The average newborn weighs The average newborn weighs 32003200 to to 34003400 g (7 to 7.5 pounds). g (7 to 7.5 pounds).

Admissible limits of the norm range Admissible limits of the norm range from 2700 to 4000 g. from 2700 to 4000 g.

Babies, whose birth weight equals Babies, whose birth weight equals more than 4000 g, are called huge.more than 4000 g, are called huge.

General Trends in Weight General Trends in Weight Gain During InfancyGain During Infancy

AgeAge

(months)(months)

Weight gain (grams)Weight gain (grams)

MonthlyMonthly For the whole For the whole periodperiod

11 600600 60060022 800800 1400140033 800800 2200220044 750750 2950295055 700700 3650365066 650650 43004300

AgeAge

(months)(months)

Weight gain (grams)Weight gain (grams)

MonthlyMonthly For the whole For the whole periodperiod

77 600600 4900490088 550550 5450545099 500500 59505950

1010 450450 640064001111 400400 680068001212 350350 71507150

Body length of a Body length of a newborn childnewborn child Birth length is influenced Birth length is influenced

considerably by the prenatal considerably by the prenatal environment and gestation age. It environment and gestation age. It is of great value as a sign of is of great value as a sign of maturity of newborn organism. maturity of newborn organism.

Its normal rate in neonate is Its normal rate in neonate is 50 to 50 to 5252 cm. cm.

Admissible limits of the norm Admissible limits of the norm range from 46 to 56 cm.range from 46 to 56 cm.

General Trends in Height General Trends in Height Gain During InfancyGain During Infancy

AgeAge

(months)(months)

Height gain (grams)Height gain (grams)

MonthlyMonthly For the whole For the whole periodperiod

11 33 3322 33 6633 33 9944 2.52.5 11.511.555 2.52.5 141466 2.52.5 16.516.5

AgeAge

(months)(months)

Height gain (grams)Height gain (grams)

MonthlyMonthly For the whole For the whole periodperiod

77 22 18.518.588 22 20.520.599 22 22.522.5

1010 1-1.51-1.5 23.5-2423.5-241111 1-1.51-1.5 24.5-2524.5-251212 1-1.51-1.5 25.5-2725.5-27

General Trends in Weight General Trends in Weight and Height Gain During and Height Gain During ChildhoodChildhood

AgeAge WeightWeight HeightHeight

Toddlers (1-4 years) Toddlers (1-4 years) Birth weight Birth weight quadruples by age quadruples by age 2.5 years 2.5 years Yearly gain: 2 kgYearly gain: 2 kg

Height at age 2 is Height at age 2 is approximately 50 % approximately 50 % of eventual adult of eventual adult height Yearly gain: height Yearly gain: 8 cm8 cm

Preschoolers (4-6 Preschoolers (4-6 years) years)

Yearly gain: 2 kg Yearly gain: 2 kg Birth length doubles Birth length doubles by age 4 Yearly by age 4 Yearly gain: 6 cmgain: 6 cm

School-age children School-age children 10 years old child 10 years old child weighs in average weighs in average 30 kg30 kg Yearly gain: 2 kgYearly gain: 2 kg

Yearly gain: 6 cm Yearly gain: 6 cm Birth length triples Birth length triples by about by about age 13age 13

Pubertal growth spurtPubertal growth spurt Females - 10-14 Females - 10-14 years years

Yearly gain: 4 Yearly gain: 4 kg kg

Height gain: 16 Height gain: 16 cm cm

Males - 11-16 Males - 11-16 years years

Yearly gain: 4 Yearly gain: 4 kg kg

Height gain: 20 Height gain: 20 cm cm

Empirical Empirical formulas:formulas:

2 -10 years: 2 -10 years: W=10+2n; W=10+2n; 10-16 years: 10-16 years: W=30+4(n-10), W=30+4(n-10), or or W=2n+8 (kg),W=2n+8 (kg),where n - age of where n - age of child in yearschild in years

1-4 years: 1-4 years: H=100-8(4-n); H=100-8(4-n); 5-15 years: 5-15 years: H= 100+6(n-4), H= 100+6(n-4), or or H=6n+80 (cm),H=6n+80 (cm),where n - age of where n - age of child in yearschild in years

Head circumference.Head circumference.Head circumference at birth is Head circumference at birth is equal 34 to 36 cm.equal 34 to 36 cm.

AgeAge HCHC

InfantsInfants Birth-6 monthsBirth-6 months

6-12 months6-12 months

Monthly Monthly gain: 1.5 cmgain: 1.5 cm

Monthly Monthly gain: 0.5 cmgain: 0.5 cm

ChildreChildrenn

1-5 years1-5 years

6-15 years6-15 years

Yearly gain: Yearly gain:

1 cm1 cm

Yearly gain: Yearly gain: 0.6 cm0.6 cm

Chest circumference.Chest circumference.ChestChest circumference at birth is circumference at birth is equal 32 to 34 cm.equal 32 to 34 cm.

AgeAge Chest Chest circumferencecircumference

InfantsInfants Birth-6 monthsBirth-6 months

6-12 months6-12 months

Monthly Monthly gain: 2 cmgain: 2 cm

Monthly Monthly gain: 0.5 cmgain: 0.5 cm

ChildreChildrenn

1 - 10 years1 - 10 years

11-15 years11-15 years

Yearly gain: Yearly gain: 1.5 cm1.5 cm

Yearly gain: Yearly gain:

3 cm3 cm

It is necessary to It is necessary to compare head compare head circumference and chest circumference and chest circumference.circumference. At birth HC exceeds chest At birth HC exceeds chest

circumference by 2 to 3 cm. circumference by 2 to 3 cm. At age 4 months HC equals chest At age 4 months HC equals chest

circumference. circumference. Later, the rate of chest circumference Later, the rate of chest circumference

increases rapidly, at the same time HC increases rapidly, at the same time HC continues to grow at a slower rate. So, continues to grow at a slower rate. So, during childhood chest circumference during childhood chest circumference exceeds HC by about 1 to 7 cm.exceeds HC by about 1 to 7 cm.

Methods of assessment of Methods of assessment of physical development of the physical development of the childchild Anthropometrical indexesAnthropometrical indexes Percentile tables Percentile tables Standard growth chartsStandard growth charts Standard deviationStandard deviation

The growth chart is primarily The growth chart is primarily meant for the mother, to visualize meant for the mother, to visualize and motivate concern for healthy and motivate concern for healthy growth in her child.growth in her child.

Body RatiosBody Ratios

They can be established by the They can be established by the mean of different indexes:mean of different indexes:– The index of fatness by Chulitska The index of fatness by Chulitska – The index by ErismannThe index by Erismann– Weight-for-height indexWeight-for-height index– Height-for-age index Height-for-age index – Stem stature indexStem stature index– Span Span

Major deviations of Major deviations of physical development physical development (growth)(growth) HypotrophyHypotrophy ParatrophyParatrophy ObesityObesity Nanism (dwarfism) Nanism (dwarfism) GigantismGigantism

There are three phases There are three phases of the process of physical of the process of physical development:development:

- Increase of its level (to 25 yr.)- Increase of its level (to 25 yr.) - Relative stabilization (up to - Relative stabilization (up to

60yr).60yr). - The gradual decline of physical - The gradual decline of physical

abilities.abilities.

LLevel of physical fitnessevel of physical fitness. . Significant levels of correlation Significant levels of correlation

indicators of physical health of children indicators of physical health of children and adolescents with the results of and adolescents with the results of motor tests that characterize the motor tests that characterize the strength (wrist and is), speed, strength (wrist and is), speed, endurance and overall speed-power endurance and overall speed-power capabilities).capabilities).

This fact can be used for improving This fact can be used for improving children's health by acting on some children's health by acting on some components of physical fitness by components of physical fitness by means of physical educationmeans of physical education. .

Degree of resistance Degree of resistance to adverse factorsto adverse factors

are determined by the number and duration of child acute are determined by the number and duration of child acute illnesses (chronic or relapse) per year.illnesses (chronic or relapse) per year.

Acute viral respiratory illness (ARI) is the most common Acute viral respiratory illness (ARI) is the most common among preschool and primary school age. Acute childhood among preschool and primary school age. Acute childhood infections (chickenpox, measles, mumps, etc.), acute infections (chickenpox, measles, mumps, etc.), acute gastro-intestinal diseases, allergic reactions occupy a large gastro-intestinal diseases, allergic reactions occupy a large share in the structure of infant morbidity.share in the structure of infant morbidity.

According to statistics, among children the most common According to statistics, among children the most common diseases are respiratory diseases (50%) and systematic diseases are respiratory diseases (50%) and systematic GRVZ (90%), indicating a decrease in resistance to GRVZ (90%), indicating a decrease in resistance to unfavorable factors of environment.unfavorable factors of environment.

By number of migrated acute illnesses per year children are By number of migrated acute illnesses per year children are divided into three groups:divided into three groups:

1 - those who has never suffered;1 - those who has never suffered; 2 - those who hurts occasionally (1-3p. During the year);2 - those who hurts occasionally (1-3p. During the year); 3 - those who was sick often (4r. and more).3 - those who was sick often (4r. and more). Lack of acute illness during the year means a good body Lack of acute illness during the year means a good body

resistance of child.resistance of child.

Presence or absence of Presence or absence of chronic diseaseschronic diseases..According to the Ministry of Health According to the Ministry of Health

about 90% of school-age children about 90% of school-age children are with deviations in health are with deviations in health status. Over the past 5 years status. Over the past 5 years amount of children who belongs amount of children who belongs to a special medical group to a special medical group increased by 41% .increased by 41% .

Comprehensive Assessment allows you to create groups that brings Comprehensive Assessment allows you to create groups that brings together children with similar health conditions, taking into account together children with similar health conditions, taking into account all the above parameters.all the above parameters.

I groupI group - healthy children with normal functional parameters of all - healthy children with normal functional parameters of all systems that rarely get sick (up to 3 times a year) with normal systems that rarely get sick (up to 3 times a year) with normal physical and psychological development, with no significant physical and psychological development, with no significant deviations in history.deviations in history.

Group IIGroup II - risk group: - risk group: Subgroup A -Subgroup A - Children with risk factors according to biological and Children with risk factors according to biological and

social history;social history; Subgroup BSubgroup B - Children with functional abnormalities, with initial - Children with functional abnormalities, with initial

changes in the physical and psychological development, which often changes in the physical and psychological development, which often sick, but do not have chronic diseases.sick, but do not have chronic diseases.

III, IV and V groupIII, IV and V group - children with chronic illnesses: - children with chronic illnesses: Group IIIGroup III - state compensation: rare exacerbation of chronic - state compensation: rare exacerbation of chronic

diseases, rare acute disease, normal levels of body functions;diseases, rare acute disease, normal levels of body functions; Group IVGroup IV - subcompensated state: observed frequently (3-4 times - subcompensated state: observed frequently (3-4 times

per year) of chronic diseases, frequent acute diseases (4 times a per year) of chronic diseases, frequent acute diseases (4 times a year or more, worsening functional status of various systems of the year or more, worsening functional status of various systems of the body;body;

V groupV group - the state of decompensation: significant functional - the state of decompensation: significant functional abnormalities (abnormal body, frequent severe exacerbation of abnormalities (abnormal body, frequent severe exacerbation of chronic diseases, frequent acute diseases, the level of physical and chronic diseases, frequent acute diseases, the level of physical and neuropsychological development of age-appropriate or behind it).neuropsychological development of age-appropriate or behind it).

Distribution of children by group Distribution of children by group health can identify people with risk health can identify people with risk factors for the development of factors for the development of pathological changes, children with pathological changes, children with early forms of diseases and early forms of diseases and functional disabilities and to develop functional disabilities and to develop a set of measures to protect and a set of measures to protect and enhance their health and prevent enhance their health and prevent chronic diseases.chronic diseases.

Comprehensive assessment of Comprehensive assessment of the health of the child is the health of the child is carried out during the initial carried out during the initial visit to the child after visit to the child after discharge from the hospital to discharge from the hospital to get an idea about the original get an idea about the original level of health.level of health.

Further assessment of the Further assessment of the health status of children of the health status of children of the 1st and 2nd years of life is 1st and 2nd years of life is conducted quarterly and of 3-conducted quarterly and of 3-year old children - at the end year old children - at the end of each semester.of each semester.

When there are multiple When there are multiple diagnoses the health group is diagnoses the health group is set by the underlying disease. set by the underlying disease.

In the process of monitoring In the process of monitoring the child care group may vary the child care group may vary depending on the dynamics of depending on the dynamics of the level of health.the level of health.

First, it applies to children and adolescents First, it applies to children and adolescents who belongs to the second group of health: who belongs to the second group of health: namelynamely

Children - convalescents;Children - convalescents; children who frequently and chronically ill;children who frequently and chronically ill; Children with a total delay and disharmony of Children with a total delay and disharmony of

physical development both by excess body physical development both by excess body weight, and due to its deficit without weight, and due to its deficit without endocrine disease;endocrine disease;

children with disorders of posture, flat feet;children with disorders of posture, flat feet; with functional side shifts the cardiovascular with functional side shifts the cardiovascular

system;system; myopia,myopia, caries,caries, hypertrophy of the tonsils II degree,hypertrophy of the tonsils II degree, allergic reactions, increased thyroid levels I allergic reactions, increased thyroid levels I

and II,and II, asthenic syndrome, etc.).asthenic syndrome, etc.).

Children and health group should be Children and health group should be observed in conventional terms established observed in conventional terms established for preventive checkups healthy. They carry for preventive checkups healthy. They carry out preventive, educational and general out preventive, educational and general health measures.health measures.

Kids of II group health deserve more Kids of II group health deserve more attention of pediatricians because attention of pediatricians because preventive and therapeutic measures can preventive and therapeutic measures can facilitate the transition of children from this facilitate the transition of children from this group to the first group. Children of this group to the first group. Children of this group are observed and healthied according group are observed and healthied according to the individual plan, which is subject to the to the individual plan, which is subject to the risk of developing chronic diseases, severity risk of developing chronic diseases, severity of functional abnormalities and the degree of functional abnormalities and the degree of resistance.of resistance.

Children of III, IV and V groups are under the Children of III, IV and V groups are under the supervision of pediatricians and specialists supervision of pediatricians and specialists according to the "Methodical according to the "Methodical recommendations for the clinical recommendations for the clinical examination of the children" and should examination of the children" and should receive the necessary treatment depending receive the necessary treatment depending on the presence of a disease.on the presence of a disease.

Features screening of Features screening of children of all ageschildren of all ages

During examination of the child you During examination of the child you must remember three things:must remember three things:

- To find contact with the child and child - To find contact with the child and child parents;parents;

- To ensure the optimal lighting - To ensure the optimal lighting conditions and temperature;conditions and temperature;

- To provide a comfortable position for - To provide a comfortable position for the doctor and his personal protection the doctor and his personal protection from possible infectionfrom possible infection

The basic method of prevention in The basic method of prevention in pediatrics - clinical examination of pediatrics - clinical examination of

healthy children.healthy children.

By 1997, pediatricians observed children By 1997, pediatricians observed children from birth to 15 years old, and now - to from birth to 15 years old, and now - to 18-year-old.18-year-old.

During the clinical examination a During the clinical examination a comprehensive assessment with health comprehensive assessment with health group definition is carried out .group definition is carried out .

According to determined health group According to determined health group the extent and nature of health and the extent and nature of health and therapeutic interventions for children therapeutic interventions for children with diagnosed disorders or with diagnosed disorders or predisposition to it are determined. predisposition to it are determined.

In modern conditions, clinical In modern conditions, clinical examination is the basic form of the examination is the basic form of the children's clinics.children's clinics.

Clinical examination is carried out as per Clinical examination is carried out as per age, as depending on the illness of a age, as depending on the illness of a child.child.

Clinical observation district Clinical observation district pediatrician subject such pediatrician subject such contingents pediatric population:contingents pediatric population:

- All children in the neonatal period;- All children in the neonatal period; - Children 1 year of life;- Children 1 year of life; - Children belonging to vulnerable - Children belonging to vulnerable

groups;groups; - Children older than 1-year-olds - Children older than 1-year-olds

who do not attend preschool who do not attend preschool institutions;institutions;

- Children with chronic illness.- Children with chronic illness.

Clinical pediatric Clinical pediatric population includes population includes measuresmeasures 1) regular medical checkups with holding fixed 1) regular medical checkups with holding fixed

amount of laboratory and instrumental studies;amount of laboratory and instrumental studies; 2) identification and evaluation of health to 2) identification and evaluation of health to

identify children with risk factors;identify children with risk factors; 3) additional examination of sick children who 3) additional examination of sick children who

need it, using all modern methods of diagnosis;need it, using all modern methods of diagnosis; 4) detection of diseases at an early stage to be 4) detection of diseases at an early stage to be

followed by complex necessary therapeutic followed by complex necessary therapeutic measures and dynamic monitoring the health of measures and dynamic monitoring the health of children.children.

The district pediatrician is The district pediatrician is responsible for conducting all responsible for conducting all phases of clinical examination of phases of clinical examination of the child population in his district the child population in his district and oversees its implementation.and oversees its implementation.

Thank you for Thank you for attention!attention!