Young child clinic

Young child clinic

Specific ObjectivesAt the end of the lecture you will be able to
1. Realize the importance of young child clinic in health promotion and prevention of childhood diseases. 2. List components of essential services provided by this clinic. 3. Draw under nutrition-disease cycle. 4. State objectives of growth assessment. 5.Describe the significance of growth assessment as an effective approach to the prevention of malnutrition

6.Use growth chart (weight for age) to explain the normal variations in weight of children. 7.Use growth chart as a tool helpful in assessing the rate of growth and detection of nutritionally at risk child. 8. Define and interpretate height for age and weight. 9.Define Body Mass Index (BMI). 10.Calculate BMI. 11.Realize the importance of BMI. 12.Identify children at high risk.

Child health care Young child clinic Preventive services are important for children Many causes of morbidity & mortality are avoidable e.g. different type of accidents, infectious disease namely the childhood targeted diseases.

Child health care

Existence of socio-economic difference. IMR in developed countries: e.g.UK <10/1000 Live Births. In developing countries : e.g. Afghanstan 125/1000 LB

Child health care

Children are exposed to variety of health hazard (infection +malnutrition) Children are more vulnerable due to the stress of growth & development


Child health care Child health care includes the following strategies instituted by WHO: Growth monitoring (assessment, surveillance) and ARI Control of diarrheal diseases Breast feeding Immunization Family planning Food supplementation Females education



weight loss growth faltering (flattening of growth line) growth lowering (direction of g. line is downward) mucosal damage (2)Inadequate DiseaseNutrition(1) *high incidence *more severe *longer duration * Loss of appetite (3) * Nutrient loss * Malabsorption *Altered metabolism (4) under nutrition –Disease Cycle

Child health care Growth monitoring (assessment, surveillance)
It is a process of sequential measurements of weight of children under the age of 5 years, in order to detect growth failure as early as possible and to correct this failure. This process should start soon after birth with the measurement of birth weight and height and recording on the growth chart.

Child growth assessment

Basic growth assessment involves measuring a child’s weight and length or height and comparing these measurements to growth standards. (WHO Standard)The purposes (objectives) are to determine whether : Child is growing “normally” or Has a growth problem (detection of growth failure) .

Child health care Careful growth assessment is best available tool of measuring the overall nutritional status & evaluate health of children under five & plan appropriate follow –up activities.

Surveillance of growth and development

Surveillance of growth and development


Child health care Growth assessment Weight-for-age Scale used in portable & relatively inexpensive. Weighing is relatively easy. Measure is not time consuming. It is sensitive.

Growth assessment Weight-for-age Child health care Growth assessment Weight-for-age  
Benefits To compare the measurement with standers. To examine trends and changes of growth. To interpret the progress of growth when the child age is unknown.

Weighing scale

Weighing scale

Weighing scale

Growth assessment Weight-for-age
Single record indicates child size at moment. It does not give any information about child's weight is increasing, stationary or declining.

Growth assessment Weight-for-age

Ideal weight measurement: Monthly during the1st year.. Every 2 months in 2nd year Every 3 months up to the end of the 5th years.

Growth assessment Weight-for-age

Minimum weight gain in 1st 3 months is 500 gm/ month Gaining weight less than 500gm means growth failure. Usually 1 Kg/month Double the birth weight by 5 months of age. Treble by end of 1st year of life. Quadruple by the age of two years.


Growth assessment Weight-for-age Facts Most growth failure is invisible. Most children with growth failure live in homes where there is no absolute shortage of sufficient food.

Height (length) –for- age Height should be taken in a standing position without foot wear. If the machine is not available, the measuring scale fixed to the wall can be employed It is suitable for children 2 years and above

Height (length) –for- age Length of baby at birth about 50 cm. Increasing by 25 cm during 1st years Increasing by 12 cm during 2nd years

Height (length) –for- age

Height (length) –for- age

Height (length) –for- age Low height for age (Nutritional Stunting, Dwarfing) It reflects past or chronic malnutrition.

Weight-for-height

Weight in relation to height is important than weight alone. It determines whether a child is within range of normal weight for his height

Weight-for-height chart

Low weight for height (acute malnutrition, wasting, emaciation)
It is associated with high mortality and morbidity rateA child who is less than 70% of the expected weight –for-height is classified as severely wasted.


Body mass index (BMI)
BMI is a number that associates a person’s weight with his or her height/length. BMI is calculated as follows: Weight in kg ч squared height/length in metersAnother way to show the formula is kg/m2. BMI is rounded to one decimal point.It is very important to use a length measurement for a child less than 2 years old and a height measurement for a child age 2 years or older

Sami’s height is 88.2 cm. weight is 11.5 kg•. The closest weight on the row for her height is 11.6 kg.• Tracing a finger upward from Sami’s weight, you find that her BMI is 15. 11.6
88
15


Motor development Personal- Social development Adaptive development Language development
Behavioral Development

Personal- Social development

Adaptive development
Language development
Motor development
Age
Looks at mother and smile
6-8 weeks
Holds head erect
3 months
Recognizes mother
Begins to reach out for objects
Listens
4-5 months
Enjoys hide and seek
Transfers object hand to hand
Experimenting with noise
Sites without support
6-8 months
Suspicious of strangers
Releases object
Increases rang of sounds
crawls
9-10 months
Says first word
Stands with support
10-11 months
Builds cubes
Walks wide base
12-14 months
Begins to explore
Joins words, begins to run
Walks narrow base
18-21 months
Dry by day
Uses short sentences
runs
24 months
Milestone Development When a child takes longer time to cross these milestone , the possibility of mentally handicap can not be overlooked

Identification of at risk children

Basic criteria include : Birth weight <2.5 kg Twins Birth order >= 5 Artificial feeding Failure to gain weight during succesive months Children with PEM, repeated attacks of diarrhea, and ARI Low socio-economic strata Illiterate mother

Summary of management of children nutritionally at risk Groups Steps taken At-risk children *regular attendance growth immunization R/ assessment * Special emphasis on feeding & giving supplements. Inadequate growth *Follow-up should be more on significant period frequent. i.e flattening of the *Attendance at a less Growth line clinic. *Home-visiting.


Continued poor growth * Admit to a nutrition early signs of rehabilitation centers. Malnutrition *Arrange daily attendance. Severe life-threatening *Admit to hospital. malnutrition.


Conclusion Under fives clinic is a part of MCH services it is intended to promote heath and wellbeing of the under fives through growth monitoring oral rehydration, immunization, breast feeding and family planning female education and food supplementation.