CHILD HEALTH CLINIC
Child health is a state of physical, mental, intellectual, social and emotional
well-being and not merely the absence of disease or infirmity.
Why children matter
•Children represent the future and ensuring their healthy growth and
development ought to be a prime concern of all societies.
•Newborns are particularly vulnerable and children are vulnerable to
malnutrition and infectious diseases, many of which can be effectively
prevented and treated.
Objectives in PHC
• Decreasing childhood death and infant mortality rate.
• Promote and protect health of child
• Nutritious diet to children
• Monitoring child growth and development
• Toward health level of children
Mortality rates
• Under-five mortality rate
• Infant mortality rate
• Neonatal mortality rate
Child health services
1. Newborn care & breastfeeding
2. Immunization
3. Monitoring growth and development
4. Personal hygiene
5. Early detection of health problems and treatment
Neonatal care
The first week of life is crucial period in infancy.
Objectives:
a.Establish and maintenance of cardio respiratory function
b.Maintenance of body temperature
c.Avoidance of infection
d.Establishment of breastfeeding
e.Early detection and treatment of any congenital disorder
Immediate care
1.Cleaning airway: to help and establish the airway and clear mucus
and other secretions
2.APGAR score: should be taken in 1 minute and again at 5 minutes
after birth.
APGAR SCRORE
Sign Score 0 Score 1 Score 2
A-Activity Absent Flexed limbs Active
P-Pulse Absent Slow (below 100 bpm) Over 100 bmp
G-Grimace No response (floppy) Minimal response to Prompt response to
stimulation stimulation
A-Appearance Pale blue Pink body; blue Pink
extremities
R-Respiration Absent Slow and irregular Vigorously crying
Total score=10 Severe depression (0-3) Mild depression (4-6) No depression (7-10)
• Care of the cord: the cord should be cut and tied when it has stopped
pulsation, care must be taken to prevent tetanus in newborns by
unsterilized instruments.
• Care of the eyes: Before the eyes are opened, the lid margins of the
newborn should be cleaned with sterile wet piece of soft cloth; one
for each eye from inner to outer side.
• Care of the skin: the first bath is given with soap and warm water to
remove vernix, meconium and blood clots, some time prefer to apply
oil before the bath.
• Maintenance of body temperature: the normal body temperature of
newborn is between (36.5◦C-37.5◦C). It is very important to quickly
dry the newborn immediately after birth and given to the mother for
skin-to-skin contact.
• Breastfeeding
• Neonatal examination
• Measuring the body height, weight, head and chest circumference
Breastfeeding
1. Encourage and facilitate early, frequent and extended skin-to-skin
care. Skin-to-skin care promotes the development and maturation
of infant feeding behaviors and enhances breast milk production.
2. Commence breast milk expression as soon as possible after birth
and at least within the first six hours, followed by frequent, regular
and effective breast milk expression to stimulate adequate breast
milk production.
3. Breast milk feeding for both preterm and unwell term infants has
major health benefits and assists recovery.
4. Initially, it is recommended to express at least eight times in 24
hours, with at least one expression over night.
• Simultaneous breast milk expression (double pumping) may enhance
milk production and saves time, therefore, it should be
recommended for any mother who will be expressing for longer than
a few days.
Growth and development
monitoring
• WHO estimates that 10% of the people in any country have some
type of impairment.
Development models
1. Development screening: This systematic process checks the
development of apparently normal children using tests, scales,
examinations, or other procedures to identify those who might be at
high risk of developmental problems.
2. Development monitoring: This series of activities includes the
promotion of normal development and the detection of developmental
problems as part of a flexible ongoing process within the primary child
health care context; it involves sharing reports and feedback from
health professionals, parents, teachers, and others.
3. Development assessment: children suspected of having
developmental problems undergo a series of detailed (usually
multidisciplinary) examinations, including diagnostic testing.
4. Development follow-up: This procedure involves close observation
of the child’s development on a periodic or ongoing basis, either
systematically or informally, with or without screening. It does not
imply the use of any specific technique or process.
Growth monitoring
A. Weight: Most widely used and simplest, reproducible
anthropometric measurements for the evaluation of nutritional
status.
Precautions to be taken while weighing
i. Zero error has to be adjusted
ii. Minimal clothing should be worn
iii. Most types of scales are sensitive.
Standard:
1.On an average, a baby weighs double the birth weight by five
months, treble his/her birth weight by one year and quadruples
his/her birth weight birth weight by two years.
2.A baby should gain at least 500g per month in the first three months
of life. If the growth is less than this, it points to malnutrition.
A. Height:
Height on an individual is influenced by genetic as well as
environmental factors.
Maximum growth potential is decided by genetic factors.
Nutrition and incidences of infection determine the extent of
exploitation of that genetic potential.
Inadequate dietary intake and/or infections reduce nutrients
available at the cellular level. This results in growth retardation. A
prolonged period of severe deprivation leads to stunting
Techniques for measurement
1. Children below two years are measured by using infantometer
2. Baby is made to lie on the scale and crown heel length is measured.
3. For children above two years and adults a vertical measurement
rod anthropometer is used and maximum height is measured.
4. Measuring scale should be capable of measuring to an accuracy of
0.1 cm
Standard:
1.Length of the baby at birth is 50 cm.
2.By first year, it increases by 50% (75 cm)
3.By third year end, it increases by 12 cm.
4.During puberty, growth spurt, boys add 20 cm to their height and
girls about 16 cm.
Growth monitoring
• Growth chart
• Head and chest circumference
• Body fat
• Mid upper arm circumference
• Behavioral development
Personal hygiene
• Oral hygiene
• Bathing ritual
• Hair care
• Foot hygiene
• Toileting hygiene
• Hand hygiene
• Coughing and sneezing hygiene
• Home hygiene
