Notes on preventive pediatrics

Mrs. Babitha K Devu
Assistant Professor

• Definition
• Types
• Components

• Child health depends upon preventive care.
Majority of the child health problems are
preventable. Preventive pediatrics is a
specialized area of child health comprises
efforts to avert rather than cure disease and
disabilities.

• Preventive pediatrics is defined as the
prevention of disease and promotion of
physical, mental and social wellbeing of
children with the aim of attaining a positive
health.
• Pediatrics is largely preventive in its
objectives.

• It has been broadly divided into –
–Antenatal preventive pediatrics
–Postnatal preventive pediatrics
–Social pediatrics

–Antenatal preventive pediatrics
It includes care of antenatal mothers with
 Adequate nutrition
 prevention of communicable diseases
 preparation for delivery and breast feeding
Mother craft training

– Postnatal preventive pediatrics
Promotion of breast feeding
Introduction of complementary
Feeding in appropriate age
Immunization
Prevention of accidents
Growth monitoring periodic health check up

–Social pediatrics
 It is defined as the application of
principles of social medicine to pediatrics
to obtain a more complete
understanding of the problems of
children in order to prevent and treat
disease and promote adequate growth &
development, through an organized
health structure.

Family Health
MCH
RCH
BFHI
ICDS
National Health
Mission
Under five’s clinic
School health service
IMNCI
Child labor
Street children
Gender Bias
Female feticide
CAN
NHP for children

– means the overall health of
the individual family members. It is
influenced by the inter-relationship and
interdependence of the physical and mental
health status of the individual members of
the family. It is determined by the effective
functioning of the family as biological and
cultural unit.

Aims of Family Health Services:
•Reduction of maternal, infant & child
mortality and morbidity rates
•Improve family planning practices
•Nutritional status improvement
•Increasing health awareness through health
education in all aspects of health care

– refers to the
health of mothers, infants, children, and
adolescents. It also refers to a profession
within public health committed to
promoting the health status and future
challenges of this vulnerable population.

Reduction in the maternal, perinatal,
infant and child mortality and morbidity
Promotion of reproductive health
Promotion of physical and psychological
development of child and adolescents
within the family

The Reproductive and Child Health (RCH)
Programme was launched in October 1997
by government of India as per the
recommendations of International
conference on population development at
Cairo in 1994. The main aim of the programme
is to reduce infant, child and maternal
mortality rates.

RCH Phase II began from 1 April 2005. The components being:
– Essential obstetrical care
– Emergency obstetrical care
– Strengthening referral system Strengthening project
management
– Strengthening infrastructure
– Capacity building
– Improving referral system
– Strengthening MIS
– Innovative schemes

Notes on preventive pediatrics

Integrated Child Development Services (ICDS) is a
government programme in India (Ministry of Social
& Women’s Welfare) which provides
food, preschool education, primary healthcare,
immunization, health check-up and referral services
to children under 6 years of age and their mothers.
The scheme was launched in 1975, discontinued in
1978 by the government of Morarji Desai, and then
relaunched by the Tenth Five Year Plan.

The beneficiaries under the Scheme are children in
the age group of 0-6 years, pregnant women and
lactating mothers.
Objectives of the Scheme are:
• to improve the nutritional and health status of
children in the age-group 0-6 years;
• to lay the foundation for proper psychological,
physical and social development of the child;

Objectives of the Scheme are:
• to reduce the incidence of mortality, morbidity,
malnutrition and school dropout;
• to achieve effective co-ordination of policy and
implementation amongst the various departments
to promote child development; and
• to enhance the capability of the mother to look
after the normal health and nutritional needs of
the child through proper nutrition and health
education.

Services under ICDS - The ICDS Scheme offers a
package of six services, viz.
Supplementary Nutrition
Pre-school non-formal education
Nutrition & health education
Immunization
Health check-up and
Referral services

Revised Nutritional Norms in ICDS (since February, 2009)
Beneficiaries Calories Protein (g)
Children
(6 months to 72 months)
500 12-15
Severely malnourished
Children (SAM)
(6 months- 72 months)
800 20-25
Pregnant women and
lactating mothers
600 18-20

The National Health Mission (NHM) was launched
by the government of India in 2013 subsuming
the National Rural Health Mission and National
Urban Health Mission. It was further extended in
March 2018, to continue until March 2020. The
National Health Mission (NHM) envisages
achievement of universal access to equitable,
affordable & quality health care services that are
accountable and responsive to people's needs.

The main programmatic components include
• Health System Strengthening in rural and
urban areas
• Reproductive-Maternal- Neonatal-Child and
Adolescent Health (RMNCH+A)
• Communicable and Non-Communicable
Diseases.

The concept of under-five’s clinic is derived from
the Well Baby clinic of the West, for
comprehensive health care of children below
five years of age. This clinic provides preventive
services along with health supervision,
treatment, nutritional surveillance and health
education.

Care
In
Illness
Immunization
Adequate
Nutrition
Family
Planning

Service provided in India:
70%-80% of illnesses can be
treated with trained nurses. They care are –
a. Diagnosis and treatment of acute illness,
chronic illnesses and disorders of growth and
development.
b. X ray and laboratory services
c. Referral services

It is vital for G & D of
children. The health worker should ensure about
adequate breastfeeding, weaning and balanced
diet of the under-five.
a. Growth monitoring & plotting on ‘Road to Health
Card’ for early detection of growth failure.
b. Health checkups done every 3 to 6 months by
physical examination & appropriate lab test.
c. Maintain ‘child health card’ to identify ’at risk’
child.
d. Food supplementation through ICDS Projects.

Immunization to prevent
six killer diseases as per national
immunization schedule is recommended.
The health worker should motivate &
promote the immunization acceptance to
prevent morbidity, mortality and disability
hazards by six killer diseases.

The mother attending
this clinic receive counseling with different
aspects of family planning practices,
which is a significant concern for the
health and well-being of the child.

It is an essential and
compulsory activity of this clinic. The
mother should receive the information
regarding preventive measures against
malnutrition, ARI, diarrhea, TB, worm
infestations etc.

In 1960 the Ministry of Health, Government
of India, set up a School Health Committee
under the chairmanship of Smt. Renuka Ray,
the then member of parliament to assess the
standard of Health and Nutrition of school
children and also to suggest ways and means
of improving these. As per the
recommendation of the committee, the
School health program was initiated in 1962.

OBJECTIVES
1. The promotion of positive health.
2. The prevention of diseases.
3. Early diagnosis, treatment and follow up of
defects.
4. Awakening health consciousness in
children.
5. The provision of healthful environment

ASPECTS OF SCHOOL HEALTH SERVICE
1. Health appraisal of school children and
school personnel

2. Remedial measures & follow-up
3. Prevention of communicable diseases

4. Healthful school environment

5. Nutritional services

6. First aid & Emergency care

7. Mental Health

8. Dental Health

9. Eye Health

10. Health Education

11. Education of Handicapped Children

12. School Health Records

WHO & UNICEF have developed a new strategy
for management of common childhood
illnesses, in an integrated manner, which are
responsible for main causes of morbidity and
mortality among children. The overall objective
is to reduce under-five mortality and morbidity
in the developing countries by improving
performances of health workers.

The remarkable components of this strategy are:
1. Improvement of case management skills of
health care providers
2. Provision of essential drugs supplies
3. Optimization of family & community practices
in relation to child health, mainly care-
seeking behaviour.

- refers to the exploitation of
children through any form of work that
deprives children of their childhood, interferes
with their ability to attend regular school, and
is mentally, physically, socially or morally
harmful.
The term 'child labour', suggests ILO, is best defined as
work that deprives children of their childhood, their
potential and their dignity, and that is harmful to
physical and mental development.

As per the Child Labour (Prohibition and
Regulation) Act, 1986, amended in 2016
("CLPR Act"), a "Child" is defined as any
person below the age of 15, and the CLPR
Act prohibits employment of a Child in any
employment including as a domestic help.
It is a cognizable criminal offence to employ
a Child for any work.

UNICEF defines a street child as, "any girl or
boy for whom the street (in the widest sense
of the word, including unoccupied dwellings,
wasteland, etc.) has become his or her
habitual abode and/or source of livelihood;
and who is inadequately protected,
supervised, or directed by responsible adults".

The contributing factors responsible for this
social problem are poverty, rapid
urbanization, rural to urban or cross
country mobility, broken family, loss of
parents, natural or manmade disasters,
accidents, child abuse and neglect &
population explosion.

These children need support from government
and NGOs to overcome their problems & to
grow as an healthy individual. Free
educational facilities, provision of health &
welfare services, housing facilities, job
opportunities, promotion of adoption, and
rehabilitation services will be useful to reduce
the problem to some extent. They need
guidance & counseling facilities towards self
support & problem solving.

Or discrimination against females is more
prominent in India and in developing countries.
For the promotion of status of girl child, UNICEF
mentioned and emphasized on the long-lasting
effects of the unfolding of potentialities of
female child and empowerment of women.
Govt. of India and various NGOs also planned
several programs towards disappearance of
gender bias and promotion of health of female
child with equal opportunities as male child.

Female feticide is a challenging social problem
related to gender bias especially in India. As per
Census 2011, India has 48.53% female
population compare to 51.47% male
population. In rural area, there are 949 females
to 1000 men, while in urban area there are 929
females to 1000 males. Ultimately this problem
may disturb the total social structure and
cultural harmony.

There is a legal ban on sex determination
through Prenatal diagnostic technique Act
1994 came into force from January 1996.
But still public awareness and prevention of
female feticide are the most significant
approach to reduce this evil practice from
the society.

These important public health problems
include all types of abuse and neglect of a
child under the age of 18 by a parent,
caregiver, or another person in a custodial
role (such as clergy, a coach, a teacher)
that results in harm, potential for harm,
or threat of harm to a child.

There are four common types of abuse and neglect:
• Physical abuse (75%) is the intentional use of
physical force that can result in physical injury
Examples include hitting, kicking, shaking, burning,
or other shows of force against a child.
• Sexual abuse (20%) involves pressuring or forcing a
child to engage in sexual acts. It includes
behaviours such as fondling, penetration, and
exposing a child to other sexual act

• Emotional abuse refers to behaviours that
harm a child’s self-worth or emotional well-
being. Examples include name calling,
shaming, rejection, withholding love.
• Neglect is the failure to meet a child’s basic
physical and emotional needs. These needs
include housing, food, clothing, education,
and access to medical care, love & affection.

A combination of individual, relational, community,
and societal factors contribute to the risk of child
abuse and neglect.
Risk Factors for Victimization
 Individual Risk Factors
• Children younger than 4 years of age
• Special needs that may increase caregiver burden
(e.g., disabilities, mental health issues, and chronic
physical illnesses)

Risk Factors for Perpetration
Individual Risk Factors
• Parents’ lack of understanding of children’s
needs, child development and parenting skills
• Parental history of child abuse and or neglect
• Substance abuse and/or mental health issues
including depression in the family

 Individual Risk Factors
• Parental characteristics such as young age, low
education, single parenthood, large number of
dependent children, and low income
• Non-biological, transient caregivers in the home
(e.g., mother’s male partner)
• Parental thoughts and emotions that tend to
support or justify maltreatment behaviours

 Family Risk Factors
• Social isolation
• Family disorganization, dissolution, and violence,
including intimate partner violence
• Parenting stress, poor parent-child relationships,
and negative interactions

 Community Risk Factors
• Community violence
• Concentrated neighbourhood disadvantage (e.g.,
high poverty and residential instability, high
unemployment rates, and high density of alcohol
outlets), and poor social connections.

• Communicable diseases
– National AIDS control programme
– National Leprosy Eradication Programme
– Revised National Tuberculosis Control
Programme
– National Vector Borne Disease Control
Programme

• Intellectual Disability related schemes
–Sarva Shiksha Abhiyan
–Disability Equity Training Programme
etc.

• Janani Suraksha Yojana
– Janani Suraksha Yojana (JSY) is a safe
motherhood intervention under the
National Rural Health Mission (NHM). It is
being implemented with the objective of
reducing maternal and infant mortality by
promoting institutional delivery among
pregnant women.

• Janani Shishu Suraksha Karyakaram
– Government of India has launched the
Janani Shishu Suraksha Karyakaram (JSSK)
on 1st June, 2011. The scheme is to
benefit pregnant women who access
Government health facilities for their
delivery.

• Mission Indhradhanush - The mission
Indradhanush which aims to cover all
those children by 2020 who are either
unvaccinated, or are partially vaccinated
against seven vaccine preventable
diseases.

• Programmes for non communicable diseases
– National Cancer Control Programme
– National Mental Health Programme
– National programme for Control of Blindness
– National Programme for Prevention and Control
of Deafness etc..

• National Nutritional Programs
– Integrated Child Development Services Scheme
– Midday Meal Programme
– Special Nutrition Programme (SNP)
– National Nutritional Anaemia Prophylaxis
Programme
– National Iodine Deficiency Disorders Control
Programme

• Programs Related To System Strengthening /
Welfare
– National Rural Health Mission
– Reproductive and Child Health Programme
– National Water supply & Sanitation
Programme
– 20 Points Programme

Notes on preventive pediatrics

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