PREVENTIVE PAEDIATRICS

PREVENTIVE PAEDIATRICS

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:

1. Antenatal preventive pediatrics
2. Postnatal preventive pediatrics
3. Social pediatrics

1. 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

2. Postnatal preventive pediatrics:
• Promotion of breast feeding
• Introduction of complementary
• Feeding in appropriate age
• Immunization
• Prevention of accidents
• Growth monitoring
• Periodic health check up

3. 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.

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▪️Family Health MCH RCH BFHI ICDS National Health Mission:

• It 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

➖It 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

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▪️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 are:
– Essential obstetrical care
– Emergency obstetrical care
– Strengthening referral system
-- Strengthening project management
– Strengthening infrastructure
– Capacity building
– Improving referral system
– Strengthening MIS
– Innovative schemes

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▪️INTEGRATED CHILD DEVELOPMENT SERVICES:

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;
• 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;
• 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

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▪️THE NATIONAL HEALTH MISSION:

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.

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▪️CONCEPT OF UNDER FIVE'S CLINIC

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.

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▪️Care In Illness/Immunization/ Adequate Nutrition/ Family Planning:

Service provided in India: 70%-80% of illnesses can be treated with trained nurses.

They care:

a. Diagnosis and treatment of acute illness, chronic illnesses and disorders of growth and development.
b. X ray and laboratory services
c. Referral services

The health worker should ensure an 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 receives 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.

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▪️THE SCHOOL HEALTH PROGRAM 

n 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

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▪️WHO and UNICEF

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.

▪️CHILD LABOUR 

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 NGOs to overcome their problems & to grow as a healthy individuthe governmental.

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 children 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 children with equal opportunities as male children.

Female feticide is a challenging social problem related to gender bias especially in India. As per Census 2011, India has 48.53% female population compared to 51.47% male population. In rural areas, there are 949 females to 1000 men, while in urban areas 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 approaches to reduce this evil practice from 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 acts.

• 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.

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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

1. 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
• 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

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

3. 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.

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▪️COMMUNICABLE DISEASES

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

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▪️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

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PREVENTIVE PAEDIATRICS

Short Summary:

Preventive pediatrics aims at the prevention of disease in children rather than focusing on cure of disease

By preventing disease, the child can attain it’s genetic potential

There are 2 aspects of preventive pediatrics

1. antenatal

2. postnatal

Prevention of disease can be best achieved through primary healthcare activities such as:

1. growth monitoring

2. promotion of breast feeding

3. oral rehydration

4. community feeding

5. immunisation

6. nutritional surveillance

7. regular health checkups