Child Care

Dr. Zeinab Saleh

Contents:
Child Health
1) Definition
2) Childhood stages
Neonatal care
1) Early neonatal care
2) late neonatal care
Infected newborn
Low Birth Weight
1) Preterm baby
2) Small-for-date baby
Development & growth
1) Factors affecting growth & development
2) Surveillance of growth & development
Pre-school Child (toddler)
Child Health Problems
Indicators of MCH Care
1) Still birth
2) Perinatal Mortality
3) Neonatal Mortality
4) Infant mortality
5) Child deaths
6) Under-5 mortality rate
Child Health
Is health of children in the age group 0-14 years

 Why we need to take care of children?

Childhood divided into three stages

Infancy (up to one year)
1- Neonatal period (first 28 days of life)
2- Post neonatal period( 28days- 1year)
Pre-school age (1-4)
School age (5-14)

Infancy
Nearly 40% of infant mortality occurs in the first
month of life

Neonatal Care
Early neonatal care: Most of neonatal deaths
occur during the first week of life, and the risk
increase during the first two days.
Objectives of early neonatal care:
Is helping the newborn to adopt the new external
environment by:
Maintenance of cardio-respiratory functions
Maintenance of body temperature
Avoidance of infection
Early detection and treatment of congenital and
acquired disease especially infections (like HSV,
Syphilis.
Establishment of satisfactory feeding regimen.
Infancy (flow chart of optimum care of the
newborn)
Immediate Neonatal Care
1) clearing Airway
2) Apgar score
3) Care of Cord
4) Care of the eyes
5) Care of the skin
6) Maintenance of body temperature
7) Brest feeding
Apgar score: Used to estimate physical condition
of the baby
Sign Score

0 1 2
Heart rate Absent Slow >100
(< 100)

Respiratory Absent Slow Good (crying)

effort (irregular)

Muscle Flaccid Some flexion Active

tone of extremities movements

Reflex No response Grimace cry

response

Color Blue ,pale Body pink, Completely pin

extremities
blue

Total score Sever Mild No

Depression Depression Depression

0-3 4-7 7-10

Neonatal Examination
1) First examination
2) Second examination
 Body size
 Body temperature
 Skin
Cardio-respiratory activities
Neuro-behavioral activities
 Head and face
Abdomen
Limbs and Joint
Spine
External Genitalia

Infected newborn
Contributing factors are:
Environmental
Course of pregnancy
Constitutional
1) Neonatal Tetanus
2) Congenital Syphilis
3) Newborn with HBV positive Mother
4) Newborn with HIV positive Mother

Measuring the baby

1) Birth weight
2) Length (Height)
3) Head Circumference
Neonatal Screening
Objective of screening:
1) Detect infants with treatable, genetic and
developmental disorders
2) Provide genetic counselling for parents

Phenylketonurea
Neonatal Hypothyrodism
Coomb’s test
Sickle cell
Congenital dislocation of hip
Identification of “at risk” infants
LBW
Twins
Birth order≥5
Artificial feeding
No weight gain during 3 successive months
Wight<70 percent of the expected weight gain

Late Neonatal Care: within the three

weeks of the first month of life.

Low Birth Weight is birth weight <2.5 kg

regardless of gestational age. It is due to
preterm or small for date.

Pre-term babies: Causes are

Multiple births
Acute infection
Hard physical work
Hypertensive disorders
 Prevention:
Good antenatal care (prenatal screening, treatment
of hypertension and infections)

Small-For -Date (SFD) Babies

Weight is less than 10th percentile for
gestational age. Causes are:
1) Maternal
2) Fetal
3) Placental

Importance of LBW
Prevention of LBW
 Direct intervention
• increase food intake
•Control infection
•Early diagnosis and treatment of medical disorders

 Indirect intervention
•Family planning
•Improve sanitation measures
•Avoid smoking
 Treatment of LBW

Intensive care
1) Incubatory care
2) Feeding
3) Prevention of infection
Causes of death for LBW
Pneumonia
Pulmonary hemorrhage
Intracranial hemorrhage secondary to anoxia
Atelectasis
Development and Growth
Growth is increase in body size; development is
increase in skills and functions.
Both applied to physical, intellectual, emotional
and social aspects of individual
Factors affect growth and development
Genetic factor
Nutrition
Age
Sex
Physical surrounding
Psychological factors
Infection (during and after pregnancy and
parasitosis
Economic factors
Other factors, like parent’s education, birth
ranking, birth spacing
Surveillance of growth and development
Is to detect children who are not grow normally
Physical growth
1- Weight-for-age
2- Height(length)-for-age
3- Weight-for-height
4- Head and chest circumference

http://www.who.int/childgrowth/en/
Behavioral development
Motor development
Personal-social development
Adaptive development
Language development

Pre-school Child (toddler)

 Child between 1-4 years of age.

Why we should focus on this age group?

Large number
Mortality
Morbidity
Growth and development
Accessibility
Prevention in childhood of health problems in
adult life like dental diseases, rheumatic heart
diseases, obesity, CVD, hypertension
Child Health Problems
Low birth weight
Malnutrition
Specific nutritional deficiencies
Protein-energy malnutrition
Micronutrient malnutrition
Infection and parasitic diseases
Accident and poisoning
Behavioral problems

Other factors affect children heath

Maternal Health
Family
Socio-economic status
Environment
Social support and health care
 Indicators of MCH Care

Mortality in Infancy and Childhood

 Foetal death: is death of foetus after 28 week of

gestation and before complete extraction from its
mother of a product of conception.

Stillbirth: is death of foetus

weighing1000g(correspond to28 week gestation)
occurring during one year in every 1000 total births
(live births +stillbirths)
Stillbirth rate

Fetal death weighing>1000g at birth

X1000
Total live+ stillbirth weighing> 1000g
Causes:
1) Preventable causes like, Infection during
pregnancy, high blood pressure, DM, Rh
incompatibility
2) Non-preventable causes like, multiple
pregnancies, placental anomalies, cord anomalies

Perinatal Mortality
Constitute 90% of fetal death
Two-third of it occurs with infants who are
<2500g birth weight
It associated with LSES, high(≥35) and low (<16)
maternal age, high parity (5 or more), heavy
smoking, multiple pregnancy, bad past obstetric
history, malnutrition.

Causes of death:
Intrauterine and birth asphyxia
Intrauterine or neonatal infection
LBW
Birth trauma

Perinatal Mortality rate(PMR) =
Late fetal death (28 week gestation and more) +early neonatal
death (first seven days)
x100
Total Live births in same area

Neonatal deaths, are deaths occurring during

neonatal period (start from birth until completed
28days after birth)
Directly related to BW and gestational age. Also to
the health of mother and the quality of the health
care she received.
It measures the intensity endogenous factors(like
LBW)
It linked to the quality of MCH services.
Causes

1) Early neonatal period (first week)

LBW and Prematurity
Congenital anomalies
Asphyxia
Birth injuries
2) Late neonatal period (0-3 weeks)
Infection (diarrhea, tetanus)

Neonatal Mortality rate=

No of deaths of children under 28daysofage in a year
x1000
Total live birth in the same area

Post-neonatal deaths are deaths that

occurring from 28 days of life to under one year.
 is dominant by exogenous factors
Causes
 Diarrhoea
respiratory infection
Malnutrition
Congenital anomalies (Developed countries)

Post-neonatal mortality rate=

No of death of children (between 28days and one year of age in
given year
X1000
Total live births in the same area

Infant Mortality rate (IMR)=

No of deaths of children less than one year
x1000
No of live births in the same area

Why it is important to measure IMR?

Indicator of health status of the community and
MCH services
Directly and quickly affected by health programs
than general death rate
 It reflects the deaths due to diseases that affect
infants than adults.
It reflects the socioeconomic status of the country

Causes
Neonatal mortality(0-4 weeks)
Post-neonatal mortality (4 weeks-1year)

Neonatal Mortality (0-4 Post-neonatal mortality (1-12 months)

weeks)
1. LBW and prematurity 1.Diarrhoeal diseases
2. Birth injury and difficult 2.Acute respiratory infections
labour 3.Other communicable disease
3. Sepsis 4.Malnutrition
4. Congenital malformation 5.Congenital malformation
5. Haemolytic disease of 6.Accident
newborn
6. Condition of placenta and
cord

7. Infection (diarrhea, acute

respiratory infections)
Factors affecting infant mortality
Biological factors
•Birth weight
•Age of mother
•Birth order
•Birth spacing
•Multiple births
•Family size
•High fertility
Economic factors
Cultural and social factors
•Breast feeding
•Religion
•Early marriages
•Sex of the child
•Quality of mothering
•Maternal education
•Quality of health care
•The indigenous dai
•Bad environmental sanitation
Prevention of IMR
Prenatal care and nutrition
Prevention of infections
Breast feeding
Growth monitoring
Family planning
Sanitation
Socio-economic development
Education

Child death rate, is the number of deaths of

children aged 1-4 years per 1000 children in same
area
Child death rate =
No of death among children aged 1-4 years during a year
X1000
No of children aged 1-4 years at the middle of the year

It reflects the social and environmental health

hazards (malnutrition, infections, accident)
more than IMR
 Causes different between developed and
developing countries

Developing Countries Developed Countries

1. Diarrhoeal diseases 1.Accident

2. Respiratory infection 2.Congenital malformation
3. Malnutrition 3.Malignant neoplasm
4. Infectious disease (measles, 4.Influenza
Whooping cough) 5.Pnumonia
5. Accident and injury
Under-5 mortality rate (Child mortality
rate) is the annual number of deaths of children
with age less than five years old.
Child Mortality rate =
No of deaths of children < 5 years of age in given year
x1000
No of live birth I same area

Neonatal mortality contribute40% of Under-5

mortality.
Causes
Neonatal causes(37%) like preterm births, birth
asphyxia and infections
Acute respiratory infection (19%)
Diarrhea (17%)

In 2012
Libyan neonatal mortality rate=9 per 1000 live births
Infant mortality rate (IMR)= 13.5 per 1000 live births
Under-5 mortality rate 16 per 1000 live births, and its
mainly due to injuries, prematurity, and congenital
anomalies