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1. INTRODUCTION
2. OBJECTIVES
i. GENERAL: By the end of the class the students will have indepth
knowledge about “concept, aims, scope of preventive paediatrics,
maternal health and its influences on child health, antenatal aspects of
preventive paediatrics”
3.
ii. SPECIFIC: By the end of the class the students will be able to- a
a) state the aims, steps and types of preventive paediatrics
e) discuss the antenatal and post natal care of the mother and child
4. TERMINOLOGIES:
a) amniocentesis
b) chorion biopsy
c) fetoscopy
d) genetic counselling
e) mortality
f) morbidity
g) tetanus neonatorum
h) toxaemia
8. - Barker Hypothesis
SL. CONTENT
No.
9.
- Need for early prevention
10.
- Nurse as an integral part
-Social paediatrics
11.
12. -Maternal health and its influences on child health
- antenatal services
15. CONCLUSION
17. BIBLIOGRAPHY
INTRODUCTION
Child health depends upon preventive care. Majority of the child health
problems are preventable. Preventive paediatrics is a specialized area of child
health comprises efforts to avert rather than cure disease and disabilities.
TERMINOLOGIES:
DEFINITION:
Recent research indicates that most of the diseases in adults and elderly
have a fetal correlate. David J. Barker and his colleagues are involved in
identifying various risk factors during pregnancy and infancy, which predispose
the fetus or infant to disease in later life.
Barker suggested that fetal under nutrition operating in different
trimesters would have different effects on birth weight and subsequent
disease pattern.
-First trimester under nutrition: It may result into the birth of
symmetrical small babies with low birth weight at one year. These infants are
prone to hypertension and death from hemorrhagic stroke in their later life.
-Second trimester undernutrition: As a result of disturbed feto-placental
relationship causes a low ponderal index [weight (g)/length (cms)3 x 100] and a
normal weight at one year. As an adult these babies are prone to hypertension
and non-insulin dependent diabetes mellitus and have high mortality from
coronary artery disease.
-Third trimester undernutrition: On the other hand, results in
asymmetric growth retardation with spared brain growth and reduced weight
at one year. These infants are predisposed to hypertension, low LDL and
fibrinogen and an increased mortality rate associated with coronary heart
disease and thrombotic strokes.
NEED FOR EARLY PREVENTION
All these observations suggest that prevention should start even before
conception and continue during pregnancy. This will require attention to the
risk factors for low birth weight before pregnancy since nutritional
supplements during pregnancy are inadequate. Paediatrics as such is a
preventive medicine and disease in later life also rests on the paediatric nurse.
Preventive child health service should not be viewed as a one-time
measure but is a continuum including primary, secondary and tertiary
preventive efforts. This should lay equal emphasis on –
i. Finding disease incidence/prevalence by screening.
ii. Health promotion and prevention of these disease
iii. Patient management and subsequent follow-up.
SOCIAL PAEDIATRICS
- To meet the health needs of a child. Total health needs should be provided as-
-To ensure adequate physical, mental and social growth of the child.
Antenatal care-
The primary aim of antenatal care is to achieve healthy mother and baby at the
end of pregnancy.
Antenatal services:
➢ Physical examination-
This includes height, weight, blood pressure, head to toe examination to detect
any abnormality which might interfere with formal labour. Laboratory tests
should include: Blood for haemoglobin. Sugar urine and tests for abnormal
findings e.g., low haemoglobin, high sugar and albumin, etc. Measurement of
fundal height and foetal heart sound to check the growth of child.
➢ Radiological examination-
Ultrasounds can be done as per doctor’s prescription to identify any foetal
abnormalities and the exact condition of the foetus.
➢ Antenatal visits-
Ideally antenatal mother should visit the antenatal care clinic once a month
during first seven months, twice a month during the next two months and
once a week during the last month if everything is normal. At least three visits
during the antenatal care entire pregnancy period, should be aimed at the first
visit to 20 weeks, second visit at 32 weeks, third visit at 36 weeks.
➢ Antenatal advice (health education)
The antenatal advices are the most important aspect of antenatal care. Mother
should be educated about herself and her baby. Mothers must be educated on
the following aspects-
▪ Nutrition- The women during pregnancy must take one extra meal
everyday. The food should contain green leafy vegetables, pulses, fruits
and milk, eggs, cheese, etc.
▪ Reproduction cost energy- A pregnancy in total duration consumes about
60,000 kcal, extra than normal metabolic requirements. Lactation also
requires more than 500 kcal/day. Further, child survival is correlated with
birth survival and birth weight is correlated to the weight gain of the
mother during pregnancy by consuming extra calorie and nutrients. If
mother consumes less iron during pregnancy, leads to less storage, foetus
may receive insufficient iron store. Such baby may show normal
haemoglobin at birth, but may become severely anaemic later, due to lack
of iron in breast milk.
▪ Hygiene- personal hygiene is equally important during pregnancy. Mother
must take care to the cleanliness of the environment in which she lives, to
prevent various infections and diseases.
▪ Regular exercises- Mother is advised to have regular walking exercises. She
can perform light household work, though hard physical labour and lifting
of heavy weight is not advised, which may affect the foetal growth.
▪ Regular bowel movement- Avoid constipation, which may strain the
mother and cause piles. She must have regular bowel movement, by
regular intake of green leafy vegetables, milk, fruit and extra fruit.
Purgatives should be avoided during pregnancy.
▪ Rest and sleep- At least eight hours sleep at night and two hours rest and
relaxation after mid-day meal. If mother has been advised to bed rest, she
must follow the proper instruction to avoid complications, e.g., IUGR,
preterm delivery, bleeding and abortions, etc.
▪ Healthy lifestyle- She must develop healthy lifestyle and avoid smoking or
drinking alcohol, etc. heavy smoking may lead to abnormality among
foetus and placenta due to nicotine effect. Consumption of alcohol may
lead to spontaneous abortion, intrauterine growth retardation, fertility
problems among women and if children are born they may have various
physical and mental problems.
▪ Sexual relationship- Sexual intercourse should be restricted during
pregnancy especially during first and third trimester. If mother has bad
obstetrical history, then avoid sexual intercourse during normal pregnancy.
▪ Drugs- Certain drugs e.g., antibiotics, antipyretics, antitubercle,
corticosteroids taken during pregnancy may, especially first trimester
period, affect the foetal growth and cause foetal malformation.
Streptomycin may cause deafness in the foetus. Corticosteroid may impair
the foetal growth, tetracycline may affect the growth of bones and enamel
formation of teeth. During breastfeeding certain drugs taken may be
excreted in breast milk and may affect the newborn. Hence the drug must
be taken with great caution and under medical supervision.
▪ Radiation- Abdominal X-rays during pregnancy, may lead to congenital
malformation e.g., microcephaly, leukaemia and neoplastic anaemia. X-ray
during pregnancy should be carried out under definite indication,
otherwise it should be avoided as much as possible. Ultrasound radiations
appear to have no effect in pregnancy; this should also be restricted to
once or twice during pregnancy.
▪ Medication- The mother must be given vitamin, supplementation, calcium
and iron tablets regularly after the first trimester; under safe motherhood
programme, every pregnant woman must take 100 iron tablets during her
pregnancy.
▪ Immunization- All antenatal mothers must get two tetanus toxoid
immunization at the interval of at least one month period and if she is
immunized during first pregnancy a year ago, then she can take one dose
of tetanus toxoid at 5 months of pregnancy.
Prevention of health problems:
Though pregnancy is a natural physiological phenomenon, complications
do arise even with best antenatal care. It is therefore important to instruct
the mother to recognize the danger sign and report immediately if:
☻ Bleeding or discharge per vagina
☻ No foetal movement
☻ Swelling of the feet and face
☻ Blurring of vision
☻ Headache
☻ Any other unusual symptoms.
Prevention of health problems during pregnancy-
➢ Toxaemia of pregnancy
Hypertension and presence of albumin in the urine indicate toxaemia of
pregnancy. It is important to diagnose at early stage and treat the
patient.
➢ Anaemia
More than 60% pregnant women in India are anaemic due to low
sociogroup and lack of nutrition, more labour, multiple pregnancy,
neglected female child, etc. Anaemia may lead to premature delivery,
antepartum haemorrhage, postpartum haemorrhage, puerperal sepsis,
etc.
➢ Nutrition deficiency
The nutritional demand is more than the normal requirement during
pregnancy. Hence, intake of milk, vegetables, fruits and vitamin
supplementation, especially vitamins A and D, is important to prevent
nutritional deficiency.
Postnatal care:
Physical examination-
Postnatal examination should be done immediately after delivery, which
includes temperature, pulse, respiration, B.P., head to toe examination
of the mother, inspection for abdomen, cervix for any tear or bleeding,
involution of uterus bladder and bowel movement, breast examination,
etc. The mother is advised for follow up after discharge. Further visits
should be done once a month during first six months and once in 3
months till one year.
Nutrition-
Mother should eat more than her usual diet including milk, fruits,
vegetables, etc., she needs additional nutrition like vitamins and
minerals. She must take plenty of water so that she can regain her
normal health and breastfeed her infant.
Hygiene-
Mother and child must maintain proper hygiene to prevent infection and
feel fresh. The mother must take bath with soap and water and put on
clean and loose clothes.
Rest and exercise-
Postnatal mother should get enough rest and sleep. This helps to
maintain breast milk production. She must avoid straneous work for at
least six weeks and follow abstinence during postnatal period.
Prevent complications-
A number of complications may arise after delivery. Follow up is
important to identify any danger sign and get appropriate treatment.
Breast feeding-
Post natal care gives an excellent opportunity for the motherly touch to
the child, physically as well as psychologically by breastfeeding. It
provides the main source of nourishment in the first year of child’s life.
Timely and adequate breastfeeding is the best guaranteed aid of
ensuring that the newborn is not malnourished, and it also ensures that
the infant is not exposed to unnecessary and preventable infection.
Breast milk is the best food available and is tailor- made to suit the
child’s needs.
Child should be given breastfeed within half an hour of delivery.
Children delivered by caesarean, feeding should be put on the breast
within 4 to 6 hours or as soon as the mother’s condition is stabilized.
CONCLUSION:
BIBLIOGRAPHY: