THE WELL CHILD

MRS E.K MWANJELEKA

2020
 Objectives

Learning objectives
 At the end of this unit you should be

able to:
 Define key terms in growth and

development of a child
 Discuss growth and development

 Describe physical assessment of a child

 Explain monitoring the health of a child

 Discuss factors related to health promotion

DEFINITION OF TERMS

 Well child – is a child who is not sick

or born relatively with no physical and
mentally difficulties.
 Development: It refers to change or
growth that occurs in a child during the
life span from birth to adolescence.
This change occurs in an orderly
sequence, involving physical, cognitive,
and emotional development.
 Growth refers to an increase in
physical changes in the body size and
weight. It can be measured in cm,
inches or kgs.
 Neonate: This is a newborn (zero days)
up to 28 days or 1 month of life.
 Infant: This comprises neonatal period
up to twelve (12) months of life.
 Adolescence: This is the teenage
years between 13 and 19.

 Growth-refers to increase in physical

size whilst development refers to
progressive increase in skill and
capacity to function
GROWTH AND DEVELOPMENT
 Reasons why the nurse should
understand growth and
development
 The nurse must know what to expect
of a particular child at any given age
and what behavior is expected at a
certain age
 This knowledge is important for the
purpose of assessing each child in
terms of specific levels of
development
CONT`
 In order for the nurse to formulate a
plan for total care which the
physician and other team members
are outlined for the child. She must
know what to expect at different age
groups and must know the
developmental sequence which
occurs through out childhood and
adolescent
 It enables the nurse to understand reasons
for certain diseases and illnesses which
occur in various age groups
 It helps the nurse to teach the mothers
how to use such knowledge on their own
children in order to achieve optimal
development. The nurse should remember
that every child is an individual. Each child
has his/her own growth rate and so their
level of intelligence
PRINCIPLES OF GROWTH
 A traditional definition of growth is
limited to physical maturation but
should include functional maturation
 Growth is measured in quantitative and
qualitative over time
 Growth is a continuous and orderly
process e.g. infant is the most rapid
growth and during puberty growth
declines till death
 Different parts of the body grow at
different rates e.g. prenatally, the head
grows faster and during the first year
elongation of the trunk dominates
 Both the rate and pattern of growth can
be modified by nutrition.
CONT`
 There are critical periods of growth and
development such as brain growth
during uterine life and infancy
 Although there are specified sequences
for achieving (milestones), growth and
development each individual proceeds
at his/her own rate
CONT`

 Stages of growth and

development (Growth Period)
 Ovum – from conception to 2 weeks
 Zygote – from 2 weeks
 Embryo – up to 12 weeks intrauterine
life
 Fetus – up to birth
 Prenatal period – 0 – 40 weeks, during
the perinatal stage the zygote grows
 Neonate – 0 – 28 days after delivery
 Infancy – from 28 days to one year
 Toddler – from 1 year to 3 years
 Early childhood (preschool) – from 3 to
6 years
 Late childhood (school age) – from 6 to
12 years or puberty
 Adolescence – from puberty 13 yrs to
20 years
 Early adulthood – 15 – 21 years
 Late adulthood – 36 – 55 years
 Senescence – 56 and above
CONT`

 Factors that influence growth

and development
 Heredity – plays a major role in
growth and development in some
families. Height, weight and rate of
growth often more alike among
siblings
 Race – also plays a role in growth
and development as certain races
have distinguishing characteristics
e.g. height
 Nationality – individuals or people
from the same country have the same
physical characteristics e.g.
Scandinavian countries, African
countries
 Environment – the environment at
which the child has been brought up
affects the growth and development
 Sex – sex is determined at conception.
The male infant is both longer and
heavier than the female infant. Girls
mature earlier than boys and on
average are taller than boys. Boys
during the pre-puberty stage of growth
are taller than girls. Girls have earlier
eruption of the permanent teeth.
 Intrauterine devpt
 Nutritional deficiency in the mother,
infections and drugs used during
pregnancy have effects on the child. Eg
tetracycline may affect bone formation
 Intelligence
 Intelligence influences child’s motor,
social, mental devpt.
CONT`

 Pre-natal environmental factors

- Mothers nutrition – fetus will be
affected if the mother is not taking a
well balanced diet
- Excessive exposure to X-rays may
affect growth especially in the first
trimester
- Infection of the mother e.g. rubella
during the first trimester of pregnancy
may lead to abnormal and retarded
development of the fetus
- Social habits – excessive smoking and
alcohol intake will cause retardation
CONT`
 Mother – fetal reaction e.g. antibody
antigen reaction called erythroblastosis
foetalis were the baby will be born with
severe anemia
 Endocrine disorders e.g. DM which
can lead to mothers having large
babies
 Anoxia of both mother and child
due to dysfunction of the placenta. The
fetus will be receiving less nutrients for
growth and development
CONT`

 Post-natal environment factors –

these affect after birth of the baby
 Nutrition – the quality and quantity
should be enough for the child to
grow well.
 Geographical variation – children
living in urban areas tend to develop
faster than those in the rural areas.
 Season of the year – weight and
height gain is at maximum in the hot
season due to reduced rate of
metabolism and minimum in cold
season due to increased metabolism.
Keep child warm by giving extra feeds
during the cold season
 Social economical status of the
family – the amount of money the
parents have will determine the food
production. It also determines the type
of home, education and clothing etc.
 Illness of the child – chronic illnesses
will affect the child development and
growth e.g. diarrhea, TB as they may
affect eating habits of the child
CONT`

 Maternal illness – will affect growth

and development for they will be no
mother child bonding and the mother
won`t be producing enough milk if
breast feeding
 Some physical congenital
abnormalities e.g. cleft palate
affect eating pattern
 Some hemorrhagic disorders –
leukemia, SCD
 Cultural factors – certain beliefs
affect growth and development of a
child. Children are not allowed to eat
certain foods e.g. eggs
 Poor housing – as it favors diseases
due to poor ventilation which leads to
poor growth and development
 CONT`

 Poor sanitation and water supply –

leads to diseases
 Social factors such as family disruption
e.g. divorce, death, war which affect
the children and lead to growth
retardation
TYPES OF GROWTH AND DEVELOPMENT

 Physical growth – includes the

following; changes in general body
growth, head circumference, thoracic
diameter, abdominal and pelvic
measurement, weight increase which is
the best gross index of nutrition and
growth, height and muscle
development
 Mental development depends on
numerous factors such as problem
solving and understanding what to do
in certain situations. This also tests
intelligence and mental development.
Intelligence quotient (IQ) is the ratio
between the child`s chronological age
and his mental age.
CONT`
 Emotional Development –
personality is not a specific attribute,
but the quality of any person`s total
behavior. Two attributes of a healthy
personality in adult life is the ability to
love and work. Will discuss stages of
personality development later.
 Social Development – socialization or
social development, means training the
child in the culture of the group e.g.
willingness to sacrifice present comfort
for future benefits, individual
cooperation for the benefit of the
group.
APPROXIMATE AVERAGE WEIGHT FOR AGE

 At Birth – baby should weigh about 2.5kg

to 4 kg
 At 6 months should double the weight
 At 1 year the child should weigh 10 kg
 2 years – 12 kg
 3 years – 14 kg
 4 years – 16 kg
 5 years – 18 kg
 6 years – 20 kg
APPROXIMATE WEIGHT GAIN
 3 months – child should weigh 30
grams per day
 3 – 12 months – 5 grams/month
 2 years – 0.25kg/month and there after
2kg/year till 10 years
 After 10 years gaining weight is
irregular
HEIGHT

 Average infant increase in length by

50 % during the first year
 Infants under 2 years are measured
in supine position on special boards
 While children above 2 years height
is measured while standing.
 Average Height for age
 At birth – 55 cm
 6 months – 65 cm
 1 year – 75 cm
 2 years – 85 cm
 4 years – 100 cm
 6 years – 115 cm
 Average Height gain
– during the first year should increase by
50%.
- At 4 years the height should double
DENTAL GROWTH AND
DEVELOPMENT
 Temporal teeth appear between 6
months and 30 months
 8th Incisor appears at 6 months
 4 premolars appear between 12 – 18
months
 4 canines appear between 16 – 22
months
 The 2 molars appear between 24 – 30
months
 The temporal teeth begin to fall off
between 5 to 6 years old and are
completed 10 to 12 years.
 The permanent teeth begin to appear
at 6 years and completed at 21 years
old.
CONT`
 Head circumference
- at birth head circumference is 35cm
- By 4 months it should increase by 1 – 2
cm.
- At 1 year it should be about 45cm (40 –
45cm)
- At 20 years – 54 – 56cm
 Muscle growth
- In early childhood muscle growth is
rapid and contributes to the child`s need
for protein
CONT`
 Skeletal Growth
- The anterior fontanel closes at 18 months and
posterior fontanel closes at 4 – 6 months
 Arm Circumference
- the upper arm of the child at birth should be
10cm
- At 12 months – 16 cm
- There after it increases by 1 cm per year for 4
years
 Heart rate – at birth it`s about 140b/min
CONT`
 Behavior and mental development
– the behavior develops when the CNS
also develops and includes positive
combine use of muscle and sense e.g.
speech
MILESTONES
Average Motor Development Language and social skill
age
0 – 1 month Child grasps, lift head when Child fixes the eye at an
in prone position object, smiles when tickled
3–6 Child should have a good Follows an object with eyes
months head control as expected and plays with hands
6–9 Sits up unsupported Grasps things actively and
months makes loud noises
9 – 12 Stands unsupported Understands few words and
months tries to use them
12 – 18 Expected to walk and Can say few words
months grasps few
Things with fingers
2 years Child runs They are able to tell a story
CONT`
Average Motor Development Language and Social Skills
Age
3 years Child plays actively and is Reports a lot of things curious
clever at climbing and and inquisitive
jumping
4 -5 years Able to count physically 1 Can sing, read and tell stories
– 10
5 – 9 years Goes to school, very Fluent in talking and singing
active hence need good
nutrition
EMOTIONAL DEVELOPMENT ACCORDING TO AGE

Stage Approxim Psychosocial Significa Task

ate Age nce
Infanc 0 – 1 year Sense of trust mother Tolerates
y verses frustrations in
mistrust small doses and
recognizes the
mother as different
from others
Toddle 1 -3 years Sense of parents Tries on power of
r autonomy, speech and begins
shame and to accept relatives
doubt
Pre- 3 – 6 years Sense of Basic Questions and
school initiative family explores own body
verses guilty and and development.
immediat Differentiates sex
e family
School 6 - 12 Sense of Neighborh Learning to write.
going industry ood and Recognition by
verses school producing things,
CONT`
Stag Approxim Psychosocial Significa Task
e ate age nce
Adole 12 -20 Sense of identity peers - Begins
scenc years verses identification separating from
e confusion the family
- Moves towards
hetro-sexually
Late 21 – 35 Sense of intimacy - Partners - Becoming
adole years and solidarity verses and capable of
scenc isolation friends. establishing a
e and - Sex lasting
youn competitio relationship
g n and with opposite
adult cooperatio sex
n - Learning to be
creative and
productive.
STAGES OF NORMAL DEVPT IN CHILDREN

 STAGE 1-INFANCY (1-12 months)

 In this stage, personality, social attachment ,
thinking and language first take place. Close
relationships to people are vital for infancy
personality and personal development.
 Infants exhibit a variety of emotions such as
joy, distress, surprise, interests and sadness
but they have difficulties in managing these
feelings and they depend on the caregiver to
regulate the emotion arousal.
 By the end of the first year infants have
developed emotional attachments to
their parents and other regular
caregivers and depend on them for
security and confidence especially in
their familiar setting.
 STAGE 2-EARLY CHILDHOOD (2-6
years)
 In this stage, the child has developed
communication through language. The
child is aware for being a boy or girl
and they begin to enact gender roles
and stereotypes by the time they are 3
years. Emotional attachments of
children to their parents remains a
cornerstone of psychological wellbeing.
 But as children develop their sense of
self and learn to negotiate compromise,
resist and assert their own preferences
they are likely to come in conflict with
their caregivers.
 STAGE 3-MIDDLE CHILDHOOD (6-12 years)
 This is a school age and children begin to
develop a more complex balanced self image.
As they move in deferent social world, older
children begin to grasp the informal rules of
each setting and manage them accordingly.
Peer friendship became richer and more
complicated. They form groups and create
stronger pressure on their group members to
conform to their style and behaviour.
 STAGE 4-ADOLESCENCE (13-19 yrs)
 The onset of puberty marks the
beginning of adolescence. Physical
growth and development including
sexual maturation is an important part
of adolescence.
PHYSICAL ASSESSMENT OF THE CHILD

 The physical assessment of a child is

distinct in certain areas from that of the
adult. There is no definite order to be
followed while examination for every
child. It is important to individualize the
examination for every child. Invasive
and discomforting examinations should
be done at the end.
 The child should be allowed to be in its
most comfortable position, and place it
in the mother’s lap. It is important for
you to note that every child should
receive a complete systematic
examination at regular intervals. You
should not restrict the examination to
those portions of the body considered
to be involved on the basis of the
presenting complaint.
GENERAL EXAMINATION
 Before starting general physical
examination; analyze the history and
based on that look for specific features
that you think to be relevant to the
history which will help you to give a
perfect diagnosis.
 Vital Signs and Measurements
 The general physical examination will
start with checking the vital signs of a
child and include temperature, pulse
rate, and respiratory rate (TPR); blood
pressure (the cuff should cover 2/3 of
the upper arm).
 Weight, height, and head
circumference must be measured. The
weight should be recorded at each
visit; the height should be determined
at monthly intervals during the first
year, at 3-month intervals in the
second year, and twice a year
thereafter.
 The height, weight, and circumference
of the child should be compared with
standard charts and the approximate
percentiles recorded. Multiple
measurements at intervals are of much
greater value than single ones since
they give information regarding the
pattern of growth that cannot be
determined by single measurements.
 General Appearance
 You need to assess whether the child appears
well or ill. It is also important to assess the
degree of cooperation; state of comfort,
nutrition, and consciousness; abnormalities,
gait, posture, and coordination; estimate of
intelligence; reaction to parents, physician, and
examination; nature of cry and degree of
activity, facie’s and facial expression. After you
have assessed the general appearance you
need to go to the skin
 SKIN- The skin of the child should be
assessed for color (for color check
whether the child has cyanosis,
jaundice, pallor, erythema), texture,
eruptions, hydration, edema,
hemorrhagic manifestations, scars,
dilated vessels and direction of blood
flow, hemangiomas, nevi,
 Mongolian (blue-black) spots,
pigmentation, turgor, elasticity, and
subcutaneous nodules. Striae and
wrinkling may indicate rapid weight
gain or loss. Assess the skin sensitivity,
hair distribution and character, and
desquamation.
 As you examine the skin you need to
take note of the following:
 If the child has loss of skin turgor,

especially of the calf muscles and skin

over abdomen, is evidence of
dehydration.
 The soles and palms are often bluish

and cold in early infancy; this is of no

significance.
 The degree of anemia cannot be
determined reliably by inspection, since
pallor (even in the newborn) may be
normal and not due to anemia.
 If you want to demonstrate pitting

edema in a child it may be necessary

to exert prolonged pressure
 A few small pigmented nevi are
commonly found, particularly in older
children.
 "Mongolian spots" (large, flat black or
blue-black areas) are frequently
present over the lower back and
buttocks; they have no pathologic
significance.
 Cyanosis will not be evident unless at
least 5 gm of reduced hemoglobin are
present; therefore, it develops less
easily in an anemic child.
 Carotenemic pigmentation is usually
most prominent over the palms and
soles and around the nose, and spares
the conjunctivas.
 Lymph Nodes
 When examining the lymph nodes you
need to take note of the location, size,
sensitivity, mobility and consistency.
You should attempt to palpate
suboccipital, pre-auricular, anterior
cervical, posterior cervical,
submaxillary, sublingual, axillary,
epitrochlear, and inguinal lymph nodes.
 As you examine the lymph nodes take
note of the following:
 Enlargement of the lymph nodes occurs
much more readily in children than in
adults.
 Small inguinal lymph nodes are
palpable in almost all healthy young
children. Small, mobile, non-tender
Shorty nodes are commonly found in
residue of previous infection.
 After you have looked at the general
appearance you need to examine the
child from head to toe
 Head
 The head of a child will be assessed for:
 The size,
 The shape: Note the shape of the head whether
microcephaly, macrocephaly, (asymmetrical due
to lying of the normal infants with their heads
persistently on one side), scaphocephaly (boat
shaped with increased diameter due to
premature closing of sagittal suture),
brachycephaly (decreased AP diameter)and
oxycephaly (tower-shaped skull).
 circumference,
 asymmetry,
 cephalohematoma,
 bosses,
 craniotabes,
 control,
 molding,
 bruit,
 fontanel (size, tension, number,
abnormally late or early closure),
 Sutures,
 Dilated veins,
 The scalp,
 The hair note the texture, distribution,
and there are any parasites such as lice
 The face
 During examination of the head ensure
that you measure the head at its
greatest circumference; this is usually
at the midforehead anteriorly and
around to the most prominent portion
of the occiput posteriorly.
 The ration of head circumference to
circumference of the chest or abdomen
is usually of little value. Fontanel
tension is best determined with the
quiet child in the sitting position. Take
note that slight pulsations over the
anterior fontanel may occur in normal
infants..
 Although bruits may be heard over the
temporal areas in normal children, the
possibility of an existing abnormality
should not be overlooked.
 You may also find that a positive
Macewen's sign ("cracked pot" sound
when skull is purcussed with one
finger) may be present normally as
long as the fontanel is open
 Face
 Assess the face for symmetry,
paralysis, distance between nose and
mouth, depth of nasolabial folds, bridge
of nose, distribution of hair, size of
mandible, swellings, and tenderness
over sinuses.
 Eyes
 The eyes should be assessed for photophobia,
visual acuity, muscular control, nystagmus,
Mongolian slant, Brushfield spots, epicanthic
folds, lacrimation, discharge, lids,
exophthalmos or enophthalmos, conjunctivas;
pupillary size, shape, reaction to light and
accommodation; media (corneal opacities,
cataracts), fundi, visual fields (in older
children). It is important to note that at 2-4
weeks an infant will follow light
 By 3-4 months, coordinated eye movements
should be seen.
 During the examination of the eye
remember that one pupil is normally larger
than the other. This sometimes occurs only
in bright or in subdued light. It is important
to note that a mild degree of strabismus
may be present during the first 6 months of
life but should be considered abnormal after
that time.
 To test for strabismus in the very young
or uncooperative child, note where a
distant source of light is reflected from
the surface of the eyes; the reflection
should be present on corresponding
portions of the two eyes.
 Nose
 Assess the exterior, shape, mucosa,
patency, discharge, bleeding, and
pressure over sinuses, flaring of nostrils
and septum. At 2-4 years
pneumatization of the frontal sinus
takes place but is rarely a site of
infection until the 6th - 10th year.
 Mouth and Lips: Assess the mouth
and lips for thinness, fissures, color,
cleft and the teeth number, position,
caries, mottling, discoloration,
notching, malocclusion or
misalignment, gums, palate, tongue,
uvula, mouth breathing, geographic
tongue (usually normal).
 While examining the mouth it is
important to check the number and
condition of the teeth which should be
recorded. (A child should have 20 teeth
by age 2½ years). When the teeth
begin to erupt is quite variable but
most infants have their two lower
central incisors by 8-10 months.
 Throat
 The throat is assessed by looking at the
tonsils; you need to check for size,
inflammation, exudate, crypts, and
inflammation of the anterior pillars. Assess
mucosa and see if there is any hypertrophic
lymphoid tissue and check also the status
of the epiglottis. Finally on the throat,
assess the voice for hoarseness, stridor,
grunting, type of cry and speech.
 Neck
 Assess the position of the neck to rule out
torticollis, opisthotonos, inability to support
head and mobility. Assess if there is any
swelling on the neck and also assess the
thyroid for size, contour, isthmus, nodules
and tenderness. Still on the neck, assess
the lymph nodes, check the veins and
position of trachea. Check the neck for
webbing, edema and its movement.
 Ears
 Pinna is pulled down and back to straighten ear
canal in children less than 3 years. Assess the
pinnas for position and size.
 Before actually examining the ears, it is often
helpful to place the speculum just within the
canal, remove it and place it lightly in the other
ear, remove it again, and proceed in this way
from one ear to the other, gradually going
farther and farther, until satisfactory
examination is completed
 Examine the ear canals and tympanic
membranes for landmarks, mobility,
perforation, inflammation and
discharge. The mastoid bone should be
assessed for tenderness and swelling.
 The otoscope should be used and held
balanced in the hand by holding the
handle at the end nearest the
speculum.
 One finger should rest against the head
to prevent injury resulting from sudden
movement by the child. To examine the
ears of an infant it is usually necessary
to pull the auricle backward and
downward, in the older child the
external ear is pulled backward and
upward.
 Lungs
 For the lungs, the type of breathing and
see if there is any dyspnea or any
prolongation of expiration. Examine the
child for any cough, expansion,
fremitus, flatness or dullness to
percussion, resonance, breath and
voice sounds, rales and wheezing.
 Heart
 The heart is assessed to see its location and
intensity of apex beat, precordial bulging,
pulsation of vessels, thrills, size, shape. The
next thing to do is auscultation of the heart and
take note the rate, rhythm, force and quality of
sounds - compare with pulse as to rate and
rhythm; friction rub-variation with pressure),
murmurs (location, position in cycle, intensity,
pitch, effect of change of position, transmission,
effect of exercise).
 Many children normally have sinus
arrhythmia. The child should be asked
to take a deep breath to determine its
effect on the rhythm.
 Extra systoles are not uncommon in
childhood.
 The heart should be examined with the
child in recumbent.
 Abdomen
 Size and contour, visible peristalsis,
respiratory movements, veins (distension,
direction of flow), umbilicus, hernia,
musculature, tenderness and rigidity,
tympany, shifting dullness, tenderness,
rebound tenderness, pulsation, palpable
organs or masses (size, shape, position,
mobility), fluid wave, reflexes, femoral
pulsations, bowel sounds
 If the liver is palpable below the right
costal margin, its total span must be
recorded. A deep abdomen palpation
must be done on every child.
 The abdomen may be examined while
the child is lying prone in the mother's
lap or held over her shoulder, or seated
on the examining table with his back to
the doctor.
 These positions may be particularly
helpful where tenderness, rigidity, or a
mass must be palpated.
 Light palpation, especially for the
spleen, often will give more information
than deep.
 Umbilical hernias are common during
the first 2 years of life. They usually
disappear spontaneously.
 Male Genitalia
 Check for the following in the child: if
circumcised, meatal opening,
hypospadias, phimosis, adherent
foreskin, size of testes, cryptorchidism,
scrotum, hydrocele, hernia, pubertal
changes.
 A. In examining a suspected case of
cryptorchidism, palpation for the
testicles should be done before the
child has fully undressed or become
chilled or had the cremasteric reflex
stimulated. In some cases, examination
while the child is in a hot bath may be
helpful
 The boy should also be examined while
sitting in a chair holding his knees with
his heels on the seat; the increased
intra-abdominal pressure may push the
testes into the scrotum.
 To examine for cryptorchidism, one
should start above the inguinal canal
and work downward to prevent pushing
the testes up into the canal or
abdomen.
 In the obese body, the penis may be
so obscured by as to appear
abnormally small. If this fat is pushed
back, a penis of normal size is usually
found.
 Female Genitalia
 Check the vagina for imperforate,
discharge and adhesions. Check for the
hypertrophy of clitoris and for pubertal
changes.
 Rectum and Anus
 Check for any irritation, fissures,
prolapse, imperforate anus. The rectal
examination should be performed with
the little finger (inserted slowly). Note
muscle tone, character of stool,
masses, tenderness, sensation.
Examine stool on glove finger (gross,
microscopic, culture) as indicated.
 Extremities
 A. General: Deformity, hemiatrophy,
bowlegs (common in infancy), knock-
knees (common after age 2), paralysis,
edema, coldness, posture, gait, stance,
asymmetry.
 B. Joints: Swelling, redness, pain,
limitation, tenderness, motion,
rheumatic nodules, carrying angle of
elbows, tibial torsion.
 Hands and feet: Extra digits, clubbing,
simian lines, curvature of little finger,
deformity of nails, splinter hemorrhages,
flat feet (feet commonly appear flat
during first 2 years), abnormalities of feet,
width of thumbs and big toes, length of
various segments, dimpling of dorsa.
 Peripheral Vessels: Presence, absence or
diminution of arterial pulses.
 Spine and Back
 Posture, curvatures, rigidity, webbed
neck, spina bifida, pilonidal dimple or
cyst, tufts of hair, mobility,spots, and
tenderness over spine, pelvis or
kidneys.
MONITORING THE HEALTH OF CHILDREN
The health of a child should be monitored well
and the following areas should be considered:
 Nutrition

 Feeding of infants and children

 Methods of feeding

 Immunizations

 Vitamin A supplemention

 Deworming
Nutrition
 Nutrition is essential for children

because proper nutrition helps prevent

illness and disease, and affects their
growth, development and learning.
Eating the right food promotes a better
quality of life because when children
feel good physically, they’re able to
take part in the activities they enjoy.
 The child needs to receive all important
nutrients in-order to facilitate growth
and development and nutrients are:
 Carbohydrates
 Proteins
 Fats
 Vitamins and minerals
 Water
 Feeding of infants and children
 Infant and young child feeding are a
cornerstone of care for childhood
development. World-wide about 30% of
children under five are stunted as a
consequence of poor feeding and repeated
infections. Even in limited resource settings,
improved feeding practices can lead to
improved intakes of energy and nutrients,
leading to better nutritional status.
 The communities need to be counseled
on infant and children’s nutrition to
improve feeding practices, food intake,
growth and development in children.
 Methods of feeding
 Cup feeding
 Cup feeding is a method of feeding milk
to an infant from a small polypropylene
or glass tumbler without a spout or lip.
 Indications of cup feeding
 Infants nearing discharge who were
already established on the breast but
whose mothers were not residents on
the unit.
 Preterm infants or immature to breast
feed or unable to complete a breast
feed, or whose mothers were not
present at the time of a feed.
 Infants with a cleft lip and/or palate.
 Infants with an uncoordinated suck,
swallow, and breathing pattern caused
by asphyxia or some other neurological
condition that interfer with the
successful establishment of breast or
bottle feeding.
 Infants born by caesarean section, if
breast feeding was not possible within
the first few hours of surgery, or whose
mothers were initially unwell but who
intended to breast feed.
 SPOON-FEEDING
 Spoon-feeding practices vary from one
family to another. Breast fed infants
tend to start spoon-feeding later than
those who are not breast fed.
Remember, babies have special
nutritional needs and what is healthy
for adults (e.g. high fibre, low fat) is not
suitable for infants and small children.
 TUBE FEEDING
 Tube feeding can be administered via
different types of tubes but usually a
nasogastric tube or gastrostomy
feeding tube is used. This facilities
improvement in the child’s health and
growth as a result of tube feeding and
serious complications are rare. This
method is used as it provides adequate
nutrition.
 Indications for tube feeding
 Under nutrition associated with or due
to any of the following and may require
tube feeding:-
 Poor weight gain
 Inability to swallow
 Reflux / Vomiting
 Distress during feeding
 Prolonged feeding times
Aspiration/inhalation of food/drink
 Neurological dysfunction
 Special diets
Types of feeding tubes
 Nasogastric feeding tube

 Percutaneous endoscopic gastrostomy (PEG)

 Balloon inflated gastrostomy

Nasogastric tubes are fine bore tubes with a

small internal diameter and are commonly
used for short term feeding. These tubes
are available in two main types: short term
and long term tubes.
 Short-term tubes: These tubes are
made of polyvinylchloride (PVC) and
can remain in place for between 3-10
days, dependent on manufacturer’s
guidelines. These tubes are single use
and should the tube become dislodged
it should be replaced with a new tube.
 Long-term tubes: These tubes are
made of polyurethane and have a
guide-wire to aid the passing of the
tube. Once the tube has been passed,
the guide-wire is removed and should
be kept in a safe place as it will be
required should the tube become
dislodged.
 This tube can normally remain in situ
for approximately 6 – 8 weeks
dependent on manufacturer’s
guidance. Within this time, the tube
can be cleaned and re-passed.
Cleaning of the tube should also be in
accordance with manufacturer’s
guidance and local policy.
 INDICATIONS FOR PARENTERAL
FEEDING
 Children who are unable to obtain
adequate nutrients by oral or enteral
routes. This type of feeding may be the
only feasible option for providing nutrition
to children who do not have a functioning
gastrointestinal tract or who have
disorders requiring complete bowel rest,
including:
 bowel obstruction,
 short bowel syndrome,
 Gastroschisis,
 Prolonged diarrhea regardless of its cause,
 high-output fistula,
 Very severe Crohn's disease or ulcerative
colitis, and
 Certain pediatric GI disorders including
congenital GI anomalies.
 Immunisation
 Immunization is one of the most
important of the public health
activities. Immunization forms one of
the most important and cost effective
strategies for the prevention of
childhood sicknesses and disabilities
and is thus a basic need for all children.
IMMUNIZATION DEFNITION
 This is a process of making a person
immuned or resistant to infectious
diseases through administration of
vaccines.
 Vaccines stimulate the bodys own
immune system to protect the person
against subsequent infections.
TYPES OF ACQUIRED IMMUNITY
 1.Active immunity
 2. Passive immunity
 Vitamin A supplementation
 Globally, it is estimated that 140–250
million children under five years of age
are affected by vitamin A deficiency.
These children suffer a dramatically
increased risk of death, blindness and
illness, especially from measles and
diarrhoea.
 As part of the global call to action, the UN
Special Session on Children in 2002 set as
one of its goals the elimination of vitamin A
deficiency and its consequences by the year
2015. The strategy to achieve this goal is to
ensure that young children living in areas
where the intake of vitamin A is inadequate
receive the vitamin through a combination
of breast feeding, dietary improvement,
food fortification, and supplementation.
 Combining the administration of vitamin A
supplements with immunization is an
important part of this effort. Since 1987,
WHO has advocated the routine
administration of vitamin A with measles
vaccine in countries where vitamin A
deficiency is a problem. Great success and
many millions of children have been
reached by including vitamin A with National
Immunization Days (NIDs) to eradicate polio.
 Providing immunization-linked high-
dose supplementation to new mothers
soon after delivery has provided a
further benefit to young infants through
enriched breast milk. Provision of
vitamin A supplements every four to six
months is an inexpensive, quick, and
effective way to improve vitamin A
status and save children's lives.
 Vitamin A is essential for the
functioning of the immune system and
the healthy growth and development of
children.
 High-dose vitamin A should be avoided
during pregnancy because of the
theoretical risk of teratogenisis (birth
defects).
 From a programmatic perspective,
high-dose vitamin A supplementation
must occur during the safe infertile
period immediately after delivery.
Accordingly, high-dose vitamin A
supplementation can be provided
safely to all postpartum mothers within
six weeks of delivery, when the chance
of pregnancy is remote.
 For breastfeeding mothers, the safe
infertile period extends up to eight
weeks after delivery. The first contact
with the infant immunization services
provides an excellent opportunity to
supplement postpartum mothers and
improve the vitamin A content of their
breast milk
 There is a well-established scientific
basis for the treatment of measles
cases with vitamin A supplementation
that is recommended by WHO as part
of the integrated management of
childhood illness.
 The recommended dosages for vitamin
A:
 SCHEDULE FOR VITAMIN A
SUPPLEMENTATION
Target group Vitamin A dose
All mothers irrespective of their mode of 200 000 IU (4
infant feeding up to 4 weeks postpartum if drops)
they have not received vitamin A
supplementation after delivery

Infants aged 6–11 months (or if < 8 kg ) 100 000 IU (2

drops)

Children aged 12 months to 59 months

200 000 IU (4
drops)
 * The optimal interval between doses is
four to six months. A dose should not
be given too soon after a previous dose
of vitamin A supplement.
Deworming
 According to the World Health Organization
, nearly 2 billion people worldwide are
infected with soil-transmitted helminthes
(intestinal worms) or water-borne
nematode worms called schistosomes.
Many of those affected by worms live in
low-income countries and do not have
access to clean water and functional
sanitation systems.
 For example, children who have worms
are more likely to become seriously ill
and less likely to attend school on a
regular basis.
 Soil-transmitted helminths are among
the most common infections in
developing countries. They impair the
nutritional status of the people they
infect in multiple ways, including:
 Feeding on host tissues, including
blood, which leads to a loss of iron and
protein
 Increasing malabsorption of nutrients.
 Some soil-transmitted helminths also
cause loss of appetite and therefore a
reduction of nutrition intake and
physical fitness.
 To reduce the worm burden, WHO
recommends periodic drug treatment
(deworming) of all children living in
endemic areas.
 Preschool children aged 1 to 5 years
are often infested with intestinal
worms.
 Worms aggravate malnutrition, anemia
and stunting levels and retard both
physical and cognitive development.
The common types of worms are round
worms, hook worms and whip worms.
 Treating children for worms is one of
the simplest and cost effective
interventions for improving child’s
health.
 VERMOX (mebendazole) is a (synthetic)
broad-spectrum anthelmintic available as
chewable tablets, each containing 100 or 500
mg of mebendazole.
 Vermox is indicated for the treatment of
Enterobius vermicularis (pinworm), Trichuris
trichiura (whipworm), Ascaris lumbricoides
(common roundworm), Ancylostoma duodenale
(common hookworm), Necator americanus
(American hookworm) in single or mixed
infections.
FACTORS RELATED TO HEALTH PROMOTION
 Health promotion is the process of enabling

people to exert control over the determinants

of health and thereby improve their health.
There are so many factors that are related to
children health promotion:
 Hygiene

 Training children in health habits

 Environment

 Growth monitoring tools

HYGIENE
 Hygiene is a set of practices performed
for the preservation of health. Hygiene
is also the name of a branch of science
that deals with the promotion and
preservation of health, also called
hygienic.
 The practices are important because
they prevent spread of infections. The
three areas that promote hygiene of a
child:
 Bathing of the baby,
 Changing of napkins and
 Oral toilet
TRAINING CHILDREN IN HEALTH HABITS
 Hand washing after using the toilet,

before eating food, after playing outside,

after sneezing, or after petting the dog.
 Children should also be taught to cover

their mouths when they cough and

sneeze, and to use a tissue (rather than
their shirt sleeve) when they need to wipe
their nose or mouth.
 Children should also be taught that
sharing cups and eating utensils,
particularly at school, is an easy way to
spread germs and become sick, and
should therefore be avoided.
 Brush their teeth every day at least
twice a day
 Bathing every day
 Have nutritious meal everyday and
they should not miss their breakfast
Environmental health risks to
children’s health
 Indoor Air Pollution

 Outdoor Air Pollution

 Unsafe Drinking Water and Poor

Sanitation
 Infectious Disease Vectors
 Exposure to Hazardous Chemicals
Growth monitoring tools
 The scale: This is used to weigh the child

 The child health card: This is used to

plot the channel of the child and counsel

the mother about her child’s health status
 The growth monitoring programme

(GMP) rooster book or register: This is

used to record the weight and channel of
the child.