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ASSESSMENT OF HEALTH IN CHILDREN Nirmala Roberts Paediatric Nursing

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HEALTH <ul><li>A state of complete physical, mental and social well being, and not merely the absence of disease or infirmity (WHO 1947) </li></ul><ul><li>Not a condition, but an adjustment </li></ul><ul><li>Not a state, but a process </li></ul><ul><li>The process helps us to adapt not only to our physical, but also to our social environments </li></ul>

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CHILD HEALTH <ul><li>Closely related to her growth & development </li></ul><ul><li>Directly proportional to the growth & development </li></ul><ul><li>Is the responsibility of every adult </li></ul><ul><li>Needs to be assessed frequently to avoid pitfalls </li></ul><ul><li>A healthy child will grow to be a healthy adult </li></ul>

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STAGES OF GROWTH IN CHILDREN <ul><li>Infancy – Birth to 12 months </li></ul><ul><ul><li>Neonate – 0–28 days </li></ul></ul><ul><ul><li>Infancy – 1–12 months </li></ul></ul><ul><li>Early childhood – 1–6 yrs </li></ul><ul><ul><li>Toddler – 1–3 yrs </li></ul></ul><ul><ul><li>Preschooler – 3-6 yrs </li></ul></ul><ul><li>Middle Childhood ( School age) – 6–12 yrs </li></ul><ul><li>Late Childhood – 11–19 yrs </li></ul><ul><ul><li>Pre pubertal – 10-13 yrs </li></ul></ul><ul><ul><li>Adolescence – 13-18 yrs </li></ul></ul>

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WHY ASSESS HEALTH IN CHILDREN? <ul><li>Peculiarities of the child – Dependent, poor communication skills, and low immunity </li></ul><ul><li>Ensure normal health </li></ul><ul><li>Provide timely guidance for optimal health </li></ul><ul><li>Detect abnormal states and correct them </li></ul><ul><li>Educate parents on ways to ensure good health </li></ul>

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METHODS OF HEALTH ASSESSMENT (For all age groups) <ul><li>Dietary History </li></ul><ul><li>H/O illness </li></ul><ul><li>General examination </li></ul><ul><li>Biochemical examination </li></ul>

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DIETARY HISTORY (0 – 5 yrs) <ul><li>Nature of diet </li></ul><ul><li>Staple food </li></ul><ul><li>Appetite </li></ul><ul><li>Breast feeding, weaning, feeding problems </li></ul><ul><li>Vitamin/ mineral supplements </li></ul><ul><li>Food allergy/ fads </li></ul><ul><li>Birth weight, recent weight loss </li></ul><ul><li>Veg garden/ poultry/ cattle </li></ul>

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HISTORY OF ILLNESS <ul><li>Infections </li></ul><ul><li>Infestations </li></ul><ul><li>Immunization status – For all VPDs </li></ul><ul><li>Personal hygienic habits </li></ul><ul><li>Emotional health </li></ul><ul><li>Social health </li></ul><ul><li>Access to civic amenities </li></ul><ul><ul><li>Potable water </li></ul></ul><ul><ul><li>Waste disposal </li></ul></ul><ul><ul><li>Medical facilities </li></ul></ul>

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GENERAL EXAMINATION <ul><li>General physical examination </li></ul><ul><li>Nutritional anthropometry </li></ul><ul><li>Neuromuscular control </li></ul><ul><li>Assessment of tissue growth </li></ul><ul><li>Bone age </li></ul><ul><li>Dental age </li></ul><ul><li>Biochemical & histological means </li></ul><ul><li>Psychological tests </li></ul>

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GENERAL PHYSICAL EXAMINATION <ul><li>General condition </li></ul><ul><ul><li>Appearance, activity, stature </li></ul></ul><ul><ul><li>Face – Appearance, eyes, lips, oral cavity </li></ul></ul><ul><ul><li>Glands & lymph nodes </li></ul></ul><ul><ul><li>Skin – colour, hydration, rashes, edema </li></ul></ul><ul><li>Systemic – CVS, Resp, Congenital anomalies </li></ul><ul><li>Others - </li></ul><ul><ul><li>Sleep </li></ul></ul><ul><ul><li>Play </li></ul></ul><ul><ul><li>Bowel & bladder function </li></ul></ul>

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MEASUREMENT OF GROWTH <ul><li>Weight – Infant weighing scale (manual/ electronic), Salter spring machine, Bathroom scale </li></ul><ul><li>Length – Infantometer, Stadiometer </li></ul><ul><li>MAC – Tape measure, Bangle, Shakir’s tape </li></ul><ul><li>OFC – Tape measure </li></ul><ul><li>Chest circumference – Tape measure </li></ul><ul><li>BMI - Wt/ Ht2 </li></ul><ul><li>Skin fold thickness – Harpenden/ Best skin calipers </li></ul><ul><li>Dental development </li></ul><ul><li>Neuromuscular control – Milestones, motor skills </li></ul>

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SCHOOL AGE

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DIETARY HISTORY <ul><li>Nature of diet – NV/PV, Fads, preferences, fast foods, snacking, beverages </li></ul><ul><li>Staple food, lunch box </li></ul><ul><li>Appetite – Lack of interest </li></ul><ul><li>Food allergy </li></ul><ul><li>Recent weight loss </li></ul><ul><li>Veg garden/ poultry/ cattle </li></ul>

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HISTORY OF ILLNESS <ul><li>Infections </li></ul><ul><li>Infestations </li></ul><ul><li>Immunization status – TT, HBV, BCG </li></ul><ul><li>Personal hygienic habits </li></ul><ul><li>Emotional health </li></ul><ul><li>Social health </li></ul><ul><li>Access to civic amenities </li></ul><ul><ul><li>Potable water </li></ul></ul><ul><ul><li>Waste disposal </li></ul></ul><ul><ul><li>Medical facilities </li></ul></ul>

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GENERAL EXAMINATION <ul><li>General physical examination </li></ul><ul><li>Nutritional anthropometry </li></ul><ul><li>Neuromuscular control </li></ul><ul><li>Assessment of tissue growth </li></ul><ul><li>Biochemical & histological means </li></ul><ul><li>Psychological tests </li></ul>

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GENERAL PHYSICAL EXAMINATION <ul><li>General condition </li></ul><ul><ul><li>Appearance, activity, stature </li></ul></ul><ul><ul><li>Face – Appearance, eyes, lips, oral cavity </li></ul></ul><ul><ul><li>Glands & lymph nodes </li></ul></ul><ul><ul><li>Skin – colour, hydration, rashes, edema </li></ul></ul><ul><li>Systemic – CVS, Resp, Genito urinary </li></ul><ul><li>Others - </li></ul><ul><ul><li>Sleep </li></ul></ul><ul><ul><li>Play </li></ul></ul><ul><ul><li>Bowel & bladder function </li></ul></ul>

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MEASUREMENT OF GROWTH <ul><li>Weight – Bathroom scale </li></ul><ul><li>Length – Stadiometer </li></ul><ul><li>Chest circumference – Tape measure </li></ul><ul><li>BMI - Wt/ Ht2 </li></ul><ul><li>Skin fold thickness – Harpenden/ Best skin calipers </li></ul><ul><li>Neuromuscular control – Motor skills </li></ul>

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ADOLESCENCE

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DIETARY HISTORY <ul><li>Nature of diet – NV/PV, Fads, preferences, fast foods, snacking, beverages </li></ul><ul><li>Staple food </li></ul><ul><li>Appetite – Anorexia Nervosa, obesity </li></ul><ul><li>Food allergy </li></ul><ul><li>Recent weight loss </li></ul><ul><li>Veg garden/ poultry/ cattle </li></ul>

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HISTORY OF ILLNESS <ul><li>Infections </li></ul><ul><li>Infestations </li></ul><ul><li>Immunization status – TT, HBV, BCG </li></ul><ul><li>Gynaecological health </li></ul><ul><li>Urological health </li></ul><ul><li>Personal hygienic habits </li></ul><ul><li>Emotional health </li></ul><ul><li>Social health </li></ul><ul><li>Access to civic amenities </li></ul><ul><ul><li>potable water </li></ul></ul><ul><ul><li>Waste disposal </li></ul></ul><ul><ul><li>Medical facilities </li></ul></ul>

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GENERAL EXAMINATION <ul><li>General physical examination </li></ul><ul><li>Nutritional anthropometry </li></ul><ul><li>Neuromuscular control </li></ul><ul><li>Assessment of tissue growth </li></ul><ul><li>Biochemical & histological means </li></ul><ul><li>Psychological tests </li></ul>

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GENERAL PHYSICAL EXAMINATION <ul><li>General condition </li></ul><ul><ul><li>Appearance, activity, stature </li></ul></ul><ul><ul><li>Face – Appearance, eyes, lips, oral cavity </li></ul></ul><ul><ul><li>Glands & lymph nodes </li></ul></ul><ul><ul><li>Skin – colour, hydration, rashes, edema, pricks </li></ul></ul><ul><li>Systemic – CVS, Resp, Genito urinary </li></ul><ul><li>Others - </li></ul><ul><ul><li>Sleep </li></ul></ul><ul><ul><li>Play </li></ul></ul><ul><ul><li>Bowel & bladder function </li></ul></ul>

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MEASUREMENT OF GROWTH <ul><li>Weight – Bathroom scale </li></ul><ul><li>Length – Stadiometer </li></ul><ul><li>Chest circumference – Tape measure </li></ul><ul><li>BMI - Wt/ Ht2 </li></ul><ul><li>Skin fold thickness – Harpenden/ Best skin calipers </li></ul><ul><li>Neuromuscular control – Motor skills </li></ul>

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BIOCHEMICAL EXAMINATION ( For all age children) <ul><li>Blood – Hb%, PCV, S Protein </li></ul><ul><li>Urine – RE </li></ul><ul><li>Stool - RE </li></ul>

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PSYCHOLOGICAL EXAMINATION – INFANTS & TODDLERS <ul><li>Compare against normal children </li></ul><ul><li>Take ‘Corrected age’ for preterms </li></ul><ul><li>Take note of disability or handicap </li></ul>

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PSYCHOLOGICAL EXAMINATION – PRESCHOOL AGE <ul><li>Adaptive behaviour - Play, climbing, speech, feeding </li></ul><ul><li>Vision – Posture, walking, play, manipulation with toys </li></ul><ul><li>Performance – understanding matching color, concentration, visual acuity </li></ul><ul><li>Comprehension of language – Body parts, pictures, commands </li></ul>

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PSYCHOLOGICAL EXAMINATION –SCHOOL AGE & ADOLESCENCE <ul><li>Application, concentration, organizational skills -Three ‘R’s, drawing </li></ul><ul><li>Vision, hearing </li></ul><ul><li>IQ tests </li></ul><ul><ul><li>Stanford Binet Intelligence Scale </li></ul></ul><ul><ul><li>Wechsler Intelligence Scale </li></ul></ul><ul><ul><li>Goodenough ‘Draw a Man’ test </li></ul></ul><ul><ul><li>Denver Development Screening Test </li></ul></ul>

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PRE REQUISITE <ul><li>Venue – Congenial environment </li></ul><ul><li>- Good lighting, pictures, posters </li></ul><ul><li>- Good sleep, food, warmth </li></ul><ul><li>- Good IPR, ‘relaxed’, ‘stories’ </li></ul><ul><li>- Ensure presence of parents </li></ul><ul><li>Articles – Weighing scale, Stadiometer, Tape measure, books, paper, pencil, crayons, toys </li></ul><ul><li>- NCHS chart </li></ul><ul><li>- Growth chart </li></ul>