ASSESSMENT OF HEALTH IN CHILDREN Nirmala Roberts Paediatric Nursing

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

A state of complete physical, mental and social well being, and not merely the absence of disease or infirmity (WHO 1947)

Not a condition, but an adjustment

Not a state, but a process

The process helps us to adapt not only to our physical, but also to our social environments

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

Closely related to her growth & development

Directly proportional to the growth & development

Is the responsibility of every adult

Needs to be assessed frequently to avoid pitfalls

A healthy child will grow to be a healthy adult

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

Infancy – Birth to 12 months

Neonate – 0–28 days

Infancy – 1–12 months

Early childhood – 1–6 yrs

Toddler – 1–3 yrs

Preschooler – 3-6 yrs

Middle Childhood ( School age) – 6–12 yrs

Late Childhood – 11–19 yrs

Pre pubertal – 10-13 yrs

Adolescence – 13-18 yrs

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

Peculiarities of the child – Dependent, poor communication skills, and low immunity

Ensure normal health

Provide timely guidance for optimal health

Detect abnormal states and correct them

Educate parents on ways to ensure good health

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

Dietary History

H/O illness

General examination

Biochemical examination

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

Nature of diet

Staple food

Appetite

Breast feeding, weaning, feeding problems

Vitamin/ mineral supplements

Food allergy/ fads

Birth weight, recent weight loss

Veg garden/ poultry/ cattle

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

Infections

Infestations

Immunization status – For all VPDs

Personal hygienic habits

Emotional health

Social health

Access to civic amenities

Potable water

Waste disposal

Medical facilities

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

General physical examination

Nutritional anthropometry

Neuromuscular control

Assessment of tissue growth

Bone age

Dental age

Biochemical & histological means

Psychological tests

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

General condition

Appearance, activity, stature

Face – Appearance, eyes, lips, oral cavity

Glands & lymph nodes

Skin – colour, hydration, rashes, edema

Systemic – CVS, Resp, Congenital anomalies

Others -

Sleep

Play

Bowel & bladder function

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

Weight – Infant weighing scale (manual/ electronic), Salter spring machine, Bathroom scale

Length – Infantometer, Stadiometer

MAC – Tape measure, Bangle, Shakir’s tape

OFC – Tape measure

Chest circumference – Tape measure

BMI - Wt/ Ht2

Skin fold thickness – Harpenden/ Best skin calipers

Dental development

Neuromuscular control – Milestones, motor skills

SCHOOL AGE

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

Nature of diet – NV/PV, Fads, preferences, fast foods, snacking, beverages

Staple food, lunch box

Appetite – Lack of interest

Food allergy

Recent weight loss

Veg garden/ poultry/ cattle

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

Infections

Infestations

Immunization status – TT, HBV, BCG

Personal hygienic habits

Emotional health

Social health

Access to civic amenities

Potable water

Waste disposal

Medical facilities

GENERAL EXAMINATION General physical examination Nutritional anthropometry Neuromuscular control Assessment of tissue growth Biochemical & histological means Psychological tests

General physical examination

Nutritional anthropometry

Neuromuscular control

Assessment of tissue growth

Biochemical & histological means

Psychological tests

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

General condition

Appearance, activity, stature

Face – Appearance, eyes, lips, oral cavity

Glands & lymph nodes

Skin – colour, hydration, rashes, edema

Systemic – CVS, Resp, Genito urinary

Others -

Sleep

Play

Bowel & bladder function

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

Weight – Bathroom scale

Length – Stadiometer

Chest circumference – Tape measure

BMI - Wt/ Ht2

Skin fold thickness – Harpenden/ Best skin calipers

Neuromuscular control – Motor skills

ADOLESCENCE

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

Nature of diet – NV/PV, Fads, preferences, fast foods, snacking, beverages

Staple food

Appetite – Anorexia Nervosa, obesity

Food allergy

Recent weight loss

Veg garden/ poultry/ cattle

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

Infections

Infestations

Immunization status – TT, HBV, BCG

Gynaecological health

Urological health

Personal hygienic habits

Emotional health

Social health

Access to civic amenities

potable water

Waste disposal

Medical facilities

GENERAL EXAMINATION General physical examination Nutritional anthropometry Neuromuscular control Assessment of tissue growth Biochemical & histological means Psychological tests

General physical examination

Nutritional anthropometry

Neuromuscular control

Assessment of tissue growth

Biochemical & histological means

Psychological tests

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

General condition

Appearance, activity, stature

Face – Appearance, eyes, lips, oral cavity

Glands & lymph nodes

Skin – colour, hydration, rashes, edema, pricks

Systemic – CVS, Resp, Genito urinary

Others -

Sleep

Play

Bowel & bladder function

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

Weight – Bathroom scale

Length – Stadiometer

Chest circumference – Tape measure

BMI - Wt/ Ht2

Skin fold thickness – Harpenden/ Best skin calipers

Neuromuscular control – Motor skills

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

Blood – Hb%, PCV, S Protein

Urine – RE

Stool - RE

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

Compare against normal children

Take ‘Corrected age’ for preterms

Take note of disability or handicap

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

Adaptive behaviour - Play, climbing, speech, feeding

Vision – Posture, walking, play, manipulation with toys

Performance – understanding matching color, concentration, visual acuity

Comprehension of language – Body parts, pictures, commands

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

Application, concentration, organizational skills -Three ‘R’s, drawing

Vision, hearing

IQ tests

Stanford Binet Intelligence Scale

Wechsler Intelligence Scale

Goodenough ‘Draw a Man’ test

Denver Development Screening Test

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

Venue – Congenial environment

- Good lighting, pictures, posters

- Good sleep, food, warmth

- Good IPR, ‘relaxed’, ‘stories’

- Ensure presence of parents

Articles – Weighing scale, Stadiometer, Tape measure, books, paper, pencil, crayons, toys

- NCHS chart

- Growth chart