4--Child health care and preventive pediatrics{4}.ppt

First year feeding problems
Underfeeding
Underfeeding Is suggested by restlessness
and crying and by failure to gain weight
adequately.
In these cases, the frequency of feedings, the
mechanics of feeding, the size of the holes in the
nipple, the adequacy of eructation of air, the
possibility of abnormal mother-infant “bonding”
and possible systemic disease in the baby
should be investigated.

Overfeeding
Regurgitation and vomiting are frequent
symptoms.
Diets too high in fat delay gastric emptying,
cause distention and abdominal discomfort, and
may cause excessive gain in weight.
Diets too high in carbohydrate are likely to
cause resulting in too rapid a gain in weight.

Regurgitation and vomiting
The return of small amounts of swallowed
food during or shortly after eating is called
regurgitation. more complete emptying of the
stomach, especially the occurring some time
after feeding, is called vomiting.
Regurgitation can be reduced to a negligible
amount by adequate eructation of swallowed air
and after eating, by gentle handling, by avoiding
emotional conflicts, and by placing the infant on
the right side for a nap immediately after eating.
The cause of vomiting should always be
investigated

Constipation
Constipation in the artificially fed infant
may be caused by an insufficient amount
of food or fluid
May result from diets too high in fat or
protein or deficient in bulk.
Simply increasing the amount of fluid or
sugar in the formula may be corrective in
the first few months of life

Feeding during the second year of life
Reduced caloric intake:
During the second year, because of the constantly
decelerating rate of growth, there is a gradual
reduction in the infant’s caloric intake per unit of
body weight.
Self-selection of diet:
Children’s strong likes or dislikes of particular
foods should be respected whenever possible
and practicable.
Self-feeding by infants:
Before 1yr of age, the infant should be
permitted to participate in the act of feeding.

Daily basic diet:
parents should be given a daily basic diet for the
child from which the family menu can be
prepared. Daily selection provides a balanced
diet with sufficient macronutrients and
micronutrients.
Eating habits:
Eating habits formed in the 1st yr or 2yrs of life
distinctly affect those of the subsequent years.
Snacks between meals:
Orange juice or fruit, together with a cracker,
may be given in either or both of the between-
meal periods.

Later childhood and adolescence
As the child reaches age 2 yrs, diet is similar
to that of the family.

Child health care and
preventive pediatrics

Preventive pediatrics
Definition: prevention of illness in children at
five levels:
Promotion of general health
Prevention of specific diseases
Early diagnosis of asymtomatic disease, so
as to permit early therapy and prevent
sequelae
Early diagnosis and appropriate therapy of
symptomatic disease to prevent sequelae
Prevention of unnecessary disability due to
established symptomatic disease

Scope:
preventive services must be related
to the health problem. Health problems
include those that cause death, acute
or chronic diseases, functional
disabilities of emotional or social
nature, or other kinds of distress and
dissatisfaction.

Periodic health supervision visits
pediatrician spend 40% of their time
performing clinical preventive services
throughout infancy, childhood, and
adolescence.
During supervision visit some disorders,
such as those of vision or hearing, may
be detected and to be prevented.

Recommended the following
schedule for health supervision
Prenatal: initial contact with pediatrician
urged
Birth: at least two examinations in the
hospital: one within the first 24 hours, the
second just before discharge
First 6 months: monthly visits
Second 6 months: visits every 2 month
Second year of life: 4 visits
2 to 6 years: one or two visits a year
After 6 years: annual visits

Development: each well-child visit
should determine a child’s
developmental achievements, such
as by the widely used Denver
Developmental Screening Test.
Questions in the gross motor,
personal-social, language, and fine
motor adaptive realms can be
presented and responses scored.
Topics of frequent concern
during health supervision

Feeding and diet:
many changes occur in the dietary intake
of those in the pediatric age group, and these
should be reviewed with the parents and
children.
During the first 12 months of life, breast
milk or infant formulas is the major source of
calories and nutrients. The introduction of
infant cereals, strained food, the junior foods,
and finally table foods are issues of daily
concern for parents.

For older children, the intake of
excessive salt, carbohydrates, or
cholesterol can adversely affect health.

Accident prevention: at each well-child
care visit, accident prevention should be
reviewed. e.g. when a child have ability to
crawl, grasp and place objects in the
mouth, issue of poison prevention is
critical.

Growth:
at each well-child visit, the weight ,
height, and the head circumference are
measured. These are plotted on
standard graphs.
if abnormalities in the rate of growth
are noted, the clinical evaluation can
focus on possible causes.

Diaper dermatitis:
Diaper dermatitis peak at age 9-12mo
Wearing diapers is the cause of most cases.
Diaper rashes are self-limited and respond to
frequent diaper changes.
More absorbent diapers have helped to
prevent diaper rashes
Diarrheal disease is a major exacerbating
factor

Teething:
most infants have their first teeth erupt at
age 6(4-10)months and may have associated
mild symptoms of gingival swelling and
sensitivity, increased salivation, and
irritability related to gum discomfort.
No evidence shows that diarrhea,
rhinorrhea, rashes, or fever is related to
teething.

Screening tests:
the recording of height and weight on a
growth chart constitutes the most important
screening procedure.
Screening for visual acuity can be done from
approximately 3 years of age. Between 5 and
10 percent of preschool children have some
visual impaired.
Screening for hearing are difficult. It is better
to use audiometer for screening of hearing loss
in neonate period.

Urinalysis is a traditional screening test, the
dip stick tests for protein and glucose are
simple and adequate.
Tuberculin tests give increasingly fewer
positive reactions, so that a positive test is
likely to identify significantly infected
children; the early detection and
identification of their contacts are important
both for therapy and prophylaxis.

Test approach: the mantoux test is
performed by injecting 5 tuberculin units of
purified protein derivative (PPD)
intracutaneously. The response is measured
as the amount of induration at 48-72 hours.
The size of induration, rather than erythema,
is diagnostic. Interpretation of skin test
depends on the size of induration, patient’s
age and risk factors. The size of induration is
less than 5mm, the result is negative. When
the patient have immune deficiency, PPD is
often negative in patient with primary or
miliary TB.

The size of induration:
﹤5mm negative reaction -
﹥5mm positive reaction +
10-19mm, moderate ++
﹥20mm strong +++
vesicles, lymphangitis ++++

Clinical significance: (positive response)
1) Vaccinated BCG before
2) the reveals mild positive response for old
children without clinical symptoms. Result
suggest that the children has suffered from
tuberculosis;
3) Infants and toddlers are not vaccinated but
their skin tests are positive, the result often
suggest that fresh tuberculous foci exist in
the body, especially for infants;

4) Strong positive reaction suggests an
active tuberculosis;
5) Reverse to positive from negative, or
reactive induration increase to more
than 10mm from previous 10mm.

Negative response:
1) May not suffer from tuberculosis
2) Within 4-8 weeks after primary infection of
tuberculosis
3) False negative response due to decreased
or inhibited immune function, e.g. some
severe tuberculosis, acute infectious
diseases such as measles, whooping
cough, extremely weak patients with severe
malnutrition, severe dehydration, or severe
edema, treatment with corticosteroids or
immune inhibitors, primary or secondary
immune defects,
4) Technical error or invalidated PPD

The only biochemical abnormality that is
presently tested for routinely is phenylketonuria,
through examination of blood of the newborn
infant after milk feedings are begun. (plasma
phenylalanine level above 20mg/dl)
Screening for thyroid function: hypothyroidism
can be found by measuring thyroxin.
Screening for lead poisoning is recommended
for children of 18 months to 5 years of age.
Serum lead normal value:﹤0.1mg/L

Principle and main points of health
care at different age periods
Prenatal and neonatal periods:
During pregnancy the maintenance of good
maternal nutrition, the early diagnosis and
adequate management of maternal infections,
the cautious use of drugs and minimal use of
radiation
A careful physical examination of the
newborn infant within 24 hours of delivery
should be carried out. Such examination aim
at early detection of anomalies, such as
congenital heart disease, hip dysplasia, and
neurologic disorders.

Infancy: the main problems are
nutritional disorders, infections,
developmental problems.
congenital anomalies and hereditary
metabolic disturbance
Vitamin D deficiency—rickets
Iron deficiency– iron deficiency anemia

Preschool period:
Acute infections, accidents, chronic
diseases
Malignant neoplasms, including
leukemia are second cause of death.

School age:
Developmental problem are best
indicated by school performance,
emotional and learning problems are
frequent.

hygiene
Habits:
the daily practices which promote good
health, usually referred to as personal
hygiene, are facilitated by the
development of habits.
Habits are considered to be good.
Praise, encouragement, attention and
personal satisfaction strengthen them.

Sleep:
There is considerable variation in the amount of
sleep required by different children.
Early establishment of regularity of bedtime is most
important.
The presleep period should be free of excitement,
rushing, scolding and physical activity.
At bedtime a quiet interaction between parents and
child should start, like reading a bedtime story,
transitional objects such as teddy bears, it facilitates
falling asleep

Hours of sleep
Age nighttime sleep daytime sleep total hours of
sleep
1week 8.5 8 16.5
1months 8.5 7 15.5
3months 10 5 15.0
6months 11 3.25 14.25
12months 11.75 2 13.75
2years 12 1 13
5years 11 11
10years 9.75 9.75
18years 8.25 8.25
from Nelson textbook of pediatrics

Elimination:
Control of the anal and bladder sphincters is
naturally acquired by most children during
the second or third year of life.
About 18 months of age most toddler have
acquired enough bladder control to retain
urine for 2 hours or so.
The average age of successful toilet training
is 27 months, with a range of up to 3-4 years
in US.

Exercise:
the normal infant or child, in a
reasonable environment, will have
sufficient muscular activity for good
growth and development.

Sunlight and fresh air
Sunlight and fresh air are essential for the
development and maintenance of sound
health.

Cleanliness
Certain aspects of cleanliness such as the
bath, washing hands at mealtimes and at
toilet time, the use of a handkerchief and a
napkin, brushing the teeth and some
responsibility are essential.

Immunization procedure
Definition: vaccination is administration of
any vaccine or inactivated toxin for
prevention of disease. Immunization is the
process of inducing immunity artificially by
either vaccination( active immunization) or
administration of antibody ( passive
immunization) .
Immunizing agents: vaccines, toxoids,
antitoxins and immune globulin.

Vaccine: a preparation of proteins,
polysaccharides, or nucleic acids of
pathogens that are delivered to the
immune system as single entities, as
part of complex particles, or by live-
attenuated agents or vectors, to induce
specific responses that inactivate,
destroy, or suppress the pathogen.

toxoid: a modified bacterial toxin that has
been made nontoxic but retains the capacity
to stimulate the formation of antitoxin.
Immune globulin: an antibody-containing
solution derived from human blood obtained
by cold ethanol fractionation of large pools
of plasma and used primarily for the
maintenance of immunity of immunodeficient
persons or for passive immunization;
available in intramuscular and intravenous
preparations.

Antitoxin: an antibody derived from the
serum of humans or animals after
stimulation with specific antigens; used
to provide passive immunity.

Passive immunization: the
administration of antibody from an
exogenous source. It provides
temporary immunity and is effective if
the disorder is preventable by adequate
levels of serum antibody and if this
antibody is given before or early in the
incubation period of the organism.

Side effect of passive immunization
Acute allergic reaction
Chronic reaction such as serum sickness
Two of the most important uses of passive
immunization
For children with hypogammaglobulinemia.
To prevent the development of anti-Rh
antibodies in Rh-negative mother.

Active immunization: stimulating the
immune system to produce antibodies
and cellular immune responses that
protect against the infectious agent.

Active immunization: the process
whereby material is administered to a
subject before exposure to the
infectious agent. The subject produces
antibody against the administered
material and is capable of rapidly
increasing the concentration of this
antibody on subsequent exposure
against the same material.

Vaccinated against diphtheria, tetanus,
pertussis, measles, hepatitis B,
tuberculosis, and poliomyelitis unless
contraindicated. ( in china)

Immunization course in infancy ( before 1 year )
age ( month ) vaccine
after birth BCG vaccine hepatitis B vaccine
1 hepatitis B vaccine (intensify)
2 TOPV poliomyelitis pill (first)
3 TOPV poliomyelitis pill (2nd) triple vaccine (first)
4 TOPV poliomyelitis pill (3rd) triple vaccine (2nd)
5 triple vaccine (3rd) diphtheria tetanus pertussis
6 hepatitis B vaccine (intensify )
8 measles vaccine
12 B variant encephalitis vaccine

The disease for which vaccines are
available but not routinely administered
include influenza, hepatitis A, rabies,
mumps, varicella and rubella (in china)

Allergic reaction: reaction may be local
or systematic. Local reaction such as
erythema, pain, and swelling;
systematic reaction such as fever,
irritability, vomiting, severe systematic
reaction such as shock, convulsion,
encephalopathy.
Active immunization adverse events

severe facial swelling, especially of lips

Swelling of eyelids,
Angioedema

Fever: often occurs within 12-24hours,
administration of ibuprofen may
decrease the temperature. It is not a
contraindication to further injections.

generic contraindications to vaccination
Moderate or severe illness, regardless of
presence or absence of fever
An anaphylactic reaction to previous dose of
the same vaccine.
An anaphylactic reaction to a vaccine
constituent, such as egg protein, gelatin, or
antibiotics
Acute febrile illness is reason to defer
immunization.
Children with immunodeficiency disorders
should not be vaccinated with live virus
vaccines.

Vaccines in special circumstances
Immunodeficiency: recommendation for
vaccination of immunocompromised person
vary according to the degree and cause of
the immunodeficiency, risk of exposure to
the disease and the type of vaccine.
OPV is contraindicated in
immunocompromised children
BCG is contraindicated in HIV-infected
children

Preterm infants:
Preterm infants including those of very
low birth weight should be vaccinated
at the same chronologic age and
according to the routine childhood
immunization schedule. Vaccination
should be delayed until the infant either
weighs 2 kg or is 2 months of age.

Drug therapy:
Rational pharmocologic treatment
requires adequate knowledge about the
disease process, the pharmocokinetic
properties of the drug selected, and the
individual’s ability to tolerate the
medicine.

Antibiotics:
Penicillin: 100,000-250,000units/kg/d iv,
divided q4-6hr
Ampicillin: 100-200mg/kg/d iv divided q6h.
Ceftriaxone: the third-generation
cephalosporin active against gram-positive
and negative pathogens.
Children: 80-100mg/kg/day iv divided q12-
24h

Cefuroxime: second-generation cephalosporin
children: 200-240mg/kg/day iv divided q8h;
oral administration 20-30mg/kg/day divided
q8h.
Azithromycin: azilide antibiotic with activity
streptococcus, H. influenzae, mycoplasma.
children: 10mg/kg PO on day 1(max 500mg)
followed by 5mg/kg PO qd for 4 days.

Corticosteroids: systemically and locally
for acute and chronic inflammation;
allergic, neoplastic, and autoimmune
diseases, cerebral edema, septic shock, H.
influenzae meningitis, diagnostic agent
( decrease inflammation and suppresses
normal immune response)
Dexamethasone: children: IV 0.1-0.3
mg/kg/day divided every 6-12hr.

Hydrocortisone: Children: IV 1-5mg/kg/day
in 1-2 doses
Prednisone: children: 0.1-2mg/kg/24hr PO
q6-qd.

Adverse events of corticosteroids:
Hypertension
Hyperglycemia
GI hyperacidity
Cataracts
Adrenal suppression
Poor growth

Antipyretic:
acetaminophen: inhibits hypothalamic heat
regulation center.
infants and children<12yr:10-15mg/kg/dose,
q4-6h;
children>12yr and adult: 325-650mg,q4-6h
or 1,000mg 3-4 times daily. Maximum 5
doses/24hr(children) or 4g/d(adult)
administered PO or PR.

Ibuprofen: inhibit prostaglandin synthesis.
children: 5-10mg/kg/dose every 6-8hr.
adult: 400-800mg/dose, 3-4 times
daily (max 3.2g/day)

Anticonvulsant:
Phenobarbital: loading dose: children:
15-20mg/kg IM, maintenance dose:
children: 5-6mg/kg/24hr IM q12-24hr.
Valium: IV :0.1-0.3mg/kg/dose given over
2-3min may repeat every 30min to max
total dose of 5-10mg;
10% chloral hydrate: rectal: 0.5ml/kg/dose

antitussive agent and anti-asthmatic
Compound Pholcodine Syrup:
Constituent: pholcodine, ephedrine,
guaiphenesin. Pholcodine is an opioid
cough suppressant; ephedrine can relax the
smooth muscles that line the airway ;
guaiphenesin is a expectorant drug
At about 2 yr, 2.5ml/dose tid
At about 5 yr, 5ml/dose tid
At about 7 yr, 10ml/dose tid

Antidiarrheals:
Smecta Powder: less than 1yr, 1
package/d, 1-2yr,1-2package/d; more than
2yr, 3 package/d; divided 3 times.

Drug for neonates, especially preterm
infants: the liver and renal function is not
mature, some drugs have side effect for
them. Such as: sulphonamides, vitamin K3
can cause hyperbilirubinemia;
chloramphenicol can cause gray baby
syndrome

Route of administration:
Oral: achlorhydria results in enhanced
absorption of certain drugs. Decreased
absorption of the others
Parenteral administration,
intramuscular, intravenous,
subcutaneous, rectal route, inhalation

Drug dosage: based on body weight and
body surface area
Calculation of body surface area
<30kg body surface(m2)
=weight(kg)×0.035+0.1
>30kg body surface(m2)
=(weight–30) ×0.02+1.05

Calculation of body surface area

Drug dosage: based on body weight
Dosage = weight X dose/kg/d
Drug dosage: based on body surface area
Dosage =body surface area(m2) X dose/m2
Drug dosage: based on adult dosage
Dosage = adult dosage X weight /50
Drug dosage: based on age
e.g. antitussive,

Clinical pediatrics
It involves the systematic and psychological
diseases. It mostly deals with the diagnosis
of childhood diseases and treatment to
decrease morbidity and mortality. Clinical is
branched into different groups according to
system: pediatric cardiovasology, pediatric
respiratory medicine, pediatric hematology,
pediatric neurology, pediatric endocrinology,
pediatric genetics, pediatric emergency
medicine.

Neonatology: hyaline membrane disease
Respiratory system disorders: pneumonia
Gastrointestinal system disorders: infantile diarrhea
Cardiovascular system disorders: congenital heart
disease
Hematologic disorders: iron deficiency anemia;
nutritional megaloblastic anemia
Nephrology disorder: poststreptococcal acute
glomerulonephritis; nephrotic syndrome
Diseases of nervous system: purulent meningitis

Newborn period is ( )
A. the first month of life
B. the first 6 week of life
C. the first 1 year of life
D. the first 2 year of life

In which period nutritional disturbances
and infection most easily occur ( )
A: newborn period
B: perinatal stage
C: infancy period
D: prescool period

In which stage physical growth increase
most rapidly ( )
A: neonate period
B: preschool period
C: toddler’s period
D: adolescence

The median weight of an 8-month –old
infant is (whose birth weight is 3kg) ( )
A.8.5kg
B.8.0kg
C.12kg
D.7kg

Which is the reliable indicator of physical
growth and nutrition ( )
A. height
B. weight
C. head circumference
D. dentition

The median height of a 8-year-old child
is ( )
– A: 105cm
– B: 112cm
– C: 119cm
– D: 126cm

Head and chest circumference are
almost the same around the age of ( )
– A: 6 months
– B: 1 year
– C: 2 years
– D: 3 years

The anterior fontanel usually closes
between ( )
– A: 9 and 18 months
– B: 18 and 24 months
– C: 24 and 30 months
D: 30 and 36 months

How many deciduous teeth should erupt
by the age of 1 year ( )
– A: 3 to 5
– B: 4 to 6
– C: 5 to 7
– D: 6 to 8

The posterior fontanel closes by ( )
A. the sixth week of life
B. the sixth month of life
C. the sixteenth month
D. the eighteenth month

The median head circumference of a 3-
month-old infant is ( )
A. 30cm
B. 34cm
C. 40cm
D. 46cm

An infant can move his head from
side to side while following a moving
objects, can lift his head from a prone
position 45 degrees off the examing
table, smiles when encouraged, and
makes cooling sounds. He cannot
maintain a seated position. The most
likely age of the infant is
A 1 month
B 3 months
C 6 months
D 9 months
E 12 months

An infant who sits with only
minimal support, attempts to attain
a toy beyond reach, and turns over
from supine to the prone position,
but doses not have a pincer grasp,
is at a developmental level of
a. 2 months b. 4 months
c.6 months d. 9 months
d.e. 1 years

A child can dress with help, ride a tricycle,
knows her age, and can speak in short
sentences. She had difficulty in copying a
square. The number of ossification center in her
left wrist is 4. The age of the this child is most
likely ( )
A. 1 year
B. 2 years
C. 3 years
D. 4 years

Nutritional requirements of infants and
children include following except ( )
A. minerals
B. protein
C. water
D. oxygen

The best food for a 2-month-old infant is ( )
A. human’s milk
B. infant formulas
C. cow’s milk
D. human’s milk and rice cereal

Which vaccine should be finished at birth
( )
A. BCG
B. Polio
C. Measles
D. TDP (diphtheria tetanus pertussis)

When does a child should vaccine
measles ( )
A. at birth
B. 3 month after birth
C. 6 month after birth
D. 8 month after birth

Mantoux test( PPD skin test) should be
observed in ( )
A. 36hrs
B. 48hrs
C. 72hrs
D. 48 to 72hrs

False about Mantoux test( )
A. 0.1ml of PPD used
B. subcutaneous injection
C. volar aspect of forearm
D. weal of 5mm should be raised

Polio vaccine should be given in ( )
A. 1,2,3 months
B. 2,3,4 months
C. 3,4,5 months
D. 4,5,6 months

There are seven Pediatrics age groups
during childhood:
(1) Fetal period
(2) Neonatal period (the first four weeks of
life)
(3) Infant period (the first one year of life)
(4) toddler’s age
(5) Preschool age
(6) School age
(7) Adolescent period

Rules of growth and
development
Continuous course and two growth peaks
General principles of growth and
development
Development of systems and organs is
imbalance
Individual variation

General principal of growth and
development
Up to
down(cephalocau
dal)
From proximal to
distal
from gross to fine
From junior to
senoir
From simple to
complex

The formula for calculating child’ body weight had
been revised in the new edited pediatrics book.
Birth weight: 3kg
4months: 6kg
1yrs: 9kg
2yrs 12kg
2y~12ys: age(years)×2+8
Birth weight+age(mo)x0.7(kg)
6kg+age(mo)x0.25(kg)
＜6mo
7-12mo

Height a reliable indicator of skeletal growth
The average length is about 50cm at birth,
about 75cm at 1 year
about 85cm at 2 years of age.
Thereafter, during preschool and early school years ,
height gain is steady at 7cm a year until the
adolescent growth spurt
The formula for calculating the height: (2years--
12years)
Height(cm) = age× 7+70cm
(or age× 6+77cm)

neonate
4 months old
1 year old
2 years old
50cm, 3kg
65cm, 6.5kg
75cm,
9kg
85cm,
12kg
The increment of weight and height

Head circumference usually a reliable indicator of
brain growth in infancy
head circumference measures
approximately 34--35cm at birth
46cm at age 1 year
48cm at age 2 year
50cm at age 5 year
The posterior fontanel closed by 6-8 weeks .
The anterior fontanel closed between 12 to 18 months

Abnormality of fontanel may be a sign of some
diseases.
larger
smalle
r
bulging
sunken
microcephaly
Rickets,
hypothyroidism
dehydration
Increased ICP:

The total ossification centers in
mature left wrist, are 10 (8 wrist bones+
2 distal long bone of forearm);
The number of ossifications centers in
wrist between age 1~9 years:
ossification center= bone age+1;

The number of tooth may be equal the
months of age minus 6

Gross motor development
2 months lift, 4 m turn over, 6 m, sit, 7 m roll,
8 m crawl, 1 years walk

The energy from food for the average
child 6 to 12 years of age is used in
following ways:
(1) 50% for basal metabolism
(2) 25% for physical activity
(3) 12% for growth
(4) 10% for fecal loss
(5) 3%--5% for specific dynamic
action of food (SDA)

Daily energy requirements based on weight and age.
The daily energy requirement is approximately 100--
120kcal per kg for the first year of life ,with
subsequent decrease of 10 Kcal per kg for each
succeeding 3-year period.

the advantages of breast feeding
(1) Human milk provides the full-term
infant with all necessary nutrients,
including taurine and polyamine and
other compounds, that may be essential
for the growing infant.
(2) Human milk is easier to digest and
absorb than cow milk.

(3) Human milk is better at preventing from
infection than cow milk.
(4) In breast-fed infants allergic reaction such
as atopic eczema and gastrointestinal
symptom are less frequent
(5) Human milk is economic and convenient .
(6) Breast feeding can promote the feelings
between infant and mother

The calculation of amount of milk that a infant need every day
example A 8 months old infant
1. body weight : 8 kg (measured or caculated)
2. The requirement of liquid: 150ml/kg (1200ml )
3. Energy requirement: 110kcal/kg (880kcal)
4. The requirement of cow milk containing 8% sugar
(880ml)
5. In addition to 880ml milk, 320ml water should be given
moreover.

principle of additional foods
Any new food should be offered initially once a
day in small amounts (1 to 2 teaspoonfuls). New
foods are generally best accepted if fairly thin or
dilute. It is usually wise to offer the same food
daily until the baby becomes accustomed to it and
not to introduce new foods more often than every
week or two.

Clinical significance:
1) Vaccinated BCG before
2) the reveals mild positive response for old
children without clinical symptoms. Result
suggest that the children has suffered from
tuberculosis;
3) Infants and toddlers are not vaccinated but
their skin tests are positive, the result often
suggest that fresh tuberculous foci exist in
the body, especially for infants;
PPD for screening test of tuberculosis

north
kindergarten
100m
Cross of ziwu
road
university

4--Child health care and preventive pediatrics{4}.ppt

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4--Child health care and preventive pediatrics{4}.ppt