PREVENTIVE PEDIATRICS

Mrs. Shivani Thakur
Associate Professor
PREVENTIVE PEDIATRICS

INTRODUCTION:
There is a famous saying healthy children contribute to
healthy nation. Prevention is the best measure to maintain
health, an old saying ‘A STICH IN TIME SAVES NINE’
supports this.
Child survival strategies are extremely important to tackle
current problems of malnutrition, infections, diarrhoeal
diseases and poor maternal health. The approach should be
based low cost interventions acceptable to the people.

• In the past , maternal and child health services were rather
fragmented and provide piecemeal “ personal health
services” by different agencies, in different ways and
separate clinics. The current trend in many countries is to
provide integrated MCH and family planning services as
compact family welfare service.
• This implies a close relationship of maternity health to
child health, of maternal and child health to the health of
the family; and of family to the general health of the
community.

• In providing these services , specialists in obstetrics and
child health have joined hands , and are now looking
beyond the four walls of hospitals into community to
meet health needs of mothers and children aimed at
positive health.
• In the process they have linked to community medicine
(preventive and social medicine ) and as a result , terms
such as “social obstetrics” , “preventive pediatrics” and
“social pediatrics” have come into vogue.

VITAL STATISTICS
• 70% of the population is of developing countries.
• In India women of child bearing age (15-44 Yrs) are 19%.
Children under 15 years are 40%, Together 59%.
• They are vulnerable or special –risk group.
• Risk –
 Connected with childbearing for women.
 Growth development and survival for children.
• 50% of deaths are among under-five children.

• Maternal mortality rates vary from 13- 440 per 100,000
live births.
• Sickness and deaths among mothers and children are
largely preventable. This have led to the formation of
special health services for mother and children all over the
world.
• The present strategy is to provide maternal and child as an
integrated package of “Essential health care” also known
as “Primary health care”.

MEANING OF PREVENTIVE
PEDIATRICS:
Preventive paediatrics refers to ‘prevention
of disease and promotion of physical,
mental, and social well being of children
with aim of attaining a positive health’. It
comprises efforts to avert rather than cure
disease and disabilities.

Preventive paediatrics comprises efforts to avert
rather than cure disease and disabilities.
It is broadly divided into:
• Antenatal Preventive Paediatrics
• Postnatal Preventive Paediatrics

ANTE-NATAL
• Adequate nutrition of the pregnant mother
• Preparation and education of the mother for
delivery
• Prevention of communicable
diseases
• Mother craft and breast feeding

POST-NATAL PREVENTIVE
PEDIATRIC
• Periodic medical check up of infant
• Supervision of nutrition
• Immunization
• Accident prevention
• Psychological
supervision

AIMS
The aims of preventive paediatrics are similar to
that of preventive medicine ,i.e.
 Prevention of disease and promotion of physical,
mental, and social well-being of children so that
each child may achieve the genetic potential with
which he/she is born.

 To achieve these aims, hospitals have adopted the
strategy of “primary health care” to improve the health
status of children like,
• Growth monitoring
• Oral rehydration
• Nutritional surveillance
• Promotion of breast feeding
• Immunization
• Community feeding
• Regular health check-ups etc.

 Primary health care with its potential for vast
increased coverage through an integrated system
of service delivery is increasingly looked upon as
the best solution to reach to millions of children,
especially those who are in most need of
preventive and curative services.

COMPONENTS OF
There are Five Components of Preventive
Pediatrics:
• Nutrition to promotes good health.
• Health care and health maintenance.
• Immunizations prevents childhood diseases.
• Safety and accident prevention.
• Emotional climate in the home.

1. Nutrition Promotes Good Health:
• Good nutrition is every child’s birth right.
• Every child will instinctively choose the right food
in the right amount at the right time if it is
available to him.
• Nutritional needs varies in children through
different age-groups.

The various programs run by the GOI for the appraisal of
nutritional status of the children are:
i. Integrated child developmental scheme
ii. Nutritional program for adolescent girls
iii. Vitamin A supplementation of children of 9-36 months
of age group
iv. National iodine deficiency control program
v. Iron and folic acid supplementation of pregnant women
vi. Mid day meal program

MID DAY MEAL
PROGRAMME
The National Programme of Mid-Day Meals in Schools
covers approximately 11.74 crore children (Primary State:
8.24 crore, Upper Primary Stage: 3.50 crore)
NET CONTENT PRIMARY
(I-V)
UPPER PRIMARY
(VI-VIII)
CALORIES (kcal) 450 700
PROTEIN (grams) 12 20
FOODGRAIN(WHEAT/RICE) 100 grams per child/school day 150 grams per child/school day

RECOMMENDED DIETARY ALLOWANCE FOR PROTEIN
GRAMS OF PROTEIN
NEEDED EACH DAY
CHILDREN AGES 1 – 3 13
GIRLS AGES 14 – 18 46
BOYS AGES 14 – 18 52

AGES 2 TO 3: GIRLS AND BOYS
CALORIES 1,000 to 1,400, depending on growth and activity level
PROTEIN 5 to 20 percent of daily calories (13 to 50 grams for 1,000 daily calories)
CARBOHYDRATES 45 to 65 percent of daily calories (113 to 163 grams for 1,000 daily calories)
TOTAL FAT 30 to 40 percent of daily calories (33 to 44 grams for 1,000 daily calories)
SODIUM 1,000 milligrams a day
FIBER 14 to 20 grams a day, depending on daily calories and activity level
CALCIUM 700 milligrams a day
VITAMIN D 600 international units a day

DIETARY GUIDELINES FOR SCHOOLAGE CHILDREN
VEGETABLES 3-5 servings per day. A serving might be one cup of raw leafy vegetables, 3/4 cup of
vegetable juice, or 1/2 cup of other vegetables, raw or cooked.
FRUITS 2-4 servings per day. A serving may consist of 1/2 cup of sliced fruit, 3/4 cup of fruit
juice, or a medium-size whole fruit, such as an apple, banana or pear.
WHOLE GRAINS 6-11 servings per day. Each serving should equal one slice of bread, 1/2 cup of rice or 1
ounce of cereal.
PROTEIN 2-3 servings of 2-3 ounces of cooked lean meat, poultry, or fish per day. A serving in
this group may also consist of 1/2 cup of cooked dry beans, one egg, or 2 tablespoons
of peanut butter for each ounce of lean meat.
DAIRY PRODUCTS 2-3 servings (cups) per day of low-fat milk or yogurt, or natural cheese (1.5
ounces=one serving).
ZINC Studies indicate that zinc may improve memory and school performance, especially in
boys. Good sources of zinc are oysters, beef, pork, liver, dried beans and peas, whole
grains, fortified cereals, nuts, milk, cocoa, and poultry.

SPECIAL NUTRITIONAL NEEDS FOR TEENS
CALORIES Due to all the growth and activity, adolescent boys need 2,500-2,800 per day, while
girls need around 2,200 per day. It’s best to get these calories from lean protein, low-fat
dairy, whole grains, and fruits and veggies.
PROTEIN In order for the body to grow and maintain muscle, teens need 45-60 grams per day.
Most teenagers easily meet this need from eating meat, fish, and dairy, but vegetarians
may need to increase their protein intake from non-animal sources like soy foods,
beans and nuts.
CALCIUM Many teens do not get sufficient amounts of calcium, leading to weak bones and
osteoporosis later in life. Encourage teens to cut back on soda and other overly-sugary
foods, which suck calcium from bones. The 1,200 mg of calcium needed per day
should come from dairy, calcium-fortified juice and cereal, and other calcium-rich
foods such as sesame seeds and leafy greens like spinach.
IRON Iron deficiency can lead to anemia, fatigue, and weakness. Boys need 12 mg each day,
and teen girls, who often lose iron during menstruation, need 15 mg. Iron-rich foods
include red meat, chicken, beans, nuts, enriched whole grains, and leafy greens like
spinach and kale.

2. Health Care and Health Maintenance:
 Provision of well child checks-ups.
 Each assessment will include:
• Growth/development assessment
• Head-to-toe physical assessment
• Health teaching
• Immunizations
• Screening for problems.

WELL CHILD CHECK-UP:
After the baby is born, the next visit should be 2-3
days after bringing the baby home (for breast-fed
babies) or when the baby is 2-4 days old (for all
babies who are released from a hospital before
they are 2 days old). For experienced parents,
some health care providers will delay the visit
until the baby is 1-2 weeks old.

After that, visits should occur at the following ages:
• By 1 month (although experienced parents can wait until
2 months)
• 2 months
• 4 months
• 6 months
• 9 months
• 1 year
• 15 months

• 18 months
• 2 years
• 3 years
• 4 years
• 5 years
• 6 years
• 8 years
• 10 years
• Each year after that until age 21

• In addition to these visits, parents can call and visit
a health care provider any time the child seems ill
or whenever parents are worried about their baby's
health or development.

3. Immunizations Prevent Illness:
• Recommendation for schedule of immunizations.
• Nursing responsibilities: to check for the vaccine before
administration, teach the parents
about the response of the vaccine
and about the next date of the
schedule.
 Parent teaching.
 Side effects and special concerns.

RECOMENDATIONS
OF
IAP COMMITTEE
ON
IMMUNIZATION
(2020-21)

Abstract....
ARTICLE: Pulse Polio Immunization In District Panipat: A
Process Evaluation.
Objectives: To evaluate all steps of pulse polio
immunization on special sub national immunization day.
Methods: On a sub-national immunization day (SNID), 120
booths were randomly selected from 662 booths by
probability proportionate to size (PPS) sampling
technique.

Results: 34% workers were doing this work for the 1st time
without training. 40% of the vaccinators were neither
working according to micro plan nor were same as
mentioned in the micro plan. Supervision too was found
deficient. So it is concluded that sustaining the interest
and motivation of health personnel is paramount. This
paper emphasises the importance of continued re-
orientation training to keep them motivated and updated.
[Indian J Pediatr 2009;76(1):29-32]

4. Safety and Accident Prevention:
• Rate of incidence among children is very high .
• Common types of accidents affecting the various
age-groups of childhood are burns, fall, road side
accidents, home hazards etc.
• Parental teaching to anticipate safety needs to
create a safe environment.

5. Emotional Climate in the Home
• Common types of accidents affecting the various
age-groups of childhood are mostly home hazards.
• Parental teaching to anticipate safety needs to
create a safe environment.
• Parents are guided to prevent
Sudden Infant Death Syndrome.
Also called “crib death”.

SCOPES OF
PREVENTIVEPEDIATRICS
1. COMMUNITY PEDIATRICS:
A concept rather than a branch of pediatrics,
implying that “health is determined by interaction
between the child, his environment and the society
in which he lives.”
The objective is to carry
the health care to the
doorstep of the needy.

Basic principles
• The two essential areas of study in community
pediatrics are:
• The health of the child population in relation to its
social environment, i.e. the total community that
constitutes part of social medicine.
• The health of the individual child as a result of
multitude of social influences(both positive and
negative) that constitutes part of clinical medicine.

ADVANTAGES
i) Health care goes to the susceptible population,
thus ensuring protection to those who may not
otherwise seek advice.
ii) The concept ensures community participation at
all stages.
iii) A community based project can be started in a
simple mud-walled /tiled structure .the equipment
and manpower, locally available are relatively
cheap.

CONTINUE....
iv) Monitors the health and nutritional status of infants and
children on a continuous basis; this brings down the
mortality and morbidity considerably.
v) Contributes to family welfare by ensuring survival of the
child and convincing the parents of the advisability, to
"restrict the number of children to 1 or 2”.
vi) Reduces undue burden on the hospitals which, in any
case, are not the right place for tackling most of the
problems encountered in the developing regions.

2. SOCIAL PEDIATRICS:
Social pediatrics refers to application of the
principles of social medicine to pediatrics in order
to obtain a more complete understanding of the
problems of children so as to prevent and treat
disease and promote their adequate growth and
development through an organized health
structure.

AIMS
• Its main aim is to study child health in relation to
community, to social values and to social policy.
• This has given rise to concept of social pediatrics
it is concerned not only with the social factors
which influence child health but also with the
influence of these factors on the organization,
delivery and utilization of child health care
services.

• In other words , social pediatrics is concerned with
the delivery of comprehensive and continuous
child health care services and to bring these
services within the reach of the local community.
• Social pediatrics also covers various social welfare
measures – local , national, international – aimed
to meet the total health needs of the child.

Concerned with the delivery of
comprehensive and continuing
child heath needs (total health
needs):
• Healthy and happy parents
• Balanced and nutritious diet
• Clean, healthful house and environments
• Developmental needs like play, amusement, love,
affection, security, recognition, recreation,
company with other children
• Educational provision/opportunities.

CONTRIBUTION OF PREVENTIVE AND SOCIAL
MEDICINE TO SOCIAL OBSTETRICS AND PEDIATRICS:
1. Collection and interpretation of community statistics,
delineating groups “at risk” for special care.
2. Correlation of vital statistics ( eg., IMR, MMR, perinatal
and child mortality rates )with social and biological
characteristics such as birth weight , parity, age, stature,
employment etc., in the elucidation of etiological
relationships.

3.Study of cultural patterns, beliefs and practices relating to
childbearing and childrearing, knowledge of which might
be useful in promoting acceptance and utilization of
obstetric and paediatric services by the community.
4.To determine priorities and contribute to the planning of
MCH services and Programmes for evaluating whether
MCH services and programmes are accomplishing their
objectives.

MOTHER’S HEALTH
EFFECTS THE CHILD’S
WELBEING
Mother and child as one unit- because;
1. During the antenatal period , the fetus is part of
the mother – development –280 days, during this
period fetus receives nutrition and oxygen from
the mother.
2. Child health is closely related to maternal health;
a healthy mother brings forth a healthy baby; there
is less chances of premature, still birth or abortion.

CONTINUE....
3. Certain diseases and conditions of the mother during
pregnancy ( eg. Syphilis, German measles, drug intake)
are likely to have their effects on the fetus.
4. After birth, the child is dependant on the mother. Up to6 -
9 months completely for feeding.
5. The mental and social development is also dependant on
the mother, if the mother dies the child's growth and
development are affected (maternal deprivation
syndrome).

CONTINUE....
6. In the care cycle of women, there are few
occasions when the service of the child is
simultaneously called for . For instance post
partum care is inseparable from neonatal care and
family planning advice.
7. The mother is also the first teacher of the child.

Abstract....
ARTICLE: Maternal reports of child health status and
health conditions: the influence of self-reported maternal
health status.
Objective: The aim of this study was to examine the
influence of maternal health status (MHS) on the
relationship between child health conditions and child
health status (CHS).

Methods: The study sample included 38,207 children aged
5 to 17 years in the 2001 to 2008 National Health
Interview Surveys whose mothers were the survey
respondent for the child and herself. Information was
collected about CHS, MHS, diagnosed child health
conditions, and socio demographic characteristics.
Responses to a question on general health status were
used to rate CHS and MHS as "better" or "worse“.

Results: Adjusting for child and family socio demographic
characteristics had a negligible effect on the association between
CHS and a 4-level variable that classified children by both MHS
and child health conditions. The adjusted percentage of children
with worse CHS was higher among children whose mothers had
worse MHS compared with children whose mothers had better
MHS. Moreover, among children whose mothers had worse MHS,
there was a weak relationship between child health conditions and
worse CHS. Among children whose mothers had better MHS, there
was a strong relationship between child health conditions and worse
CHS.

Conclusion: Because mother-reported CHS is used widely
in epidemiological studies as a measure of a child's actual
state of health, it is important to consider how maternal
characteristics may influence a mother's report of a child's
status. In particular, CHS reported by mothers with worse
health status merits further investigation.

MATERNALASPECT OF
ANTENATAL CARE:
Objectives:
• To promote, protect and maintain the health of the mother
during pregnancy.
• To detect “high risk” cases and give them special
attention.
• To foresee complications and prevent them.
• To remove anxiety and dread associated with delivery.
• To reduce maternal and infant mortality and morbidity.

• To teach the mother elements of child care, nutrition,
personal hygiene and environmental sanitation.
• To sensitize the mother to the need for family planning,
including advice to cases seeking medical termination of
pregnancy.
• To attend to the under fives accompanying the mother.

Antenatal Visits
• Mother should attend Antenatal clinics.
• Once a month during first 7
months.
• Twice a month during the next
month.
• Thereafter once a week in the
ninth month, if everything is
normal.

Minimum 3 Antenatal
Visits
1. At 20 weeks or as soon as pregnancy is known.
2. At 32 weeks
3. At 36 weeks
4. At least 1 home visit by health worker

PREVENTIVE SERVICES
FOR THE MOTHERS:
 Prenatal services ( before delivery).
 First visit should include following: Health history,
Physical examination, Laboratory examination.
Lab tests includes:
1. Complete urine analysis
2. Stool examination, Serological examination
3. Complete blood count, including Hb estimation
4. Blood grouping and Rh determination
5. Chest x- ray if needed, pap tests, Gonorrhea culture
(Optional).

 On subsequent visits:
• Physical examination
• Laboratory tests
• Tetanus Immunization(2 doses of adsorbed tetanus toxoid
should be given. First dose 16 – 20 weeks and second 20-
24 weeks of pregnancy. Minimum interval between 2
doses should be 1 month, Second dose should be given at
least 1 month before the EDD)

• Group or individual instruction on nutrition, family
planning, self care, delivery and parenthood.
• Home visiting by female health worker / trained dai.
• Referral services , where necessary. Haemoglobin
estimate.

RISK APPROACH
Identify high risk cases from a large
group of antenatal mothers and arrange
them for skilled care, while continuing
to provide appropriate care for all
mothers.

At Risk Mothers
1. Elderly primi (30 years and over)
2. Short statured primi ( 140 cm and over)
3. Mal-presentations ( breech, transverse lie)
4. Ante-partum hemorrhage, threatened abortion
5. Pre – eclampsia and eclampsia
6. Anemia
7.Twins, hydramnios

8. Previous still birth, intrauterine death, manual removal of
placenta.
9. Elderly grand multi-para
10. Prolonged pregnancy( 14 days after expected date of
delivery)
11. History of previous caesarean or instrumental delivery
12. Pregnancy associated with general diseases –
cardiovascular disease, kidney disease, diabetes,
tuberculosis, liver disease.

Risk Approach Is A Managerial Tool:
• Services for all but with special attention to those
who need them the most.
• Maximum utilization of all resources including
some which are not involved in such care –
traditional birth attendants, community health
workers, women groups.
• Improvements in coverage & quality of health
care.

Maintenance Of Records:
• Antenatal card- in first examination, thick paper to
facilitate filing.
• Registration number. Identifying data, previous health
history, main health events.
• Record is kept at MCH/FP centre.
• A link is maintained between the antenatal card, postnatal
card and under-fives card.
• Essential for evaluation and further improvement.

Home Visits:
• Home visiting is the backbone of all MCH services.
• Even if the expectant mother is attending the ante natal
clinic regularly, she must be paid one home visit by the
health worker female or public health nurse.
• More visits are required if the delivery is planned at
home.

PRENATALADVICE
• Mother s more receptive to the advice concerning herself
and her baby at this time than at other times.
• The talking points should cover not only the specific
problems of pregnancy and childbirth but also about
family and child health care.
Prenatal advice – diet:
• Reproduction costs energy.
• Pregnancy in total duration consumes about 60000 k cal
over and above normal metabolic requirements.
• Lactation demands about 550 kcal / day.

RDA During Pregnancy And
Lactation
NUTRIENT PRE-
PREGNANCY
PREGNANCY LACTATION
• Calories (kcal) 2200 2500 2700
• Proteins (g) 45-50 60 65
• Vitamin A (mg) 800 800 1300
• Vitamin C (mg) 60 75 90
• Folate (ug) 180 400 280
• Calcium (mg) 800 1200 1200
• Phosphorus (mg) 800 1200 1200
• Iron (ug) 15 30 15
• Iodine (ug) 60 75 90
• Zinc (mg) 12 15 19

• Child survival is correlated with birth weight.
Birth weight is correlated to the weight gain of the
mother. A normal healthy women gains about 12
kg of weight during pregnancy. Thus pregnancy
imposes extra calorie and nutritional requirements.
• If maternal stores of iron are poor and if enough
iron is not available to the mother during
pregnancy, it is possible that foetus may lay down
insufficient iron stores.

Weight Gain During Pregnancy
In Relation To Pre-pregnancy
BMI
BODY MASS INDEX WEIGHT GAIN
• <19.8 (Under weight) 12-18 kg
• 19.8-25 (Normal weight) 11-16 kg
• 26-29 (Over weight ) 7-11 kg
• >29 (Obese) Upto 6 kg

• Such a baby may show a normal Hb at birth but
will lack the stores of iron necessary for rapid
growth and increase in blood volume and muscle
mass in the first year of life.
• Stresses in the form of malaria and other
childhood infections will make the deficiency
more acute, and many infants become severely
anaemic during the early months of life. Therefore
a balanced diet is necessary.

PERSONAL HYGIENE AND
HABITS
Personal
cleanliness
Rest and
sleep
Bowel
habit
Exercise
Smoking
Alcohol
Dental
care.
Sexual
intercourse
Drugs Radiation Child care

SPECIFIC PROTECTION
AND HEALTH PROMOTION
1.Anaemia: eg. Iron deficiency anaemia
• About 50% to 60% of mothers in India of low
socio economic groups are anemic in the last
trimester of pregnancy.
• Etiology is iron and folic acid deficiency.
• Associated with high incidence of premature
births, postpartum hemorrhage, peuerperal sepsis
and thromboembolic phenomena in the mother.
• IFA supplementation is done by Govt. Of India.

2.Other nutritional deficiencies: eg. Kwashiorkar
and marasmus.
• Protein, vitamin and minerals
• Especially vit. A and iodine
• Milk should be supplemented, or skimmed milk
should be given.
• Capsules of vitamin A and D also supplied free of
cost

3.Immunization:
• 2 doses of adsorbed tetanus toxoid should be given.
• First dose 16 – 20 weeks and second 20-24 weeks
of pregnancy.
• Minimum interval between 2
doses should be 1 month.
• Second dose should be given
at least 1 month before the EDD.

4.HIV infection:
• HIV in child may occur through placenta, delivery,
breast feeding.
• 1/3 of the children get infected through above
routes.
• Risk is higher if the mother is newly infected or she
had already developed AIDS
• Voluntary prenatal testing for HIV infection should
be done as early in pregnancy for all.

5.Prenatal genetic screening:
Prenatal genetic screening includes screening for
chromosomal abnormalities associated with
serious birth defects, screening for direct evidence
of congenital structural anomalies, screening for
hemoglobinopathies and other inherited conditions
detectable by biochemical assays.

6.Mental preparation:
• It is also important.
• A free and frank talks on all aspects of pregnancy
and delivery.
• Removing the fears about confinement.
• The mother craft classes at the MCH centres.

7.Family planning:
• Related to every phase of maternity cycle.
• Mothers are psychologically more receptive to the advice
on family planning than at other times.
• Motivation and education should be done during the
antenatal period.
• If the mother has had 2 or more children she should be
motivated for puerperal sterilization.
• All India post partum programme services are available.

Abstract....
ARTICLE: Impact of training of traditional birth
attendants on the newborn care.
Objectives: To study the impact of training of
traditional birth attendants on the newborn care in
resource poor setting in rural area.
Methods: A community based study in the PHC area was
conducted over 1 yr period between March 2006-FEB
2007. 50 traditional birth attendants were taken who
conducted home deliveries in the PHC area.

Training was conducted for 2 days which includes topics on
techniques of conducted safe delivery and newborn
practices. Pre-evaluation test regarding knowledge and
practices about newborn care was done. Post test
evaluation was done at 1st month (early) and at 5th month
(late) after the training. Results shows that the knowledge
of TBAs was poor before the training. And the
progressive improvement was seen at the early and late
post test evaluation.

Conclusion: Training programme for TBAs with regular
reinforcements in the resources poor setting will not only
improve quality of newborn care but also reduces peri-
natal deaths.
[Indian J Pediatr 2009;76(1): 33-36]

PREVENTIVE PEDIATRICS

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to PREVENTIVE PEDIATRICS

Similar to PREVENTIVE PEDIATRICS (20)

Recently uploaded

Recently uploaded (20)

PREVENTIVE PEDIATRICS