Children's health encompasses physical, mental, emotional and social well-being from infancy through adolescence. Key concepts include infant mortality rate, preterm and small for gestational age babies. Leading causes of neonatal and under-5 mortality in India are preterm birth, pneumonia, congenital abnormalities, and diarrhea. The Integrated Management of Neonatal and Childhood Illness strategy and Rashtriya Bal Swasthya Karyakram screen for and manage 4Ds - defects at birth, deficiencies, diseases and developmental delays. Nutrition interventions target severe and moderate acute malnutrition.

1. CONCEPTS OF CHILD HEALTH
from RMNCH+A perspective
Dr. Ananya Ray Laskar
Associate Professor
Dept. Community Medicine
Lady Hardinge Medical College New Delhi

2. Children's health encompasses the
physical, mental, emotional, and social
well-being of children from infancy through
adolescence.

3. Basic Terminologies
• Infant: first 12months
• Neonate: First 28days
• Early Neonate: 0-7days
• Late Neonate: after 7days to 28days
• Infant mortality is the death of an infant
before his or her first birthday. The infant
mortality rate is the number of infant deaths
for every 1,000 live births.

4. Preterm is defined as babies born alive before
<37 weeks of pregnancy are completed.
extremely preterm (less than 28 weeks)
very preterm (28 to less than 32 weeks)
moderate to late preterm (32 to 37 weeks)

5. Small for Date Babies
• Also known as Small for gestational age (SGA)
is defined as a birth weight of < 10th percentile
for gestational age.
• They may be term/preterm
• Children born FGR SGA have a higher risk of
mortality and morbidity during the neonatal
period and beyond

6. CAUSES
Preterm
1.Provider Initiated
2.Spontaneous-
unidentified in half
cases
• Maternal risk factors
–age, lifestyle,
Infections
• Genetic
• Epigenetic

7. CAUSES
Preterm
1.Provider Initiated
2.Spontaneous-
unidentified in half
cases
• Maternal risk factors
–age, lifestyle,
Infections
• Genetic
• Epigenetic
SFD/IUGR
• Maternal: malnutrition,
anaemia, heavy physical
work, malaria,
hypertension, toxemia,
Multipara, underage
• Placental: insufficiency
/abnormality
• Fetal: congenital/
chromosomal
abnormalities,

8. IMR, NMR in India
• Infant mortality rate- 2022 was 27.695 deaths per
1000 live births, a 3.74% decline from 2021.
• Neonatal Mortality Rate- SRS (2018)
Early NMR 18 per 1000 live births (20 Rural &
10Urban)
Neonatal Mortality is dominated by endogenous
factors, post NMR is effected by exogenous
factors (Diarrhoea, respiratory infections,
malnutrition)

9. Causes of Neonatal Deaths in India

10. Causes of child mortality in India
Neonatal causes
(46%)
Pneumonia 13%
Congenital (4%)
Pre term birth (2%)
Malaria (5%)
Diarrhea (8%)
Injury (6%)
Others (12%)
Meningitis (2%)
Measles (1%), AIDS (1%)
Source: UNICEF India
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11. Trends of IMR for India

12. IMR –Indicator of health status & std
of living
• Largest single Age-category of mortality
• Deaths at this age are due to a peculiar set of
Ds/conditions to which the adult popn is less
vulnerable
• IMR is affected quickly & directly by specific
health programmes

13. Malnutrition among children

15. Life Cycle Approach
15
Maternal
Neo natal and
post natal
Childhood
Adolescence
Reproductive

16. Interventions across life stages
There are two dimensions to health care:
• Stages of life cycle
• Places where the care is provided
 These two together constitute the
“Continuum of care”
 5 by 5 matrix lists out 5 high impact
interventions under each of 5 pillars
16

17. 17

18. Thrust areas
• Thrust Area 1 : Neonatal Health (Essential
Newborn Care & HBNC)
• Thrust Area 2 : Nutrition
• Thrust Area 3: Management of common
childhood illnesses (IMNCI)
• Thrust Area 4: Immunization
• Thrust Area 5: Child health Screening.
(RBSK)
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19. Essential newborn care
Immediate care at birth (delayed cord
clamping, thorough drying, assessment
of breathing, skin-to-skin contact, early
initiation of breastfeeding)
Thermal care
Resuscitation when needed
Support for breast milk feeding
Nurturing care
Infection prevention
Assessment of health problems
Recognition and response to danger
signs
Timely and safe referral when needed

20. Home Based New Born Care (HBNC)
• implemented since 2011 revised in 2014
has incentivized ASHA for making visits to all
newborns and their mothers according to
specified schedule up to 42 days of life.
The incentive amounts to a total of Rs. 250 for 6
visits (3, 7, 14, 21, 28 and 42nd day) in case of
institutional delivery and
7 visits in case of home delivery

21. Following points to be ensured by
ASHAs
a) recording of weight of the newborn in Mother
Child Protection (MCP) card
b) ensuring BCG at birth & RI
c) both the mother and the newborn are safe
till 42 days of the delivery
d) registration of birth has been done

22. Facility- based care of sick newborns
Health facility All newborns at birth Sick newborn
PHC
MCH Level 1
Newborn care corner
(NBCC) in labor
rooms
Prompt referral
CHC/ FRU
MCH Level 2
NBCC in labor
rooms and OTs
Newborn
Stabilisation unit
(NBSU)
District hospital
MCH Level 3
NBCC in labor
rooms and in
operation theatre
Special newborn
care unit (SNCU)
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23. For newborns d/s from SCNU
• Provision for extra care to all newborn discharged after
treatment of sickness from SCNU is being ensured through
structured home visits follow up by ASHA till 1 year of life.
• In case of SNCU discharged newborns, the day of discharge is
to be taken as day 1.
• ASHAs would make the 1st home visit within 24 hours of
discharge (Day 1) and complete the remaining home visits as
per HBNC visit schedule
• On completion of these visits ASHA will conduct follow up visit
once every quarter starting from 3rd month onwards till one
year of life i.e.
• 4 visits at the completion of 3rd, 6th, 9th and 12th mth

25. Management Malnutrition
 Early detection & Timely Mgt
 SAM wt-f-ht<-3SD : referred to NRC (Nutritional
Rehabilitation centre)
 MAM<-2SD upto 3SD: Treat infection, Home Mgt,
Dietary counselling weekly follow-ups
 Ensure enrolment in Anganwadi (ICDS)-
Supplementary feeds(1/4th calorie & ½ proteins)
 Visit by ANM/ASHA for routine follow-up

26. Nutrition Rehabilitation Centre (NRC)
• For management of SAM (severe acute
malnutrition)
• at level of District & Tertiary care hospitals &
Medical colleges
• Deaths among these SAM are preventable if
timely & appropriate actions are taken

27. Services provided at NRC
• 24hrs care & monitoring
• T/t of medical complications
• Therapeutic feeding
• Sensory Stimulation & emotional care
• Counseling on appropriate feed, care & hygiene
• Demo & practice by doing on prepn of Energy dense
food
• Social Assessment of the family to identify
determinants
• Follow up of children discharged from the facility

28. Principles of Hospital based Mgt
Initially Triage is done: rapidly screening for
emergency signs (ABC3D)
3 PHASES:
• 1. Stabilization phase-(1-2d) T/t & starter diet
• 2. Transition Phase- catch-up diet
• 3.Rehabilitation Phase-aim to promote rapid
Wt gain
• Weekly f/u by AWWx 4wks & fortnighly

29. MICRONUTRIENT SUPPLEMENTATION
Vit A
• <6mths -50,000 IU
• 6-12moths or wt<8kg= 1Lakh IU
• >12moths= 2Lakhs IU
Signs of Vit A def- Day1,2 & 14day
Multivit Supplements –Vit A,C, D, E, B12
Folic Acid, elemental Zinc, Cu

31. Rashtriya Bal Swasthya Karyakram
(RBSK)
• an innovative initiative, which envisages Child Health
Screening and Early Intervention Services, a systemic
approach of early identification and link to care, support
and treatment.
• Targets 4Ds spanning 32 common health conditions for
early detection and free treatment and management
Target groups are classified as:
1. Birth to 6 weeks
2. 6 weeks to 6 years (pre school children)
3. 6 years to 18 years (enrolled in govt/govt. aided
schools)

32. RBSK-4Ds
Defects at
Birth
Deficiencies
Diseases
Developmental
delays

33. RBSK- Intersectoral Coordination
To facilitate screening:
• Ministry of Women and Child Development :
for screening children the age group 0-6 yrs
enrolled at Anganwadi centres &
• Ministry of Human Resource Development:
screening the children enrolled in Government
and Government aided schools.

34. IMCI
• Many children present with overlapping signs
and symptoms of diseases.
• Single diagnosis can be difficult, and may not
be feasible or appropriate
• World Health Organization (WHO), in
collaboration with UNICEF developed a
strategy known as the Integrated
Management of Childhood Illness (IMCI)

35. IMNCI
(Integrated Management of Neonatal and Childhood Illness)
• Indian adaptation of IMCI is Integrated
Management of Neonatal and Childhood
Illness (IMNCI)
• Implementation of IMNCI started in India in
2003.
• By June 2010, it had been implemented in 223
of India’s 640 districts

36. Components of the Integrated Approach
The strategy includes Improvements in
3main components:
–in the case-management skills of health staff
through use of locally-adapted guidelines
–in the quality of overall health system
–in family and community health care
practices.

37. Principles of Integrated Care
• All children must be examined for conditions which
indicate immediate referral
• Major symptoms are assessed: nutritional and
immunization status, feeding problems
• Limited number of carefully selected clinical signs
are used
• Combination of individual signs leads to a child’s
classification(s) rather than a diagnosis:
– Pink : referral
– Yellow: initiation of treatment at health facility
– Green : management at home

38. Schemes started to nurture women
and children’s health
• POSHAN Abhiyaan (under the ICDS)
• Anganwadi Service Scheme
• Pradhan Mantri Matru Vandana Yojana
(PMMVY)
• Rajiv Gandhi Scheme for Empowerment of
Adolescent Girls ‘SABLA’
• Indira Gandhi Matritva Sahayog Yojana
• National Food Security Act, 2013