This document provides an overview of preventive paediatric services in India, including Integrated Child Development Services (ICDS), Under 5 Clinics, Baby Friendly Hospital Initiatives (BFHI), Maternal and Child Health (MCH) services, Reproductive and Child Health (RCH) services, and School Health Services. It discusses the definitions, classifications, components, and objectives of these various services, which aim to promote physical, mental and social wellbeing in children through activities like immunizations, nutrition programs, health education, and family planning support.

1. PREVENTIVE PAEDIATRIC
(ICDS, UNDER 5 CLINICS, BFHI, MCH, RCH,
SCHOOL HEALTH SERVICES)
PRESENNTED BY,
MR. ABHIJIT P. BHOYAR
M. SC. NURSING
CHILD HEALTH NURSING

2. DEFINITIONS
• Preventive paediatric is defined as the prevention of disease and
promotion of physical, mental and social wellbeing of children with
the aim of attaining a positive health

3. CLASSIFICATION
• Antenatal preventive paediatric
• Postnatal preventive paediatric
• Social preventive paediatric

4. ANTENATAL PREVENTIVE
PAEDIATRIC
Care of antenatal mother
• Adequate nutrition
• Prevention of communicable diseases
• Preparation for delivery and breast feeding.
• Mother craft training

5. POSTNATAL PREVENTIVE PAEDIATRIC
• Promotion of breast feeding
• Introducing to complementary
feeding according to the age
• Immunization
• Prevention of accident
• Growth monitoring
• Periodic health check ups.

6. SOCIAL PREVENTIVE PAEDIATRIC
• It is an application of Principal of
social medicine To paediatric to
obtain More complete understanding
of The problems of the children in
order to prevent and treat diseases
and promote Adequate growth.

7. PREVENTIVE PAEDIATRIC
• Maternal and child health
• Reproductive and child health
• Integrated child development services
• Under five clinics
• Baby friendly hospital initiatives
• School health services

8. MATERNAL AND CHILD HEALTH
DEFINITIONS
• According to WHO (1976) maternal and child health services can be
defined as “promotive, preventive, therapeutic or rehabilitative
facilities for the mother and child”.
• Thus maternal and child health services is an important and essential
Services related to the mother and child’s overall development.

9. AIMS AND OBJECTIVES
• Reducing maternal, perinatal, infants
and child mortality and morbidity
rates.
• Improve child survival
• Promoting reproductive health or safe
motherhood.
• Ensure birth of healthy child
• Prevent malnutrition.
• Prevent communicable diseases.
• Early diagnosis and treatment of the
health problems.
• Health education and family planning
services.

10. COMPONENTS
• Maternal health
• School health
• Child health.
• Family planning
• Handicap children
• Care of the children in special care unit such as day care center.

11. CRITERIA OF MATERNAL & CHILD HEALTH
• Improvements of maternal health
• Improvements of child health
• Family planning
• School health maintenance
• Reduction in maternal, perinatal, infants and children’s mortality and
morbidity rate.
• Promotion of reproductive health
• Promotion of physical and psychological development

12. ORGANIZATIONAL ACTIVITIES
• Complete health check ups.
• Care of child and mother from conception to birth.
• Studying the health problems of child and mother.
• Providing health education to parents for taking care of
children.
• Training to professionals and health care workers.

13. MCH SERVICES
• Antenatal care services
• Intra-natal care services
• Postnatal care services
• Under five child health care services

14. ANTENATAL SERVICES
OBJECTIVES
• To detect high risk cases and give them special care.
• To identify complication and prevent them.
• To educate mother.
• To promote, protect and maintained health.
• Provided by prenatal clinics and antenatal clinic.
• Urban areas- MCH center's and hospitals.
• Rural areas – CHC, PHC and subcenter’s.

15. INTRANATAL SERVICES
OBJECTIVES
• To provide thorough asepsis.
• To prevent injury to baby and mother.
• To prevent complications.
• To provide care to the baby.
Delivery may be arranged at home or hospital

16. POSTNATAL SERVICES
OBJECTIVES
• To provide care to mother and baby
• To prevent complications
• To provide family planning services &
basic education to mother
• Postnatal examination
• Teaching postnatal exercises
• Family planning services
• Health education

17. CHILD HEALTH SERVICES
OBJECTIVES
• Decrease child death and infant
mortality rate
• Complete protection of child
• Nutritious diet to children
• Overall growth of children
• Preserve and promote health of Under
five children
• Increasing health level of children
• Immunization
• Breast feeding
• Growth and development
• Personnel hygiene
• Detection of health problems and
treatment

18. REPRODUCTIVE AND CHILD HEALTH
• INTRODUCTION
• The RCH programme incorporated to earlier Existing program that is
national Family welfare program And child survival and safe motherhood
program (CSSM) And added two more components One relating to
sexuality transmitted diseases And other relating to reproductive Track
infections.
• The program was formally launched on 15 October 1997

19. Reproductive and child health
• People have the ability to reproduce And regulate their fertility,
women’s Are able to go through pregnancy And child birth safety,
• The outcome of pregnancy is successful In terms of maternal and
infant Survival and wellbeing.
• And couple are able To have sexual relations , free of fear of
pregnancy And of contracting diseases.

20. RCH PHASE - 1
“The program was formally launched on 15th October 1997”.
RCH package and components.
•Child survival and safe motherhood.
•Client approach to health care.
•Family planning.
•Presentation and management of STD, RTI AND AIDS.

21. RCH phase I intervention
In all district
• Child survival intervention- That is immunization, vitamin A, Ort and
prevention of pneumonia.
• Safe motherhood intervention- that is Antenatal checkups, immunization,
Safe delivery, anaemia control program .
• Implementation of target free Approach
• High quality Training at all level.
• IEC activities.

22. Conti...
• Specially designed RCH package for Urban slums and Tribal areas.
• District subprojects Under local capacity enhancement.
• RTI/ STD clinics at district hospital.
• Facility for safe abortion at PHC by providing By equipment and contractual
Doctors.
• Adolescent health and reproductive hygiene.
• Enhance community participation Through panchayat, women's groups and
NGO’S

23. Contii..
In selected states.
• Screening and treatment of STD/RTI At subdivisional level.
• Emergency obstetric care at Selected FRUs.
• Essential obstetric care.
• Additional ANM at sub-centres.

24. Lacunae of first phase
• Outreach services were not available to the vulnerable and needy population.
• The management of financial resources was inadequate.
• The human resources such as doctors, nurses, health workers, etc. Were deficit.
• The management information and evaluation system was lacking.
• The effective network of the first referral unit was lacking.
• The quality of services in the PHCs and CHCs was poor.
• Lack of community participation.

25. RCH phase II
• It was launched on 1St april 2005.
• The RCHs vision articulates
• "improving Access, use and quality of RCHs services, especially for the
poor and undeserved population “.

26. Aims and objectives of phase 2
Aims
• To reduce
Infant mortality rate,
Maternal mortality rate,
Fatal mortality rate,
Total fertility rate
To increase couple protection rate
Immunization coverage especially in rural area.

27. Conti..
Objectives
• To improve the management performance
• To develop human resources intensively.
• To expand RCH services to tribal areas also.
• To Monitor and evaluate the services.
• To improve the quality services, Coverage and effectiveness of the
family Welfare services and Essential RCH services With a special
focus on the above mention EAG states.

28. Components of RCH II
• Population stabilization.
• Maternal health
• Newborn care
• Child health adolescent health.
• Control of RTIS and STDS
• Urban health
• Tribal health.
• Monitoring and evaluation
• Other priority areas.

30. INTRODUCTION
• This scheme represents worlds largest And most unique program For
early childhood development.
• ICDS is the foremost symbol of INDIAS committed to her child.
• The main beneficiaries of the program Were aimed to be the Girl
child up to her adolescence, all children's below 6 years of age,
pregnant and lactating mothers.

31. Purposes
• Routine MCH services not reaching Target population.
• Nutritional components not Covered by health services.
• Need for community participation.

32. Objectives
• To improve nutritional status of preschool child 0 to 6 year of age.
• To lay the proper foundation of psychological development.
• To reduce the incidence of mortality, morbidity and malnutrition and school drop
out.
• To achieve effective coordination of policy and implementation in various
departments to promote child development.
• To enhance the capability of the mother to look after the normal health and
nutritiolnql need of the child through proper nutrition and health education.

33. Benificiaries
• Child less than 3 years
• Children in age 3 to 6 years.
• Adolescence girls 11 to 18 years.
• Women's 15 to 45 years.
• Pregnant woman's
• Lactating mothers

34. Services in ICDS
• Children less than 3 years.
• Health checkups, immunization, supplementary nutrition, referral
services.
• Children in age 3 to 6 years.
• Health checkups, immunization, supplementary nutrition, referrel
services, non formal education.
• Adolescence girls 11 to 18 years.
• Supplementary nutrition and health education

36. Conti..
• Women's 15 to 45 years
• Nutrition and health education
• Pregnant women's.
• Health check ups, immunization, supplementary nutrition, health
and nutritional education.
• Lactating women's
• Health check ups, supplementary nutrition, health and nutritional
education.

37. COMPONENTS OF ICDS
• Health check ups
•Immunization
•Growth promotion and supplementary
feeding
•Referral services
•Early childhood care and preschool education
•Nutrition
•Health education.

38. Immunization
• Immunization of children against six Vaccine preventable disease
being done, while for expectant mother , immunizations is
recommended against tetanus

39. Health checkups
• Record of ht. and wt. of children at periodical interval.
• Developmental milestones.
• Immunization
• General check up for detection of diseases.
• Treatment of diseases like diarrhoea and ARI.

40. Conti…
• Prophylaxis against vitamin A deficiency and anaemia.
• Referral of serious cases.
• Antenatal care of expectant mother.
• Postnatal care of nursing mother and care of newborn infant.

41. Supplementary nutrition
The aim is to supplement Nutritional intake as follows,
• Each child up to 6 years of age to get 300 calories and 8 to 10 grams
of proteins.
• Each adolescent girl to get 500 calories and 20 to 25 grams of protein.
• Each pregnant woman and lactating mother to get 500 calories and
20 to 25 grams of protein.
• Malnourish child to get 600 calories and 16 to 20 grams of proteins.

42. Referral services.
• During health check ups and growth monitoring, sick children,
malnourished children's , in need of prompt medical attention, Are
referred to the primary health centre Or its sub-center.
• Nutrition and health education- Health education, is given to
women, so that they can look after Their own health, Nutrition and
development needs As well as that of their children and families.

43. Non formal pre-education
• Children between the age 3 to 6 years , are imparted to non formal
preschool education In an Anganwadi in every village with about 1000
population.
• The objective is to provide Opportunities to develop Desirable attitude,
Values and behavioural pattern Among children.
• Locally produce Inexpensive toys use ,organizing play and creating activity.

44. UNDER 5 CLINIC
• Under five clinic is a centre where
preventive, promotive and curative,
referral and educational services are
provided In a package manner to under
five children under one roof.

45. Goal
• To provide comprehensive healthcare to younger children in a
specialized facility.
• Monitor growth and development of the children until 5 years of age.
• Identify factors that may hinders the growth and development of the
children.

46. UNDER FIVE COMPONENTS

47. Care in illness
• Children are treated for acute and chronic illnesses and ailments of growth and
development at these clinic.
• Need of the mother and child for which any child brought to the clinic.
• The usual illnesses encountered in children under five are fever, diarrhoea, ARI,
infection of the skin and helminthiasis.
• The facility should provide for essential laboratory investigations and x ray
facilities.
• Nurse can play an important role in taking care of sick child.

48. Growth monitoring
• This is one of the most important function of the clinic.
• The child weighted periodically Every month during the first year, Every 2 months
from 1 to 3 years Of age and every 3 monthly 4th and 5 th year.
• Beside weighting, measuring height, Mid arm circumference can also be Carried
out depending upon the availability Of trained manpower and Equipments.
• The growth Is allotted in the growth chart Then growth curve is prepared To
monitor the growth of the child.

49. Preventive care
This includes.
• Timely physical examination of the child.
• Primarily the immunization services During the first five year of life vitamin
A supplementation and Administration of iron supplements and
antihelminthics treatment to prevent anaemia.
• The preventive care also provides for Regular health check ups And use of
ORS during Diarrhoea to prevent dehydration From developing.

50. Family planning
• Family planning is a central to any program Directed towards women
and Children.
• The mother Are more receptive to family planning During early
puerperium and lactation.
• Mother is counselled on various available options, their merits and
demerits So that she can make choice.

51. Health education.
Educate people on following Issues.
• Spread the awareness regarding the use of contraceptive pills.
• Health education on family planning and birth spacing.
• Psychological support to mother.
• Educate the mother about child care, Breast feeding, nutrition,
immunization , growth monitoring and cleanliness, etc..

52. Role of nurse
• Providing immunization services
• Warm welcome to mother and child.
• Maintaining growth chart, immunization card, Recording general
examination, nutritional level, And weight of the child.
• Assessing growth and development of the child.

53. Conti…
• Carry out physical examination.
• Prevention and treatment of general diseases And injuries and
referring the Critical patient.
• Providing Health education to The mother.
• Arranging the entertainment facilities.

54. BABY
FRIENDLY
HOSPITAL INITIATIVES

55. INTRODUCTION
• It is also known as baby friendly initiatives (BFI)
• Its a worldwide program of the World health organization and UNICEF,
• Launched in 1992 In INDIA following the adaptation of the innocent declaration
on breastfeeding promotion In 1990.
• A maternity facility can be designed ‘ baby friendly ‘ When it does not accept
free or low Cost breast milk substitutes, feeding bottles or teats And has
implemented 10 specific steps to support Successful breastfeeding.

56. 10 successful steps of BFHI
1. Have a written breastfeeding policy that is routinely communicated to all
health care workers.
2. Train all health care staff in skills necessary to implement this policy.
3. Informed all pregnant women about the benefits and management of
breastfeeding.
4. Help mothers initiatives breastfeeding within one or half hour of birth.
5. Show mother how to breast feed and how to maintained lactation even if
they should be separated from their infant .

57. Conti..
6. Give newborn infant no food or drink other than breast milk, unless medically
indicated.
7. Practice rooming in: allow mother and infant to remain together for 24 hours A
day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called “dummies or soother” ) to
breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers
to them on discharged from hospitals and clinics.

58. SCHOOL HEALTH SERVICES SCHOOL
HEALTH
SERVISES

59. INTRODUCTION
• In 1909, the beginning of the school health services In BARODA city, india For the
first time medical examination In school.
• In 1953, the secondary Education committee Emphasized the need for medical
examination for the pupils and school feeding programs.
• In 1960, the government of India Constituted a school health committee To
assess the standard of health and nutrition Of school children.
• In 1961, During the five year plan, many state government Providing schools
health and school feeding programs.

60. DEFINITION
• .
School health- it refers to a state of complete, physical , mental, social and spiritual
well being and not mearly the absence of disease or infirmity among the pupils,
teachers and other school personnel.
School health services – it refers to need based comprehensive services renders to pupils,
teachers and other personnel in the school to promote, protect their health, prevent and
control their diseases and maintained their health.

61. Aims
• The ultimate aims of this program to promote, Protect and maintained the health
of the school children And reduce mortality and morbidity in them.
Objectives
• The promotion of positive health
• The prevention of disease
• Early diagnosis, treatment and follow up of Defects.
• Awakening health consciousness in children.
• The provision of health full environment.

62. Goals of SHP
• To prepare the younger generation to adapt Measures to remain healthy so as
help then to make Best use Of educational facilities, to utilize leisure In
productive and constructive manner, to enjoy recreation and to develop Concern
for others.
• To help the younger generation become Healthy and useful citizen who will Be
able to perform Their role effectively For the welfare of themselves, their
families and the community At large and country as a whole.

63. Need for school health services
• School children constitute vital and substantial segment of population.
• School children are vulnerable section of and population by virtue of their physical, mental,
emotional and social growth and development during this period.
• School children are exposed to various stress-full situation.
• Children coming to school belong to different socioeconomic And cultural background
Which affect their health and Nutrition status and require help and guidance In promoting,
protecting, And maintaining their health And nutritional status.
• Children in school age groups prone to get Specific health problems

64. Principals of school health services
• It should focus on health needs of the children.
• It should be planned, coordination with school, health personnel, community peoples and parents.
• It should be a part of community health services.
• It should be emphasise on health education to promote, protect, improve and maintain health of
children and staff.
• It should emphasis on promotive and protective aspect.
• It should emphasis on learning through active and desirable participation.
• It should be continuous and ongoing process.
• It should be have an effective system to record keeping and reporting.

65. 12 aspects of school health services
Aspects of school health services are as follows.
1) Health appraisal Of school Children and school personnel.
2) Remedial measures and Follow up.
3) Prevention of communicable diseases.
4) Healthful school environment.
5) Nutritional services.
6) First aid and emergency care.

66. Conti...
7) Mental health .
8) Dental health.
9) Eye health
10) Health education.
11) Education of handicapped.
12) Proper maintenance and use of School health record.

67. 1. Health appraisal
• The health appraisal should cover not only the student but also the teachers and
other school personnel
• Health appraisal consists of periodic medical examination and observation of the
children by the class teacher.
• Periodic medical examination
• School personnel
• Daily morning inspection

68. 2. Remedial measures and Follow ups
• Medical examination are not an end themselves
• They should be followed by appropriate treatment an follow up.
• Special clinic should be conducted exclusively for school children at the PHC in
the rural area and in one of the selected school or dispensaries for a group of
about 5,000 children in the urban area.
• Considering a high prevalence of dental, eye, ear, nose and throat defects in the
school children in India
• Special clinic should be secured or provided.
• There should be provision for beds in the existing referral hospital for the
children.

69. 3. Prevention of communicable diseases
• Communicable diseases control through immunization in the most
emphasized schools health service function.
• A well planned immunization program should be drawn against th
common communicable diseases.
• A record of all immunization should be maintained as part of the
school health record.

70. 4. Healthful school environment
• The school building, site and
Equipments are the part of the
Environment in which The child
grow and develop.
• Location
• Site
• Structure
• Classroom
• Furniture
• Door and windows
• Lighting
• Water supply
• Eating facilities

71. 5. Nutritional services
• A child who is physically weak will be mentally weak.
• Cannot be expected to take full advantage of schooling .
• The diet should contain all the nutrients in proper proportion , adequate
for the proportion of optimum health.
A) Mid day school meal
B) Applied nutrition program
C) Specific nutrients

72. 6. First aid and emergency care
• Care to pupils who become sick or injured in school premises rest with the
teacher and therefore all teacher should receive adequate training during “
teacher training program” or “ in service training program” to prepare them to
carryout this obligation.
• Accidents leading to minor or serious injuries , medical emergency such as
gastroenteritis, colic, epileptic, fits, and fainting, etc.
• In every school or fully equipped first aid post should be provided as per
regulation of St. Jones ambulance association of India.

73. 7. Mental health
• The mental health of the child affects His physical health and the learning process.
• Juvenile delinquency, maladjustment, And drug addiction becoming a problem Among school
children.
• The school is the most strategic place For shaping the child behaviour and promoting mental
health.
• No distinction should be made between race, Religion, caste, community, rich, poor, clever and
dull students.
• It is not increasingly realized That there is a greater need Fir vocational counselor And
psychologist in school For guiding the children Into the career for they Are suited.

74. 8. Dental health
• Periodic checkups under school health program.
9. EYE HEALTH
• Detection and treatment of infection.
• Immunization of vitamin A.

75. 10. Health education
• Personal hygiene.
• Environmental hygiene
• Family hygiene
• Nutrition or diet.

76. 11. Education of handicapped
The ultimate goal is
• To assist The handicapped child and his family
So that the child will be able to Reach his
maximum potential.
• To lead as a normal life As possible.
• To become as independent as possible.
• To become a productive and self-supporting
member of the society.

77. 12.School health record
• Cumulative health record of each student should be maintained.
• Such record should contain.
• -Identifying data. Name , date of birth, parents name etc.
• Past health history
• Record of findings.

78. Purposes
• To maintain cumulative Information on health of children.
• To analyzing and evaluating school health program And providing a
useful link between The home, school and Community.