Preventive Pediatrics (MCH, RCH, ICDS, BFHI Maternal and Child Health, Reproductive and Child Health, Integrated Child Development Services, Underfive Clinic, Baby Friendly Hospital Initiative and School Health Service)..

1. Alam Nuzhathalam1
Nuzhath Alam
Associate Professor

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 Preventive pediatrics 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

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 Antenatal preventive pediatrics
 Postnatal preventive pediatrics
 Social preventive pediatrics

4. Care of Antenatal Mothers
 Adequate nutrition
 Prevention of communicable
diseases
 Preparation for delivery and
breast feeding
 Mother craft training
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5.  Promotion of Breast Feeding
 Introduction of complementary
feeding in appropriate age
 Immunization
 Prevention of accidents
 Growth monitoring
 Periodic health check up
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6. It is an application of principles
of social medicine to pediatrics
to obtain a more complete
understanding of the problems
of children in order to prevent
and treat disease and promote
adequate growth
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8. MATERNAL AND CHILD HEALTH
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Definition
 According to WHO (1976) Maternal and child
health services can be defined as “promoting,
preventing, therapeutic or rehabilitation facility or
care for the mother and child”. Thus maternal and
child health service is an important and essential
service related to mother and child’s overall
development

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 Reducing maternal, perinatal, infant and child mortality
and morbidity rates
 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

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 Maternal health
 Child health
 School health
 Family planning
 Handicapped children
 Care of the children in special setting such as
day care centers

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1. Improvement of maternal health
2. Improvement of child health
3. Family planning
4. School health maintenance
5. Reduction of maternal, perinatal, infant and
childhood mortality
6. Promotion of reproductive health
7. Promotion of physical and psychological
development

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 Complete health check up and care of the child and
mother from conception to birth
 Studying the health problems of mothers and child
 Providing health education to parents for taking
care of children
 Training to professionals and assistant workers

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 Antenatal care services
 Intranatal care services
 Postnatal care services
 Under five child health services

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Objectives
 To detect high risk cases & give them special care
 To identify complications and prevent them
 To educate the mother
 To promote, protect and maintain health
 Provided by prenatal clinics/antenatal clinics
 Urban areas - MCH centre's and hospitals
 Rural areas - CHC, PHC, Sub-centre's

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Delivery may be arranged at home or hospital
Institutional delivery is safe
Objectives
 To provide thorough asepsis
 To prevent injury to baby and mother
 To prevent complications
 To provide care to the baby

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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

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Objectives
 Decreasing 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

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 Immunization
 Breast feeding
 Growth and development
 Personal hygiene
 Detection of health problems & treatment

20. REPRODUCTIVE AND CHILD HEALTH
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21.  The RCH Programme incorporated the earlier
existing Programmes i.e. National Family Welfare
Program and Child Survival & Safe Motherhood
Programmes (CSSM) and added two more
components one relating to sexually transmitted
disease and the other relating to reproductive
tract infections. The Programme was formally
launched on 15 October 1997
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22. People have the ability to reproduce and regulate
their fertility, women are able to go through
pregnancy and child birth safely, the outcome of
pregnancies is successful in terms of maternal and
infant survival and well being, and couples are able
to have sexual relations, free of fear of pregnancy
and of contracting diseases
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23. “The programme was formally launched on
15th October 1997”
RCH Package/Components
 Child Survival and Safe Motherhood
 Client approach to health care
 Family Planning
 Prevention and management of RTI/STDs/AIDS
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24. In all Districts
❑ Child survival interventions i.e., Immunization, Vit-A, ORT
and Prevention of pneumonia
❑ Safe motherhood interventions e.g. antenatal check up,
immunization for tetanus, safe delivery, anaemia control
programme
❑ Implementation of target free approach
❑ High quality training at all levels
❑ IEC activities
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25. ❑ Specially designed RCH package for urban slums and
tribal areas
❑ District sub-projects under local capacity enhancement
❑ RTI/STD clinics at district hospitals
❑ Facility for safe abortions at PHC by providing
equipments and contractual doctors
❑ Adolescent health and reproductive hygiene
❑ Enhanced community participation through panchayats,
women’s group and NGOs
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26. In selected States
❑ Screening and treatment of RTI/STD at sub-divisional
level
❑ Emergency obstetric care at selected FRUs
❑ Essential obstetric care
❑ Additional ANM at sub-centres
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 The outreach services were not available to the
vulnerable and needy population
 The management of financial resources was inadequate
 The human resources such as doctors, nurse, health
worker, etc were deficient
 The management information and evaluation system
was lacking
 The effective network of first referral units was lacking
 Quality of services in PHCs and CHCs was poor
 Lack of community participation

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 It was launched 0n 1st April 2005
 The RCH-II vision articulates
“Improving access, use and quality of RCH services,
especially for the poor and underserved population”

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 Aim: To reduce infant mortality rate, maternal mortality
rate, total fertility rate, and to increase couple
protection rate and immunization coverage especially in
rural areas
 Objectives of RCH II
 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, coverage and effectiveness of the
existing family welfare services and essential RCH services
with a special focus on the above mentioned EAG states

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 Population stabilization
 Maternal health
 Newborn care
 Child health
 Adolescent health
 Control of RTI/STDs
 Urban health
 Tribal health
 Monitoring and evaluation
 Other priority areas

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INTEGRATED CHILD DEVELOPMENT SERVICES

32. Integrated Child Development Service:
Scheme represents one of the world’s largest and
most unique programmes for early childhood
development. ICDS is the foremost symbol of
India’s commitment to her children. The main
beneficiaries of the programme were aimed to be
the girl child up to her adolescence, all children
below 6 years of age, pregnant and lactating
mothers
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33.  Routine MCH services not reaching target
population
 Nutritional component not covered by health
services
 Need for community participation
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34.  To improve the nutritional status of preschool children 0-
6 years of age group
 To lay the foundation of proper psychological
development of the child
 To reduce the incidence of mortality, morbidity
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 nutritional needs of the child
through proper nutrition and health education
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 Children less than 3 Years
 Children in age 3-6 Years
 Adolescence girls 11-18 Years
 Women 15-45 Years
 Pregnant Women
 Lactating Women

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 Children less than 3 Years
 Health check up, immunization, supplementary
nutrition, referral services
 Children in age 3-6 Years
 Health check up, immunization, supplementary
nutrition, referral services, non formal education
 Adolescence girls 11-18 Years
 Supplementary nutrition and health education

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 Women 15-45 Years
 Nutrition and health education
 Pregnant Women
 Health check up, immunization, supplementary
nutrition, health and nutrition education
 Lactating Women
 Health check up, supplementary nutrition, health
and nutrition education

38.  Health Check-ups
 Immunization
 Growth Promotion and Supplementary Feeding
 Referral Services
 Early Childhood Care and Pre-school
Education
 Nutrition and Health Education
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39.  Immunization of children against 6 vaccine
preventable disease is being done, while for
expectant mothers, immunization against
tetanus is recommended
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40.  Record of weight and height of children at
periodical intervals
 Watch over milestones
 Immunization
 General check up for detection of disease
 Treatment of diseases like diarrhea, ARI
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 Prophylaxis against vitamin A deficiency and
anemia
 Referral of serious cases
 Antenatal care of expectant mothers
 Post natal care of nursing mothers and care of
new born infants

42. The aim is to supplement nutritional intake as
follows:
 Each child up to 6 years of age to get 300 calories
and 8-10 grams of protein
 Each adolescent girl to get 500 calories and 20-25
grams of protein
 Each pregnant women and lactating mother to get
500 calories and 20-25 grams of protein
 Malnourished child to get 600 calories and 16-20
grams of protein
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43.  During health check-ups and growth monitoring,
sick or malnourished children, in need of prompt
medical attention, are referred to the Primary
Health Centre or its sub-centre. Nutrition and
Health Education: Health education is given to
women's so that they can look after their own
health, nutrition and development needs as well as
that of their children and families
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44.  Children between the ages 3-6 years are imparted
non- formal pre-school education in an Anganwadi
in each village with about 1000 population. The
objective is to provide opportunities to develop
desirable attitude, values and behaviour pattern
among children. Locally produced inexpensive toys
and material are used in organizing play and
creative activity
 NUTRITION & HEALTH EDUCATION
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UNDERFIVE CLINIC

46.  Under five clinic is a
centre where preventive,
promotive, curative,
referral and educational
services are provided in a
package manner to under
five children under one
roof
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47.  To overall goal of under five clinic is to provide
comprehensive health care to young children in a
specialized facility
 Monitor growth and development of the child until 5
years of age
 Identify factors that may hinder the growth and
development of the child
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Care
in
illness
Family
Planning
Preventive
Care
Growth
Monitoring

49.  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 is
brought to the clinic. The usual illnesses encountered in
children under five are fever, diarrhoea, ARI, infections 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
children
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50.  This is one of the most important function of the clinic. The
child's weighed periodically every month during the first
year, every 2 monthly from 1 to 3 years of age and
every 3 monthly in 4th and 5th years
 Besides weighing, measuring height, mid arm
circumference can also be carried out depending upon the
availability of trained manpower and equipments
 The growth is plotted in the growth chart then growth
curve is prepared to monitor the growth of the child
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51. This includes
 Timely physical examination of the children
 Primarily the immunization services during the 1st five
years of life, vitamin A supplementation and
administration of Iron supplementation and anti-helminthic
treatment to prevent anemia
 The preventive care also provides for regular health
check up and use of ORS during Diarrhoea to prevent
dehydration from developing
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52.  Family planning is a central to any program directed
towards women and children
 The mothers are more receptive to family planning
during early puerperium and lactation
 Mother is counseled on the various options available,
their merits and demerits so that she can make choice
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53. Educate people on following issues
 Spread the awareness regarding use of
contraceptive or pills
 Health education on family planning, birth spacing
 Psychological support to mothers
 Educate the mother about childcare, breast feeding,
nutrition, growth monitoring immunization, cleanliness
etc…
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54. ❖ Providing immunization services
❖ Warm welcome to mother and children
❖ Maintaining growth chart, immunization card,
recording general examination , nutritional level and
weight of the child
❖ Assessing growth and development of the child
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55. ❖ Carry out physical examination
❖ Prevention and treatment of general diseases and
injuries and referring the critical patients
❖ Providing health education to mothers
❖ Arranging the entertainment facilities
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56. BABY FRIENDLY HOSPITAL INITIATIVE
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 The Baby Friendly Hospital Initiative (BFHI), also known
as Baby Friendly Initiative (BFI), is a worldwide
programme of the World Health Organization and
UNICEF, launched in 1992 in India following the adoption
of the Innocenti Declaration on breastfeeding promotion in
1990
 A maternity facility can be designated '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

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1. Have a written breastfeeding policy that is routinely
communicated to all health-care staff
2. Train all health-care staff in skills necessary to
implement this policy
3. Inform all pregnant women about the benefits and
management of breastfeeding
4. Help mothers initiate breastfeeding within one half-
hour of birth
5. Show mothers how to breastfeed and how to maintain
lactation even if they should be separated from their
infants

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6. Give newborn infants no food or drink other than
breast milk, unless medically indicated
7. Practice rooming in: Allow mothers and infants to
remain together 24 hours a day
8. Encourage breastfeeding on demand
9. Give no artificial teat or pacifiers (also called
“dummies” or “soothers”) to breastfeeding infants
10. Foster the establishment of breastfeeding support
groups and refer mothers to them on discharge from
hospitals or clinics

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SCHOOL HEALTH SERVICE

61. Introduction:
 In 1909, the beginning of school health services in Baroda
City, India for the first time medical examination in schools
 In 1953, the secondary education committee
emphasized the need for medical examination of pupils
and school feeding programmes
 In 1960, GOI constituted a school health committee to
assess the standards of health and nutrition of school
children
 In 1961 during the five year plans, many state govt.
provided school health, and school feeding programmes
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62. Definition
 School Health: It refers to a state of complete,
physical, mental, social and spiritual well- being
and not merely the absence of disease or infirmity
among pupils, teachers and other school personnel
 School Health Services: It refers to need based
comprehensive services rendered to pupils, teacher
and other personnel in the school to promote,
protect their health, prevent and control disease
and maintain their health
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63.  Aim:
 The ultimate aim of school health services is to promote,
protect and maintain health of school children and
reduce morbidity and mortality in them
 Objective
 1. The promotion of positive health
 2. The prevention of disease
 3. Early diagnosis, treatment and follow up of defects.
 4. Awakening health consciousness in children.
 5. The provision of healthful environment
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 To prepare the younger generation to adopt measures
to remain healthy so as to help them to make the 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

65.  School children constitute a 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 stressful
situation
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66.  Children coming to school belong to different socio-
economic 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 are prone to get specific health
problems
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67.  It should focus on health needs of children
 It should be planned in co-ordination with school, health
personnel, parents and community people
 It should be a part of community health service
 It should emphasis on health education to promote,
protect, improve and maintain health of children and
staff
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68.  It should emphasis on promotive and preventive aspects
 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
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69. Aspects of a School Health Service are as follow
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
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70. 7. Mental health
8. Dental health
9. Eye health
10. Health education
11. Education of handicapped
12. Proper maintenance and use of school health records
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 The health appraisal should cover not only the
students but also the teachers and other school
personnel. Health appraisal consists of periodic
medical examination and observation of children
by the class teacher
 PERIODIC MEDICAL EXAMINATION
 SCHOOL PERSONNEL
 DAILY MORNING INSPECTION

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 Medical examination are not an end in themselves, they
should be followed by appropriate treatment and followup
 Special clinics 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 areas
 Considering the high prevalence of dental, eye, ear, nose,
and throat defects in the school children in India, special
clinics should be secured or provided
 There should be provision for beds in the existing referral
hospital for the children

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 Communicable diseases control through
immunization is the most emphasized school health
service function
 A well planned immunization programme should be
drawn up against the common communicable
diseases
 A record of all immunization should be maintained
as part of the school health records

74. ❑ Location
❑ Site
❑ Structure
❑ Classroom
❑ Furniture
❑ Door and windows
❑ Lighting
❑ Water supply
❑ Eating facilities
❑ Lavatory
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The school building, site and equipment are part of
the environment in which the child grows and
develops.

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 A child who is physically weak will be mentally
weak. Cannot be expected to take full advantages
of schooling. The diet should contain all the nutrient
in proper proportion, adequate for the maintenance
of optimum health
 a) Mid-day school meal
 b) Applied nutrition programme
 c) Specific nutrients

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 First-aid and emergency care to pupils who become
sick or injured on school premises rests with the teacher
and therefore all teacher should receive adequate
training during “teacher training programme” or “in-
service training programme” to prepare them to carry
out this obligation
 Accidents leading to minor or serious injuries, medical
emergencies such as gastroenteritis, colic, epileptic fit,
fainting etc
 In every school a fully equipped first-aid-post should
be provided as per regulations of St. John Ambulance
Association of India

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The mental health of the child affects his physical
health and the learning process
 Juvenile delinquency, maladjustment and drug addiction are
becoming 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 student
 It is now increasingly realized that there is a great need for
vocational counselors and psychologists in school for guiding
the children into careers for which they are suited

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 Children frequently suffer from dental diseases and
defects
 Dental caries and periodontal disease are the two
common dental disease in India
 A school health programme should have provision for
dental examination, at least once a year
 Preliminary inspection of the teeth and do
prophylactic cleaning which is of great value in
preventing gum troubles and in improving personal
appearance

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 School should be responsible for the early detection
of refractive error, treatment of squint and
amblyopia
 Detection and treatment of eye infection such as
trachoma
 Administration of vitamin A to children at risk, has
shown gratifying results

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 The most important element of the school health
programme is health education
 The goal of health education to bring about
desirable changes in health knowledge , in attitude
and in practice, and not merely to teach the
children a set of rules of hygiene
 Health education in school should cover the
following area (personal hygiene, environmental
hygiene and family life)

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 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 normal a life as possible
 To become as independent as possible
 To become a productive and self-supporting
member of the society

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 A cumulative health record of each student should be
maintained
 Such records should contain
 a. identifying data- name, date of birth, parent’s
name, address, etc
 b. Past health history
 c. Record of finding of physical examination and
screening tests and record of service provided

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 Purpose:
 To maintain cumulative information on the health
aspect of school children
 To analyzing and evaluating school health
programme and providing a useful link between
the home, school and community

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Thank You