Monitoring the development of a healthy child

Visits to healthy children are aimed at ensuring healthy development of the child during training, conducting preventive vaccinations, early detection and treatment of diseases, helping parents optimize the emotional and intellectual development of the child.

The American Pediatric Academy has developed recommendations for monitoring children who do not have significant health problems that grow and develop according to age. Those who do not meet these criteria should be observed more often and intensively. If a child is late for the first time under observation or some procedures were not performed at the appropriate age, it should be done as soon as possible.

In addition to physical examination, the child's intellectual and social development, as well as relationships with parents, should be assessed. The conclusion can be drawn by collecting a detailed anamnesis from parents and a child, personally observing the behavior of the child and even sometimes referring to external sources of information, such as teachers and people caring for the child. The funds available for office use make it easier to evaluate intellectual and social development.

Both physical examination and screening procedures are important parts of preventive work with children of the first year of life and older children. Most parameters, such as weight, are mandatory for all children, some are only used selectively for certain groups, for example, lead levels at 1 and 2 years.

[1], [2], [3], [4], [5], [6], [7]

General examination of the child

Physical development of the child

The length of the body (from the crown to the heels) or height (from the moment when the child can stand) and the weight should be measured at each visit. The head circumference should be measured at each visit up to the age of two. The child's growth rate is controlled using centile growth curves (somatograms).

Arterial pressure

Since the age of three, blood pressure should be monitored regularly using a cuff of the appropriate size. The width of the rubber part of the cuff should be about 40% of the shoulder circumference, and its length should cover from 80 to 100% of the circumference. If a suitable cuff satisfying these criteria is not available, it is better to use a larger cuff.

The systolic and diastolic pressure of the child is considered normal if it does not exceed 90 centile; the values of each centile vary depending on sex, age, and growth (they are pricing growth), so the reference to centile tables is necessary. Systolic and diastolic arterial pressure ranging from 90 to 95 centiles should prompt the physician to monitor the child and evaluate the risk factors for hypertension. If all measured values consistently correspond to or exceed 95 centiles, it should be assumed that the child has hypertension, and establish its cause.

[8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22]

Head

The most common problem is otitis media with effusion, which is manifested by a change in the tympanic membrane. Surveys for detecting hearing loss are described earlier.

Eyes should be inspected at each visit, assessing movements (strabismus converging or diverging); deviation in the size of the eyeball, which may indicate congenital glaucoma; differences in the size of the pupils, the color of the iris, or both, can be indicative of Horner's syndrome, trauma, neuroblastoma; pupillary asymmetry may be the norm, or may be a manifestation of eye pathology or intracranial pathology. The absence or distortion of the red reflex indicates cataract or retinoblastoma.

Ptosis and hemangioma of the eyelid worsen vision and require attention. Children born before 32 weeks of gestation should be examined by an ophthalmologist to identify retinopathy of prematurity and refractive disorders that occur frequently. By the 3rd or 4th year of life, vision is checked on the Snellen tables or a newer method using the apparatus. Special children's tables are preferable; visual acuity less than 0.2-0.3 requires evaluation by an ophthalmologist.

Diagnosis of dental caries is important, you should consult a dentist if the child has cavities in the teeth, even if it's only temporary teeth. Candidiasis is common in young children and is not always a sign of immunodeficiency.

A heart

Auscultation of the heart is performed to reveal new noises or rhythm disturbances; The functional noise of the blowing timbre is common and requires a differential diagnosis with pathological noises. Palpation of the apical impulse can reveal cardiomegaly; asymmetric pulse on the femoral arteries may be a sign of coarctation of the aorta.

[23], [24], [25]

Stomach

Palpation is performed at each visit, since many voluminous formations, such as Wilms' tumor and neuroblastoma, become accessible palpations only with the growth of the child. Often it is possible to palpate stool masses in the left lower quadrant.

Spine and limbs

Children who can already stand need to be examined for scoliosis, assessing the posture, the symmetry of the shoulders and collarbones, the torso inclination and especially the paravertebral asymmetry when leaning forward. The different length of the legs, the density of the adductors (leading muscles), the asymmetry of the lead or folds of the legs, or the palpable, audible click of the femoral head when it returns to the acetabulum are signs of hip dysplasia.

Feet, turned inwards by socks, is a sign of bringing the muscles of the front surface of the leg, turning the tibia or femur. Such children need treatment, they need to be referred to the orthopedist.

Examination of the genitals

All sexually active patients should be examined for sexually transmitted diseases; in girls, the examination of the external genitalia is mandatory. Young women aged 18 to 21 years should be offered to undergo a gynecological examination and a routine Pap test. Examination of the testicles and inguinal examination are mandatory at each visit to identify the undescended testicles in younger children, bulging testicles in the late puberty, inguinal hernia at any age.

[26], [27], [28], [29], [30], [31], [32], [33]

Examination of the child

[34], [35], [36], [37], [38], [39]

Blood tests

To detect iron deficiency, you need to determine the level of hemoglobin or hematocrit at the age of 9 to 12 months in full-term newborns, at the age of 5 to 6 months in premature infants, and annually in girls who have begun menstruation. The definition of HbS can be performed at the age of 6 to 9 months, if not previously done as part of a newborn's examination.

Recommendations for controlling the level of lead in the blood vary in different states. Usually, the examination should be conducted at the age of 9 to 12 months in children at risk (living in houses built before 1980) with a second examination at 24 months. If the doctor is not sure if the child has a risk or not, a check should be carried out. A level of more than 10 μg / dL (> 0.48 μmol / L) is a threat to the development of nervous system damage, although some experts believe that any level of lead in the blood can be toxic.

Controlling the cholesterol level is indicated for children older than 2 years who are at high risk according to family history. If there are other risk factors or a family history is unknown, the examination is performed at the doctor's discretion.

[40], [41], [42], [43], [44]

Hearing

Parents may suspect hearing loss if their child stops responding appropriately to sound stimuli, or does not understand speech, or does not develop speech. Since hearing impairments also disrupt speech development, hearing problems should be corrected as soon as possible. Therefore, every time a child is visited, the doctor should try to get information from the parents about the child's ability to hear and be ready to conduct a survey or refer the child to the audiologist if there are any suspicions of hearing impairment in children.

Audiometry can be performed in the context of primary care; most other audiological procedures (electrophysiological tests) should be conducted by an audiologist. Traditional audiometry can be used when examining children older than three years; children of early age can also be examined by observing their reactions in response to sounds transmitted through headphones, noting their attempts to localize the sound or perform a simple task. Tympanometry is another procedure that can be performed directly in the doctor's office, is applicable to children of any age, and is used to diagnose the condition of the middle ear function. Abnormal tympanograms often indicate a dysfunction of the Eustachian tube or the presence of a fluid in the middle of the ear that was not detected during otoscopy. Despite the fact that otoscopy is informative in determining the condition of the middle ear, it is more effective to combine it with tympanometry.

Other Screening Tests

A tuberculin test should be conducted if contact with the MAB ( Mycobacterium tuberculosis ) is expected , in all children born in developing countries, as well as in children of newly arrived immigrants from these countries. Sexually active adolescents must take an urine test every year for leukocyturia; some doctors also add research on chlamydia infection.

Vaccination of children

Vaccination is carried out according to the schedule recommended by the Centers for Disease Control and Prevention, APA and the American Academy of Family Physicians. During adolescence, tetanus toxoid should be revaccinated, and according to new data, vaccination against meningococcal infection at the age of 11-12 years is also required .

Prevention of diseases in children

Preventive conversations are a part of every healthy child's visit and cover a wide range of topics, from parents persuading the child to sleep on their backs to preventing injuries, from nutrition advice to discussing violence, firearms, abuse.

Security

Recommendations for the prevention of injuries vary with age.

For children from birth to 6 months, safety recommendations focus on the use of children's car seats installed against traffic, lowering the house temperature of hot water less than 49 ° C (less than 120 Fahrenheit), preventing falls, putting the child to sleep on his back, avoiding food and other objects , which can be aspirated by a child.

For children from 6 to 12 months, the recommendations include the continued use of car seats [which can be placed upstream, when the child reaches 9 kg (20 pounds) and age 1 year, however, children's car seats facing the traffic remain the safest], failure from walkers, the use of safe latches, the prevention of falls from folding tables and stairs, vigilance in controlling a child in the bathroom and at a time when the child is learning to walk.

For children from 1 to 2 years, it is recommended to revise the safety of the car for both the passenger and pedestrians, tie up the window cords, use safety linings and latches, prevent falls, remove firearms from the house. Precautions for children from 2 to 4 years include all of the above plus the use of age-appropriate and weight-based car seats. In children older than 5 years, preventive measures include all of the above plus the use of a bicycle helmet, safety devices for sports, instructions for safe passage through the street, clothing control, and sometimes the use of life jackets when swimming.

Food

Poor nutrition leads to obesity in children. Recommendations vary according to age; Recommendations for children under two years of age have been discussed previously. With the growth of the child, parents can allow him some variety in the choice of food, on the whole keeping the diet within the framework of healthy parameters. It is necessary to protect the child from frequent snacks and eating foods, rich in calories, salt, sugar. Soda water (soda) is considered one of the most important components in the development of obesity.

[45], [46], [47]

Exercises

Hypodinamy also underlies mass obesity in children, the benefits of maintaining good physical shape and emotional health should encourage parents to make sure that they have instilled in their children healthy habits from early childhood. Children of the first year of life and early life should be allowed to explore everything themselves, but under strict control and in a safe environment (conditions). Games on the street should be encouraged from the first year of life.

As a child grows, games become more complex, often developing into playing sports in school. Parents should set a good example and encourage both free informal games and gaming sports, constantly keeping in mind security and promoting a healthy attitude towards sport and competition. Taking sports and participating in family activities provides children with exercise and has a positive impact on the psyche and the development of the child.

The time limit for watching TV, which is directly related to inactivity and hypodynamia, should begin at birth and persist until the end of the adolescent period. Similar restrictions should be established for video games, and with the growth of a child - work on a computer not related to training.

[48], [49]