Screening in well baby clinic

Transcription

1 Screening in well baby clinic Dr. Abdulmoein Al-Agha, Ass. Professor & Consultant Pediatrician, KAUH & Erfan Hospital, Jeddah

2 Well baby clinic IS Not only for vaccinations and check up for fever & URTI!!!

3 1. Growth assessments Length, weight & head circumference measurements should be taken with each visit These measurements are plotted on growth charts and are compared to previous and later markings to make sure the baby is growing as expected 2. Well baby clinic is an excellent place for Primary Prevention & Family Education especially on breast feeding & good nutrition 3. Immunization 4. Assessments of the baby's reflexes and neurological developments 5. Visual & hearing assessment 6. Systemic examinations to detect any childhood diseases from earlier stages Well baby clinic s rules

4 Growth assessments Using height for age measurement to monitor growth as will as weight for age Use CDC chart for this purpose Refer to specialist clinic as early as possible when a child's growth curve is abnormal Encourage parents to come for growth monitoring as they are dealing with the vaccination program

5 Early detection of growth disorders!!

6 What is normal infant growth? 1. Head circumference Approximately 35 cm at birth Approximately 47 cm at 1 year of age Use charts to detect any abnormalities: Large or small head

7 What is normal infant growth? 2. Length/ height Length at birth approximately 50 cm Length at 1 year = 75 cm Double birth length by 4 years (100 cm) Use charts to detect any abnormalities: Under/ over growth

8 What is normal infant growth? 3. Weight Weight at birth = kg 4-6 months: birth weight doubles 1st year: birth weight triples 2nd year: birth weight quadruples Gain rate: 1st month: g / day 1st year: 10 g / day

9 Growth Charts are very important tool for detection any growth disorders

10 Well baby clinic is an excellent place for Primary Prevention & Family Education

11 What are benefits of breastfeeding Breast feeding has short and long term benefits: Provides all essential energy and nutrients Protection against infectious diseases Decreases rates of infant mortality Decreases rates of other health outcomes Enhances cognitive development Enhances normal psychosocial behaviors Reduces risk of development of autoimmune diseases e.g. type 1 DM & allergic diseases later on life!!!

12 Breastfeeding encouragement Please avoid adding formula feeding as much as possible!! Age of introduction of solid food at six months of age not at 4 th. Months of age Iron & vitamin D supplements for breast - fed babies to prevent common diseases in our community e.g. rickets & IDA

13 Prevention & Education will prevent common nutritional diseases in our community!!!

14 Important Prophylactic Issues Not to introduce cow s milk in first year of life To encourage exclusive breastfeeding for first six months of life with emphasis on mother s iron, vitamin D & calcium good intake during pregnancy & lactation Introduction of iron containing foods at six months or to supplement oral iron (ferrous sulphate drops) prophylaxis If not breastfeeding, use iron-fortified formula until one year of age After one year of life, limit cow s milk consumption to 2 cups /day & encourage vegetables, fruits & meat Toddlers: diversified diet rich in iron containing foods & vitamin C, avoid excessive juice intake; may give multivitamin containing iron

15 Prevention of iron deficiency should be of paramount effort for all parties caring for healthy childhood!!

16 Hypochromic Microcytic RBCs

17 Pallor

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19 Why should we prevent iron deficiency anemia? Treatment of IDA with complete resolution of anemia does not correct all of the behavior effects Infant & toddlers with IDA, in a long trial, reevaluated at age of 11-14y of age demonstrate functional impairment despite complete resolution of IDA Their behavior was characterized by parents as irritable, poor appetite, poor weight gain & problematic (Lozoff et al, 2000)

20 Rickets bone disease that affects children, usually 6 to 24 months of age caused by a lack of vitamin D (fish, liver, eggs, milk and exposure to sunlight results in progressive softening & weakening of the bones structure 20

21 Rickets

22 Rickets

23 Prevention of vitamin D deficiency Increase sunlight exposure For exclusive breast-feed, Vitamin D supplementation of IU daily Asian children should take supplement until 5 years of age The potential importance of maintaining adequate vitamin D extend far beyond the prevention of rickets & osteomalacia

24 Immunizations Individual & series immunizations are started or continued at well-child visits (better to rename it, as well-child clinic because vaccination continues beyond first year of life!!) Family should be provided with a schedule so that they know how many injections to expect at each visit as well additional optional vaccines Please ask history of medications e.g. steroid or history of immunodeficiency prior of introduction of live attenuated vaccines to avoid complications

25 Developmental Screening Developmental screening is a procedure designed to identify children who should receive more intensive assessment or diagnosis for potential developmental delays It can allow for earlier detection of delays & improve child health and well-being for identified children

26 Key Concept Development during the period of childhood is marked by steady, incremental changes in the cognitive, affective, and motor domains 26

27 Risk Factors of developmental delay Biological Low birth weight Prematurity Micro/macrocephaly CNS infection Teratogens exposure Environmental Extreme poverty Lack of permanent housing Parental substance abuse Teen parents

28 Why developmental assessment? Early detection of deviation in child s pattern of development Simple & time efficient mechanism to ensure adequate surveillance of developmental progress Domains assessed in well baby clinic: cognitive, motor, language, social / behavioral and adaptive

29 Gross Motor Skills The acquisition of gross motor skills precedes the development of fine motor skills Both processes occur in a cephalocaudal fashion Head control preceding arm & hand control, Followed by leg and foot control

30 Head Control Newborn Age 6 months

31 Sitting Up Age 2 months Age 8 months

32 Ambulation Nine to 12-months 13 month old

33 Fine motor development Newborn has very little control Objects will be involuntarily grasped & dropped without notice 6 month old: palmar grasp uses entire hand to pick up an object 9 month old: pincer grasp can grasp small objects using thumb & forefinger

34 Fine Motor Development 6-month-old 12-month-old

35 Speech milestones 1-2 months: coos 2-6 months: laughs 8-9 months babbles: mama/dada as sounds months: mama/dada specific months: words (50% understood by strangers) months: two word sentences, >50 words, 75% understood by strangers months: almost all speech understood by strangers

36 Hearing BAER hearing test done at birth Ability to hear correlates with ability enunciate words properly Always ask about history of otitis media ear infection, placement of PET tubes in ear Early referral to ENT to assess for possible fluid in ears (effusion) to avoid speech delay Repeat hearing screening test Speech therapist as needed

37 Red Flags in infant development Unable to sit alone by age 9 months Unable to transfer objects from hand to hand by age 1 year Abnormal pincer grip or grasp by age 15 months Unable to walk alone by 18 months Failure to speak recognizable words by 2 years

38 Take Home messages 1) Well baby clinic IS Not only for vaccinations 2) Growth assessments are very important in every visit 3) Use CDC chart or Saudi local charts 4) Growth Charts are very important tool for detection any growth disorders 5) Well baby clinic is an excellent place for primary prevention & family Education

39 Take Home messages 6) To encourage exclusive breastfeeding for first six months of life with emphasis on mother s iron & calcium good intake 7) Not to introduce cow s milk in first year of life 8) Prevention & education will prevent common nutritional diseases in community especially iron deficiency anemia & rickets (common in Saudi Arabia)

40 Take Home messages 9) Prevention of iron deficiency & rickets should be of paramount effort for all parties caring for healthy childhood!! 10)For exclusive breast-feeding: Vitamin D supplementation of IU daily Iron drops of 2-3 mg/ kg/ day 11)Development assessment is very crucial in the first five years of life

41 Last Home Message!!! Early detection of any childhood disorders will prevent or minimize later adult handicapping

42 The End Thank You