CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdf

This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.

1. CHILD HEALTH NURSING - I
PREVENTIVE PEDIATRIC
Mr. Sachin Sharma
Assistant Professor
Department of Child Health Nursing
SEMESTER -V UNIT-1

2. OBJECTIVES
•Definition & Concept
•Nurses’ Responsibility In Preventive Pediatrics
•Immunization & Cold Chain
•Care of Under-five And Under-five Clinics /
Well- Baby Clinics
•Preventive Measures Towards Accidents
•Child Morbidity And Mortality Rates

3. “Preventive pediatrics is defined as
applying social medicine principles to pediatrics
to prevent disease and promote the physical,
mental, and social well- being of children and
their families to attain positive health.”
Define

4. Dutch philosopher Desiderius Erasmus coined
the phrase “Prevention is better than cure” in
around 1500 A.D. Prevention is the main attribute
of pediatric care, as most childhood diseases are
preventable.

CONCEPT OF PREVENTIVE PEDIATRICS

5. Pattern of Preventive Care in Pediatrics
It has been broadly divided into Antenatal and Post-natal
pediatrics.
Antenatal preventive pediatrics aims
•To improve the health of adolescent girls and expecting mothers
to ensure the birth of a healthy child.
•Antenatal care includes health education on hygienic practices,
menstrual hygiene, safe sex practices, family planning methods,
immunization for the prevention of infectious diseases, screening
for genetically transmitted diseases such as thalassemia and
sexually transmitted diseases (e.g., HIV and aids),
•Elimination of unhealthy behaviors by eligible couples for the
prevention of congenital anomalies (e.g., Prevention of smoking,
alcohol abuse, illicit drug intake, over-the-counter use of
medications especially emergency contraceptives, etc.) And
preparation of mothers for delivery and breastfeeding following
delivery.

6. Postnatal preventive pediatrics promotes a healthy
environment
•To prevent common childhood illnesses. It includes
health education on breastfeeding
•Introduction to complementary feeding, the
importance of immunization, and follow-up of
children,
•Which provides for growth assessment,
psychological assessment at regular intervals,
promotion of health education, promotion of a
healthy environment at home, and maintenance of
hygiene.

7. Nurses’ Responsibility In Preventive
Pediatrics

8. Nurses’ Responsibility In Preventive Pediatrics
•Creating awareness about the care of girl children and gender equality.
•Creating community awareness about available antenatal services to
have healthy children and educating mothers regarding labor and
childbirth, breastfeeding through mothercraft training.
•Promoting institutional delivery to reduce perinatal hazards and
neonatal problems.
•Emphasizing exclusive breastfeeding practices among mothers and
providing essential newborn care during the neonatal period.
•Promoting culture-congruent beneficial child-rearing practices for the
prevention of childhood illnesses.
•Prompt identification and adequate care of sick and injured children
collaboratively.
•Health assessment of children regularly for early interventions of
childhood illnesses.

10. IMMUNIZATION
Definition of Terms
•Immunity refers to resistance against infection caused by
microorganisms and their toxins.
Vaccine
•A preparation to stimulate the body’s immune response against
diseases.
Vaccine Diluent
•A diluent is a liquid used to reconstitute a lyophilized (freeze-
dried) vaccine (BCG, Measles/MR, and JE) per manufacturers
guidelines. It may be sensitive to heat or
freezing, thus requiring transportation and storage in the cold chain.

11. Vaccination
•It is introducing a vaccine into the body to
produce protective antibodies from a specific
disease.
•Immunization is when a person is made
immune or resistant to an infectious disease,
typically by administering a vaccine.

13. Types
of
Vaccines

14. Sites of Immunization in Children
Each vaccine is administered at the same,
specific site on the body to maintain uniformity of
administration and to determine vaccination history
(during follow-up visits or household surveys) by
asking the beneficiary or caretaker (in case an
immunization card is unavailable or lost).

15. Side Effects of Vaccination
•Vaccines are introduced in the body to induce the response of the
recipient’s immune system to the vaccine. Components of some
vaccines (e.g., aluminum adjuvants, stabilizers, or preservatives) can
also lead to reactions.
Common Reactions
Which usually appear after vaccination and can last for 1-3 days are as
follow:
•Mild fever and mild systemic symptoms. Although, it is also
customary that some children might not develop any rise in body
temperature. Gentle rise can be managed with antipyretics and tepid
sponging. Although prophylactic doses of paracetamol are not
recommended currently.
•Cold compresses can manage redness, mild pain, and swelling at
the injection site, which can be used to control swelling and redness.

16. Absolute Contraindication Applicable for All Vaccines
•A child who has had a severe allergic reaction to an earlier dose of
any vaccine should not be given another dose of the same vaccine.
•If a child has an allergy to one conjugate vaccine (like DPT), any
other conjugated vaccine (like PCV) pneumococcal conjugate
vaccine should not be given (or may be given under medical
observations) to the child.
•IPV should not be given to children allergic to streptomycin,
neomycin.
•Vaccination should be given only after medical advice if a child is
allergic to egg proteins.
•Rotavirus vaccine should not be given to children with a history of
intussusception, abdominal surgery, or intestinal malformation.
•Live vaccines should not be given to immune-compromised
children (e.g., HIV, Leukaemia) and those taking steroid therapy or
immune-suppressant drugs.

17. Intussusception (in-tuh-suh-SEP-shun) happens
when one part of the bowel slides into the next,
much like the pieces of a telescope. When this
"telescoping" happens: The flow of fluids and
food through the bowel can get blocked. The
intestine can swell and bleed.

18. IMMUNIZATION PROGRAMME
The immunization division is a part of the
reproductive and child health program under the National
Health Mission (NHM). It is at the Ministry of Health and
Family Welfare, Nirman Bhawan, New Delhi. This division
provides all the technical assistance required to undertake
the activities under the Universal Immunization
Programme (UIP).

19. Objectives
The stated goals of UIP are as follow:
•To rapidly increase immunization coverage.
•To improve the quality of services.
•To establish a reliable cold chain system at the
health facility level.
•Monitoring of performance.
•To achieve self-sufficiency in vaccine production.

21. COLD CHAIN

22. Definition
“Cold Chain” is a system of storing and transporting vaccine and
their diluents at the recommended temperature range (2-8) from
the point of manufacture to the vaccination site.
Supply Chain
India has a vast cold chain infrastructure to ensure that only potent
and effective vaccines reach millions of beneficiaries nationwide.
There are more than 29,000 Cold Chain Points (CCPs) across the
country where the vaccines are stored and further delivered to the
lower-level stores or immunization sessions attached to them.

23. Holdover Time
In the event of power failure, “holdover time” for any
functional, healthy cold-chain equipment is defined as
“the time taken by the equipment to raise the inside
cabinet temperature from its cut-off temperature to the
maximum temperature limit of its recommended range,”
e.g., in the case of ILR, if the temperature is four °C,
then the time taken to reach eight °C from 4°C will be
the holdover time for that ice-lined refrigerator (ILR).

25. Types of Cold Chain Equipment (CCE)
Walk-in-Cooler (WIC)
Walk-in-Freezer (WIF)
Ice-Lined Refrigerator (ILR)
Deep Freezer (DF)
Solar Direct Drive (SDD) Combo
Cold Box
Vaccine Carrier
Ice Packs
Refrigerated Vaccine Truck
Vaccine Vial Monitor (VVM)

26. The following are the cold chain equipment used for the safe storage and
transportation of vaccines.
•Walk-in-Cooler (WIC)
These are established at regional levels to store prominent qualities of vaccines for
about 4-5 districts. They maintain a temperature of +2°C to +8°C. They are
available in sizes of 16.5 Cum. and 32 Cum.

27. •Walk-in-Freezer (WIF)
These are used for bulk storage of OPV and to prepare bulk quantities of ice packs
at state stores. They maintain a temperature around (-) 20°C.

28. Ice-Lined Refrigerator (ILR)
•These refrigerators with top openings can better hold the
cold air inside than a refrigerator with a front door. It can
keep vaccines safe with as little as eight continuous
electricity supply in 24 hours. Inside the ILR is a lining of
ice packs fitted around the walls and held in place by a
frame. When the refrigerator is functioning, the ice packs
freeze.

29. Deep Freezer (DF)
•The cabinet temperature is maintained between -15°C to -
25°C. This is used for storing OPV (district level and above
only) and freezing ice packs. In case of power failure, it can
maintain the cabinet temperature of -15°C to -25°C for 18 to
26 hours at ambient temperatures of 42°C and 32°C,
respectively, if not opened.

30. Solar Direct Drive (SDD) Combo
•A solar refrigerator operates on the same principle as regular
compression refrigerators but incorporates low voltage (12
or 24V) DC compressors and motors rather than mains
voltage

31. Cold Box
•Cold boxes are insulated containers that collect and transport
vaccine supplies from State to Regional Vaccine Stores and
District Vaccine Stores to PHC. AC types.

32. Vaccine Carrier
•Vaccine carriers carry small quantities of vaccines (16-20
vials) from PHC to the sub-centers or session sites. These are
made up of insulated material with a capacity of 1.7 liters.

33. Ice Packs
•Ice packs are an essential component of the cold
chain. These are water-filled plastic containers of
0.3/0.4 litre capacity. Water is filled to the mark’s
level on the pack’s side. The remaining space is
required for expansion after freezing.

34. Refrigerated Vaccine Truck
•It is used to transport vaccines in bulk quantities by
road The refrigerated vaccine van can provide a
temperature range as per the specific requirement of
the vaccine, like +2°C to +8°C or -15°C to -25°C.

35. Vaccine Vial Monitor (VVM)
It is a label that helps identify vaccines to be
discarded. It contains a heat-sensitive material to
record cumulative heat exposure over time.

37. Nurse’s Responsibility in Immunization of Children
•Conducting procurement and distribution of IEC (information,
education, and communication) materials related to immunization.
•Organization of immunization sessions at various healthcare
settings by national guidelines.
•Regular assessment of vaccine stocks and arranging vaccines in
advance as per the need of the immunization session.
•Maintenance of the cold chain system at the immunization
center or during transportation.
•Administration of vaccines as per the national guidelines.
•Observation of possible adverse effects of vaccination.
•Informing parents about the possible minor reactions following
vaccinations and how to manage them at home.

38. CARE OF UNDER-FIVE
AND UNDER-FIVE CLINICS/
WELL- BABY CLINICS

39. A well-baby clinic (WBC), or Well Child Clinic, is a primary
health-care facility.
•These kinds of clinics, primarily found in developed countries,
are directed toward providing preventive, promotive care at the
community level.
•Mothers generally come to the clinic voluntarily with their
infants and children to assess their children’s growth and
development.
Symbol of the under five
clinic

40. Care in Illness
•Diagnosis and management of acute illnesses, e.g.,
diarrhea and fever are managed by oral rehydration salt
and antipyretics free of cost.
•Early identification of growth and developmental delay.
•Diagnosis and management of chronic congenital or
acquired abnormalities (physical, mental conditions).
•X-ray and essential laboratory services
•Referral services.

43. PREVENTIVE MEASURES
TOWARDS ACCIDENTS

44. PREVENTIVE MEASURES TOWARDS ACCIDENTS
Children are more prone to accidents and injuries due to their
unstable gaits and inability to predict the consequences of their
actions. As they grow up, they become curious about their
surroundings and try to explore things of their own, which also
drags them toward untoward events.
Fall
Fall injuries are common in the age group of 4–12 months.
This age group is prone to fall-related injury as the infant
learns to roll over in the bed or creep to reach for objects and
has an unstable gait. Toddlers are also prone to fall-related
injuries due to experimenting and exploring the surrounding
world.

45. Preventive Measures for Infants
•Never let the infant play alone in a high cot. It is
better to place the child on the floor during play if
left unattended, even for a short period. If it is not
possible, then lower the level of the mattress.
•Cribs with long rails should be used if feasible, as
soft side pillows are not enough for older children.
•Avoid leaving colorful, large toys in the crib or
outside, as these can attract the child’s attention to
come out of the crib. Large toys inside the crib can
also act as stepping stones for the infant to trip off.

46. Preventive Measures for Toddlers
•Never leave an infant of any age on a raised surface
that does not have side rails without the presence of
adults.
•Never allow parents to allow children to play on
unfenced terraces or balconies. Advise them to grill
all the windows with closely spaced bars and fence
the terrace or balcony. If it is impossible, keep the
terrace door under lock and key.
•Never allow the child to play while wearing ankle-
length dresses.
•Ensure that the shoe laces are tied, and the shoes are
not slippery.

47. Aspiration/Swallowing of Foreign Body
As the infants are in the oral phase, they grow and explore
everything by mouth. This can lead to accidental aspiration of
toys, buttons, pins, etc., and may cause death of infants deaths.
Preventive Measures for Infants
Ensure that toys given to the child do not have small
detachable parts that can be accidentally swallowed.
Provide only well-constructed rattles and pacifiers for
infants so that it doesn't breakdown and choke the infant
while playing with it.
Remove small parts that could be aspirated or swallowed
from toys.
Do not permit infants to play with balloons.
Do not give infants nuts, hard candies, and fruits that
contain pits or seeds.

48. Preventive Measures for Toddlers
•Avoid giving fruits with tiny seeds, such as oranges
and pomegranates. Do not give raw apples, pears or
other hard food that might get aspirated.
•Ensure that the fruits and vegetables are adequately
chopped before giving them to the child.
•Don’t engage children in laughter or play activities
or don’t allow them to speak while eating a piece of
food.
•Never let the kids run, play, and shout with a
lollypop in their mouth.

49. Suffocation
Preventive Measures for Infants
•Use a firm mattress with no pillows so that the infant’s face
is not buried in one.
•Furniture in the home should be adequately spaced to
ensure the infant does not get stuck in between them
while crawling.
•Avoid using nonporous films like plastic covers and bags,
as the infant can inadvertently play by covering the face
with them. Dispose of the polythene bags that are
nonporous immediately
•During cold winters, cover the baby adequately in the
head, body, and feet with warm clothes, sparing the nose
and mouth.

50. Preventive Measures for Toddlers
•Remove the bones from fish, meat, and stones
from the rice before cooking and serving the
children.
•Keep unused storerooms and garages under lock
and key.
•Never let the children play with plastic bags by
covering their faces or with utensils such as
pressure cookers, buckets, tin containers, etc., with
small openings as their heads can get lodged,
which can suffocate a child to death.

52. Preventive Measures for Toddlers
•Keep lighters, matchboxes, crackers, candles, and
cigarettes safe so that toddlers cannot access them.
•If possible, keep a fire extinguisher in the house, or know
the location of a fire extinguisher in your apartment.
•Keep all the hot cooked food items away from the
table’s edge.
•Always keep hot electrical heating rods and steam presses
in a secure place away from the kids.
•Avoid standing beneath a tree on a rainy thunderstorm
night.

53. Drowning
•Drowning can occur commonly in an infant over 10 months in the
bathroom. Toddlers and preschoolers can be drowned if there is a
local waterbody nearby their home and they are left unattended.
Preventive Measures for Infants and Toddlers
•Keep the infant away from swimming pools or other water bodies
like wells and put fences around them.
•Never leave the infant alone in a bathroom, as they can peep into the
collection of water out of curiosity and drown themselves in the
bathtub or a bucket filled with water.
•Always keep the bathroom door locked after use, as water play
interests children, and they can drown themselves.
•The bucket must be kept upside down.

54. Poisoning
•A curious infant and toddler wanting to explore his
surroundings are most susceptible to infestation common
household poisons.
Preventive Measures for Infants and Toddlers
•Always keep fuel like kerosene, detergents, washing powder,
floor cleaner, utensil cleanser, insecticides, mosquito
repellents, rodenticides, medicines, and pills in a well-locked
high shelf well away from the reach of infants and toddlers.
•Never change the storage container of the above-mentioned
everyday household essentials into water bottles as they can
be mistakenly consumed (for instance, by storing kerosene
or floor cleaners in soft drink bottles).
•Never reuse the containers that had stored toxic substances
earlier.

55. Motor Vehicle Accidents
•Motor vehicle accidents are a familiar mode of accidents
in toddlers and preschoolers.
Preventive Measures
•Avoid driving cars or any vehicles with infants in their lap.
•Do not leave the infant in a stroller or carriage alone
behind a parked car.
•Secure an infant seat in the vehicle and check for its
integrity before placing the infant in the seat.
•Toddlers and older children must be securely strapped and
fastened to the seat before starting the ride. If such
provision is not available in the car, parents must hold the
child securely in their lap before starting the vehicle.

56. CHILD MORBIDITY AND MORTALITY
RATES
Vital statistics such as birthrate and death rates
indicate any Nation’s health. Child health status is
assessed by measuring mortality and morbidity in
different age groups. These data are collected through
surveys such as The National Family Health Survey
(NFHS) and Sample Registration Survey (SRS).
Morbidity data contained in specific surveys are
relatively scarce and poorly standardized.
Measurement of growth and development is also an
essential indicator of a child’s health status.

57. Perinatal Mortality Rate
Perinatal mortality is defined as the number of fetal deaths past
22 (or 28) completed weeks of pregnancy plus the early
neonatal deaths (number of deaths among live-born children
up to 7 completed days of life) per 1000 total births (live births
and stillbirths).
Neonatal Mortality Rate
Number of deaths during the first 28 completed days of life
per 1000 live births in a given year.
Postneonatal Mortality
Post-neonatal mortality rate is defined as the “ratio per post-
neonatal death in a given year to the total number of live births
in the same year, usually expressed as a rate per 1000”.

58. Infant Mortality Rate
•The Infant mortality rate is “the ratio of infant
deaths registered in a given year to the total number
of live births registered in the same year, usually
expressed as a rate per 1000 live births”.
Under-Five Mortality Rate
•UNICEF defines it as the “annual number of deaths
of children under five years, expressed as a rate per
1000 live births”.

59. Causes of Child Mortality
As per the SRS report of 2017-2019, the causes of child mortality in
India are as follows:
•The leading causes of under-five death were prematurity and low
birth weight (31.2%), pneumonia (17.5%), birth asphyxia and birth
trauma (9.9%), diarrhoeal diseases (5.8%), congenital anomalies
(5.7%), injuries (4.9%).
•The leading cause of infant deaths were prematurity and low birth
weight (36.1%), pneumonia (17.4%), birth asphyxia and birth
trauma (11.5%), congenital anomalies (5.7%) and diarrhoeal
diseases (4.5%)
•Preterm birth and low birth weight (45.9%), birth asphyxia and
birth trauma (14.6%), pneumonia (13%), sepsis (5.2%), congenital
disabilities (4.8%) were the leading causes of neonatal deaths in
India in 2017- 2019.

60. THANK YOU