Preventive pediatrics in Child Health Nursing

Preventive pediatrics has been defined as the prevention of diseases and the promotion of physical, mental, and social well-being for children to reach optimal growth and development.

1. Welcome to DPCN

2. What you have noticed?

3. Mrs.Dhara Vyas , Assistant Professor,DPCN, Nadiad Preventive Pediatrics

4. The structure of the presentation Definition Aims of Preventive Pediatrics Concept of Preventive pediatrics Antenatal Aspects of Preventive Pediatrics Postnatal Aspects of Preventive Pediatrics Social Aspects of Preventive Pediatrics

5. Definition Preventive pediatrics  has been defined as the  prevention  of diseases and the promotion of physical, mental, and social well-being for children to reach optimal growth and development.

6. Aims of Preventive Pediatric

7. Concept of Preventive Pediatric

8. Why…?

9. Antenatal Preventive Pediatric

10. Maternal Age Less than 18 years of age may cause abortion because of poorly develop uterus More than 35 yeas of age can cause Down’s Syndrome as the age of ova increase and spindles becomes more week to separate chromatides leads Trisomy 21

11. Maternal Infection(STORCH) S - Streptococus/ Staphylococcus infection T - Toxoplasmosis O - Others includes HIV, TB, STDs etc R – Rubella C - Cytomegalo Virus H – Herpes Simplex and Herpes Zoster Fetal infection are manifested by intrauterine growth retardation, meningoencephalitis , hepatitis, congenital malformation, abortion and still birth

12. Maternal Nutrition Folic Acid deficiency can cause Neural Tube Defect – requirement 400 microgram Calorie requirement - 2500kcal Protein requirement – 60gm Iron requirement -30mg- Severe iron deficiency anemia up to 5 to 6 month of age Iodine requirement – 75microgram Zinc requirement – 15mg- deficiency can affect the fetal growth DHA ( Docosahexaenoic acid), omega-3 is recommended for fetal growth

13. Maternal Disease Maternal Disease Baby Can Affect with Hypertension / Gestational Hypertension Prematurity, IUGR, Fetal Hypoxia, Preeclampsia/ eclampsia RDS , Meconium aspiration Syndrom , neonatal infection Polyhydroamnios Anencephaly, intestinal obstruction, GI anomalies Oligohydroamnios Renal agenesis, Renal dysplasia, limb deformities Antepartum hemorrhage IUGR, fetal hypoxia Rh and ABO incompatibility Pathological jaundice PROM Preterm delivery, perinatal infection

14. Maternal Disorders Endocrinal disorders Psychiatric Disorders Malignant disorder Hypothyroidism Thrombocytopenia Myasthenia gravis Pemphigus vulgaris

15. Maternal Disorders Chronic Disorders Baby can affect Cardiac disease Abortion, prematurity, IUGR, asphyxia Chronic renal disease RDS, septicemia, congenital anomalies Viral hepatitis Still birth, prematurity Maternal hypothyroidism Sterility, early fetal death, neonatal hypothyroidism, Maternal thyrotoxicosis Fetal goiter, hypothyroidism Diabetes mellitus Macrosomia , organomeghaly

16. Maternal Drugs Thalidomide Psychiatric Drugs Cancer Drugs Cardiac drugs Hormonal Treatment Live vaccines are contraindicated during pregnancy Iron is Teratogenic drug during 1 st Trimester Antithyroid drugs Vitamine – A,D,K

17. Maternal Alcoholism Maternal Alcoholism can cause IUGR, microcephaly , slow physical and mental growth, facial dysmorphism includes short upturned nose, thin upper lip, ptosis , maxillary hypoplasia , cardiac malformation, ear anomaly, restricted joint movement

18. Maternal Stress High levels of  stress  that continue for a long time may cause health problems, like high blood pressure and heart disease. When you're  pregnant , this type of  stress can  increase the chances of having a premature baby  (born before 37 weeks of pregnancy) or a low- birthweight  baby  (weighing less than 5½ pounds).

19. Maternal Exposure to Radiation In utero radiation produces microcephaly and mental retardation. Later in life there is increased incidence of hematopoietic malignancies and leukemia 

20. Fetal Diagnosis and Treatment Preventive Fetal Therapy Acceleration fetal Maturation – betamethasone , dexamethasone Prevention of Intracranial Hemorrhage – Vit - K Prevention of Fetal Infection- Penicilline Prevention of neural tube defect – Folic acid

21. Fetal Diagnosis and Treatment Medical therapy Cardiac arrhythmias – Digoxin to mother Congenital hypothyroidism – iodized salt Inborn errors of metabolism – Vitamine B12 Thyrotoxicosis-Carbimazole Therapy

22. Fetal Diagnosis and Treatment Surgical Intervention Intrauterine blood Transfusion Obstructive uropathy - vesico –amniotic shunt Congenital hydrocephalus- ventriculo amniotic shunt Pleural effusion- pleuro amniotic shunt

23. Postnatal Preventive Pediatric GOBIFF

24. Growth Monitoring Growth monitoring  is the regular measurement of your child's size to  monitor  his  growth .

25. Oral Rehydration Salt

26. Breast feeding

27. Proper position of baby while breastfeeding includes Supporting whole of baby’s body. Ensure baby’s head, neck and back are in same plane. Entire baby’s body should face mother. Baby’s abdomen touches mother’s abdomen . Correct positioning will ensure effective sucking and prevent sore nipples and breast engorgement. 28

28. Attachment of baby on mother’s breast Four signs of good attachment are: Baby’s mouth wide open. Lower lip turned outwards. Baby’s chin touches mother’s breast. Majority of areola inside baby’s mouth. 29

29. 28.09.2018 Breast Feeding 30

30. Causes of poor attachment 28.09.2018 Breast Feeding 31

31. Ten Steps of Baby Friendly Hospital Initiative Every facility providing maternity services and care for newborn infants should: 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 half-hour of birth. 34

32. Conti… 5. Show mothers how to breastfeed, and how to maintain lactation even if they are separated from their infants . 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 teats 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 the hospital or clinic. 35

33. INDICATORS OF ADEQUATE BREASTFEEDING 36

34. Immunization BCG OPV IPV Hep B Pentavalent Measles – Vitamin A MMR Vericella

35. Food Breast feed Weaning Nutritive food with different colour and texture Serving of food Finger food Avoid chocolates, cake, sweets with sugar Avoid junk food Healthy eating pattern to prevent obesity

36. Female Child and Female Literacy Objectives Prevent gender biased sex selective elimination Ensure survival & protection of the girl child Ensure education of the girl child

37. Prevention of Accidents and Poisoning

38. Social Preventive Pediatric

39. Child Welfare

40. Child Labour Minimum Age for Employment. In accordance with the Constitution of India, no child below the age of  fourteen years  shall be employed to work in any factory or mine or engaged in any other hazardous employment. The minimum age for employment is 14 years .

41. Street Children “Children of the street” are  homeless  children who live and sleep on the streets in urban areas. They are totally on their own, living with other street children or homeless adult street people. On the other hand, “children on the street” earn their living or beg for money on the street and return home at night. There are  18 million street children  in India, the largest number of any country in the world, with 11 million being urban. 

42. Gender Bias

43. Child Abuse and Neglect Physical violence Sexual molestation Mental and emotional maltreatment Deprivation Lack of opportunity Rape Sexual injury Death

44. 9/28/2018 Preventive Pediatrics 47 Role of Nurse in Preventive Pediatrics

45. 9/28/2018 Preventive Pediatrics 48 Hungry?

46. Healthy Eating Tips 9/28/2018 Preventive Pediatrics 49

47. Thank You