One of critical issues modern pediatrics in our country is children's health, which is based on general principles of organizing treatment and preventive care: accessibility, freeness, locality of medical care, use dispensary observation, sequence of outpatient and inpatient care, stages of medical care.
The precinct principle is based on dividing the territory of settlements on a site in such a way that in one area no more than 800 children lived under the age of 15 years, of which up to 100 children are 1 year of age. Medical care for children provided by the local pediatrician and a nurse.
Stages and sequence of medical support- is the provision medical care children in a certain order. First, the child is examined by a local doctor with the involvement (if necessary, consultations) of specialists of a narrow profile. For further examination and treatment, the child is sent to a district or city hospital, then to a regional hospital. If necessary, medical care can be provided at maternal and child health centers and research institutes. The last stage of assistance to children is rehabilitation and health institutions (sanatoriums and resorts).
In our country, a powerful network of children's treatment and preventive institutions has been created to provide medical care. In all regional centers and large cities, children receive general and specialized care in multidisciplinary children's hospitals. The composition of these medical institutions includes cardiological, pulmonary, gastroenterological, nephrological and other departments, as well as the department intensive care and intensive care unit, neonatal pathology department, premature infant care department, and the like.
2.Principles of organizing medical and preventive care for children.
Leading institution in providing medical and preventive care to children is a children's clinic. The clinic operates on a local basis. The work of the doctor and nurse at the site includes continuous dynamic monitoring of children, starting from birth, providing medical care to children with acute and chronic diseases, medical examination of children from risk groups, children who have suffered acute diseases, and children with chronic pathology.
Pediatricians carry out preventive and anti-epidemic measures aimed at ensuring proper physical and neuropsychic child development, to reduce morbidity and mortality, prepare and conduct vaccinations. In addition, an important aspect of the work of a pediatrician and nurse is sanitary education and legal protection of children.
Effective preventive measures on site begin even before the baby is born. The district nurse provides prenatal care to the pregnant woman within 10 days after receiving notification of the pregnant woman from the antenatal clinic. She conducts a conversation about the importance of a woman’s daily routine and nutrition for the development of the fetus and the birth process. The nurse visits for the second time expectant mother at the 32nd week of pregnancy, in order to determine the family’s preparedness for the birth of a child, the availability of what is necessary to care for the newborn, talks about the characteristics of its behavior, feeding and development. A pediatrician visits a pregnant woman at the end of pregnancy only if necessary.
The organization of child care is of great importance in reducing morbidity and child mortality after discharge from the maternity ward. First patronage newborn baby The pediatrician and nurse carry out the examination within the first 3 days after receiving the notification. The purpose of the first visit is to determine the child’s health status and assess his physical and neuropsychic development. Special attention You should pay attention to the child’s behavior (excitement or lethargy), sucking activity, skin condition (pallor, jaundice, cyanosis, rash, lumps) and umbilical ring. After a thorough examination of the child, they assess her condition, specify her health group, outline health-improving measures, and draw up a plan for further monitoring of the child. Also, during the first visit, it is necessary to familiarize the mother with the rules of feeding, bathing and caring for a newborn, breast care, and pumping techniques. breast milk. During the 1st month, the pediatrician must examine the newborn three times, and a child at risk - at least 4 times. During repeated visits to the newborn child, the local pediatrician and the nurse make sure that the child is developing correctly. Particular attention should be paid to these children: premature babies, twins, bottle-fed children, children who have suffered asphyxia, birth trauma; patients with rickets, malnutrition, anemia, diathesis, children who often suffer from acute respiratory diseases. These children belong to a high-risk group and are subject to clinical examination together with specialists (neurologist, ophthalmologist, surgeon, otolaryngologist, etc.). According to an individual schedule.
At the clinic, a “Child’s Individual Development Card” is issued for the child, which is maintained until the age of 15. It notes the dates of visits, the age of the child, the dynamics of physical and mental development, features of feeding, violations of care, data on the disease.
Further observation of healthy children of the 1st year of life is carried out monthly by a local pediatrician and a nurse in the clinic. The doctor evaluates the child’s physical and neuropsychic development, state of various functional systems child's body. Prescribes measures to prevent the most common diseases (rickets, anemia, etc.). The pediatrician examines healthy children from 1 to 2 years old once a quarter, from 2 to 3 years old - once every 6 months.
In the future, planned regular medical examinations are carried out in clinics. Based on examination data, anthropometric indicators and laboratory tests, the doctor determines the health group for each child, since the volume of necessary treatment, preventive and rehabilitation measures depends on this. The distribution of children into health groups is as follows. The first group includes children who do not have deviations in the functional state of the main organs and systems. Acute diseases are rare and have mild course. The physical development of children corresponds to their age. The second group includes children with functional changes in one organ or system, as well as children of the 1st year of life with a burdened obstetric history (preeclampsia, complicated labor, multiple pregnancies, etc.), prematurity without pronounced signs of immaturity, unfavorable course of early pregnancy. neonatal period. These children often suffer from acute illnesses, and the recovery process is protracted. Basically they have normal physical development, but minor deviations in the form of deficiency or excess body weight are possible. Possible delay in neuropsychic development. The third group includes children with chronic diseases or congenital anomalies of the development of organs and systems in the compensation stage. Existing functional and pathological changes in the main organs and systems, but without clinical manifestations. Children rarely suffer from intercurrent diseases, but their course is complicated by a mild exacerbation of the underlying chronic disease. The physical and neuropsychic development of these children corresponds to their age; there may be deficiency or excess body weight and short stature. Children of the fourth group have chronic diseases or developmental defects in the subcompensation stage, functional disorders of one or more pathologically altered organs or systems. With intercurrent diseases, there is an exacerbation of the underlying chronic disease with a violation general condition and well-being or with a protracted period of recovery. Children may lag behind in neuropsychic and physical development. The fifth group includes children with chronic diseases or congenital malformations in the stage of decompensation, which leads to the child’s disability. Existing congenital functional disorders of pathologically altered organs or systems. Frequent exacerbations of the underlying chronic disease are observed.
The local pediatrician sets the timing of preventive vaccinations and immunobiological tests according to the latest instructions. It is important to correctly select children for preventive vaccinations. Before vaccinations, the pediatrician must carefully collect anamnesis and examine the child and, if necessary, prepare the child for vaccination. Medical examination of older children– this is dynamic observation and organization of therapeutic and recreational activities among children with identified pathology. The doctor enters all data on the identified pathology in the “Dispensary Observation Control Card”, outlines in it the scope and nature of the necessary measures aimed at preventing relapses of diseases, and records the number of examinations during the year.
At the pediatric site Much attention is paid to sanitary education work, which includes individual and group conversations about raising a healthy, harmoniously developed child, systematic sanitary and hygienic education of parents and other family members, and promotion of a healthy lifestyle.
In the medical care of the children's population, hospitals occupy an important place, where sick children receive highly qualified medical care. A children's hospital may have general and specialized departments, taking into account the specifics of local conditions, morbidity characteristics, and the age composition of children. When organizing children's hospitals, it is taken into account that the vast majority of acute pathologies in children are of an infectious nature. Taking this into account, the need to create conditions for maximum separation of children has been proven, which is achieved by organizing a box or drinking box system of departments and applying the principle of one-time occupancy of wards.
In any department, the child is under the supervision of a resident physician, whose job is to collect anamnesis, conduct a clinical examination and instrumental examination, establish a diagnosis, treat the child, and determine a plan of rehabilitation measures. If necessary, specialized specialists and employees of scientific institutions are involved in examining the child.
Each child is assigned an individual regimen, taking into account the severity of the pathology, the child’s age, changes in his behavior, and the number of feedings. All this is recorded in the “Inpatient History”, which is drawn up upon the child’s admission to the hospital. Referring children to hospital treatment It can be planned (by referral from local pediatricians) or emergency (by self-referral or referral by emergency or emergency medical services).
Compliance with the regime necessary for the child, fulfillment of assignments is possible only in the case of clearly coordinated work medical personnel departments. All necessary data on the course of the disease, changes in the child’s condition, and the implementation of doctor’s orders are reported by the nurse; her work must be well thought out, clearly regulated and coordinated with the actions of other employees in order to ensure maximum continuous monitoring of sick children.
The main functional responsibilities of a ward nurse are to carry out doctor’s orders, toilet sick children, measure body temperature, feed children, monitor their leisure time and sleep, organize walks, and assist doctors during their rounds. During the round, the nurse receives clear instructions from the doctor about changing the prescriptions and regimen for each sick child.
The nurse pays special attention to strict compliance with the sanitary and anti-epidemic regime in the department and monitors the work of junior medical staff. She places patients in wards according to the type of disease, age and gender, monitors the cyclical filling of the wards and compliance with the daily routine. Seriously ill children require special attention. Another nurse monitors the breathing, pulse, condition of the mouth, eyes, and skin of such children, comfortably places them in, turns them over, picks them up, records any changes in their condition, changes diapers and underwear. If the condition of a seriously ill child worsens, she must immediately call a doctor and provide emergency medical care before he arrives.
The nurse monitors the correct organization of nutrition for sick children, which must correspond to the age, nature of the disease, and individual tastes of the child. Even minor disturbances in feeding can cause deterioration in health.
With older children, they carry out educational work, and in some hospitals where children stay for a long time, educational work, which is included in the therapeutic and protective regime and significantly affects the emotional tone of the child, accelerating the recovery process.
The organization of medical care for children is determined by the Federal Law “On the fundamentals of protecting the health of citizens in Russian Federation"(dated November 21, 2011 No. 323-FZ).
The law defines the basic principles of health protection: state guarantees and responsibility of authorities, local government, officials in ensuring rights in the field of health care, social protection of citizens in the event of loss of health, accessibility and ILC, inadmissibility of refusal of it, priority of the patient’s interests in its provision and prevention, observance of medical confidentiality.
These principles fully apply to protecting children's health. For the first time, the law defines as a main principle the priority of protecting children's health - one of the most important and necessary areas of state activity, creating conditions for the optimal physical and mental development of children. Children, regardless of their family and social well-being.
must have adequate legal protection in the field of health protection and the right to provide medical care.
Government bodies at various levels, in accordance with their powers, develop and implement programs for the prevention, early detection and treatment of diseases, reducing infant and child mortality, creating motivation in children and their parents for a healthy lifestyle and taking measures to provide for children medicines, specialized products therapeutic nutrition, medical products.
Organs state power The Russian Federation and its constituent entities, in accordance with their powers, create children's medical organizations providing favorable conditions of stay, including for disabled children, and the presence of parents and (or) other family members with them, as well as social infrastructure for organized recreation, health improvement of children and restoring their health.
The most important component of the health care system is ensuring accessibility and ILC. The main mechanisms for its implementation:
Organization of medical care for children as close as possible to their place of residence or education;
Availability of the required number of medical workers with a sufficiently high level of qualifications;
Compliance with the procedure for the provision and standard of medical care;
Providing a guaranteed volume of medical care in accordance with the SGBP;
Transport accessibility of medical institutions for all groups of the population. including disabled people;
Seamless use medical worker means of communication or vehicles for transporting the patient when indicated to the nearest medical organization.
The procedure for providing medical care is determined by Article 37 of the Federal Law of November 21, 2011 No. 323-FZ-
Medical care is provided in accordance with the procedure mandatory for implementation on the territory of the Russian Federation by all medical organizations since 2013. The procedure for providing medical care is approved by the authorized federal body executive power(Ministry of Health of Russia). The procedure for providing medical care has been developed according to its individual types and profiles. diseases or conditions include:
Stages of medical care;
Rules for the activities of a medical organization (its structural unit, doctor);
Equipment standard for a medical organization and its structural divisions;
Staffing standards of a medical organization and its structural divisions;
Other provisions based on the specifics of medical care. Pediatric care is provided in accordance with the order of the Ministry of Health
Russia *On approval of the Procedure for the provision of pediatric care" (dated April 16, 2012 No. 366n). The procedure establishes the rules for the provision of pediatric care by medical organizations, regardless of their organizational and legal form.
Types of medical pediatric care:
Ambulance, including specialized ambulance;
Specialized, including high-tech.
Conditions for providing medical pediatric care:
Outside a medical facility (at the place where the emergency medical team is called, as well as in a vehicle during medical evacuation);
Outpatient, including at home when calling a medical professional;
In a day hospital (in conditions providing medical supervision and treatment in daytime that do not require round-the-clock medical supervision and treatment):
Inpatient (in conditions that provide round-the-clock medical supervision and treatment).
Within the framework of emergency, including specialized emergency care, pediatric care for diseases, accidents, injuries, poisoning and other conditions requiring urgent medical intervention, is provided by paramedic mobile ambulance teams, medical mobile ambulance teams in accordance with the order of the Ministry of Health and Social Development of Russia “On approval of the procedure for providing emergency medical care” (dated November 1, 2004 No. 179) as amended by orders of the Ministry of Health and Social Development of Russia dated August 2 2010 No. 586n and dated March 15, 2011 No. 202n. When providing emergency medical care, if necessary, carry out medical evacuation, including sanitary aviation and sanitary. Ambulance, including specialized emergency medical care, is provided in an emergency and emergency form outside a medical organization, on an outpatient and inpatient basis.
The ambulance team delivers children with childhood illnesses complicated by a life-threatening condition to a medical organization that has a department or block (ward) of resuscitation and intensive care for round-the-clock monitoring and treatment of children. If there are medical indications after elimination life-threatening the child’s condition is transferred to the pediatric department (beds), and in its absence - to therapeutic department for further treatment.
Specialized, including high-tech, medical care for children is provided by pediatricians and medical specialists in hospitals (including day care) and includes prevention, diagnosis, treatment of diseases and conditions that require the use of special methods and complex medical technologies, medical rehabilitation.
Planned pediatric medical care is provided for prevention, diseases and conditions that are not accompanied by a threat to the child’s life. not requiring emergency and immediate assistance, the delay of which for a certain time will not entail a deterioration in the child’s condition or a threat to his life and health.
For medical reasons, children are sent for rehabilitation treatment in accordance with the Procedure for organizing medical care for restorative medicine, approved by order of the Ministry of Health and Social Development of Russia dated March 9, 2007 No. 156.
Medical organizations (their structural units), providing pediatric care, carry out their activities in accordance with the annexes to the Procedure for providing pediatric care.
Effective formation and maintenance of children's health is possible only through the interaction of medical and social measures and consistent state policy in the field of maternal and child health. The Russian Federation (RF) has adopted more than 100 legal acts aimed at protecting children. In accordance with the Constitution of the Russian Federation, motherhood, childhood and family are under the protection of the state, which means the creation of socio-economic and legal prerequisites for the normal development and upbringing of children. The Federal Law “On Basic Guarantees of the Rights of the Child in the Russian Federation” (1998) provides for the establishment of indicators of the quality of life of children, including the minimum amount social services, guaranteed and publicly available free education, social services, social protection children, organization of health improvement and recreation, provision of food in accordance with minimum standards, free medical service. The Russian Federation has ratified the UN Conventions “On the Rights of the Child” and “On the Elimination of All Forms of Discrimination against Women” and is pursuing state social policy to protect children and women through the implementation of federal target programs “Children of Russia”, “Family Planning” and “Safe Motherhood”. These programs are aimed at reducing the number unwanted pregnancies and abortions (especially among teenage girls), a decrease in the level gynecological diseases, reduction in maternal and infant mortality, restoration reproductive function women suffering from infertility, prevention of infertility in young men, implementation in the country of monitoring maternal and infant mortality, congenital malformations, as well as the development and implementation federal standards provision of medical care. Achieving the effect of the adopted programs is possible subject to health improvement environment, development social infrastructure and creating conditions for a healthy lifestyle. Medical and demographic monitoring shows that government measures do not curb negative influence socio-economic factors on the quality of life of children, the system of benefits and allowances, including for disabled children, do not compensate for the growth rate of the cost of living. Recently, there has been a deterioration in the health of children and adolescents, a decrease in indicators of their physical development and puberty, an increase in general morbidity and high level socially significant diseases. The latter are associated with unfavorable social and living factors and environmental impacts, malnutrition, untimely medical, psychological and pedagogical correction. In this regard, the introduction of low-cost and development of hospital-replacement technologies, the elimination of existing imbalances and the implementation of targeted programs can be considered promising. A developed network has been created perinatal centers, V maternity hospitals Intensive care wards for newborns were opened, equipped with modern equipment, including devices artificial ventilation lungs (ventilation), to carry out effective primary resuscitation of newborns, modern technologies for caring for newborns with low body weight are being introduced, diagnostic and treatment issues are being developed intrauterine infections(VUI), being improved prenatal diagnosis congenital developmental anomalies and many hereditary diseases. Early diagnosis,
preoperative preparation and emergency surgical care children with congenital defects heart disease (CHD) significantly improves outcomes in this group of newborns. Newborns are screened for phenylketonuria, congenital hypothyroidism, cystic fibrosis, galactosemia, adrenogenital syndrome. There are medical and genetic departments and offices, consultative and diagnostic units, which makes it possible to improve medical care for pregnant women and children and prevent children from becoming disabled.
The strategic basis for giving birth and raising a healthy child is prevention. In this area, an important place in all age groups occupies the primary level of medical care - a pediatrician at the clinic. Preventive examinations are the first and mandatory stage of medical examination of the child population. Their goal is early detection of diseases and implementation of a complex of preventive, therapeutic, health-improving and medical-social measures. Volume and content preventive examinations must correspond to the age-related physical and neuropsychic development of the child. Preventive examination is carried out in stages.
An important place in the work of a pediatrician is occupied by constant monitoring of the health of children in the 1st year of life: regular examinations with assessment of physical and mental development, nutritional recommendations, correction of identified disorders, and preventive vaccinations. The pediatrician examines the newborn at home during the first two days after the child is discharged from the maternity hospital, then one day after the first visit, on the 14th and 21st days of life and at the age of 1 month (in the children's clinic). During the neonatal period, according to indications, consultations with specialists are provided at home and vaccination against tuberculosis is carried out if it was not given in the maternity hospital.
At 1 month, in a clinic, based on the findings of the neonatologist at the maternity hospital, the local pediatrician and specialists (neurologist, ophthalmologist and orthopedic surgeon), the child’s health group is determined. Mothers are trained in complex massage and methods of preventing rickets. Conducting educational work to ensure breastfeeding and rational supplementary feeding of children. If the mother does not have milk, the artificial feeding scheme is controlled.
In the subsequent months of the first half of life (also in a children's clinic), children are examined by a local pediatrician monthly (further at 8, 10 and 20 months). He corrects the child’s nutrition, carries out preventive vaccinations, gives recommendations for hardening, and monitors neuropsychic development. If a child is sick, he must be consulted by specialists. If necessary
conditions provide active monitoring by a local pediatrician and 24-hour medical care doctors at home.
At 3 months, a screening laboratory examination is carried out, the child is examined by specialists (neurologist, ophthalmologist, orthopedic surgeon), and a conclusion is drawn up on the indications and contraindications for preventive vaccinations.
The local pediatrician, taking into account previous diseases and examination data from the same specialists, makes a new conclusion about the child’s health at 1 year of age.
In the 2nd year of children’s life, preventive examinations are carried out twice (at 1.5 and 2 years), and subsequently annually.
At the age of 3 years, before entering a preschool institution, children are examined by a pediatrician and medical specialists; conduct a laboratory examination, assess neuropsychic and physical development, determine health groups and distribute them into medical groups for classes physical culture. Then, at 5 and 6 years old, the same examination is carried out as at 3 years old, and the children’s functional readiness for school is determined. At the age of 8, with a full medical examination, adaptation to learning at school is assessed; at the age of 8-14, the state of health is also monitored as it progresses. school curriculum. The program of preventive examinations for 6- and 12-year-old children includes electrocardiography (ECG).
A comprehensive examination by medical specialists (ophthalmologist, orthopedic surgeon, otolaryngologist, dentist, neurologist and other specialists if indicated) is mandatory for children aged 1, 3, 5, 6, 8, 10, 12 and 14 years. Every year, children are examined by a dentist and pediatrician, and doctors of other specialties - as indicated. Adolescents are monitored in full in a clinic until they are 17 years old, including the help of a psychologist.
Particular attention is paid to the prevention of gynecological and extragenital diseases in teenage girls; according to indications, they are examined by a pediatric gynecologist.
Improving consultative and diagnostic work with children consists of increasing their availability of qualified specialized medical care, reducing economic costs, organizing day hospitals to quickly clarify the diagnosis and reduce the length of hospital stay.
Dispensary observation Children who have risk factors for diseases (second health group) and chronic diseases (third health group) are especially carefully monitored, including a set of preventive, therapeutic and health measures and medical and pedagogical correction. Rehabilitation
carried out in centers and departments rehabilitation treatment, as well as in specialized sanatoriums.
Children with chronic diseases considered at risk and with unusual reactions and post-vaccination complications Vaccine prophylaxis is carried out using optimal regimens after consultation with specialists and taking into account the results of clinical, functional and laboratory studies.
It is known that proper nutrition It has vital importance for the development of the child's body. Current negative trends include a decrease in the number of children in breastfeeding, increased prevalence of diseases gastrointestinal tract(Gastrointestinal tract). Promotion of natural feeding and the use of various types of stimulation of lactation is an important link in the system of measures aimed at improving the health of children and reducing morbidity. This work uses the main provisions of the joint WHO/UNICEF Declaration on the Protection, Promotion and Support of Breastfeeding.
Dairy distribution points provide children with free dairy products based on doctor’s prescriptions. Due to the high prevalence of diseases of the digestive system, careful medical and sanitary supervision of the nutrition of schoolchildren is necessary. Industry development baby food makes it possible to provide the child population, especially the first 3 years of life and children with chronic diseases, with special food products, including medicinal ones.
If a child becomes ill, full observation and examination are provided at prehospital stage, if necessary, the child is sent to a hospital, including specialized departments. In order to provide qualified assistance to children, a 24-hour home medical service, ambulance and emergency medical care stations operate throughout the day.
A comprehensive solution to the problems of organizing assistance to disabled children includes socio-pedagogical, psychological and medical aspects and contributes to the social orientation of children and their integration into society.
Organization of medical care for children
One of the main problems of Russia at present is the deterioration of the demographic situation due to a decrease in the birth rate and an increase in mortality. Thus, infant mortality and mortality of children in the 1st year of life in our country are 2-4 times higher than in economically developed countries. In addition, recently there has been a deterioration in the health of children and adolescents, a decrease in indicators of their physical development and puberty, an increase in general morbidity and a high level of socially significant diseases. The latter are associated with unfavorable social and everyday factors and environmental influences, poor nutrition, untimely medical, psychological and pedagogical correction. The most obvious reasons for the increase in mortality of children under one year of age in the early 90s. The 20th century includes Russia’s transition to a new definition of live birth, recommended by WHO, and the deterioration of the general socio-economic situation in the country.
Improving children's health is possible only with a consistent state policy in the field of maternal and child health. In this regard, the Russian Federation has adopted more than 100 legal acts aimed at protecting children. In accordance with the Constitution of the Russian Federation, motherhood, childhood and family are under the protection of the state, which means the creation of socio-economic and legal prerequisites for the normal development and upbringing of children. The Federal Law “On Basic Guarantees of the Rights of the Child in the Russian Federation” (1998) in Articles 5 and 8 provides for the establishment of indicators of the quality of life of children, including a minimum amount of social services, guaranteed and publicly available free education, social services, social protection of children, organization of health and recreation , provision of food in accordance with minimum standards, free medical care. However, medical and demographic monitoring shows that the measures taken by the state do not restrain the negative impact of socio-economic factors on the quality of life of children; the system of benefits and allowances, including for disabled children, does not compensate for the growth rate of the cost of living. In this regard, the introduction of low-cost and development of hospital-replacement technologies, the elimination of existing imbalances and the implementation of targeted programs can be considered promising. In Russia, the UN Conventions “On the Rights of the Child” and “On the Elimination of All Forms of Discrimination against Women” have been ratified, and a state social politics for the protection and care of children and women through the implementation of federal target programs “Children of Russia”, “Family Planning” and “Safe Motherhood”. Achieving the effect of the adopted programs is possible subject to the improvement of the environment, the development of social infrastructure and the creation of conditions for a healthy lifestyle.
Medical care for children in Russia
In our country there is a family planning service, a developed network of perinatal centers, medical genetic departments and offices, consultative and diagnostic services, and medical care for children and pregnant women is being improved. Family planning is aimed at reducing the number of unwanted pregnancies and abortions (especially among teenage girls), reducing the level of gynecological diseases, reducing maternal and infant mortality, restoring the reproductive function of women suffering from infertility, and preventing infertility in young men. To continue the implementation of state policy on protecting the health of women and children, the federal target program “Children of Russia” has been developed and is being implemented, which provides for the introduction in the country of monitoring of maternal and infant mortality, congenital malformations, as well as the development and implementation of federal standards for the provision of medical care to newborns and children early age and the use of new medical technologies for the prevention, diagnosis and treatment of socially significant diseases.
In maternity hospitals, intensive care wards for newborns are opened, equipped with modern equipment, including artificial lung ventilation devices (ALVs), to carry out effective primary resuscitation of a child born in asphyxia. The equipment provides objective monitoring of vital important functions body during long-term intensive therapy. Modern technologies for caring for newborns with low body weight are being introduced. Children who were in critical condition, as well as those with perinatal pathology or low body weight, are transferred to the second stage of nursing in specialized departments. They are developing issues of diagnosis and treatment of intrauterine infections (IUI).
Prenatal diagnosis of congenital developmental anomalies and many hereditary diseases helps reduce the birth rate of children with developmental defects incompatible with life.
Newborns are examined for phenylketonuria and congenital hypothyroidism, which makes it possible to timely identify children with this pathology and prevent their disability.
Early diagnosis, preoperative preparation, and emergency surgical care for children with congenital heart defects (CHD) significantly improve outcomes in this group of newborns. Continuity in the management of children with perinatal pathology between hospitals, clinics and consultative and diagnostic centers plays an important role.
The strategic basis for giving birth and raising a healthy child is prevention. In this area, an important place in all age groups is occupied by the primary health care provider - the pediatrician of the district clinic. Preventive examinations are the first and mandatory stage of medical examination of the child population. Their goal is the early detection of diseases and the implementation of the necessary set of preventive, therapeutic, health, and medical and social measures. The scope and content of preventive examinations must correspond to the age-related physical and neuropsychic development of the child.
Preventive examination is carried out in stages:
- Stage I - pre-medical examination according to the screening program.
- Stage II - a pediatrician examines the child, then, based on examination data and screening diagnostics and taking into account the child’s age, assesses the level of his psychomotor, neuropsychic, physical development and determines the scope of a specialized examination.
- Stage III - a doctor of the appropriate profile examines the child in the presence of the parents.
- Stage IV - based on the results of a preventive examination, the pediatrician makes a conclusion about the child’s health status (assigns him to the appropriate health group), gives recommendations (on regimen, nutrition, physical education, vaccination).
Disease Prevention
An important place in the work of a pediatrician is occupied by constant monitoring of the health status of children in the 1st year of life: regular examinations with assessment of physical and mental development, nutritional recommendations, correction of identified disorders, and preventive vaccinations. The pediatrician examines the newborn at home during the first two days after the child is discharged from the maternity hospital, then one day after the first visit, on the 10th and 21st days of life and at the age of 1 month (in the children's clinic). During the neonatal period, according to indications, consultations with specialists are provided at home and vaccination against tuberculosis is carried out if it was not given in the maternity hospital.
At 1 month, in a clinic, based on the findings of the neonatologist at the maternity hospital, the local pediatrician and specialists (neurologist, ophthalmologist and orthopedic surgeon), the child’s health group is determined. Mothers are trained in complex massage and methods of preventing rickets. Conducting educational work to ensure breastfeeding and rational supplementary feeding of children. If the mother does not have milk, the artificial feeding scheme and the rules for introducing complementary foods are monitored.
During the first year of life, the pediatrician examines the child 11 times - 4 times during the newborn period, then at 2, 3, 5, 7, 9 and 12 months. Newborns of the second and third health groups are examined at home by a pediatrician 4 times a year, and by a neurologist once.
At 3 months, a screening laboratory examination is carried out, the child is examined by specialists (neurologist, ophthalmologist, orthopedic surgeon), and a conclusion is drawn up on the indications and contraindications for preventive vaccinations. In the subsequent months of the first year of life (also in a children's clinic), children are examined by a local pediatrician. He corrects the child’s nutrition, carries out preventive vaccinations, gives recommendations for hardening, and monitors neuropsychic development. If a child is sick, he must be consulted by specialists. If necessary, provide active monitoring by a local pediatrician and 24-hour medical care doctors at home.
At 1 year of age, the local pediatrician, taking into account previous diseases and examination data from the same specialists, makes a new conclusion about the child’s health status.
In the 2nd year of life, preventive examinations are carried out twice (at 1.5 and 2 years), and subsequently annually.
At the age of 3 years, before entering a preschool institution, children undergo pre-medical and laboratory examinations, they are examined by a pediatrician and medical specialists; at the same time, neuropsychic and physical development is assessed, health groups are determined and distributed to medical groups for physical education. Then, at 5 and 6 years old, the same examination is carried out as at 3 years old, and the children’s functional readiness for school is determined. At the age of 8, with a full medical examination, adaptation to learning at school is assessed; at the ages of 8, 9, 10, 11, 12, 13 and 14, the assimilation of the school curriculum is also monitored. At 6 and 12 years of age, electrocardiography (ECG) is included in the preventive examination program.
A comprehensive examination by medical specialists (ophthalmologist, orthopedic surgeon, otolaryngologist, dentist, neurologist and other specialists if indicated) is mandatory at 1, 3, 5, 6, 8, 10, 12 and 14 years of age. Every year, children are examined by a dentist and pediatrician, and doctors of other specialties - as indicated. Adolescents are monitored in full in a clinic until they are 17 years old, including the help of a psychologist.
Particular attention is paid to the prevention of gynecological and extragenital diseases in teenage girls; according to indications, they are examined by a pediatric gynecologist.
Improving consultative and diagnostic work with children consists of increasing their availability of qualified specialized medical care, reducing economic costs, organizing day hospitals to quickly clarify the diagnosis and reduce the length of hospital stay.
Dispensary observation is especially carefully carried out for children who have risk factors for diseases (second health group) and chronic diseases (third health group), including a set of preventive, therapeutic and health measures and medical and pedagogical correction. Rehabilitation is carried out in rehabilitation treatment centers and departments, as well as in specialized sanatoriums.
Children with chronic diseases considered at risk and with unusual reactions and post-vaccination complications specific immunoprophylaxis carried out using optimal regimens after consultation with specialists and taking into account the results of clinical, functional and laboratory studies.
Children's diet
It is known that proper nutrition is essential for the development of a child’s body. Current negative trends include a decrease in the number of breastfed children, early introduction of complementary foods, and an increase in the prevalence of gastrointestinal (GIT) diseases. Promotion of natural feeding and the use of various types of stimulation of lactation is an important link in the system of measures aimed at improving the health of children and reducing morbidity. This work uses the main provisions of the joint WHO/UNICEF Declaration on the Protection, Promotion and Support of Breastfeeding.
Dairy distribution points provide children with free dairy products based on doctor’s prescriptions. Due to the high prevalence of diseases of the digestive system, careful medical and sanitary supervision of the nutrition of schoolchildren is necessary. The development of the baby food industry makes it possible to provide the child population, especially the first 3 years of life and children with chronic diseases, with special food products, including medicinal ones.
If a child becomes ill, full observation and examination are provided at the prehospital stage; if necessary, the child is sent to a hospital, including specialized departments. In order to provide qualified assistance to children, a 24-hour home medical service, ambulance and emergency medical care stations operate throughout the day.
A comprehensive solution to the problems of organizing assistance to disabled children includes socio-pedagogical, psychological and medical aspects and contributes to the social orientation of children and their integration into society.
I. Treatment and preventive care is a state system of providing the population with all types of preventive and curative care. It turns out that it is an institution that includes 67 types of treatment and prophylactic facilities; 12 - sanitary and preventive; 11 - pharmacies and a number of others.
They can be combined into 4 groups:
1. Treatment and prophylaxis, which includes:
General and specialized hospitals;
Dispensaries;
Outpatient clinics;
Ambulance and emergency care facilities, blood transfusion stations;
Institutions of the maternal and child health system (maternity hospital, antenatal clinic, children's clinic, nurseries, kindergartens, children's homes, dairy kitchens);
Sanatorium-resort;
2. Sanitary and preventive, which unite sanitation centers. epid. supervision, health centers, etc.
3. Pharmacy.
4. Forensic medical examination institutions.
Treatment and preventive care for children is provided directly in the children's clinic, preschool institutions, schools, in-patient departments of children's hospitals or children's departments of general and specialized hospitals, children's sanatoriums, sanatorium-forest schools and other health institutions.
The basic principles of organizing medical and preventive care for children are:
1. Public availability and free of charge;
2. Synthesis of therapeutic and preventive care;
3. Precinct-territorial;
4. The principle of a single pediatrician;
5. The principle of active patronage;
6. Differentiation of observation by age, social and medical criteria and conditions of education;
7. The principle of continuity between all institutions providing medical care to children;
8. Continuity of observation at all stages of the child’s development, antenatal, perinatal, postnatal, etc. teenager and adult child.
Outpatient care for children occupies a leading place in common system healthcare. Main medical institutions The provider of this type of assistance is a children's clinic. This government agency, which can be independent or part of a children's city hospital.
In the area of its operation, the children's clinic provides treatment and preventive care to children up to 14 years of age inclusive, more precisely up to 14 years, 11 months, 29 days; medical care is provided directly in the clinic, at home, preschool institutions and schools.
The structure and organization of activities of the city children's clinic is regulated by order Ministry of Health of the USSR No. 60 dated January 19, 1983 “On further improvement of outpatient care for children in cities.”
According to this order, the following units are provided in the children's clinic:
Filter with separate input and output, isolators with boxes;
Offices of pediatricians and other specialist doctors (surgeon, ENT, ophthalmologist, cardio-rheumatologist, dermatologist, psychoneurologist, department (office) healthy child carrying out preventive work with children);
Branch inflammatory treatment(rehabilitation department);
Treatment and diagnostic rooms (X-ray, physiotherapy, massage, treatment, vaccination, etc.);
Registry;
Administrative and economic part.
Features of the structure of a children's clinic compared to an adult clinic:
1. Healthy child department.
2. Preschool and school department.
3. Separate entrance and exit for sick children and healthy ones.
4. Established days for receiving healthy children (1-2 times a week).
5. Availability of filter, insulator, boxes.
6. Availability of a vaccination room (in the healthy child department).
7. Cabinet for Mantoux and BCG reactions.
The main tasks of the city clinic are:
I. Organization and implementation of preventive measures to preserve and manage healthy children. This includes:
Dynamic observation of healthy children;
Preventive examinations and medical examination of children;
Preventive vaccinations within the time limits established by directive documents;
Collection breast milk and ensuring the uninterrupted operation of the dairy kitchens included in the clinic;
Organization of lectures, conversations, conferences for parents, classes at mothers’ school;
P. Organization of medical and advisory assistance at home and in clinics, referral of children for treatment in a hospital, for rehabilitation treatment in a sanatorium, selection to specialized nurseries, kindergartens, forest schools, etc.
III. Organization of medical preventive work in preschools and schools.
IV. Carrying out anti-epidemic measures together with sanitary and epidemiological surveillance centers.
V. Ensuring legal protection for children.
The positions of local pediatricians are established at the rate of 1 position per 800 children under 15 years of age. The positions of doctors of other specialties are established on the basis of staff standards.
The staff of doctors to work in children's institutions is established at the rate of: 1 pediatrician for 180-200 children in nurseries; 600 kindergarten children; 2000 school students.
The positions of district nurses are established at the rate of 1.5 positions per 1 district pediatrician.
The activities of the children's clinic are managed by the chief physician or the head of the clinic. This is usually a pediatrician with experience in medical and organizational work. Chief physician bears full responsibility for the quality of medical and preventive care for children, as well as for the administrative and economic activities and financial activities of the institution. He is responsible for the modern and complete staffing staff positions, advanced training of medical personnel, for the introduction of scientific organization of labor and best practices. In a polyclinic with more than 40 medical positions, the position of deputy chief physician for medical affairs is being introduced. When serving more than 10 thousand children, a 0.5 substitution rate is introduced. chief physician for disability examination.
In the structure of the children's clinic there are 2 departments: pediatric and preschool-school. The pediatric department includes local pediatricians, specialist doctors and nurses, and in pre-school and school - doctors and secondary nurses. personnel working in preschool institutions and schools. These departments are headed by managers who are appointed full-time when the number of pediatricians in them is more than 9.
The leading figure in organizing medical care for children is the local pediatrician. This specialist accounts for more than 60% of all visits by children to large city clinics. Over 90% of doctor visits to a child at home also occur with the local pediatrician. The local pediatrician serves 800 children at the site, of which children under the age of 1 year, the working day of the local pediatrician is 6.5 hours, 39 hours work week. House calls from 8 to 14, service from 14 to 20, from 20 to 8 - inter-district urgent Care. Once a week is a healthy child's day.
The main task of the local pediatrician is:
Reducing morbidity and mortality of children of all ages;
Ensuring optimal physical and neuropsychic development of children;
The areas of work of a local pediatrician are:
I. Clinical examination of healthy and sick children. This work begins even before the baby is born. The main form in this case is active patronage, which can be prenatal and postnatal. Prenatal care healthy woman with a good obstetric history, it is carried out by a local or visiting nurse twice - the first, after receiving information from the antenatal clinic about registering the pregnant woman, and the second - after she leaves maternity leave(30-31 weeks).
Prenatal care has the following goals:
Establish contact between the children's clinic and the expectant mother;
Find out the state of her health, the social status of the family and the psychological climate, the living conditions of the unborn child;
Warn the woman against bad habits (smoking, drinking alcohol);
Monitor the regularity of the woman’s attendance at the school for young mothers;
If there are social and everyday difficulties, refer the pregnant woman for consultation with a lawyer;
Postpartum care consists of a joint visit with a doctor and a medical professional. the sister of the newborn in the first 3 days, it is recommended to visit the first child in the family on the first day after discharge. The local pediatrician visits the child again 7-10 days before he is 1 month old. Regularity of medical visits. The nurse determines and controls the doctor.
During primary postpartum care, the condition of the newborn is determined, the genealogical, obstetric-gynecological and social history is clarified.
A plan for further monitoring of the child is drawn up and advice is given on care, feeding, daily routine, and walks. At patronage visit at the 4th week of life honey. the sister invites the mother and child to an appointment at the clinic.
In the future, the doctor observes healthy children in the clinic once a month on specially designated days for the reception of healthy children under the age of 1 year.
Healthy children under 2-3 months of age. should be examined by an orthopedic surgeon to identify dysplasia hip joints. During the first year of a child’s life, an ophthalmologist, a neurologist, an otolaryngologist, and a dentist are also examined. Do general tests blood and urine.
The regularity of examination by a pediatrician of children of the 2nd year of life is once a quarter. In the 3rd year of life, the pediatrician examines children once every six months.
The main attention is paid to the organization of the regime, the hardening technique, physical education, rational nutrition, neuropsychic development of the child.
Later children preschool age are observed by a local pediatrician once a year.
Before entering school, children are examined by a neurologist, ENT specialist, ophthalmologist, orthopedic surgeon, dentist, as well as a speech therapist and clinical tests blood and urine.
Children entering preschool institutions, as well as schoolchildren, are examined at prescribed times by doctors from the preschool and school department of the clinic and medical specialists.
Clinical examination of the child population should be carried out differentially depending on the level of health, dividing it into 5 health groups.
I - healthy children who do not have deviations in all signs of health;
II - endangered children or children at risk of developing chronic pathology: premature, post-term, malnourished, often and for a long time ill, with underlying conditions, children from mothers with extragenital pathology, diabetes mellitus, children from multiple pregnancies, with encephalopathy, with umbilical cord entanglement, artificial feeding, children at social risk from large, single-parent families, mother's age under 19 and over 40 years old, presence in the family of a disabled child with a developmental defect, stillborn children, children from families alcohol abusers, bad psychological climate, low-income families, children who have had pneumonia, Botkin's disease and other diseases.
III - children with chronic diseases in a state of compensation.
IV - children with chronic diseases in a state of subcompensation.
V - children with chronic diseases in a state of decompensation (disabled people).
Children of health group I should be observed at the usual times established for preventive examinations of healthy children. The period of observation for children of group II is established by the doctor individually for each child in accordance with the degree of risk in relation to the formation of chronic pathology.
Clinical examination of children with chronic diseases involves dynamic monitoring of their health, improvement and analysis of the effectiveness of medical examination.
P. Organization of rational nutrition for children, especially in the 1st year of life - strive to preserve breastfeeding as much as possible.
Timely introduction of juices into the diet, different kinds complementary feeding based on age;
Strict control of the compliance of the nutrition received with the physiological needs of the child;
Identifying breast milk donors and involving them in providing assistance to mothers suffering from hypogalactia;
Supply of baby food through dairy kitchens.
III. Prevention of rickets, its active detection at early stages- the most important preventive measure on pediatric participation.
Events for nonspecific prevention rickets are an integral part of the entire complex of preventive work to raise a healthy child.
IV. The organization of preventive vaccinations is a responsible section of the activity of a local pediatrician. The timing of active immunization of the child population is determined by Order of the USSR Ministry of Health No. 50 of 1980 “On the calendar of preventive vaccinations and the main provisions on their organization and implementation” and against measles No. 426 of 03/20/1986 and No. 450 of 04/02/1986 against diphtheria.
Preventive vaccinations should be carried out in vaccination rooms of children's clinics.
The local pediatrician must have lists of children with allergic reactions, diseases that interfere with immunization.
Before vaccination, it is mandatory to examine the child with thermometry. Children with allergies are specially prepared for vaccination. The question of preventive vaccinations for weakened children suffering from chronic pathology is decided by a commission consisting of the attending physician, immunologist and head. pediatric department. Information on preventive vaccinations is entered into the “Preventive Vaccination Card” f-063-u.
V. Physical education and hardening of the child from the moment he is admitted under the supervision of the clinic. Weak children, as well as those who are often and long-term ill, should be under special supervision.
VI. Providing medical care to sick children at home and in the clinic. He is obliged to visit sick children on the day the call is received and provide medical assistance to the sick child. The doctor visits at home all acutely ill children discharged from the hospital and undergoing further treatment at home, as well as chronically ill children who are unable to visit the clinic. Children in contact with infectious patients should not visit the clinic throughout the quarantine. A special feature of treating children is serving them at home until full recovery, hospitalization, since the clinic mainly receives healthy children.
The local doctor is obliged to refer the child for treatment to a hospital in accordance with the established procedure, and in necessary cases take all measures for the immediate hospitalization of the child.
Resolve, in agreement with the head of the pediatric department, issues of calling other clinic specialists to the house;
Refer sick children for consultation to specialists in the clinic;
Inform the management of the clinic about all seriously ill children in the area;
Conduct examination of work disability;
Notify via telephone message within 2 hours, IES (f-058-u) within 12 hours the sanitary and epidemiological surveillance center about identified infectious patients and suspected cases. infection, reports the child’s illness to preschool institutions, together with the center, sanitary and epidemiological supervision, establishes quarantine and, through district sister monitoring contacts.
VII. The local pediatrician must examine, improve health and carry out general and special training children for admission to preschool institutions.
VIII. A local pediatrician is required to systematically improve his skills and be able to work with medical documentation.
IX. Conduct sanitary educational work, organize sanitary activists from the population in your area and involve them in sanitary and preventive measures.
Thus, the local pediatrician actually plays the role of a preventive doctor, general practitioner, infectious disease specialist, social hygienist and organizer of outpatient care for the children's population.
Optimal condition for high-quality examination of young children with for preventive purposes A healthy child department has been created in the clinic since 1975. This department carries out health education work with the child’s family. Classes with parents are conducted in a specially equipped room. visual aids: posters, stands, vitamins, with specially selected literature, recommendations and monuments.
Visual propaganda should also be on stands in corridors and halls. A paramedic or honey works in the office of a healthy child. sister trained in preventive and health education work.
Manages the activities of the office of the head. pediatric department of the clinic.
The main objectives of the healthy child’s office are:
Promoting a healthy lifestyle in the family;
Training parents in the basic rules of raising a healthy child (regime, nutrition, physical education, hardening care);
Health education of parents on issues of hygienic education, prevention of disease and developmental disorders.
A healthy child's office should be provided with teaching materials and visual aids. Its exposition should include tables of standards for physical and neuropsychic development, schemes for physical education and hardening of age-related regimes for a child, and an exhibition of child care items.
The leading theme of the exposition of the healthy child room is rational feeding and nutrition. Work on the prevention of rickets should also be carried out here, teaching parents how to take vitamin D. Schools for young mothers and fathers are organizing classes on the basis of this office.
A special section of the work should include individual activities with children preparing to enter preschool education. The opening of admission for healthy young children, consultations with a teacher, speech therapist, and nutritionist are also held here.
In order to improve rehabilitation treatment in outpatient settings, in accordance with the order of the USSR Ministry of Health No. 184 of February 15, 1982, rehabilitation treatment departments were organized in city clinics. It is created as part of one or several large clinics to treat the consequences of respiratory diseases, nervous system, as well as congenital and acquired diseases of the musculoskeletal system. The rehabilitation department includes physiotherapy rooms, as well as a hearing therapy room.
The department is headed by the head of the department, who has been trained in rehabilitation treatment.
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