Child Health

®
Program MCPS/MRCGP/CEFM CME ©
Course Paediatrics
Module Child Health

Approach to Child, character building, injury
Topic
prevention, IMCI
Credit Hours 2 CME credit hour
Total Educational hours 4 educational hour
MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health
®
©
Prof. Nasir Shah

MCPS, FCPS, MRCGP [INT], FRCGP [INT]
Dean Family Medicine Faculty, College of

Physicians and Surgeons Pakistan
Convener National Family Medicine Committee of

Pakistan

FUNDAMENTAL PHILOSOPHY ®
©
1. Children are not “small sized adults”
2. They are physically, emotionally, mentally and socially

developing
3. They are dependent for their needs
PEDIATRIC HISTORY ®
©
1. Presenting complaints
2. Danger signs
3. Past history
4. Family history, first cousin marriage
5. Social history, siblings
6. Parental concerns
7. Birth history B
8. Immunization history I
9. Nutrition N
10. Development D
11. Education

B.I.N.D. ®
©
• B Birth
• I Immunization
• N Nutrition
• D Development
BIRTH HISTORY ®
©
1. Pre-natal problems
2. Natal problems
3. Postnatal problems
4. Mode of delivery
5. Remain focused and relevant

IMMUNIZATION ®
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• Ask for card
• Ask for specific vaccine/time of vaccination
• Ask about missing ones
• If missing, ask about reasons
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NUTRITIONAL HISTORY ®
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1. Details of breastfeeding
2. Breastfeed during the night
3. Details of other foods or fluids
4. Amount of food or serving
5. Type of food
6. Food provider
7. Hand and food hygiene
8. Financial status of family
DETAILS OF BREASTFEEDING ®
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1. Check for positioning
2. Check for attachment
3. Effective suckling
4. Baby’s satisfaction

DEVELOPMENT ®
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• Physical
- Neck holding
- Sitting
- Walking
• Language
- Words
- Sentences
NEWBORN ®
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MORO REFLEX ®
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CAPUT SUCCEDANEUM ®
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CEPHALHEMATOMA ®
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CAPUT SUCCEDANEUM VS CEPHALHEMATOMA ®
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CYANOTIC HEART DISEASES ®

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BIRTH SPOTS ®
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Port wine stain Mongolian spots

3 MONTHS OLD BABY ®

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SPEECH-3 MONTHS ®
©
By the end of 3 months
• Smile when you appear
• Make "cooing" sounds
• Seem to recognize your voice
• Cry differently for different needs
Cooing
6 MONTHS CHILD ®
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SPEECH- 6 MONTHS ®
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• Make gurgling sounds when playing
• Babble and make a variety of sounds
• Respond to changes in the tone of your voice
Babbling
9 MONTHS OLD CHILD ®

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1 YEAR OLD CHILD ®
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SPEECH- 12 MONTHS ®
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• Try imitating speech sounds
• Say a few words, such as "dada," "mama" and "uh-oh"
• Understand simple instructions, such as "Come here"
• Recognize words for common items, such as "shoe"

EINSTEIN SYNDROME ®
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• Late onset of language
• Giftedness in other areas
GENERAL DANGER SIGNS ®

©
General Danger signs
1. Reluctance to feed
2. Drowsiness
3. Lethargy
4. Apathy
5. Seizure
6. Anuria for 6 hours during illness

SPECIFIC DANGER SIGNS ®
©
Specific Danger signs
1. Bleedings
2. Generalized lymphadenopathy
3. Hepatosplenomegaly
4. Progressive wasting
5. Neurological deficit
6. Sudden onset of shortness of breath or cough
7. Unusual bruising or fracture or injury
APPROACH TO EXAMINATION ®
©
1. Do not disturb the child unnecessarily
2. Leave the child in the arms of the mother/carer
3. Observe any signs possible before touching the child
4. Is the child alert, interested and looking about?
5. Does the child appear drowsy?
6. Is the child irritable?
7. Is the child in respiratory distress?
8. Is there a stridor?

APPROACH TO EXAMINATION ®
©
1. Body weight in kg
2. Height in cm
3. Mid Arm circumference
4. FOC (up to 1 year)
5. Vitals
6. General Physical examination
7. Focused systemic examination
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GROWTH MONITORING ®
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• Growth charts
• Types
• Weight for age
• Height for age
• Weight for height
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INVESTIGATIONS ®
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1. Order only essential labs
2. Try not to force children, they get scared
3. Try noninvasive tests first
4. Order invasive test in one go to prevent restraining and
forcing
MANAGEMENT OF CHILDHOOD ILLNESS ®

©
• Disintegrated approach
• Integrated approach (WHO)

DISINTEGRATED MANAGEMENT OF
NEONATAL AND CHILDHOOD ILLNESS ®
©
Separate Separate Health

disease
disease worker
specific
clinical specific attempts to
guidelines training “Integrate”
and training
courses guidelines
materials
INTEGRATED MANAGEMENT OF NEONATAL

AND CHILDHOOD ILLNESS ®
©
Integrated
Integrated Integrated
clinical
clinical
guidelines clinical case
and training training
materials courses management
WHO Department of Child and Adolescent Health and Development RB-03-99

THE IMCI CASE MANAGEMENT PROCESS ®
©
Child brought to a first-level health facility
1. Assessment of the child

2. Classification of the illness
3. Identification of the treatment
4. Referral, treatment or counselling of the child's caretaker
(depending on the identified classification(s)
5. Follow up care
IMNCI CASE MANAGEMENT PROCESS ®

©
Classification based on a colour-coded triage system
Red Urgent pre-referral treatments and referral
Yellow Specific medical treatment and advice
Green Simple advice on home management

WHAT IS IMCI ®
©
1. Strategy for reducing mortality and morbidity
2. Includes preventive and curative interventions
3. Integrated approach
4. Focuses on the well being of the whole child
IMCI BASIC CONCEPT ®

©
Diarrhea Malaria ARI
Severe illness (cause of mortality)
Severe Severe Nutrition

Malaria
Dehydration Pneumonia
Some Other Worms

Pneumonia
Dehydration infection
Anemia
No Cough &
No Malaria
Dehydration Cold
EPI

BETTER THAN SINGLE-CONDITION APPROACHES ®
©
1. Children in the developing world are often suffering from
more than one condition
2. This overlap means that a single diagnosis may not be

possible or appropriate
3. Treatment may be complicated by the need to combine

therapy for several conditions.
IMCI STRATEGY ®
©
 Is not another vertical program
 Improves the quality of care of sick children in the primary
health care context
 Incorporates elements of;
1. Diarrheal diseases
2. ARI control program
3. Malaria control
4. Nutrition
5. EPI
6. Other relevant programs

DISEASES COVERED BY IMCI ®
©
1. Diarrheal diseases
2. Acute respiratory infections
3. Malaria
4. Measles
5. Malnutrition
• Lead to more than 70% of child mortality and morbidity
DISEASES NOT COVERED BY IMCI ®

©
• Health provider to assess problems not included in IMCI
charts.

AGE GROUPS COVERED BY IMCI ®
©
IMCI guidelines recommend case management procedures based
on two age categories:-
1. Children aged 2 months up to 5 years

2. Young infants age up to 2 months
PEDIATRIC CLINIC COURTESIES ®

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KEROSINE OIL IN WATER BOTTLE ®
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THE MOST PAINFUL SENTENCE FOR OLD PARENTS ®
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• Despite all hard work and sacrifices for children, when the
grown-up sons say;
• “Papa, what have you done for us, look at …….”
THE BURDEN OF PARENTS? ®

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THE BURDEN OF HAPPINESS ®
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THE BURDEN OF FAILURE ®

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CHARACTER BUILDING-PIT FALLS ®
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1. No education about marriage and child up bringing
2. Marriage education mostly by films or TV dramas
3. No concept of character building among parents
4. No concept of role modelling by parents
5. Over-indulgence as parenting norm
6. Fighting parents as bad role models
OVER INDULGANCE PARENTING ®

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DIFFERENCE BETWEEN NEEDS AND DESIRES ®

©
• Parents responsibility to
• Fulfill 100 % of child’s needs
• Fulfill 25 % of desires
• Refuse to 75 % of desires
• Teach how to value things

HADITH SHARIF ®
©
• "The best gift from a Father to his child is education and
upbringing."
HADITH SHARIF ®
©
• “When a person dies, all his deeds come to an end except
three:
1. Sadaqah jaariyah (ongoing charity)
2. Beneficial knowledge (which he has left behind and

others benefit from it)
3. A righteous child who will pray for him.”

DO AS PARENTS ®
©
• Children learn from what we do and not what we say
• Be the person you want your children to be like
• Avoid cross cutting evils (affect every aspect of life) are

1. Telling lies
2. Hypocrisy
3. Back biting
INSTILL FEELINGS IN CHILDREN ®

©
• Let them feel and think:
1. Hunger
2. Pain
3. Deprivation
4. Graceful losing
5. Life cycle of dependency

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• Let them feel:
• Unconditional love and affection
UNCONDITIONAL AFFECTION ®
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UNCONDITIONAL AFFECTION ®
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• Let them feel:
• No comparison with others

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• Let them feel:
• Sharing the joys with others
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• Let them feel:
• Tolerance and acceptance

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• Let them feel:
• Sacrifice as a strength (Not being sacrificed)

THE POWER OF STORIES ®
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THE BLIND POSITIVE EMOTIONS ®
©
1. Happiness
2. Love and affection
3. Respect
4. Sincerity
5. Empathy
6. Kindness
7. Humility
THE BLIND NEGATIVE EMOTIONS ®

©
1. Jealousy
2. Hatred
3. Prejudice
4. Arrogance
5. Grudge
6. Show off

SUMMARY ®
©
“Don’t prepare the way for your children, prepare your children
for the way”
1. Emotionally
2. Socially
3. Physically
4. Mentally
5. Academically
REFERENCES ®
©
• https://www.nice.org.uk/guidance
• https://www.patient.co.uk
• https://www.aafp.org
• https://www.mayoclinic.org
• https://www.medscape.com
• https://www.who.int
• https://www.webmd.com
• Oxford Handbook of Clinical Medicine, 20th edition

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©

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Program MCPS/MRCGP/CEFM CME ©

Module Child Health

Total Educational hours 4 educational hour

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

Prof. Nasir Shah

Dean Family Medicine Faculty, College of

Convener National Family Medicine Committee of

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

2. They are physically, emotionally, mentally and socially

3. They are dependent for their needs

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

5. Remain focused and relevant

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

• If missing, ask about reasons

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

2. Check for attachment

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

CYANOTIC HEART DISEASES ®

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

Port wine stain Mongolian spots

3 MONTHS OLD BABY ®

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

9 MONTHS OLD CHILD ®

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

• Giftedness in other areas

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

GENERAL DANGER SIGNS ®

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

• Weight for height

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

MANAGEMENT OF CHILDHOOD ILLNESS ®

• Integrated approach (WHO)

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

Separate Separate Health

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

INTEGRATED MANAGEMENT OF NEONATAL

WHO Department of Child and Adolescent Health and Development RB-03-99

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

1. Assessment of the child

MCPS-MRCGP[INT]-CEFM | Pediatrics | Child Health

IMNCI CASE MANAGEMENT PROCESS ®