Community Pediatrics

Individual Report By: Vincent Patrick Uy 3-D

Family Profile Names Aristotle Sese Lydia Sese Joel Ramirez Age/Gender/Stat us 34/M/Married 30/F/Married 38/M/Single Educational Attainment 2nd year college 1st year college 2nd year college None None Occupation Health Status

Overseas Healthy Worker (Dubai) None Healthy None Healthy None None Healthy Healthy

Allen Sese 3/M/Single Alleris Sese 2/M/Single * BOLDFACE: Assigned child Family Roles

The Sese family is a nuclear family. Only the father (Aristotle Sese) contributes to the family earnings. The father is often abroad, and is usually absent from family activities. The mother (Lydia Sese) stays at home to care for the children and is responsible for the partitioning of daily expenses. The children are still too young to start schooling; they stay at home. The uncle (Joel Ramirez), does not contribute to the family earnings. Environmental Checklist Parameters House/Room Type of House/Make Number of Partitions Cleanliness / Orderliness Ventilation Lighting Lighting Facility Water Source Garbage Collection Drainage System Vermin and Insect Control Vermin and Insect types Animals Neighborhood Transportation Household Appliance Checklist The family owns a few common household appliances, but due to the cramp space, these appliances are stored in a neighbor’s house. Appliance TV CD Player Radio √ √ √ √ Electric Fan Refrigerator Electric flat iron Washing machine √ √ √ √ Observation Owned (Inherited) Concrete & wood 1 No Poor / 1 window only Yes Fluorescent light; Candle sticks when brownout Tap water (private); Commercial sources for drinking water Municipal garbage collection system; frequent collection Open; Often gets flooded on heavy rains Not a concern Rats and Flies None (inside the home) Residential type Pedicab/jeep

Other appliances that we observed includes a gas stove and a DVD player Economic Profile

The combined family income is about 25,000 pesos a month. One hundred percent of the family income is derived from the monthly salary of the father. Monthly expenses were partitioned by the mother. Almost half of the monthly income is dedicated to acquisition of daily food. Household items, electricity and water bills, and daily consumables are divided among the other half of the income. Since the family owns the house, they do not shoulder any expenses for this matter. Floor Plan of The House (Not drawn to scale)

Master Bedroom

Living Area
Kitchen Counter

Location of house (In respect to Neighboorhood) [Not drawn to scale] 437-B Palmera St., Sampaloc Manila

The highlighted box represents the location of the house in respect to other houses in the neighborhood. If the map is drawn to completion, the house should be located at the far end of the whole street. The house is shared by two families, but each has his own house number. One of the many dark alleyways is located proximal to their house. A bingo/gamble area is also

Review of the Child

Picture 1: The Sese family outside their house

Picture 2: Allen Sese with Vincent Uy

Alleywa y

Bingo Area

Children’s Bedroom

Picture 3: The Sese family with Mayjane Tumulak and Vincent Uy

HISTORY / PHYSICAL EXAM I. General data This is the case of Allen Sese, a three (3) year old male, born in UERM hospital and presently residing in Sampaloc. The informant is Mrs. Lydia Sese, the child’s mother. Her reliability is tagged at 90%.

II. Chief Complaint The child was seen as a well-child care patient. III. History of Present Illness The child is not ill, and has no significant history to present IV. Past Personal History The child is being offered a variety of food, and eats three meals a day including occasional snacks. The child has no food preference and is not a picky eater. The usual food consists of rice, fish, pork and vegetables. The mother claims to avoid offering fatty foods. On the other hand, she does not restrain the child from eating junk food and drinking softdrinks. By gross observation, the child is able to perform well, and does not have any developmental impairment. The child is attentive and listens to command/instructions. The child plays with his friends and does not avoid social contact with others. The child had a previous admission in UERM hospital for accidental ingestion of firecrackers a year ago. The mother narrates that while preparing food, the child was seen with black residues on his tongue. The mother then reports seeing the child convulsing within a few minutes prior to this admission. She immediately rushed the child to UERM hospital for emergency care. The child was treated with an unknown medication and was sent home. The mother denies any surgical procedures done on the child, history of allergies and gross injuries. No other significant admissions were revealed. Initial immunizations at birth were provided by the UERM hospital, and all other follow-ups and completion doses were administered by a private practitioner. The following table summarizes the child’s immunization status: BCG √ 1 √ DPT 2 √ OPV 2 √ Hepatitis B 1 2 3 √ √ √ Measl es √ HiB √

3 √

1 √

3 √

V. Family History The parents of the child, including their ages and occupations were already stated above. Both parents have a good bill of health and denied any significant familial illnesses such as diabetes, hypertension, thyroid anomalies, epilepsy, mental retardation and congenital defects. The patient has one 2 year old brother who is also in good state of health. VI. Socioeconomic and Environment (As emphasized above) VII. Physical Examination A. General Appearance The child is conscious, not in respiratory distress and listens to simple instructions. He appears well-nourished with a healthy external feature. Because he child responds to simple play activities, he is considered well developed. B. Vital Signs 0 a. Temperature: 36.5 C e. Height: 93 cm. (Axillary) f. WFA: 92.8% b. Pulse rate: 83 bpm g. HFA: 97% c. Respiratory rate: 22 cpm h. WFH: 96% d. Weight: 13 kg. C. Skin The child is fair skinned. The description of the skin is warm and moist and does not exhibit and external lesions or active dermatoses D. Head The head is normocephalic and atraumatic. Hair on the scalp has adequate quantity and equally distributed. There is no evidence of any

E.

F.

G.

H.

I.

J.

K.

L.

M. N. O.

P.

prominences of the skull bones and there is also no evidence of swelling Eyes The eyes were irritable to stimulus, and the infant would guard his face when approached. The red orange reflex was appreciated on both eyes and shows no dullness or irregularities. Extraocular movements were normal, and the child was able to perform the maneuvers with ease. Due to lack of materials, vision screening was not done Ears and Mastoids Ears were normal in shape and size and were equal on both sides of the head. There was absence of abnormal discharges. Hearing was equal on both sides. Otoscopic exam reveals no obstruction and a clear tympanic membrane (with a cone of light) on both sides. Nose and Sinuses The child’s nose show normal patency with no evidence of trauma. There is n evidence of discharge. Further examination reveals a pinkish mucus membrane with no inflammation of the turbinates. Septum appears to be in the midline. Mouth and Throat Lips were moist, red and showed no fissuring and masses. The buccal mucosa appears pinkish and moist with no evidence of bleeding and infection. There was absence of excessive drooling. The child has complete set of deciduous teeth. The tongue was midline with no evidence of trauma or infection. There was absence of swollen tonsils or any other abnormalities Neck Neck was smooth and supple with absence of remarkable masses or enlargements. The thyroid gland and thymus glands were unpalpable (WHO Goiter Grade 0). There was absence of neck enlargements such as hematoma or thyroglossal duct cysts. Thorax and Lungs The child had symmetrical chest expansion without chest retractions. The transverse diameter of the chest is greater than the anteriorposterior diameter. Vocal and tactile femitus were equal bilaterally. Breath sounds were clear with absence of stridorous breathing and other abnormal breath sounds. Cardiovascular The child had an adynamic precordium with absence of precordial bulge and thrills. The apex beat was located at the left 4th intercostal space midclavicular line. No murmurs and aortic bruits were appreciated. Gastrointestinal The abdomen was soft and globular. Abdominal distention seems to be absent due to the inverted umbilicus and absence of venous engorgements. Renal Was not evaluated Anus Was not evaluated Spine and Extremities The spine showed absence of gross deformities and was not deviated to any side. There was absence of sacral dimpling and pilonidal sinuses. The child did not complain of local tenderness when the spine was being palpated. Ortolani maneuver tested negative for hip dislocation. Lymph Nodes Negative for lymph node enlargement and tenderness.

Assessment on Health and Psychosocial Problems The nutritional status of the child is summarized below:

Weight (kg)

Height (cm)

WFA

HFA

WFH

Interpretat ions
The child appears to have a normal nutritional status

13

93

92.8%

97%

96%

Compared to his brother, this child rarely gets sick, probably due to. The child is both active and playful. Hygienic practices are poor, and the child is often seen without pants and slippers. The child does not know how to wash his hands before eating, and still defecates in inappropriate places. Proposed Environment and Health Promotion Strategies • • • • • Mother must be educated with regards to the importance of hygienic practices. There is a need to teach the children good toilet habits and simple ways to help around in the maintenance of the home. Get the children used to more nutritious food (consequently, nutritious foods are cheaper) instead of allowing them to drink carbonated beverages or junk food. Avoid exposure to cigarette smoke by doing more frequent activities indoors rather than outdoors. However, early morning outdoor activities will promote physical exercise. The mother should be more aware of diseases that can be transmitted, and they should impress on their children the importance of wearing appropriate clothes and slippers when playing outdoors. Protect the child from ingesting or playing with dangerous household items. Some of these items were seen lying around the house and should be put away.

Reflection Time is very precious in such crucial moments of a 3rd year student’s life, and every minute consumed is important. When I first heard about this activity, I was actually excited. Aside from the regular school work that we are often exposed to almost 8 hours a day, this activity is a means to mirror what is being learnt inside the classroom. When I arrived in the community, however, my impression changed from excitement to disgust. I was surprised to see the crowded spaces, the way of living, children exposed to many hazards and the disarrayed environment. On top of the heat, it was also hard to convince families to get involved. Fortunately, my partner and I were able to convince the Sese family to undergo the study. Unlike any family, our family is less productive. They live on the many simplicities of daily living paying no particular attention to items that will not make them survive a day.

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