Preventive Pediatrics: A

holistic approach to child

health

Dr. Javeria Saleem

Preventive Pediatrics
Social Pediatrics
Social & Preventive Pediatrics
Community Pediatrics
Ambulatory Pediatrics
3.2.2 The Main Determinants of health
Persistently high mortality rates
IMR=55/1000
Epidemics of controllable infectious
diseases like tuberculosis
Very low life expectancy
Probability of dying under five 63/1000 live births
 Definition
By Dr. Wasti
A roving staff is attached with pediatric
department which should go in the
community to promote mother & child
health.
Community pediatrics is described as a "concern
for all children in a population, those who remain
well but need preventive services, those who have
symptoms but do not receive effective care, and
those who do seek medical care either in a
physician's office or in a hospital." Community
pediatrics recognizes that children are best
understood, and their needs attended to, within
the interlocking contexts of biology, family, and
community.
A perspective that enlarges the pediatrician’s
focus from one child to all children in the
community.
 A recognition that family, educational, social,
cultural, spiritual, economic, environmental, and
political force, act favorable or unfavorable, but
always significantly, on the health and
functioning of children.
 Definition
By Suraj Gupta
 Community pediatrics means pediatrics as it is
applies to the child, his family and the
community. The objective is to carry the health
care to the doorstep of the “needy” through
various categories of workers, including those
trained at grass root level.
Essential areas of study.
 The health of child population in relation to its
social environment. i.e. the total community.
 The health of the individual child as a result of
multitude of social influences (both, positive and
negative)
 COMMUNITY PAEDIATRICS
 Community pediatrics is a diverse challenging
and fulfilling specialty more rewarding and
diverse some might expect. Its hallmarks are:
 The promotion of health for all
• Very close working on a day to day basis with
other community base children services mainly
education and social service and those deliver
by primary health care teams
• A population overview of child health as well as
individual perspective
 AIM OF COMMUNITY
PAEDIATRICIANS
• Provide assessment and ongoing clinical
management to children refers to the service.
• Most of service is secondary in nature they
participate in multi agency assessment and
follow up for children with special needs.
• Work closely with social services and education
authority to provide integrated child centered
care and work closely with child and adolescent
mental health team to ensure that children care
is co-coordinated therefore avoiding duplication
of service.
 SERVICE PROVIDED BY COMMUNITY
PAEDIATRICIANS
 Clinical Diagnosis and management
 General pediatrics
 Disability
 Emotional and behavioral difficulty
 Neuron disability
 Complex disability
 Autistic spectrum disorder, Epilepsy
 Assessing school age children with neurological
disorder
 Neuron development follow up for pre term
babies
 SERVICE PROVIDED BY
COMMUNITY PAEDIATRICIANS
Child protection
 Designated pediatricians

 Adoption

 Fostering

 Residential care

 Clinical child protection

 Clinical examination of child abuse case

Child mental health

 Child emotional and behavioral disorder

(ADHD)
 SERVICE PROVIDED BY COMMUNITY
PAEDIATRICIANS
Child Public Health
 Immunization schedule with special advice

clinic, Health promotion initiative

 School health care service, Home safety

 Suggestion and implementation of

prevention strategies
Audiology and Ophthalmology
 Visual impairment multi disciplinary service

 Screening diagnosis and management by

using skills in developmental assessment to

identify children who have needs in addition
to hearing loss
 SERVICE PROVIDED BY COMMUNITY
PAEDIATRICIANS
Academic training
o Provision of knowledge and systematic
evidence based reviews of what is known and
new research into treatments and other
interventions
Education designated role providing pediatrics
advice
o Children and young people
o Parents
o School teachers and education authorities
o Social worker and social work department
o Court and other legally constituted bodies
 SERVICE PROVIDED BY COMMUNITY
PAEDIATRICIANS

Service management
o Medical teams and finance appointments
o Contribution at health authority, trust
o Primary care trust locality and clinic level
o Risk management and clinical governance
Service framework
o Clinical guidelines and their audit
o Service framework for each program of care
 SERVICE PROVIDED BY COMMUNITY
PAEDIATRICIANS
RECENT INNOVATIONS
Individual pediatricians are now developing
expertise in psychopharmacology, advocacy for
children, services for refugees, asylum seeking
and imprison young people, patient
information system and commissioning
services for children.
 “The great end of life is not knowledge but

action. This is the time to put knowledge into

action.”
Every Community Pediatrician Should have
1. Fixed area:
For his community practice
2. Team of Workers
(a) Field Workers
• Multi Purpose Health Workers (LHW)
• To collect Data
• To identify risk factors
• To health education
• To early disease identification
(b) Paramedics
• LHV, Vaccinators, TBA
• To implement interventional strategies e.g. vaccination
antenatal post natal care.
• Care of new born etc.
• Community pediatrician should use community data to
determine needs of the community.

• Situational analysis of the community (epidemiologic,

demographic, and economic data.

• To observe the environmental and social risks for

children.

• Interaction with other members of the community to all

setting and organization where children spend time(e.g.
Child care facilities, schools, youth programs).
 Community pediatricians should strive to bring
community and school resources to bear on the
problems that children face.
 Community pediatricians should work collaboratively
with public health departments and colleagues in
related professionals and mitigate hindrances to the
health and well being of children in communities they
serve. In many cases needed services already exist in the
community.
 Community pediatricians should work for medical home
for every child in the community.
 DEPARTMENT OF SOCIAL & PREVENTIVE PEDIATRICS
IN TERTIARY CARE HOSPITAL
Out door In door Out reach Surveillance Health Education
Community work programme

Growth Nutrition City slum or Polio Peads Unit

Rehabilitation village Measles  Nursery Section
Monitoring + Diphteria Diarrhea Section
Clinic Collaborative Pertusis Medical Section
research projects Tetanus Family Planning
Nutrition Clinic with international Cholera
Genetic Clinic agencies like
WHO,UNICEF
Vaccination
Centre
Lactation Clinic
Play Therapy
BROOKDALE COMMUNITY PEDIATRICS
“To laugh often and much, to win the respect of
intelligent people and the affection of children,
to earn the appreciation of honest critics and
endure the betrayal of false friends, to
appreciate beauty, to find the best in others, to
leave the world bit better whether by healthy
child, a garden patch or redeemed social
conditions, to know even one life has breathed is
your because you have lived this is to have
succeeded.”