Introduction To Child Health CHAPTER 1

CHAPTER HIGHLIGHTS
 Concept of Child Health

 Trends in Child Health Care

 Child Health Problems

 Disease Patterns in Children

 Statistics Related to Child Health

 Child Health Care in India

 Rights of the Child

 Universal Children's Day

 National Policy for Children

 Children Act

CONCEPT OF CHILD HEALTH

The term ‘Pediatrics’ is derived from the Greek words, ‘Pedia’ means child, ‘iatrike’ means treatment and ‘ics’
means branch of science. Thus, pediatrics means the science of childcare and scientific treatment of childhood
diseases. Pediatrics is synonymous with child health.
Pediatrics can be defined as the branch of medical science that deals with the care of children from
conception to adolescence in health and illness. It is concerned with preventive, promotive, curative and
rehabilitative care of children.
Children are major consumers of health care. In India, about 35% of total population are children below 15
years of age. They are not only large in number but also vulnerable to various health problems and considered as
special risk group. Majority of the childhood sickness and death are preventable by simple low-cost measures.
Disease patterns and management of childhood illness are different than that of adult. Children always need
special care to survive and thrive. Good health of these precious members of the society should be ensured as
prime importance in all countries. As said by Karl Meninger ‘What is done to children, they will do to the
society?.’ Children are the wealth of tomorrow.
A child is unique individual; he or she is not a miniature adult, not a little man or woman. The childhood
period is vital because of socialization process by the transmission of attitude, customs and behavior through the
influence of the family and community. Family's cultural and religious belief, educational level and ways of
living influence the promotion and maintenance of child health. Children are vulnerable to disease, death and
disability owing to their age, sex, place of living, socioeconomic status and a host of other variables. They need
appropriate care for survival and healthy development.
The triad problems, poverty, population explosion and environmental stress are great threat towards child
health in developing countries. Better nutrition, education (especially of girls) and family planning are essential
aspects to improve child health. Healthy well-nourished children develop better mentally and benefit more from
education. Better education associated with more health knowledge, better health practices and more use of
health services.

FACTORS AFFECTING CHILD HEALTH

The important factors affecting the health of children are mainly maternal health, family health, socioeconomic
situation, environment, social support and available health care facilities.
Maternal health is a major determinant of child health. The healthy mother brings forth a healthy baby
with better chance of survival (Figs. 1.1A To D). Child health is adversely affected, if the mother is
malnourished or diseased. Mother's age, parity, prepregnant health, antenatal care and lack of spacing between
two children affect the health of the child.
Child health is greatly depending upon family health. It depends upon family's physical and social
environment which includes the lifestyle, culture, customs, taboos, rituals, religious practices, traditional habits,
child-bearing and child-rearing practices, like son-complex, neglect to female child, etc. Family size, family
relationship and family stability also influence the child health. For example, number of episodes of childhood
diarrhea increases with the size of the family and prevalence of malnutrition increases with more than four
children in a family. So, fewer children would mean better nutrition, better health care, less morbidity and lower
infant mortality.
The socioeconomic condition of the family is a very important factor in child health. The physical and
intellectual 2 development of children varies with the socioeconomic status of the family. Parent's education,

profession, income, housing, urban or rural living, industrial life, etc., are significant factors which influence on
child health. Poverty, ignorance, superstition, illiteracy especially mother's illiteracy and sickness pass from one
generation to the next. The differences in health status between rich and poor can be observed in all age groups
but particularly striking among children.
Figs. 1.1A to D: Healthy mother and healthy children: A. Healthy mother and child of a rich family; B. Healthy infant of 6 months age; C. Healthy mother and
healthy child of a poor family; D. Healthy infant of 9 months age

Environment plays a very great role as determinants of infant and childhood morbidity and mortality.
Insanitary and hostile environment are responsible for various illnesses like infections, infestations, accidents,
etc. Home and family hygiene, local epidemiological conditions, insufficient supply of safe water, inadequate
disposal of human excreta and other waste, an abundance of insects and other disease carriers are the continuous
threat to child health. Healthy environmental stimulation as interpersonal relationship is an essential factor for
child's development. Congenial family relationship, healthy interaction with neighbors, teachers, schoolmates
and playmates, exposure to mass media like radio, television, and magazines are significant requirements for
psychological and intellectual development of children.
Social support measures from the community and organized health care systems are indispensable for
improvement and maintenance of health status of children (Figs. 1.2A To F).

TRENDS IN CHILD HEALTH CARE

Historically, the concept of pediatrics was limited to the curative aspects of diseases peculiar to the children.
Hippocrates (460-370 bc) made many significant observations on disease found in children and devoted a great
part of his treatise to children. Galen of Rome (1200–1300 ad) wrote on the care of infants and children. Rhazes
of Arab (850–923 ad) devoted much of his treatise to the subject of childhood illness. The first printed book on
Pediatrics was in Italian (1472) by Bagallarder's 3 ‘Little Book on Disease in Children’. The first English book

on children's disease was ‘Book of Children’ written by Thomas Phaer (1545 ad).

Figs. 1.2 A to F: Children in need for support services: A. Teenage mother (second gravida); B. Young mother with four daughters waiting to have a
son; C. Smiling lady in presence of several problems; D. Malnourished children of urban slum; E. Malnourished child of 2 years; F. Children in need

The world's first Pediatricians were two Indians, Kashyapa and Jeevaka, of sixth century BC. Their
pioneering works on child care and childhood disease are as relevant today as many of the modern concepts of
child health. Sushruta, also wrote many aspects of child-rearing and Charka wrote about care and management
of newborn.
Child health care has changed dramatically in recent years due to advances in medical knowledge and
understanding of emotional response of children. Advancement of understanding of different aspect of human
development influences the changing concept of health. Health exists when an individual meets minimum
physical, physiological, intellectual, psychological and social aspects to function appropriately for their age and
sex level. Illness is the situations when individual experiences a disturbance in any of these areas that prevents
functioning at appropriate level. Thus, attention is directed to psychosocial as well as physiological
characteristics of health and illness.
 Modern concept of child health emphasizes on continuous care of ‘whole child’. According to United
Nations International Children's Emergency Fund (UNICEF), assistance for meeting the needs of children
should no longer be restricted to only one aspect like nutrition, but it should 4 be broad-based and geared to

their long-term personal development ensuring holistic health care of children.

At present, in child health care more emphasis given on preventive approach rather than curative care only.
Primary health care concept with team approach and multidisciplinary collaboration are adopted for child care.
The challenge of this time is to study child health in relation to community, to social values and social policy.
Increased public awareness, consumerism and family participation in child care are newer trends. Family health,
a new concept is accepted for the care of children in their families and families in society. Need based, problem-
oriented, risk approach care is practiced for better child health.
In developed countries child health care extended up to adolescent, whereas in developing countries and in
India, child care is extended up to 10 to 12 years of age. Recently special emphasis is given on adolescent health
through reproductive and child health (RCH) package services in our country. Special attention is given on the
children at-risk like, orphans, destitute, disastrous, pavement dwellers, slum dwellers, child labors and
handicapped children. Movement against gender bias, female fetocide, child abuse and neglect and maltreatment
are in highlight at present.
Interest of the political leaders and understanding the importance of child health, constitution of national
health policy for children and implementation of various health programs for improvement of child health are
great achievements for children. Population control and family welfare approach, improvement of educational
status specially women education and women empowerment, involvement of government and nongovernment
organizations, political commitment and special budgetary allocation for child health activities, international
guidance by World Health Organization (WHO), UNICEF and other child welfare organizations for
improvement of child health are promising aspects towards survival, health and well-being of children.

Growth of subspecialities for the superspecialized care of children is recent

trend. The subareas are neonatology, perinatology, pediatric surgery, pediatric
cardiology, pediatric neurology, pediatric hematology, pediatric nephrology,
preventive pediatrics, child psychology, child psychiatry, pediatric intensive
care unit, neonatal intensive care unit, etc. Medical science is advancing in
every moment. So child health will also progress by va rious movements
towards the aims to improve the survival and well-being of all children, as per
WHO theme of the year 2005, ‘healthy mothers and healthy children.’

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