Organization of medical and

preventive care for children in a

children's polyclinic
 Introduction
• In 1959, the UN General Assembly adopted the "Declaration of the Rights
of the Child".
• Its 10 principles form the rights that children should enjoy in all countries
of the world.
• The child should enjoy all the benefits of social security: have the right to
necessary food, housing, entertainment and medical care.
• In Russia, the protection of children's health is provided by a network of
medical and preventive institutions. Their activities are aimed at
continuous medical examination of the child population from the first days
of life to the age of 17, 11 months and 29 days, prevention and early
detection of diseases, timely qualified assistance to sick children.
 According to the Order of the Ministry of Health and Social
Development of the Russian Federation No. 56 dated January 23, 2007
"On approval of the approximate procedure for organizing the activities
and structure of a children's polyclinic", a children's polyclinic is created
by a local government body as an independent medical and preventive
institution of a municipal district (city district) or as a structural
subdivision of a medical and preventive institution of a municipal
district (city district) to provide primary health care to the children's
population according to the territorial principle.
 Organization of the work of the children's
polyclinic
• Polyclinic - polis(city), klinike (art of healing).
Share:
• By territorial basis: urban and rural (outpatient clinics).
• Organizational: independent and combined with a hospital.
• By profile: adults, children, dental, physiotherapy, etc.
 Organization of the work of the children's
polyclinic. Structure.
Filter with separate entrance and insulators with boxes;
•Offices of pediatricians and specialist doctors;
•Office for preventive work with children (office of a healthy child);
•Department of Rehabilitation Treatment;
•Diagnostic and treatment rooms (X-ray, physiotherapy, physical therapy,
ECG, ultrasound, FGDS, laboratories, etc.);
•Vaccination room, treatment room;
•Preschool and school department;
•Reception, cloakroom and other auxiliary rooms, waiting halls;
•Administrative and economic part.
 Organization of the work of the children's
polyclinic
The head of the polyclinic:
•an independent institution – the chief physician
•combined with the hospital – the deputy chief physician for
the polyclinic part.
For 9-10 plots - 1 rate of the head of the polyclinic
department.
 Sections of the work of the district doctor
The precinct principle of service
•Rolling work schedule
•Allocate the day of reception of healthy children
Work standards:
•for the maintenance of the 1st child on the site - 30 min.
•at the reception: 12 min. for the 1st child
Work sections:
•Preventive
•Therapeutic
•Organizational and methodological.
 Preventive work
Prenatal care
Conducted by a nurse
•I prenatal patronage – is carried out up to 10-12 weeks of pregnancy.
II prenatal patronage – 28-36 weeks of pregnancy (maternity leave)
Tasks: taking care of the child, preparing everything necessary for him.
 Patronage of a newborn
• I –in the first 3 days after discharge from the maternity hospital (from the
maternity hospital (5-7 days)).
• II - in 14 days.
• III- in 20 days.
When conducting patronage:
• Anamnesis
• Examination of the child
• Recommendations (care, nutrition)
• 1 month (at the reception of children’s polyclinic):weight, height, chest
circumference, head, prevention of rickets- vit. D at a dose of 400-500 IU
 Patronage of premature babies
Degrees:
I – 35-37 weeks (weight: 2,000-2,500).
II – 32-34 weeks(1500-2000)
III – 29-31 weeks (1,000-1,500)
IV – less than 29 weeks (less than 1,000)
•Up to 1 month - visit by a doctor 1-2 times a week.
•Up to 6 months - visit by a doctor 2 times a month.
•Consultation of specialists.
•Prevention of rickets from 2-3 weeks
 Preventive work
• The struggle for natural feeding
• Prevention of background diseases (rickets, dystrophy, anemia,
allergic diseases)
• Conducting examinations of unorganized children by a pediatrician
within the prescribed period (3 months; 1 year; 3, 5, 6, 8, 10, 12, 14,
15, 16, 17 years)
• Consultations of specialist doctors
• Organization and implementation of preventive vaccinations
• Sanitary and educational work
Office of a healthy child
 Medical work
• Service for acutely ill children
• Service for children with exacerbations of chronic diseases
• Medical examination of children with chronic diseases
• If necessary - emergency care
Organizational and methodological work
Work planning
Monthly job analysis
Maintaining medical documentation
Working with a district nurse
 Documentation
Registration form:
•025 – statistical coupon (accounting of morbidity)
•030 –card of dispensary observation
•058 – emergency notification
•063 – card of preventive vaccinations
•112 – the history of child development
•026 – medical card (DDU, school)
 Medical examination of children
• One of the main sections of the work of a district pediatrician is
preventive work
• Special attention is paid to primary prevention - the upbringing of a
healthy child.
• Therefore, measures aimedat increasing the effectiveness of primary
prevention and improving the work on the development and
upbringing of a healthy child occupy a special place in the activities of
medical and preventive institutions.
 Medical examination
A method of monitoring the health status of large populations.
Types of medical examination:
•Medical examination of healthy children (I gr. health)
•Medical examination of children with risk factors (grade II of health)
Goal: maximum elimination of endo- and exogenous risk factors
•Medical examination of patients with chronic diseases (III, IV, V gr.
health).
Purpose: prevention of relapses and disability.
 Comprehensive assessment of children's
health
• According to the WHO definition, «Health is a state of complete physical, mental
and social well–being, and not only the absence of diseases and physical
defects».
It is customary to distinguish the following components of health:
• Somatic – the state of the organs and systems of the body, the basis of which is
the biological program of individual development.
• Physical – the level of growth and development of organs and systems of the
body, which are based on morphofunctional reserves that provide adaptive
reactions
• Mental –the state of the mental sphere, the full development of higher mental
functions, processes and mechanisms.
• Psychological – a complex of interests in a person's life, freedom of thought,
initiative, passion for their work, activity, independence, responsibility.
• Moral is a complex of characteristics of the motivational and need-
informative sphere of life activity, the basis of which is determined by
the system of values, attitudes, motives of an individual's behavior in
society.
• Reproductive – the absence of organic disorders, diseases and
deficiencies that interfere with the exercise of sexual and
reproductive functions.
• Sexual is a complex of somatic, emotional, intellectual and social
factors that positively enrich the personality, increase a person's
sociability and his ability to love.
 Comprehensive assessment of children's
health
The assessment is based on 6 health criteria (S.M. Grombakh):
•Features of ontogenesis (genealogical, biological, social history)
•The level of physical development and the degree of its harmony
•Neuropsychic development
•The level of resistance of the body
•Functional state of organs and systems
•The presence or absence of chronic diseases or congenital
malformations
 Health Groups
• I – absolutely healthy children
• II – risk group
• IIa – minimal risk group (history of abnormalities)
• IIb – the maximum risk group (deviations in health status)
• III – chronic diseases, compensation
• IV - chronic diseases, subcompensation
• V - chronic diseases, decompensation
 Medical examination of children of the 1st
year of life (I group of health)
Pediatrician – monthly weight, height, chest circumference, head.
•1 month: consultations of a surgeon, orthopedist, prevention of
rickets- vit. D at a dose of 400-500 IU
•3 months: consultations with a neurologist, oculist, blood and urine
analysis
•1 year: consultations with specialist doctors, blood and urine tests,
feces for worm eggs.
Medical examination of children from 1 year
to 7 years
Pediatrician:
From 1 to 2 years – 1 time per quarter
From 2 to 3 years – 1 time in 6 months.
From 4 to 7 years – 1 time per year
Annually – dentist
•3, 5,6,7 years – neurologist, surgeon, orthopedist, oculist,
otolaryngologist
•5 and 7 years old – psychiatrist
•2-3 years (5 years) - speech therapist
Medical examination of children from 1 year
to 7 years
Annually:
•Blood and urine analysis,
•Feces on worm eggs
•Visual and hearing acuity
•Plantography (from 3 years old)
In 3 years and 7 years
•blood sugar
 II health group
II a – history of abnormalities (obstetric, hereditary, social)
II b: at the 1st year of life
•Prematurity, large weight (more than 4 kg.)
•Mixed or artificial feeding
•Background diseases
•Transferred diseases and conditions during the newborn period and after 1
month, often sick children.
II b: Older than a year
•often sick children, hypertrophy of tonsils 1-2 tbsp., adenoids 1 tbsp., mild
myopia, moderate hyperopia, subcompensated caries, transferred acute
diseases
 Frequently ill children (Albitsky V.Yu. and
co-authors, 1986)
The number of acute illnesses suffered by a child in a year:
•Up to 1 year – 4 and >
•1-2 years – 6 and >
•Up to 4 years – 5 and >
•4-5 years -4 and >
•6 and > years -3 and >
The main indicators of the work of the district
pediatrician
• Order No. 283 of 19.04.2007 of the Ministry of Health. And Soc. Development of
the Russian Federation.
Criteria for evaluating the effectiveness of a pediatrician
- Evaluation of preventive work
- Prenatal care coverage
- Observation of newborns
- Coverage of patronage of children of the 1st year
- Completeness of coverage of children by professional examinations:
• Up to 1 year – 100%, older than a year – at least 95%
• Coverage of preventive vaccinations - at least 95%
• The proportion of naturally fed children:3 months – at least 80%, 6 months. at
least 50%, 9 months. at least 30%
 Evaluation of medical work:
• Quality of dispensary observation of children
• Assessment of morbidity dynamics
• Analysis of cases of death of children at home (including the 1st year)
• Analysis of cases of daily mortality
• Morbidity rates (by nosological forms, by age)
• Infant mortality
• Infant mortality (from 0 to 17 years 11 months 29 days)
 National calendar of preventive vaccinations
Age Name of the vaccination
Newborns (in the first 12 hours of life) The first vaccination against viral hepatitis B
Newborns (3-7 days) Vaccination against tuberculosis
1 month The second vaccination against viral hepatitis B
3 months The first vaccination against diphtheria, whooping
cough, tetanus, polio

4.5 months The second vaccination against diphtheria, whooping

cough, tetanus, polio

6 months The third vaccination against diphtheria, whooping

cough, tetanus, polio The third vaccination against viral
hepatitis B

12 months Vaccination against measles, rubella and mumps

 National calendar of preventive vaccinations
Age Name of the vaccination
18 months The first revaccination against diphtheria, whooping
cough, tetanus, polio
20 months The second revaccination against polio
6 years Revaccination against measles, rubella, mumps
7 years Revaccination against tuberculosis Second
revaccination against diphtheria, tetanus

13 years Vaccination against rubella (girls) Vaccination against

viral hepatitis B (not previously vaccinated)

14 years The third revaccination against diphtheria, tetanus 

Revaccination against tuberculosis  The third
revaccination against polio

adults Revaccination against diphtheria, tetanus – every 10

years from the moment of the last revaccination