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Infant feeding, Child health

Infant feeding, Child health. Dr. Pracheth R., MBBS, MD, PGDPHSM., Assistant Professor, Community Medicine, Yenepoya Medical College. Outline. Breastfeeding Growth monitoring Child health problems Child health indicators IMNCI. Introduction. Ideal food for infant

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Infant feeding, Child health

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  1. Infant feeding, Child health Dr. Pracheth R., MBBS, MD, PGDPHSM., Assistant Professor, Community Medicine, Yenepoya Medical College

  2. Outline • Breastfeeding • Growth monitoring • Child health problems • Child health indicators • IMNCI

  3. Introduction • Ideal food for infant • No other food-6 months • Exclusive breast feeding, on demand • Declined significantly

  4. Reflexes- mother

  5. Reflexes-baby

  6. Advantages • Safe, clean, cheap • Meets nutritional needs • Antimicrobial factors: protect-diarrhoea, respiratrorydisease • Bonding • Easily digested-premature , normal babies

  7. Advantages • Sucking-develops jaws, teeth • Prevents malnutrition • Hypocalcemia, hypomagnesemia • Special fatty acids: IQ, visual acuity

  8. Advantages-mother • Spacing • Restores original physique • Boosts immune system • Reduces insulin requirement-diabetics

  9. Baby Friendly Hospital Initiative (BFHI)

  10. Ten steps-BFHI • Written policy-communicate: staff • Train staff-implement policy • Inform pregnant women: benefits, management: breast-feeding • Help mothers initiate : birth • Show : how-breastfeed, maintain lactation

  11. Continued 6. Give newborns no food/drink: unless medical 7. Rooming in 8. Encourage on demand 9. No artificial teats/ pacifiers 10. Foster establishment of support groups

  12. National guidelines • Infant Milk Substitutes, Feeding Bottles and Infant Food Act: 1992. • Prohibits: promotion artificial foods • Amended again in 2003.

  13. Growth and Development • Growth: increase in size • Development: increase-skills, functions • Not only physical-intellectual, emotional, social

  14. Determinants • Genetic factors • Nutrition • Age: maximum 1st year, puberty • Sex: females-10 to 11 • Physical surroundings • Psychological factors • Infections • Economic factors

  15. Normal growth • Characteristics- within range of measurements: normal • 2 standard deviations above, below mean (between 3rd -97th percentiles) • Mean: 2 standard deviations: either side • Outside 3 SD : significant abnormality • Physical : measurements; milestones

  16. Reference/standard values • Harvard/ Boston : 1930-56; Longitudinal • WHO : cross-sectional , NCHS • Multicentric: 1997-2003 • Z-scores, percentiles • New: 2006; gold standard • Indian Standards: ICMR: nation-wide cross-sectional: 1956-65; low socio-economic status

  17. Growth Chart • Road to health • David Morley – WHO • Visible display-growth, development • Longitudinal surveys • Weight for age

  18. Growth Chart

  19. Growth chart used in India • 2009: new WHO Child Growth Standards-NRHM • Mother and Child Protection Card: joint • Three zones: • Normal • <2 SD: underweight • <3 SD: severe underweight • Flattening/ falling : earliest sign PEM before clinical signs

  20. Uses: growth chart • Growth monitoring • Diagnostic tool • Planning, policy making • Tool for action • Educational tool • Tool for teaching: adequate feeding, diarrhoea • Evaluation of effectiveness-programme

  21. Care of pre-school child • 1-4 years: toddlers • Large numbers • Accessibility • Mortality: infection, malnutrition • Morbidity: Malnutrition, anaemia, diarrhoea • Growth and development • Prevention of health problems in later life

  22. Child health problems • Low birth weight • Malnutrition • Specific nutritional deficiencies • Infectious and parasitic diseases • Accidents and poisoning • Behavioural problems

  23. Continued… • Other problems: • Maternal health • Family • Environment • Socio-economic status

  24. Under-5 Mortality Rate • UNICEF: best indicator- socio-economic development • Annual number- deaths: under 5 per 1000 live births • 12 million: 1990- 6.3 million • India: 53/1000

  25. Child Survival Index • Percentage of those who survive upto 5 years • (1000-Under 5 Mortality Rate) /10 • India: 94.70%

  26. IMNCI • Signs and symptoms non specific • Overlap: no single diagnosis • Integrated approach

  27. Objectives • Reduce deaths, frequency and severity : illness • Improve growth and development

  28. Main components • Improve case management skills: locally adapted guidelines • Improve health system : better management • Improve family, community practices

  29. Management process (ACT) • Assess: danger signs, main symptoms • Danger signs: • Convulsions • Lethargy/unconsciousness • Unable: drink • Vomiting

  30. Continued….. • Main symptoms: • Cough • Diarrhoea • Ear problem • Fever • CDEF • IF (Immunization, Feeding) • Check : malnutrition/anaemia

  31. Continued…. • If 1 present: Assess for sign related to main symptom • Classify: colour coded triage system • Urgent referral (Pink) • Specific medical treatment, advice (Yellow) • Simple advice : home management (Green) • Identify specific treatment • Treatment: • Instruct caretaker: home fluids, follow up

  32. Upto 2 months BCD IF Hypothermic • Serious bacterial/local infection • Colourof skin (Jaundice) • Diarrhoea • Check immunization • Check feeding • Low body temperature (Hypothermic) • Classify, treat

  33. Under five clinic • Preventive, promotive , curative, referral, educational : package-one roof • Aim: comprehensive health care to under fives: non-medical person, economical way • Services through: trained nurses • Sub-Center, Primary Health Center: one afternoon every week

  34. Summary

  35. Questions 1. Enumerate causes for under-five mortality in India. Describe various programmes for protection of pre-school children in India (2+4= 6 marks) 2. Define exclusive breastfeeding. Enumerate benefits of breastfeeding (1+5=6 marks) 3. What is Baby Friendly Hospital Initiative (BFHI)? Enumerate it’s 10 steps(1+5=6 marks).

  36. Continued….. 4. Describe growth chart and write it’s uses (3+3=6 marks) 5. Integrated management of a sick child (6 marks) 6. Enumerate various child health problems (3 marks)

  37. Continued 7. Child Survival Index (3 marks) 8. Describe the activities carried out in an under-five clinic (3 marks) 9. What is weaning ? Which weaning foods you would recommend for an infant ? (2+1=3 marks)

  38. THANKS

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