health assessment

ASSESSMENT OF HEALTH IN CHILDREN

Nirmala RobertsPaediatric Nursing

HEALTH

A state of complete physical, mental and social well being, and not merely the absence of disease or infirmity (WHO 1947)

Not a condition, but an adjustment Not a state, but a process The process helps us to adapt not only to our

physical, but also to our social environments

CHILD HEALTH

Closely related to her growth & development Directly proportional to the growth &

development Is the responsibility of every adult Needs to be assessed frequently to avoid

pitfallsA healthy child will grow to be a healthy adult

STAGES OF GROWTH IN CHILDREN

Infancy – Birth to 12 months Neonate – 0–28 days Infancy – 1–12 months

Early childhood – 1–6 yrs Toddler – 1–3 yrs Preschooler – 3-6 yrs

Middle Childhood ( School age) – 6–12 yrs Late Childhood – 11–19 yrs

Pre pubertal – 10-13 yrs Adolescence – 13-18 yrs

WHY ASSESS HEALTH IN CHILDREN?

Peculiarities of the child – Dependent, poor communication skills, and low immunity

Ensure normal health Provide timely guidance for optimal health Detect abnormal states and correct them Educate parents on ways to ensure good

health

METHODS OF HEALTH ASSESSMENT (For all age groups)

Dietary History H/O illness General examination Biochemical examination

DIETARY HISTORY(0 – 5 yrs)

Nature of diet Staple food Appetite Breast feeding, weaning, feeding problems Vitamin/ mineral supplements Food allergy/ fads Birth weight, recent weight loss Veg garden/ poultry/ cattle

HISTORY OF ILLNESS

Infections Infestations Immunization status – For all VPDs Personal hygienic habits Emotional health Social health Access to civic amenities

Potable water Waste disposal Medical facilities

GENERAL EXAMINATION

General physical examination Nutritional anthropometry Neuromuscular control Assessment of tissue growth Bone age Dental age Biochemical & histological means Psychological tests

GENERAL PHYSICAL EXAMINATION

General condition Appearance, activity, stature Face – Appearance, eyes, lips, oral cavity Glands & lymph nodes Skin – colour, hydration, rashes, edema

Systemic – CVS, Resp, Congenital anomalies Others -

Sleep Play Bowel & bladder function

MEASUREMENT OF GROWTH

• Weight – Infant weighing scale (manual/ electronic), Salter spring machine, Bathroom scale

• Length – Infantometer, Stadiometer• MAC – Tape measure, Bangle, Shakir’s tape• OFC – Tape measure • Chest circumference – Tape measure• BMI - Wt/ Ht2 • Skin fold thickness – Harpenden/ Best skin calipers• Dental development • Neuromuscular control – Milestones, motor skills

SCHOOL AGE

DIETARY HISTORY

Nature of diet – NV/PV, Fads, preferences, fast foods, snacking, beverages

Staple food, lunch box Appetite – Lack of interest Food allergy Recent weight loss Veg garden/ poultry/ cattle

HISTORY OF ILLNESS

Infections Infestations Immunization status – TT, HBV, BCG Personal hygienic habits Emotional health Social health Access to civic amenities

Potable water Waste disposal Medical facilities

GENERAL EXAMINATION

General physical examination Nutritional anthropometry Neuromuscular control Assessment of tissue growth Biochemical & histological means Psychological tests

GENERAL PHYSICAL EXAMINATION

General condition Appearance, activity, stature Face – Appearance, eyes, lips, oral cavity Glands & lymph nodes Skin – colour, hydration, rashes, edema

Systemic – CVS, Resp, Genito urinary Others -

Sleep Play Bowel & bladder function

MEASUREMENT OF GROWTH

• Weight – Bathroom scale• Length – Stadiometer• Chest circumference – Tape measure• BMI - Wt/ Ht2 • Skin fold thickness – Harpenden/ Best skin

calipers• Neuromuscular control – Motor skills

ADOLESCENCE

DIETARY HISTORY

Nature of diet – NV/PV, Fads, preferences, fast foods, snacking, beverages

Staple food Appetite – Anorexia Nervosa, obesity Food allergy Recent weight loss Veg garden/ poultry/ cattle

HISTORY OF ILLNESS

Infections Infestations Immunization status – TT, HBV, BCG Gynaecological health Urological health Personal hygienic habits Emotional health Social health Access to civic amenities

potable water Waste disposal Medical facilities

GENERAL EXAMINATION

General physical examination Nutritional anthropometry Neuromuscular control Assessment of tissue growth Biochemical & histological means Psychological tests

GENERAL PHYSICAL EXAMINATION

General condition Appearance, activity, stature Face – Appearance, eyes, lips, oral cavity Glands & lymph nodes Skin – colour, hydration, rashes, edema, pricks

Systemic – CVS, Resp, Genito urinary Others -

Sleep Play Bowel & bladder function

MEASUREMENT OF GROWTH

• Weight – Bathroom scale• Length – Stadiometer• Chest circumference – Tape measure• BMI - Wt/ Ht2 • Skin fold thickness – Harpenden/ Best skin

calipers• Neuromuscular control – Motor skills

BIOCHEMICAL EXAMINATION( For all age children)

• Blood – Hb%, PCV, S Protein

• Urine – RE

• Stool - RE

PSYCHOLOGICAL EXAMINATION – INFANTS & TODDLERS

Compare against normal children Take ‘Corrected age’ for preterms Take note of disability or handicap

PSYCHOLOGICAL EXAMINATION – PRESCHOOL AGE

Adaptive behaviour - Play, climbing, speech, feeding

Vision – Posture, walking, play, manipulation with toys

Performance – understanding matching color, concentration, visual acuity

Comprehension of language – Body parts, pictures, commands

PSYCHOLOGICAL EXAMINATION –SCHOOL AGE & ADOLESCENCE

Application, concentration, organizational skills -Three ‘R’s, drawing

Vision, hearing IQ tests

Stanford Binet Intelligence Scale Wechsler Intelligence Scale Goodenough ‘Draw a Man’ test Denver Development Screening Test

PRE REQUISITE

• Venue – Congenial environment - Good lighting, pictures, posters - Good sleep, food, warmth - Good IPR, ‘relaxed’, ‘stories’ - Ensure presence of parents• Articles – Weighing scale, Stadiometer, Tape

measure, books, paper, pencil, crayons, toys - NCHS chart - Growth chart