HEALTHY CHILD CARE

Matei Dumitru MD, PhD

UMF Carol Davila
Family Medicine Department
 New born child care
Anamnesis dates
Usually, the new born child must take over doctor in first 24
hours after going out hospital.
At the first medical inspection ,the family doctor will be
informed about how was birth and evolution in maternity
(hospital) by mother anamnesis and medical records. (at
going out hospital)
This medical record include antenatal historian, birth,
precocious postnatal period, pregnancy age, Apgar score,
anthropometric dates (weight, waist, perimeters), sensorial
screening, physical examination dates, psyhsiologic jaundice,
incident in postnative evolution, vaccination (hepatites B,
BCG).
Also, it will register malformations existence (inclusive hip
congenital sprain).
 Clinic examination
Teguments and mucous
jaundice, cyanosis, desquamation
echymosis, haematoma
pigmented naevus, haemangioma
cutaneus lesion, vesicles, erithema, pustule
umbilical wound appearance
candidosis stomatitis or erithematous gingival
bleending
pharyngeal lesion postinstrumentarium
 Clinic examination
Adipose cellular tissue
abundant at macrosomes
decreased at prematurely born child
absent at dismatur
Muscular system
flexor muscular hypertonicity
hypotonicity
spasticity
lopsided mouvement
 Clinic examination
Osteo-articular system
integrity
articular deformation
lopsided of bony segments
fractures collarbone , skull, limbs
articular mobility
bony deformation- hip, skull_macro, microcephaly)
rachisschezis
fare fontanelle - dimension
suture dehiscence, suture hyperostosis
 Clinic examination
Respiratory system
dimension, simmetry
sonorousness
air vesicular murmur : present , absent plotting (atelectasis zone)
respiratory rhythm:frequency, 30-40/min, a little irregular

Cardiovascular system
Character and force of cardiac beatings
Cardiac frequence (normal 120/min)
Presence an cardiac blast
Pulse presence by femoral artery (it absence in aorta coarctation)
Cyanosis presence (generalisation, of extremity, perioral)
 Clinic examination
Digestive system
oral malformation (palatoschizis)
deglutition troubles
appetit, stools, vomiting
abdominal distension
hepato-splenomegalie
inguinal and umbilical hernia

Urogenital system
miction, urinary flux diuresis
hypo/hyperchrome urine, haematuria
genital malformation : hypertrophy clitoris, sexual ambiguity
testicular ectopia
 Clinic examination
Nervous system
tonus /reactivity
archaic reflex
motility, reflectivity
abnormal mouvements
apnoea and cyanosis crises
sucking and deglutition trouble
sleep/wekefulness rhythm
particulary scream
Sense organs
Ocular system strabismus, nistagmus, pupil asymmetry - cataract
microophtalmia- exophtalmia- palpebral ptosis - conjunctival
secretion
Auditory system pavilions malformations - pretragian tubercule -
nasal cones athresis- nasal pyramid malformation- hearing
 Recommendations
Nourishment breast importance
For avoidance risk that new born doesnt feed at breast, is necessary
an precocious and intense sanitary education achieved by family
doctor. In this case , are importance some measures:
explanation and promotion of breast nourishment still by antenatal
period
the mother must consider this act natural and perfect possible
the family doctor and nurse must learn the mother correct technique of
breast suckling
it explain to mother superiority of human milk comparatively formula of
artificial milk and milk cow.
It doesnt offer gratuitous powder milk to mother because she is tempt
to manage by new born.
 Recommendations
Teguments and mucous hygiene
It will explain to mother importance of keeping hygiene conditions of new born.
Because existence teguments specific feature of new born ( absence acid
pH, absence saprophytic flora, deficiency of local immunitary defence) the
risk of infections with cutaneous entrance gate is high.
In this case , it will explain to mother the importance of wash ones hands or as
many or handle the child.
necessity local toilet with boiled and cold water and sterile swabs at cutaneous
folds level and inguinogenitale region
mucous toilet: oral, ocular, genital
umbilical blunt and wound care with steril water, alcohol 70 and sterile swabs
general bath, daily, preferably at the same hour- it will insist about of hygiene
and temperature(38C) bath tub or by traditionally method with elbow
importance of massage at bath (forward or after bath) with oil with F vitamine or
boiled and cold oil
nasal toilet with physiological serum preferably forward sucking for ensure an
comfortable breathing during sucking and prevention aerophagia and
aerocolia.
 Recommendations
Swaddled technique
In this case, it recommend lightly clothes, by cotton, utilisation pampers
at the night and intermitent at the day for avoidance iritation and
erythema.
The child bed
must by include : breathable mattress by see weed
bed position must by in neutral zone of room by thermic view point
dont use the pillow for head
Air bath
the new born must go out in the open air after the first 2-3 weeks,
initially 10-15 min and after it will increase gradual to 3-4 hours 1-2
ori/day.
 Recommendations
Environment hygiene
the room must by clean and positioning in the sunny part of dwelling
temperature in room is 20-22 with 2more (24) at bath tub.
Air humidity 50-60-%, utilisation special device or vassel with water
Room aeration 3-4/day
Room temperature (possibly humidity) verification by room
termometers utilisation
Avoidance air polluted at room towards stranger persons or
agglomeration
Child room must has floor easily to keep up (gritstone, linoleum)
 Recommendations
Other counsels for mother
explanation the rhythm sleep/wakefulness
explanation nurseling colics and their treatment
recognition the first signs which can announce a disease (feed refusal,
perturbation of sleep/wakefulness rhythm, modification of child
behaviour , etc)
mother must learn how treat initially an feverish status when doctor
coming
it must explain to mother the importance of child vaccination, rickets
and anaemia prophylaxis
mother report about prohibited food in suckling period
smoking avoidance , alcoholism, spices and other food which alter the
milk taste
 Recommendations
Mother nourishment which suckling
Food contribution poised in nutritive elements.
Food preparation must be so simple: boiled meat and vegetables,
fruits, salads.
It avoid excess of sweets, pungent foods, fats, frying, salt excess,
chocolate, coffee, smoking.
Its doesnt consumption the food which modify the milk taste: mustard,
garlic.
It cant suckling in condition of weakening diet.
Protein excess dont increase dairy secretion . Fats excess can reduce
dairy secretion. Liquid excess can decrease dairy secretion by
antidiuretics hormone intervention.
Liquid quantity for mother which suckling is self-regulation by personal
thirst sensation , beer and tea dont stimulate dairy secretion.
 Periodical examination of new
born and nurseling

New born period : weekly

Nurseling period :1,2,4,6,9,12 month
1-4 year period : 15,18,24 month, 3, 4 years
5-18 year period : yearly
 Nurseling period
Content of total examination in nurseling period
- anthropometrical dates: weight, length, body
mass index
- summary of clinic examination
- phychomotor development
- estimate correctness recommended
nourishment
- assessment efficiency of rickets and anaemia
prophylaxis
Each total examination closed with a conclusion
child health state.
 Development periods of child
Intra-uterine period: - embryonic stage: 0-12 weeks
- foetal stage: 13 weeks -birth
The first childhood (from birth to 3 years)
- new born stage 0-28 days
- nurseling stage- 29 days-12 month
- anteprechool: 1-3 years
The second childhood preschool period 3-6(7) years
Third childhood : - a little pupil stage 6-12 years
- big pupil stage 12-14 (15)years
- adolescence >14years(girls) and 15 years
(boys) until 18 years
 Development in nurseling
period
Anthropometrics parameters at birth
weigh 2800-4000g
waist 50-52 cm
cranial perimeter 35-36 cm
thoracic perimeter 33-34 cm
Development in nurseling period
Growth in weigh : in first 4 months grow 750g/month
- between 5-8 month grow 500g/month
- between 9-12 months grow 250g/month
A global modality for estimate of growth in weight is that the new born birth with
3000g, his double weight at 4 month(6000g) and treble weight at 1 year
when has 9000g.
Growth in length: 5 cm in the first month
- 4 cm in the second
- 3 cm in the third
- 2 in the four
- 1 cm/month between 5-12 months.
 Dental eruption to born and
Temporary dental eruption child
inferior median incisor(2):6-9 month
superior median incisor(2) : 8-10 month
laterals incisor(4) : 10-12 month
eye teeth 14-18 month
first molar 12-14 month
second molar 20-30 month
Definitive dental eruption (permanent)
inferior incisor 6-8 year
superior incisor 7-9 year
inferior eye-tooth 10-11 year
superior eye-tooth 11-12 year
premolar 10-12 year
first molar 6-7 year
second molar 11-13 year
thirty molar 17-21 year
 Nourishment technique

a) preparation for nourishment

B )precociousness breast suckling by the first hours
c) technique of breasts alternation
D )sucking duration it is on an average 20 min
- in the first days is 10 min
e) sucking rhythm : programme is 3-4 hours between meals, with a pause at 7 hours
during night(7-8 /day)
f) milk quantity :60-70 ml/meal to 200 ml/meal
i) Assessment modality of sucking self sufficiency
- suckling behaviour after sucking
- ponderal curve aspect
- number mictions (>5-6/day)
j) Breast nourishment duration is minim 6 months and it can prolonge until 2 years.
 Breastfeeding counter-indications:

Related to the mother:

Permanent: severe infections (septicaemia, nephritis, tuberculosis,

typhoid fever), heart failure, kidney failure, systemic diseases
(neoplasia, multiple sclerosis), endocrine diseases (thyrotoxicosis,
cachexy, diabetes), psychological disorders (lactation psychosis,
neurosis, mothers with AgHB and HIV - a precautionary measure),
chronic treatments (cancer control, oral contraceptives, antiepileptic
drugs).

Temporary: acute infections with antibiotic treatment (tetracycline,

chloramphenicol, sulphamides, metronidazole), mastitis, sunken
breast nipple, bleeding nipple cracks.
 Breastfeeding counter-indications:

. Related to the infant:

Permanent: Congenital intolerance to lactose,
galactosemia, phenylketonuria.
Temporary: Neonatal icterus through
conjugation inhibitors in human milk
(pregnandiol).
 HUMAN MILK VS. COWS
MILK
HUMAN MILK COWS
Proteins: 9-11 g/1 MILKProteins: 34 g/1
Casein: 40% Casein: 80%
Milk serum proteins: Large amounts of beta
60%, especially 1- lactoglobulin, a
lactalbumin. protein fragment that is
This balance is involved in cows milk
considered to be allergies. This can lead
optimum for absorption. to anaphylactic shock
on the first intake, or to
growth failure.
 HUMAN MILK VS. COWS
MILK
HUMAN MILK COWS MILK
Fats: 40 g/1 Fats: 35 g/1
Equal proportion of Saturated fatty acids:
saturated and non- 80% Non-saturated fatty
saturated acids. These acids: 20%; these
are directly absorbed contribute to cerebral
into the portal system, development.
with no intervention by
the alimentary canal
 HUMAN MILK VS. COWS
MILK
HUMAN MILK COWS MILK
Sugars: 68-70 g/1 Sugars: 50 g/1
60 % - lactose Lactose only.
The rest - trace Cows milk will be
sacharides (fructose, administered in a
galactose) that are diluted form (1/2)
involved in the and 20 teaspoons of
synthesis of sugar will be added
cerebrosides. to one litre of milk
 HUMAN MILK VS. COWS
MILK
HUMAN MILK
Osmolarity: mineral salts:
340 mg/1, 288-310 mos./l.
Calories: 680 cal/1.
COWS MILK
Osmolarity: 1170 mg/1, of
which 500 mg are Na. This
is why cows milk is
inadequate for a salt-free
diet.
It keeps the brain in a
hypersomolar environment,
forcing it to play the
hypersomolar game and
require an increasing
amount of fluids.
Calories: 655 cal/1
 Infant formulas
According to how well their chemical formula approximates
human milk, infant formulas
can be:
Infant formulas (1st age milk) - for infants aged 0-4 months

Adapted formulas - these have a chemical formula that is close

to that of human milk E.g.:
Partially adapted formulas - these have an intermediary
chemical formula between human milk and cows milk

Follow-up formulas (2nd age milk) - for infants aged more than 4-6
months
 INFANT DIET
DIVERSIFICATION
Diversification is the gradual introduction to
infant diet of foods other than milk, at the
same time as digestive enzymes mature and
the infants dietary needs increase.
The introduction of new foods (diversification)
begins after the age of 5-6 months (earlier
4 months - for artificially-fed infants, and later -
5-6 months - for naturally-fed babies)
 Rules (advice) on dietary
diversification:
Any new foodstuff will be introduced when the infant is healthy.
The new foodstuff will be introduced progressively.
The new foodstuff will be administered before the usual foodstuff.
The diversification foodstuff will be administered with a teaspoon
(preferably).
No two foodstuffs will be introduced simultaneously - it is advisable that
one single foodstuff be introduced per week.
At the first sign of intolerance (vomiting or diarrhea) the newly
introduced foodstuff will be suspended - and its administration will
be resumed a few days after digestive tolerance is restored.
Infants must not be forced to receive the full ration that is offered to
them, so as to avoid the development of psychogenic anorexia.
NEW FOODSTUFFS MUST BE PROPOSED, NOT IMPOSED!
The favorite foodstuff must be generalized through several meals.