MCH- Neonatal and Under-5 care & Family Planning

Childhood Division
Infancy (up to 1 year) neonatal (first 28 days of life) post neonatal (28days to 1 year) preschool (1-4 years) school age (5-14 years)

Optimum Newborn Care

Objectives of Early Neonatal Care

Proper functioning of Cardio-respiratory system Maintenance of body temperature Avoidance of infection Satisfactory feeding regimen Early detection of congenital and acquired disorders

Immediate care
Clearing the airway APGAR score Maintenance of body temperature

Breast feeding
Care of cord Care of eyes Care of skin

APGAR SCORE

Neonatal examination
First examination Cyanosis Difficulty in breathing Imperforate anus Persistent vomiting

Signs for cerebral irritation

Temperature instability

Second examination
Body size Body temperature Skin Cardio-respiratory activities Neurobehavioral activity Head and face Abdomen Limbs and joints Spine External genitalia

Measuring the baby

Birth weight Length(height) Head circumference Neonatal screening

Definitions
Low Birth Weight

Pre-Term Babies

Small for Date Babies

At risk Infants
Birth weight less than 2.5 Kgs Twins Birth order 5 or more Artificial feeding Failure to gain weight during successive months

Working mother/one parent

Kangaroo mother care

4 main components Skin to skin positioning Breast feeding Ambulatory care Support for mother and her family

Feeding of the child

Breast feeding for the first 6 months Weaning started after 6 months Other artificial feeds like dried milk or diluted cows milk can be used if mother is unable to feed the child

Baby friendly hospital initiative

Created and promoted by WHO and UNICEF Includes Teach feeding Initiate feeding Feeding on demand Mother and child together No advertisements No artificial teats Assisted by other mothers, nurses

Growth and development

Growth assessment
Physical development Weight for age Behavioural development Motor development

Height for age

Head circumference

Personal- social
Adaptive Language

Growth chart

Uses of Growth Chart

Growth monitoring Planning and policy making Diagnostic tool

Educational tool
Tool for action Evaluation Tool for teaching

Care of under 5 children

Health problems in pre-school children

Low birth weight Malnutrition Infections and parasitic infestation Accidents and poisoning Behavioral problems

Other problems( Family, socio economic, Environment)

Definition
A way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitudes and responsible decisions by individuals and couples, in order to promote

the health and welfare of the family group and thus

contribute effectively to the social development of a country

Health aspects
Womens health MMR, nutritional deficiencies, complications of pregnancy and child birth

Fetal health
Abnormal development and fetal mortality

Infant and child health

IMR, birth weight, vulnerability to diseases

Contraceptive methods
Spacing methods
Barrier methods
Physical Chemical

Terminal methods

Male sterilization
Female sterilization

Combined
IUCDs Hormonal Post-conceptional Miscellaneous

BARRIER METHODS
Male Condom Female Condom Diaphragm

BARRIER METHOD
Prevents pregnancy blocks the egg and sperm from meeting Barrier methods have higher failure rates than hormonal

methods due to design and human error

MALE CONDOM
Most common and effective barrier method when

used properly
Latex and Polyurethane should only be used in the

prevention of pregnancy and spread of STIs (including

HIV) Failure rate of 2-3 per 100 women-years

Condom
Advantages

Disadvantages High failure rate

Easily available

Easy to use
No side effects Protects against STDs as well

Interferes with coitus

Diaphragm
Advantages Disadvantages

Total absence of

Has to be first demonstrated

risk and medical

contraindications

by medical personnel
Can be used only after involution of uterus after delivery If left in situ for long, can cause

toxic shock syndrome

DIAPHRAGM

SPERMICIDES
Chemicals kill sperm in the vagina

Different forms:
-Jelly -Film

-Foam

-Suppository

Some work instantly, others require pre-insertion Only 76% effective (used alone), should be used in combination with another method i.e., condoms

Intrauterine Devices (IUD)

Copper T vs.. Progestasert

10 years 99.2 % effective Copper on IUD acts as 1 year

98% effective
T shaped plastic that releases hormones over a one year time frame Thickens mucus, blocking egg

spermicide, IUD blocks egg

from implanting Must check string before intercourse and after shedding of uterine lining.

Check string before

intercourse & after shedding of uterine lining.

Hormonal Methods
Oral Contraceptives (Birth Control Pill) Injections (Depo-Provera) Implants (Norplant I & II)

Birth Control Pills

Pills can be taken to prevent pregnancy Pills are safe and effective when taken properly Pills are over 99% effective

Women must have a pap smear to get a prescription for

birth control pills Commonly used are Ethinyl oestradiol and medroxy progesterone

How does the pill work?

Stops ovulation Thins uterine lining Thickens cervical mucus

Positive Benefits of Birth Control Pills

Prevents pregnancy Decreases incidence

Eases menstrual
cramps

of ovarian cysts
Prevents ovarian and

Shortens period
Regulates period

uterine cancer
Decreases acne

Side-effects
Breast tenderness Nausea Increase in headaches Moodiness Weight change Spotting

Taking the Pill

Once a day at the same time everyday Use condoms for first month Use condoms when on antibiotics Use condoms for 1 week if you miss a pill or take one late The pill offers no protection from STDs

Injectable contraceptives
Birth control shot given once every three months to

prevent pregnancy
99.7% effective preventing pregnancy

No daily pills to remember

DMPA, NET-EN and DMPA-SC are commonly used

How does the shot work?

Stops ovulation

Stops menstrual cycles!!

Thickens cervical mucus

SIDE EFFECTS
Extremely irregular menstrual bleeding and spotting for 3-6 months! Weight change

Breast tenderness
Mood change

*NOT EVERY WOMAN HAS SIDE-EFFECTS!

IMPLANTS
Implants are placed in the body filled with hormone that prevents pregnancy Physically inserted in simple 15 minute outpatient

procedure
Plastic capsules the size of paper matchsticks inserted

under the skin in the arm

Norplant Implant

Emergency Contraception
Pills can reduce the chance of a pregnancy by 75% if taken within 72 hours of unprotected sex!

Emergency Contraception (ECP)

Must be taken within 72 hours of the act of unprotected intercourse or failure of contraception method Must receive ECP from a physician

75 84% effective in reducing pregnancy

ECP
Floods the ovaries with high amount of hormone and prevents ovulation Alters the environment of the uterus, making it

disruptive to the egg and sperm

Two sets of pills taken exactly 12 hours apart

Miscellaneous
Withdrawal Natural Family Planning Fertility Awareness Method Abstinence

Abstinence
Only 100% method of birth control Abstinence is when partners do not engage in sexual intercourse

Communication between partners is important for those

practicing abstinence to be successful

STERILIZATION
Procedure performed on a man or a woman permanently sterilizes Female = Tubal Ligation

Male = Vasectomy

LAPAROSCOPY-BAND-AID STERILIZATION

VASECTOMY
Male sterilization procedure Ligation of Vas Deferens tube No-scalpel technique available Faster and easier recovery than a tubal ligation Failure rate = 0.1%, more effective than female

sterilization

Thank You
Dr. Priya Rathi