Child Health and Rights Quiz

Child Health - Early Screening

• The UNCRC defines a child as anyone under 18, unless a different age of majority is established by national legislation
• A neonate is a child less than 28 days old
• An infant is a child less than one year old
• An adolescent is a person aged 10 to 18 inclusive

Why Focus on Child Health?

• Children are a vulnerable population segment
• Children depend on adults for development and survival
• Childhood is a critical period of rapid growth and development, making children susceptible to infections due to their immature immune systems
• Many child deaths are preventable
• Childhood illnesses contribute significantly to the global burden of disease
• Evaluating childhood health is a metric for societal progress

Highlight on the Problem

• In 2018, an estimated 6.2 million children and adolescents under 15 died from preventable causes
• Neonatal period is the time of highest risk for death in children
• 1 in 26 children died before reaching age 5 in 2018
• 1 in 11 children died before reaching age 5 in 1990

Deaths by Age (2021)

• A breakdown of global deaths by age groups in 2021 was presented in the provided data.

Infant Mortality Rate (2020)

• A map showing the global distribution of infant mortality rates in 2020 was presented.

Number of Child Deaths (1960-2020)

• A graph illustrating changes in the number of child deaths worldwide from 1960 to 2020, showcasing trends and reductions over time, is presented.

Child Mortality Rate (1960-2020)

• A graph showing the global child mortality rates, broken down regionally, from 1960 to 2020.

Causes of Death

• Causes of death vary by age; neonatal-period issues might necessitate clinical interventions, whereas public health strategies can more readily address issues beyond the neonatal period
• Most interventions linked to prenatal and maternal care interventions decrease neonatal mortality.

Leading Causes of Death (2018)

• Preterm birth complications were the leading cause of death among children under five in 2018.
• Other significant factors like pneumonia, intrapartum related issues, congenital anomalies, diarrhea, neonatal sepsis and malaria are among the key contributors to child mortality.

Factors Affecting Child Health

• Poverty
• Poor nutrition
• Lack of access to healthcare
• Lack of maternal education
• Conflict and disaster
• Lack of safe water and sanitation
• High fertility rate
• Poor maternal health services

Morbidity Causes in Children

• Vitamin A deficiency is a global leading cause of preventable blindness in children.
• Iodine deficiency is a preventable cause of development delay in children
• Iron deficiency affects over 50% of children which causes anemia, and reduces school performance.
• Helminthic infections cause anemia, poor growth and decreased learning capability.

In Jordan

• Child and infant mortality considerably decreased between 1997 and 2012 in Jordan, yet the decrease did not meet global targets.
• Neonatal mortality constitutes more than 70% of child mortality under 5 years of age
• Many of the deaths under 5 years (one-third) are preventable
• Diarrhea, respiratory infections, and other infectious diseases and injuries were other major causes of mortality in this age group as well.

Health Services in Child Health

• Monitoring growth and development
• Care in illness
• Preventive and promotive care

Monitoring Growth and Development

• Growth and development are the two primary biological processes of childhood.
• Growth is an increase in physical size, encompassing both overall body growth and the growth of individual body parts. This is associated with increasing cell number / size
• Development involves acquiring abilities and skills, including motor, social, emotional, and intellectual development.

Stages of Growth and Development (Intrauterine Stage)

• The intrauterine stage starts with fertilization and ends with birth
• Embryonic Period: It encompasses the period of organogenesis which takes place in the first trimester of pregnancy, any adverse factors in this stage may lead to congenital anomalies or miscarriage
• Fetal Period: In this phase, the mother provides nutrients and immunoglobulins to the fetus, and any conditions like stillbirth, early labor, and low birth weight.

Stages of Growth and Development (Extrauterine Stage)

• At birth, average body weight falls in the range of 2.5-4.2 kg
• Neonatal Period
• Infancy Period
• Childhood Period
• Adolescence Period

Factors Affecting Growth and Development

• Genetic factors like ethnicity are fixed, hard to modify, and impact growth from conception to adulthood
• Environmental factors like nutrition, infections during infancy and childhood, and inadequate stimulation/care affect growth and development

Growth Monitoring

• The main purpose of growth monitoring is to track healthy growth and detect any indications of slowed development to promptly address these concerns.
• Checking for growth monitoring will indicate the overall nutritional status of the child
• Identifying high-risk children requiring immediate attention, recognizing growth abnormalities linked to underlying conditions can be achieved by growth monitoring.
• Prevention of underlying nutritional disorders that lead to mortality and morbidity is another goal of growth monitoring.

Assessment of Growth

• Longitudinal assessment: Tracking growth over time by measuring at regular intervals
• Cross-sectional assessment: Comparing large numbers of children of the same age at a given point in time to evaluate growth
• Basic growth assessments typically measure weight, height, and head circumference.

Assessment of Growth (Charts)

• Weight-for-age charts are commonly used metrics to assess growth in children.
• Infants or children who weigh less than the expected range can be classified as underweight or severely underweight according to growth charts
• Average weight gain for children during their first year is around approximately 750 g per month in the first four months. 500 g/month in the following four months, and 250g/month for the third set of four months.
• Infants double their birth weight by 4-5 months, triple by the end of the first year, and quadruple by the end of the second year.
• Length or height is measured for infants below the age of 2 years while laying down, for children above the age of 2 years while standing. Average length at birth is around 50 cm and length or height may increase 25cm in the first year, 90cm at 3 years and 100 cm at 4 years of age.

Growth Charts

• Growth charts are visual aids developed to record and track child's physical growth and development
• WHO growth charts, primarily designed for monitoring children's health and nutritional status over time
• WHO growth charts are international norms that outline expected growth patterns in children, tailored for breastfed children up to the age of 2.
• X-axis represents the child's age (or age in months/years)
• Y-axis shows the measured weight, height, length, or BMI

Indicators Used to Assess Growth

• Length/height for age
• Weight for age
• Weight for length/height
• BMI for age

Identifying Growth Problems

• Length-for-age: Children with length scores below -2 are considered stunted, below -3 are severely stunted
• Weight-for-age: Children below -2 have significant underweight, while -3 indicates severe underweight.
• Weight-for-length: Scores exceeding 3 indicate obesity in children, 2 indicates overweight, and 1 indicates possible risk of overweight; -2 indicates wasting, while -3 denotes severe wasting
• BMI-for-age: 3+ above the line indicates obesity; 2+ above the line indicates overweight; BMI scores below -2 or lower indicate potential risks or wasting conditions

Development Assessment

• Development in children depends on nervous system maturity (myelination)
• Development usually follows a consistent sequence but can vary in pace among individuals
• Development generally proceeds from head to toe (cephalocaudal).

Development Assessment (Aspects)

• Motor development involves skills such as standing & sitting; fine motor abilities such as finger and eye movements
• Psychological aspects of development such as attachment to caregivers, vocalization milestones (around 9 months of age), and emotional aspects such as fear development (7–8 months)

Factors Predisposing Delay in Development

• Lack of family guidance or support
• Lack of environmental stimulation
• Emotional deprivation
• Health problems (e.g., malnutrition, congenital anomalies, rickets)

Newborn Screening of Jordan

• The goal is to identify congenital and heritable disorders through a staged approach.
• Newborn screening involves lab analysis of blood samples
• Identified abnormalities are reported to case management/clinics
• Families receive follow up appointments to confirm the test results

Expanded Newborn Screening Program Conditions in Jordan

• Includes 29 conditions (such as 20 inborn errors of metabolism, 3 hemoglobinopathies including sickle cell disease, 2 endocrine disorders, 1 hearing loss disorder, and 3 other metabolic disorders)

Hemoglobinopathies

• Worldwide, ~7% of population carries a hemoglobinopathy with clinical significance
• Screening via isoelectric focusing detects abnormal patterns indicative of the condition
• Early identification enhances the ability to initiate timely treatment for hemoglobinopathy related conditions

Hemoglobinopathies: Study Example (Northern Jordan)

• Study on 6-10-year-olds in Northern Jordan Valley identified both alpha- and beta-thalassemia.
• HbS gene frequency is low.
• HbS/β-thalassemia co-occurrence is observed.
• Prevalence of the conditions vary across geographical regions of Northern Jordan (Al-Ghor, Ajloun, Irbid)

Cystic Fibrosis

• Genetic disorder affecting mainly lungs, pancreas, liver, and intestine; caused by abnormal chloride/sodium transport across epithelium; leads to thick, viscous secretions
• Newborn screening usually involves measuring immunoreactive trypsinogen (IRT) in dried blood spots

Hearing Loss

• Undiagnosed hearing loss in children significantly impacts development in language, social interaction, and academic performance
• Early identification is critical for accessing resources to assist children's development

Congenital Heart Defects Screening

• Pulse oximetry a recently implemented bedside test for identifying critical congenital heart defects.

Screening in Early Childhood

• Recommended screenings include Anemia, TB, Lead, Urinalysis, and Cholesterol
• In Jordan, Anemia is also one of the screens done.

Anemia

• Newborn screening often includes hemoglobin electrophoresis (to identify hereditary conditions)
• Age-based anemia screening (particularly iron deficiency anemia) and routine testing in adolescence are common practices

High-Risk Groups for Anemia

• Infants fed formula or cow's milk before 12 months without sufficient iron supplementation
• Breastfed infants older than 6 months without adequate iron supplementation
• Children who consume more than 24 ounces of cow's milk daily
• Children with special health care needs

When to Screen Children?

• Preterm and low-birth-weight babies require screening before 6 months, and again in 6 months' time if not initially on iron-fortified formula
• Children and infants with risk factors should be screened at 9 to 12 months and again 6 months later
• All non-pregnant women should be screened every 5 to 10 years

Screening in Middle Childhood and Adolescence

• An integrated, sequential set of school-based strategies to support optimal physical, emotional, social, and educational development in children
• Tailored to the local community's specific needs, resources, requirements
• The screening program should include the environment of the school, health promotion and screening, special needs assessment, and health instruction

Screening in Middle Childhood/Adolescence: Specifics

• School entry
• Annual screenings
• Advantages of the method
• Screening can be done by health care workers or teachers

Screening Recommendations: School-aged Children & Adolescents

• Learning processing assessment; Speech evaluation, Vision testing; Auditory evaluation; Dental screening; Obesity assessment; Hemoglobinopathy screening; Malnutrition assessment; Strep infection screening; Heart disease assessment; Blood pressure assessment; Depression assessment

Screening for Visual Problems

• Routine vision testing is recommended at specific ages (5, 6, 8, 10, 12) by pediatricians.
• Visual acuity testing using age-appropriate methods (e.g., Snellen chart) is also important.
• Children with visual acuity less than 20/40 are often further evaluated.

Screening for Visual Problems (Conditions)

• Myopia
• Hyperopia
• Squint
• Thick cornea
• Conjunctivitis
• Other eye conditions, requiring early intervention to avoid negative effects on learning abilities

Screening for Hearing Problems

• The Bright Futures Steering Committee recommends screening for hearing loss in children at ages five, six, eight, and 10, with additional risk assessments for well-child visits.
• The assessment utilizes an audiometer, and children failing the test are referred for further evaluation.
• Early detection and treatment of hearing impairments can have a positive impact on children's learning abilities

Screening for Obesity

• 17% of children & adolescents in the U.S. are obese
• Obesity increases the risk for developmental and health issues (e.g., T2 diabetes, high blood pressure, high cholesterol, joint, sleep issues, and psychological problems).
• AAP recommends obesity screening for children aged 2 years and older, preferably yearly.
• Assessing weight, height, age and sex helps determine BMI percentile
• Screening process typically includes BMI percentile information on the standardized growth chart, a description of the results, recommendations

Screening for Obesity (Categories)

• Overweight (BMI between 85th and 94th percentile)
• Obese (BMI at or above 95th percentile)
• Screening results typically include these details: child's BMI-for-age percentile, results explanation, and follow-up action recommendations.

Dental Screening

• Oral diseases affect 98% of Americans
• Regular dental screenings are recommended.
• Screening identifies dental issues early when treatment is most effective and least painful
• Screenings can be done using a tongue depressor, gloves, and a flashlight.

Dental Screening: Categories of Conditions

• Tooth decay
• Gum disease
• Dental abnormalities and irregularities
• Dental injuries and fractures
• Oral tumors
• Other oral disorders and infections