Preventive Services in Child Health

Child Health - Preventive Services

• Many childhood, adolescent, and adult diseases can be prevented or lessened in severity with early detection.
• Preventive medical and dental services for children improve overall health by reducing preventable illnesses and diseases.
• Continuity of care is essential in children's preventative services to track physical, developmental, and emotional health trends over time.
• If providers change, a smooth transfer of complete information and records is needed for continuity.

Immunization

• Immunization prevents several easily preventable childhood diseases, contributing significantly to reduced morbidity and mortality.
• Key diseases covered by immunization include Tuberculosis (TB), Diphtheria, Pertussis, Neonatal tetanus, Poliomyelitis, Measles, and Viral hepatitis B.

Hepatitis B (HepB) Vaccine

• All infants should receive the first dose of Hepatitis B vaccine soon after birth and before hospital discharge.
• The second dose should be administered at least 4 weeks after the first dose.
• The third dose should be administered at least 16 weeks after the first dose and at least 8 weeks after the second dose.
• The final dose (third or fourth) should not be administered before 24 weeks of age.

Other Immunizations

• Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine
• Haemophilus influenzae type b (Hib) conjugate vaccine (2, 4, 6, 12)
• Measles, mumps, and rubella vaccine (MMR)
• Varicella vaccine (chickenpox) – Not a routine vaccination (<12, single dose or >13y, 2 doses 4wks apart)
• Pneumococcal vaccine
• Hepatitis A vaccine – Recommended for specific groups and regions, requiring at least 6 months between doses
• Influenza vaccine – Recommended annually for children 6 months and older with certain risk factors (asthma, cardiac disease, SCD, HIV infection, and diabetes); also recommended for household members of high-risk individuals

BCG Vaccine

• In developing countries, BCG vaccine is given intradermally for tuberculosis prophylaxis in the first year of life, often within the first week after birth.
• It is not typically recommended in developed countries due to low disease risk.

Health Checkups

• Newborns should be examined twice: within the first 24 hours after birth and just before discharge.
• Monthly health checkups throughout infancy are necessary, including during routine immunization sessions.
• Checkup data can assist in identifying children at risk of developing particular conditions.
• Screening or diagnostic tests and home visits may be necessary.

Health Checkups: Ages 0–18 Months and Beyond

• Medical history and exam at ages birth to 18 months/2 to 10 years/11 to 18
• Birth to 18 Months:*
• Height, weight, hearing, vision, head measurements, and growth, development, behavior assessment.
• Lead poisoning screening (9–12 months)
• Hematocrit/Hemoglobin (9–12 months)
• Tuberculin skin test (by age 12 months, annually for high-risk)
• HIV testing for infants born to mothers with unknown HIV status
• 2–10 years:*
• Medical history and exam: ages 2, 3, 4, 5, 6, 8 and 10
• Height, weight, hearing, vision, and growth, development, and behavior assessment
• Head measurement (until age 2)
• Blood pressure (starting at age 3)
• Cholesterol (from history or blood tests)
• Urinalysis (age 5)
• Tuberculin skin test (annually for high risk)
• 11–18 years:*
• Medical history and exam once a year
• Height, weight, hearing, vision, growth, development, and behavior assessment; BMI once a year
• Blood pressure – each visit
• Cholesterol (from history or blood tests); routine testing starting at 18
• Rubella vaccination history or blood test for females of childbearing age

Health Checkups: Additional Considerations

• Sexually active females: Urinalysis beginning at age 11, screen for sexually active individuals; routine HIV screening beginning at age 13, pelvic exam and Pap test once a year for women age 21 or within 3 years of first intercourse
• Follow-up for high-risk conditions:*
• other high-risk conditions including hepatitis A, B, C, Chlamydia, Gonorrhea, and HIV

Health Education

• Child Rearing: Proper cleaning, bathing, and importance of sun exposure
• Immunization: Benefits, timing, and possible side effects
• Family Planning: Indirectly related to child health

Nutritional Education

• Breastfeeding: Preferred food for infants; best protection against life-threatening illness; promotes healthy mother-infant bonding and birth spacing reducing infant mortality rates
• Initiation & Maintenance of Breastfeeding: Mother-infant bonding; early initiation; exclusive breastfeeding within the first 6 months of life; appropriate complementary semisolid food introduction after 6 months; continuation through at least the second year of life; avoidance of bottle or pacifier use.

Weaning Period Risks

• Malnutrition: Weaning foods tend to be less nutritious and less energy-dense than breast milk.
• Contamination: Weaning food contamination risk is higher, leading to diarrhea, and can exacerbate malnutrition.
• Diseases: Breastfeeding reduces the risk of allergies, asthma, autoimmune thyroid conditions, bacterial meningitis, breast cancer, celiac disease, Crohn's disease, diabetes, eczema, gastroenteritis, Hodgkin's lymphoma, necrotizing enterocolitis, multiple sclerosis, obesity, otitis media (ear infection), respiratory infection, rheumatoid arthritis, urinary tract infection, and others.

Safe Supplementary Feeding

• Begin at 6 months of age.
• Avoid abrupt weaning.
• Improve nutritional value of traditional weaning foods.
• Ensure food is freshly prepared
• Continue breastfeeding alongside supplements until the end of the second year of life
• Ensure hygiene and cleanliness during food preparation
• Introduce foods in small quantities and gradually increase amounts
• Avoid starvation during diarrheal episodes
• Introduce foods in an appealing and colorful manner.

Dental Education

• Oral Health: Causes and prevention of dental disease, proper oral hygiene (brushing), nutrition's effect on teeth, cleaning, scaling, and stain removal.
• Fluoride Application: Topical fluoride application prevents dental decay, and annual applications can reduce decay risk by up to 20% in high-risk individuals
• Dental Sealants: Clear plastic coatings to prevent decay in deep grooves on molars; application is effective