Well baby clinic

Dr. Khalid D. Al-HarbyMBBS,ABFM,SBFM

CONSULTANT FAMILY PHYSICIAN

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INFANT CARE

The health services given to a baby during the first year of life.

It is a function of the MCH centers ( in PHCC, and in some hospitals)

It is done through the “well baby clinics” = the clinics that are concerned with health care for all children under the age of 5 y.(started 1404 )

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Well baby clinic

Frequency of visits: (15) seven visits in first year (including visits at time

of vaccination) Two visits each year from 2-5 years Wt.,and Ht. For each p.r.n visit Every infant has a health card kept in the

PHCC containing the following information :

1) Name of parents2) Date of birth

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Cont…

3) Place of delivery4) Attendance at labor5) Type of delivery (NSVD, forceps, C.S,…)6) Health condition at birth (weight, length, and

any congenital anomalies)7) Social data of the family8) PMH, PSH9) Immunizations10) Measurements of wt., length, ? H.C and

comparison with the normal

DR/KHALID ALHARBY 5

كررت يتناصرون جمعهم أقبل القوم رأيت لمامذمم غير

في سد جدران كأنه والدفاع مارادونا يدعونمهاجم طريق

DR/KHALID ALHARBY 6

Equipments of WBC

Newborn baby weighing scales Weighing scales for older children Height scale fixed on the wall Measuring tape Infantometer Stethoscope and sphygmomanometer with

small cuff (pediatric) Torch

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Equipments

Examination table (couch) ENT and eye diagnostic sets Some attractive toys for babies Well baby register records and growth charts Posters denoting child growth and

development at different ages should be provided

Health education materials and facilities should be readily available

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Process

General examination : appearance, clothing Examine vision: ask the parents and observe the

child ( measure visual acuity at school entry and colour testing at 9-13 years)

Examine hearing:- examine hearing abilities for those under 5y.- Test child’s attention to noise\voice at 8-12 months of

age- Take parent’s notes on hearing- Arrange for audiometry for children before school

age

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Process

Growth measurements plotted on the charts. Children outside the averages are reexamined,

investigated, and treated or referred Developmental milestones are checked Detection and treatment of malnourished Health education to the mothers For ill children : vital signs, preparation and

teaching of ORS, nurse-doctor referral, and giving injections when needed

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من كل شر اتقاالرض من اقترب

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Growth indices - weight

At birth: 3-3.5 kg 1st 4 months: 3\4 kg per month 2nd 4 months :1\2 kg per month 3rd 4 months: 1\4 kg per month At the end of 4th month: 6 kg At the end of 1st year: 9 kg After 1st year: 2 kg per year

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Abnormal weight

Above 90th percentile Below 5th percentile No increase over 3 subsequent months Curve down in 2 subsequent visits

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Growth indices - HC

Between 97th and 3rd percentile At birth: 35 cm At 6 months: 43.8 cm At 1 year: 46.8 cm At 2 year: 49.1 year At 3 years: 50.2 cm At 4 years: 50.8 cm At 5 years: 51.3 cm

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Growth indices- height

At birth: 50 cm At the end of 1st year: 75 cm Thereafter: 5 cm per year Between 90th and 5th percentile

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Home visits

Should be done by the nurse of the WBC for the following children:

A. Delayed mile stones or delayed growth

B. Diarrhea : chronic OR recurrent acute

C. Social or psychiatric problems

D. Defaulters

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At risk children

I. Group A :1) Babies of working mothers

2) Babies of poor family (low income)

3) Loss of a parents, or divorce

4) History of mental or psychiatric disturbance of a parent

5) More than 7 children in the family

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Cont…

6) Non – breast feeders

7) Early weaning

8) Twins

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Management

Registration in risk records Regular follow up Call for defaulters Comprehensive health education Take out of registry if no problems by 6

months of follow-up

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Cont. at risk children

II. Group B :

9) Birth weight < 2500 gm.

10 ) Failure to gain weight in 3 successive visits.

11) Loss of weight in 2 successive visits

12) Weight below 80% of expected weight for his age

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Management

Registration in risk records Regular follow up ( at least 1 \ month) Call for defaulters Comprehensive health education Take out of registry if no problems by 6

months of risk removal

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Cont…at risk children

III. Group C :

13) Congenital abnormalities

14) Bronchial asthma

15) Diabetes mellitus

16) Handicapped ( mental or physical)

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Management

Shared care

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Child health card

o Two copies (one with the family and one in the WBC)

o It should contain the following :1. Family file number2. Child number in WBC3. Delivery information4. Growth and developmental measures in the first

5 years of life5. Immunization status6. Schedule of follow-up visits in WBC

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Health educationcontents

Care of newborn Dealing with infantile common problems Nutritional education (especially breast

feeding, weaning, and hygienic preparation of bottle feeding )

Family planning Growth curve and its importance

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Health educationmethods

A. Individual counselingB. Group discussionsC. Lectures D. Demonstration (using pictures, leaflets, posters

etc…) of the following :1) Feeding position2) Bathing3) Preparation of semi-solid foods in hygienic

methods 4) Preparation of ORS

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واسطة المهارةالى المبدعين

القمة