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Recommendation for practice

The birth certificate form (T.r. 1/1) in this handbook signed


by health personnel to certify the birth of the child is neither
an official birth certificate nor birth registration. Parents should
contact the district or local registration officer at district/
sub-district office, municipality office, or Bangkok
Metropolitan Administration Office to register the birth of the
child in order to get an official Birth Certificate and to add the
childs name into the household record within 15 days after
birth. Parents should bring with them this handbook, a copy of
household record, and the identification card of the childs
mother or father when registering for the official Birth
Certificate. If you register later than 15 days, you as the
parents, will be fined for 1,000 baht by the law.

Documents required for official birth registration :


1. A copy of household record.
2. Identification card of the childs mother or father.
3. Marriage license of the parents (if any).

For your childs well-being:


If the mother is physically and mentally
healthy, then the child will be healthy and happy.
Good physical and mental health of mother has resulted from the
good care of the husband.

Name-Surname of Child
Please do not lose
this handbook
Please bring this handbook with you every time you come in for services
at the government and private hospitals.
This handbook can be used as a reference for obtaining your babys Birth Registration Certificate,
and adding your childs name into the household record
Ministry of Public Health 2555 (2012)

Good Practice of Mother for Bringing a Healthy Child


1. Having children at the ages between 20-35

6. The childs birth-weight is 2,500 grams

years
Spacing between each child for at least 2
years.
Together with the husband, having ANC
visit soonest before 12 weeks of gestational age, following every appointment of
ANC visits, and having the delivery by
medical and health personnel.
Receiving complete doses of T.T.vaccine.
Having self-practice during the pregnancy
delivery, and postpartum periods as recommended in MCH handbook.

or more.
Having the baby suck breastmilk
instantly after birth with exclusive
breastfeeding for at least 6 months,
continuing breastfeeding for at least 24
months along with other food for ages.
Bringing up a healthy child without
malnutrition and obesity.
Promoting the childs age appropriate
development as recommended in MCH
handbook.
Bringing the child to receive vaccinations on appointments.

2.
3.

4.
5.

7.

8.
9.
10.

Mother and Child Health Handbook


Published by Bureau of Health Promotion, Department of Health, Ministry of Pubic Health, Thailand
Total
102 pages
1st Printing: 1400 copies
Printing Office : The Veteran Press, Bangkok
Chaiman of Advisory group
Dr.Vichai Tienthavorn
Former Permanent Secretary, Ministry of Health
Consultants
Dr.Somyos Deerasamee
Director-General, Department of Health
Dr.Somsak Pattarakulwanich Deputy Director-General, Department of Health
Dr.Sompong Sakulisariyaporn Director of Bureau of Health Promotion,
Department of Health
Editors
Dr.Nipunporn Woramongkol
Bureau of Technical Advisors Department of Health
Dr.Sirikul Issaranurak
Professor Emeritus, Mahidol University
Dr.Sarawut Boonsuk
Chief of Maternal and Child Health Group
Mrs.Nareeluck Kullurk
Public Health Technical Officer, Senior Professional Level
Mrs.Chailai Leartvanangkul
Public Health Technical Officer, Senior Professional Level
Ms.Sukjing Worngdechakul
Nutritionist, Senior Professional Level
Mrs.Jintana Pattanapongthorn Public Health Technical Officer, Senior Professional Level
Mrs.Nongluk Roongsubsin
Dissemination Technical Officer, Senior Professional Level
Mrs.Prapaporn Jungpanich
Public Health Technical Officer, Professional Level
Mrs.Isaree Jedprayuk
Public Health Technical Officer, Professional Level
Ms.Chaweewan Tonputsa
Public Health Technical Officer, Professional Level

ID
General Identification Number ..........................................
(Pregnant woman)

Child's

General Identification Number (Child)................................ Photograph


Firstly Issued at...................................................................
Name-surname of pregnant woman............................................................
Identification Number
Occupation............................. Religion................................................
Education (Highest educational attainment).......................................
Telephone number...............................................................................
Name-surname of the husband...................................................................
Identification Number
Occupation............................. Religion................................................
Education (Highest educational attainment).......................................
Telephone number...............................................................................
Current address No.............. Moo..............Name of village........................
Soi..............................Street...........................Sub-district.............................
District...................... Province...........................Zip Code
Name-surname of the child........................................ Blood group............
Date of birth.........Month................ Year 20...... time of delivery....... hrs.
Identification Number

If anyone picks up or finds this handbook, please reture it to the above address

Introduction to the Use of MCH Handbook


This MCH handbook is a personal health record for the mother
during pregnancy, intra-partum, and post-partum periods, and for the
child since birth up until 6 years of age.

Advantages

A source of knowledge and record for the health of mother and


child from pregnancy up until the child is 6 years old.
Helping the father and mother to take appropriate care for their
child from birth up until 6 years olds.
Providing an evidence for notification of birth and obtaining a
birth certificate using the form T.R.1/1 signed by the birth attendant presented in this handbook.

Instruction

Read through and follow all the contents in this handbook.


Bring along this book whenever you receive services at any
health facilities.
Record the data all by yourself and have your husband record
the data on the pages as identified.
When your child attends school, hand over this book to the
teacher for continuous care of the childs health.
If the book is torn or lost, obtain the new one from health
personnel.

If you have any doubts or questions about this


handbook, please ask the health personnel

CONTENTS
Page

Page

General I.D. number (pregnant woman) 1


Introduction to the use of MCH handbook 2
Part 1 Pregnancy
4
Health history of pregnant woman
4
and family
Risk assessment criteria for pregnant
5
woman at the 1st ANC visit
History of current pregnancy
6
Pregnancy examination record
7
Checklists of care for quality pregnant
9
woman
Checklists of service inclusion by
10
gestational age
Uterine heigh graph
11
Fetal movement count
12
Maternal delivery record
15
Record of the newborn
16
Part 2 Child Care
17
Risks assessment in mother and
17-18
newborn (prior to hospital discharge)
Oral health for children aged 6
19
months 5 years
Child Development and service
20-39
activities for children aged 1 month4 years
Head circumference graph
40-41
(separated for male and female)
Guide to the use of child nutritional graph 42
Child nutritional graph
43-54
Part 3 Essential Knowledge for Safe
55
and Quality Pregnancy
Discomforts during pregnancy
56
Maternal practice during pregnancy
57
Table of minimum weight for pregnant
58
woman to give birth to a newborn of
2,500 g.
Self care during pregnancy using
59-60
pregnancy pathway chart
Table of minimum weight for pregnant
61

woman to give birth to a newborn


> 2,500 g.
Advantage of nutritional graph
63
Nutritional graph for pregnant woman
64
Nutrition for pregnancy women:
65-66
Table for comparison of percentage
of standard BMI values (BMI 21 = 100)
Illustration of sets of food exchange 67-68
for pregnant woman
Fetal development
69
Thalassemia
70-71
What is hypothyroidism?
72
Prevention of mother-to-child
73
transmission of HIV
Family planning
74
Self assessment and analysis
75-76
of stress
Part 4 Child related knowledge to bring
77
up a healthy, brilliant, good, happy child
Breast-milk is the first drop of family
78
love bond
Food for infant at birth 12 months 79-80
Adequate amount of daily food intake
81
for a child 1 5 years
Caring for your child
82
Caring for your child suffering from
83
respiratory tract infection
Caring for your childs teeth
84
Vaccinations guide
85
Miracle of reading
86
Guide to bringing up a brilliant, good,
87
happy child
Suggestion for parents and guardian in
88
recording the childs development
Child development promotion
89-97
Risks and guide to prevention of
98-100
injuries in early childhood
Childs vaccination record
101
Next appointment date for health exam 102

PART 1: PREGNANCY

PART 1: PREGNANCY
Health History of Pregnant Woman and Family
(recorded by pregnant woman)
Having been married for........yrs. Use......as a contraceptive method for.years/.months.
Most recently stop using contraception before pregnancy for.yrs./.months.

Pregnancy History
Pregnancy D/M/Y
delivery/
abortion

Gesta- Delivery/ Method Birthtional abortion


of
weight
age(wks)
delivery/
abortion

Sex

Place Complica- Current


of
tions Status of
delivery/
infant
abortion

1
2
3
4
5
6
History of Illnesses
Diabetes
Hypertension
Heart Disease
Thyroid
Anemia
Thalassemia
Others................................
History of surgeries ...................in the year........at.......................................Hospital
...................in the year........at.......................................Hospital
History of drug allergy Name of the drug..........................Symptom.................................
Name of the drug..........................Symptom.................................
History of illnesses and pregnancies of family members
Seizure
Diabetes
Hypertension
Congenital anomaly
Multiple pregnancy
Mental retardation
Others....................
History of menstruation cycle Regular/irregular menstruationand at every..days

PART 1: PREGNANCY

Risk Assessment Criteria


for
st
Pregnant Woman at the 1 ANC Visit
(assessed by health personnel)
Item

1.
2.
3.
4.
5.
6.

7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.

Criteria for Assessment

No

Yes

Past History
Stillbirth or neonatal death (first 1 month)
3 consecutive abortions
Having baby with birth wieight < 2,500 g.
Having baby with birth wieight > 4,000 g.
Hospitalized for hypertension treatment during pregnancy or
toxemia of pregnancy
Undergone surgery of reproductive system organ such as
myoma, mypmecomy, cervical cerclage, etc.
Current History
Multifetal pregnancy
Age < 17 years (up to EDC)
Age > 35 years (up to EDC)
Rh Negative
Vaginal bleeding
Pelvic myoma
Diastolic pressure 90 mmHg
Diabetes
Kidney disease
Heart disease
Drug addiction, alcohol addiction
Other diseases of internal medicine such as anemia, thyroid,
SLE, tc. (please specify)..............................................................

If any of the responses fall into Yes, the new approach of pregnancy care is not
applicable to the pregnant woman and special care and/or additional assessment
should be employed.
Assessor..Date

PART 1: PREGNANCY

History of Current Pregnancy


(recorded by health personnel)
Pregnancy #........Last menstrual period.......................Expected due date.....................
Weight before pregnancy.......kg. Height.......cms. BMI before pregnancy.................
Number of C/S.......Number of living children.........Age of the last child........yrs.......months

Laboratory Test

1st time
2nd time
Blood test for HBsAg
1st time
Blood test for Hematocrit 1st time
2nd time
STIs (VDRL)

Date...................... Result.......................
Date...................... Result.......................
Date...................... Result.......................
Date...................... Result.......................
Date...................... Result.......................
Screening for Thalassemia (Wife) Date......................
Result OF............DCIP..............MCV..............
(Husband) Date......................
Result OF............DCIP..............MCV..............
Blood group and
(Wife) Blood group......Rh......Hemoglobin type....
Hemoglobin type
(Husband) Blood group......Rh......Hemoglobin type....
Other examination results...........................................................................................
Couple counseling Pre-blood test Date......................
Pre-blood test Date......................
Participation in parental school activities 1st time at gestational age............months
2nd time at gestational age............months

Tetanus Toxoid Vaccination


(Recorded by health personnel)
Received vaccination before pregnancy..............times.
Date of most recent vaccination.......................................................................................
Vaccination is not given for this pregnancy as the 3rd dose was given no more
than 10 years or with previous tetanus vaccinations for 5 times.
1st Dose, date.............................................................................................................
2nd Dose, date............................................................................................................
Booster Dose, date......................................................................................................

Stories and tales promote your child's intelligence with the sense of morality

PART 1: PREGNANCY

PART 1: PREGNANCY

7
Result of U/S exam, day....................................

BPD.......................................FL.............................
Fetal position......................Gestational age.............
Date Weight
of
Kg.
Exam

Urine Exam

Bacteria/
Protein/Sugar

Record of Pregnancy Examination


(recorded by health personnel)

Blood Size of
Fetal
Fetal
Fetal
Gestational
Pressure Uterure position/ heart movement age (wks.)
mm.Hg. (cm.) presentation sound

Corrected EDC...................
By LMP
PV U/S
Ut Size
GA............wks Sign...............Date..................

General physical
exam and risks
assessment

Diagnosis and Appointment Officer


Treatment
Place

Diabetes screening.............................................................................................................. Other special exam...............................................................................................................

.............................................................................................................................................................................................................................................................................................

PART 1: PREGNANCY

PART 1: PREGNANCY

10

Checklists of Service Inclusion by Gestational Age


(recorded by health personnel)
1st Visit, Date
(should be before 12 weeks)
Date.........(should

Checklists of Service Inclusion by Gestational Age


(recorded by health personnel)

Weeks

<12 20

1.
2.
3.
4.

Check classifying form, no high risks


Check weight, height, blood pressure
General physical examination
Urine exam (Multiple dipstick) for protein, sugar,
asymptomatic bacteria
5. Transfer to the doctor for lung and heart
sounds exam
6. Pelvic exam (may postpone to the 2nd visit)
7. Test for Hb/Hct/OF/DCIP (every gestational age)
and test for VDRL, Anti HIV, blood gr, Rhtyping,
HbsAgr
8. Give the 1st dose of tetanus toxoid vaccine
9. Give iron and/or folic, and iodine supplementation
10.Give advice in case of emergency with
abnormal signs, with telephone number for
emergency contact
nd
2 Visit, Date..........................................(20 weeks)
1. Check weight, blood pressure
2. Pelvic exam (in case not performed at the 1st
visit)
3. Ultrasound exam (if applicable)
4. Give iron, iodine, calcium supplementation
5. Give the 2nd dose of tetanus toxoid vaccine
(at least 1 month interval of the 1st dose)
6. Give post-test counseling for the blood result
and abnormal signs, with telephone number for
emergency contact
Source : WHOs guide to new approach of pregnancy care practice.

26

3nd Visit, Date


(should be before 26 weeks)
Date.........(should

32

38
1. Check weight, blood pressure
2. Test urine for protein, sugar
3. General physical examination, check for anemia,
edema
4. Pregnancy exam, estimate gestational age,
measure uterine height, Listen to fetal heart
sound
5. Give iron, iodine, calcium supplementation
through the pregnancy period
6. Advice mother to observe fetal movement
7. Give advice in case of emergency with
abnormal signs, with telephone number for
emergency contact
th
4 Visit, Date...........................................(32 weeks)
1. Test for Hb/Hct, VDRL. Anti HIV
2. Give advice about delivery, breastfeeding plan,
contraception
th
5 Visit, Date............................................(38 weeks)
1. Check fetal position, if breech presentation,
refer to ECV or CS
2. Record in ANC booklet, remind of bringing it
along when coming for delivery
3. If delivery does not occur at 41 weeks of
gestation, give advice to come to the hospital

Weeks

<12 20

26

32

38

PART 1: PREGNANCY

11

Uterine Height Graph


(recorded by health personnel)

Uterine height (cm.)

Figure 4 : Uterine height values by weeks of gestation


40
38
36
34
32
30
28
26
24
22
20
18
16
14
12
10

20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41
Gestational Age

40
38
36
34
32
30
28
26
24
22
20
18
16
14
12
10

Oral Health Exam


(recorded by health personnel)
Record of oral health exam at ANC visit
Tooth decay
Yes(number....)
Ginggivitis
Yes
Calculus
Yes
Examiner .............................................
Date of Exam ......./........./.......

No.
No.
No.

Record of oral health service at prenatal


Teaching on oral gem control
Number of fillng teeth..................
Number of removing teeth ...............
Scaling
Attendant .....................................
Date of Exam......../............./..........

Talk to the baby in your womb everyday to create your baby.

PART 1: PREGNANCY

12

Fetal Movement Count


(Recorded by pregnant woman)
1. Counting fetal movement is to prevent fetal death possibly occurs especially
in the mothers with complications such as diabetes, hypertension, toxemia of
pregnancy, approaching or beyond the due date of delivery.
2. Begin to observe and count the frequencies of fetal movement from 6 months
of gestational age up until delivery.
3. Observe fetal movement everyday and record at least 3 times a day.
4. Observe fetal movement when you are free from work such as after a meal,
before bedtime, or getting up in the morning, etc.
5. Fetal movement is when you feel your baby moves in your abdomen, if you
only feel abdominal tense or your baby stretches up, it is not considered a
fetal movement.
6. If you are doubtful, not understand or unable to do so, consult your doctor or
nurse immediately.
7. During 1 hour of observation, you should feel fetal movement at least 3
times, if not or less than 3 times in 1 hour, see your doctor or nurse promptly
for additional exam such as to check fetal heart rate with modern device.

Date

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Month
Morning Daytime Before Date Morning Daytime Before
bedtime
bedtime
(time) (time) (time)
(time) (time) (time)

17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

PART 1: PREGNANCY

13

Date

Month
Morning Daytime Before Date Morning Daytime Before
bedtime
bedtime
(time) (time) (time)
(time) (time) (time)

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

Date

Month
Morning Daytime Before Date Morning Daytime Before
bedtime
bedtime
(time) (time) (time)
(time) (time) (time)

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

When your baby moves 1 time, mark / in the grid


more then 3 /// should be marked in 1 hour of observation

PART 1: PREGNANCY

14

Record of Fetal Movement Count(continued)


Month
Date

Morning Daytime Before


bedtime
(time) (time) (time)

Date

Morning Daytime Before


bedtime
(time) (time) (time)

17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16

Abnormal signs during pregnancy to be promptly seen


by the doctor or health personnel

Headache, blurred vision


Stomachache, abdominal pain
Vaginal discharge
Irritable bowel Syndrome
Fever

Vaginal bleeding
Fluid from vagina
Less fetal movement
convulsions and coma

PART 1: PREGNANCY

15

Maternal Delivery Record (record by health personnel


Place of delivery.......................................by
( ) Doctor
( ) Nurse
( ) Others (specify)...................................................................................
Gestational age...........................weeks Mode of delivery...............................
Intrapartum complication
Yes (specify)
Postpartum complication

No

.............................................................

Yes (specify)

No

.............................................................

Record of Postpartum Check-up


Date of Blood Level Lochia Breast Flow of Hygiene of Name of
exam Pressure of
and Breast-milk Umbilical examiner
Uterus
Nipple
cord

Postpartum Check-up: Week 1 2, at


Week 6, at

least 1 time
least 1 time

Abnormal signs during postpartum period to be promptly seen


by the doctor or health personnel

Postpartum hemorrhage, blood clot


High fever for 2 days
Lochia with foul smell, turbid, or
red color for more than 2 weeks

Uretritis, obstructed urine, retention


of urine
Perineum pain, edema, or broken
wound
Sore nipples or mastitis

Postpartum check-up, safe motherhood

PART 1: PREGNANCY

16

Record of the Newborn (recorded by health personnel)


Date/month/year of birth..........................Sex.............Birth-weight................grams
Length...................................cms. Head circumference.................................cms.
Apgar Score (1 minute)................................... (5 minutes)....................................
Congenital anomaly
Yes (specify).............................................................
No
Health condition at birth
Healthy
Abnormal (specify)..........................
Date of hospital discharge.................Weight at the date of discharge.................
Vitamin K injection
Yes
No
Newborn screening
Date............................................
- Thyroid deficiency
Normal
Abnormal
- PKU
Normal
Abnormal

The newborn should be promptly seen by the doctor or


health personnel if displays the following abnormal signs

Jaundice
Refuse suckling
Raised body temperature, fever,
No urination within 24 hrs.
drowsiness
Rapid breathing over 60 breaths/minute or difficult breasting
Swelling, redness, leaking pus at the umbilicus, eyes or skin
Diarrhea and/or vomiting

Yellow stool is normal in a child.


If your child had white or pale yellow stool as in the picture below,
bring your child to the doctor promptly as he or she may have liver or
bile duct disease that needed to be treated before 2 months old.

PART 2: CHILD CARE

17

PART 2: CHILD CARE


Assessment of Risks in Mother and Newborn
(prior to hospital discharge) (recorded by health personnel)
Maternal History
1. Risk group for 6-month exclusive
breastfeeding
2. History of illness effecting child
raising
3. Less than 17 years of age
4. Father or mother or relative
raising the child alone.
5. Blood test
- HBsAg+
6. History of a genetic disease about
hearing
7. BMI < 18.5 before pregnancy
8. Malnutrition from 20 weeks of
gestation and beyond
9. Other risk conditions

Yes

No

Uncertain Unknown

Additional details
Item 11.
Item 22.
Item 99.

Risk group for 6 month exclusive breastfeeding refers to the mothers


with abnormal nipples/working outside the home.
History of illness effecting child raising refers to requirement of regular
medication or mental illness.
Other risk conditions such as undesirable pregnancy, tobacco, alcohol,
and substance uses, etc.

PART 2: CHILD CARE

18

Child History
Yes
1. Premature birth (gestational age
< 37 weeks)
2. Birth-weigh < 2,500 grams.
3. Hypoglycemia
4. Hyperbilirubinemia
5. Birth Asphyxia at 5 mins 4 and
with complication
6. Sepsis
7. Convulsion, Meningitis
8. Difficulties in suckling-swallowing,
poor suckling
9. Down Syndrome
10.Congenital Anomaly (as determined
by the doctor)
11.Anemia Central Hct < 40% (at < 7
days of age)
12.Others (specify)..................................

No

Uncertain Unknown

Family history
- History of genetic diseases, hearing,
mental retardation in the family

Remarks

If with more than 1 risk, indicating the high risk case, make an
appointment to see the doctor at 1 month old.
If none of risks, make an appointment at 2 months old at wellbaby clinic.

PART 2: CHILD CARE

19

Oral Health Record for Children Aged 6 Months-5 Years


(recorded by health personnel)
Age

months months year

1/2

year year

D/M/Y of Check
up
Having sweeten
milk
Using Bottle
feeding
Having sweet
Time/day
Brushing teeth
everyday by
parents
Using fluoride
toothpaste
Having plaque
Initial stage of
tooth aecay
Having tooth
cavities(number)
Advice tooth
Treatment
Attendant
Source : Bureau of Dental Health, Department of Health

1/2

year year

year

year

PART 2: CHILD CARE

20

Child Development at 1 Month Old ( 7 Days)


(recorded by parents or caregiver)
Yes

No

Child development
Stares at faces
Follows objects with eyes along the body midline
Makes sound (ask)
Lifts head (ask)

Food and nutrition


Exclusive breast-milk

Record of parents about the child and problems


that require counseling

...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
Consult the doctor or health personnel if the child tends to exhibit poor
development or any of the following signs.
At 3 months, no eye contact, no smiling back, no head lifting when lying
on stomach
Red or inflamed umbilicus
Self rolling over before 3 months, may due to tight muscle

Strat having your breastmilk pressed and kept in the fridge, when your child is 1 month old.

PART 2: CHILD CARE

21

Service Activities for Children at 1 Month Old ( 7 Days)


(Recorded by health personnel)
Date of examination............................................
Weight............. kg. Length............ cm. Head circumference.........cm.
Nutritional status

.................................................................................................................
.................................................................................................................
Check physical appearance, eyes, ears, mouth, heart, abdomen, sexual
organ, legs, arms, anterior fontanelle, posterior fontanelle (check
thoroughly), if not possible to complete all, check for the heart sound.
Additional check with the childs development in case with doubts.

.................................................................................................................
.................................................................................................................
Problems with child raising and health (ask from the caregiver) include:

.................................................................................................................
Parental school arrangement
Yes
No
Advices given:
How to use MCH handbook
Exclusive breastfeeding
Food for mothers
Promoting child development in subsequent ages
Accident prevention............................................................................
Refrain the child from wearing gloves, sucking finger, using pacifier,
traditional medicine, throat paint.
Others .............................................
Referral in case of abnormalities and for care and treatment
No
Yes, specify......................................

Do not use bottle milk supplementation with an idea that you have less
breastmilk because our body can produce sufficient milk supply for the baby.
Supplemrnted bottle milk will affect lower amount of breastmilk
and eventually dried up.

PART 2: CHILD CARE

22

Child Development at 2 Months Old ( 7 Days)


(recorded by parents or caregiver)
Yes

No

Child development
Social smile (ask)
Follows through with eyes along the body midline
Babbles (ask)
Lifts the head 45

Food and nutrition


Exclusive breast-milk

Record of parents about the child and problems


that require counseling

...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
Consult the doctor or health personnel if the child tends to exhibit poor
development or any of the following signs.
At 3 months, no eye contact, no smiling back, no head lifting in prone
position
Red or inflamed umbilicus
Self rolling over before 3 months, may be due to tight muscle

Teach the caregiver to feed the baby with your breastmilk by drinking from the glass.

PART 2: CHILD CARE

23

Service Activities for Children at 2 Months Old ( 7 Days)


(Recorded by health personnel)
Date of examination............................................
Weight............. kg. Length............ cm. Head circumference.........cm.
Nutritional status

.................................................................................................................
.................................................................................................................
Check physical appearance, eyes, ears, mouth, heart, abdomen, sexual
organ, legs, arms, anterior fontanelle, posterior fontanelle (check thoroughly), if not possible to complete all, check for the heart sound.

.................................................................................................................
Additional check with the childs development in case with doubts.

.................................................................................................................
.................................................................................................................
Problems with child raising and health (ask from the caregiver) include:

.................................................................................................................
.................................................................................................................
Parental school arrangement
Yes
No
Advices given:
How to use MCH handbook
Exclusive breastfeeding
Food for mothers
Promoting child development in subsequent ages
Accident prevention suckling as drowning, scald.
Refrain the child from wearing mittens, sucking finger, using pacifier,
traditional medicine, throat paint.
Others ..........................................
Referral in case of abnormalities and for care and treatment
No
Yes, specify......................................

Do not use false nipple or let the child suck finger as he or she will stick to it and it is
hard to give up in the future, and your child may develop malocclusion and flatulence.

PART 2: CHILD CARE

24

Child Development at 4 Months Old ( 15 Days)


(recorded by parents or caregiver)
Yes

No

Child development
Looks at his/her own hands (ask)
Follows objects with eyes at 180
Makes cooing sound (ask)
Lifts upper chest when lying on stomach

Food and nutrition


Exclusive breast-milk

Record of parents about the child and problems that require counseling

...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................

Consult the doctor or health personnel if the child tends to exhibits poor
development or any of the following signs.

At 4-5 months, does not lit the head, unable to grasp things.

Prevent the child from falling out of bed as he or she begins to turn over and crawl.

PART 2: CHILD CARE

25

Service Activities for Children at 4 Months Old (15 Days)


(Recorded by health personnel)
Date of examination............................................
Weight............. kg. Length............ cm. Head circumference.........cm.
Nutritional status

.................................................................................................................
.................................................................................................................
Physical check-up (If with doubts, check thoroughly)

.................................................................................................................
.................................................................................................................
Additional check with the childs development in case with doubts.

.................................................................................................................
.................................................................................................................
Problems with child raising and health.

.................................................................................................................
.................................................................................................................
Advices given:
How to use MCH handbook
Breast-milk and food at 6 months
Promoting child development in subsequent ages
Reading pictorial books with the child
No use of baby walker
Accident prevention such as drowning and scald.
Refrain the child from wearing gloves, sucking finger,
using pacifier, and baby walker.
Referral in case of abnormalities and for care and treatment
No
Yes, specify......................................

The child begins to turn over and talk, parents should frequently talk, smile,
and play with the child.

PART 2: CHILD CARE

26

Child Development at 6 Months Old ( 15 Days)


(recorded by parents or caregiver)
Yes

No

Child development
Gets things to feed him/herself (ask)
Follows falling objects with eyes
Turns toward the calling voice
Holds head steady not flop

Food and nutrition


Breast-milk
Other food include.................................................................................

Record of parents about the child and problems that require counseling

...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
Consult the doctor or health personnel if the child tends to exhibits poor
development or the child displays any of the following signs.
At 6 months, does not follow objects with eyes, does not turn toward
voice, does not pay attention to the one who plays with, does not roll
over in either front to back or back to front
front.

Do not use baby walker as it induces the child s delayed walking and
easily falls from the high.

PART 2: CHILD CARE

27

Service Activities for Children at 6 Months Old ( 15 Days)


(Recorded by health personnel)
Date of examination............................................
Weight............. kg. Length............ cm. Head circumference.........cm.
Nutritional status

.................................................................................................................
The values of Hematocrit or Hemoglobin..................................................
(Test performed when the child was.months)
Check physical appearance, eyes, ears, mouth, heart, lung, abdomen, sexual
organ, legs, arms, skin.
If time is not allowed, check for cross-eyes, tight muscles, and hearing.

.................................................................................................................
Additional check with the childs development in case with doubts.

.................................................................................................................
Problems with child raising and health (ask from the caregiver) include:

.................................................................................................................
Giving iron supplementation
Yes
No
Parental school arrangement
Yes
No
Advices given:
How to use MCH handbook
Breast-milk and age appropriate food
Promoting child development in subsequent ages
Reading pictorial books with the child, playing with the child
Accident prevention such as drowning, electric shock, scald, aspiration
No use of baby-walker
Oral health care
Try to avoid feeding the baby after bedtime during 8.00 pm.-6.00 am
and never put the baby to bed with breastfeeding
Referral in case of abnormalities and for care and treatment
No
Yes, specify ............................

Watch out for the childs domestic drowning,


turn over water bucket and basin after use.

PART 2: CHILD CARE

28

Child Development at 9 Months Old (15 Days)


(recorded by parents or caregiver)
Yes

No

Child development
Waives hands to bye bye (ask)
Holds a cube in each hand
Copies talking voices (ask)
Sits up (ask)

Food and nutrition


Breast-milk
Other food include................................................................................
Number of meals per day...........................................................meals

Record of parents about the child and problems that require counseling

...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
Consult the doctor or health personnel if the child tends to
exhibit poor development or the child displays any of the
following signs.
Stretched and tense legs when creeping and crawling
or sitting in W position.
At 9-10 months, does not turn toward the actual noise.

Do not use baby walker as it frequently cause accidents


and the child may walk on tiptoe.

PART 2: CHILD CARE

29

Service Activities for Children at 9 Months Old (15 Days)


(Recorded by health personnel)
Date of examination............................................
Weight............. kg. Length............ cm. Head circumference.........cm.
Nutritional status

...............................................................................................................
Physical check-up (If with doubts, check thoroughly)

...............................................................................................................
Dental check-up

.................................................................................................................
Additional check with the childs development in case with doubts.

.................................................................................................................
Problems with child raising and health (ask from the caregiver) include:

.................................................................................................................
.................................................................................................................
Giving iron supplementation
Yes
No
Advices given:
How to use MCH handbook
Breast-milk and 2 meals of food for ages
Promoting child development in subsequent ages
Reading pictorial books with the child, and plying with the child
Accident prevention such as drowning, electric shock, scald, aspiration
Dental health care
No milk feeding after bedtime
No use of baby-walker
No watching T.V., CD, DVD until 2 years old
Referral in case of abnormalities and for care and treatment
No
Yes, specify....................................

Never let the child play with small toy less then 2 cm. as the child may put
it into the month and be choked by it.

PART 2: CHILD CARE

30

Child Development at 12 Month Old (15 Days)


(recorded by parents or caregiver)
Yes

No

Child development
Expresses the need (ask)
Puts a cube in a container
Says meaningful words Pa-Ma (ask)
Says 1 meaningful word (ask)

Food and nutrition


Breast-milk
Other food include..................................................................................
Eat snack food

Yes

No

Record of parents about the child and problems that require counseling

...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
Consult the doctor or health personnel if the child tends to exhibit poor
developmentany or the child displays any of the following signs.
At 1 year, unable to walk holding on to something, unable to feed him/
herself with fingers, unable to imitate posture or voice, unable to say a
single word.

Telling stories for your child everyday or at least 3 time a week.

PART 2: CHILD CARE

31

Service Activities for Children at 12 Month Old (15 Days)


(Recorded by health personnel)
Date of examination............................................
Weight............. kg. Length............ cm. Head circumference.........cm.
Nutritional status

...............................................................................................................
Check physical appearance, eyes, ears, mouth, heart, lung, abdomen,
legs, arms, skin, if not possible to complete all, check the heart, abdomen,
interior fontanelle.

...............................................................................................................
Oral and dental check-up (advice given by dental officer)

.................................................................................................................
Additional check with the childs development in case with doubts.

.................................................................................................................
Autism screening
Normal
Suspicious
Problems with child raising and health (ask form the caregiver) include:

.................................................................................................................
Giving iron supplementation
Yes
No
Parental school arrangement
Yes
No
Advices given:
How to use MCH handbook
Giving the child 3 meals, continuing breastfeeding, no milk feeding
after going to bed.
Promoting child development in subsequent ages
Reading pictorial books with the child, and playing with the child
Accident prevention such as drowning, electric shock, scald, aspiration
No watching T.V., CD, DVD until 2 years old
Effects of television on the child
Referral in case of abnormalities and for care and treatment
No
Yes, specify.....................................

Initiate the potty training and give up disposable diapers.

PART 2: CHILD CARE

32

Child Development at 18 Months Old (1 Month)


(recorded by parents or caregiver)
Yes

No

Child development
Uses spoon to feed him/herself
Follows objects with eyes along the body midline
Makes sound (ask)
Lifts the head (ask)

Food and nutrition


Exclusive breast-milk

Record of parents about the child and problems that require counseling

...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
Consult the doctor or health personnel if your 18-month-old child tends to
exhibits poor developmentany or cannot follow simple instructions such as saying
hello, walking toward the mother.

Raise and play with your child on gender suitability, The father should
participate in raising the child especially the son.

PART 2: CHILD CARE

33

Service Activities for Children at 18 Month Old (1 Month)


(Recorded by health personnel)
Date of examination............................................
Weight............. kg. Length............ cm. Head circumference.........cm.
Nutritional status

...............................................................................................................
Physical check-up especially the anterior fontanelle (if with doubts, check
thoroughly)

...............................................................................................................
Additional check with the childs development in case with doubts.

.................................................................................................................
Problems with child raising and health problems (ask from the caregiver)
include:
Giving iron supplementation
Yes
No
Advices given:
How to use MCH handbook
Giving the child 3 meals, continuing breastfeeding, no milk feeding
after going to bed, allowing the child for food self-feeding.
Promoting child development in subsequent ages
Reading pictorial books with the child, and playing with the child
Accident prevention such as drowning, electric shock, scald, aspiration,
falling over the high.
Caring for the childs teeth twice a day in the morning and before
bedtime
Toilet training, give up disposable diapers.
No watching T.V./CD/DVD until the child is 2 years old
Effects of television on the child
Referral in case of abnormalities and for care and treatment
No
Yes, specify......................................

Train the child to help with easy household chores such as collecting toys,
sweeping the floor.

PART 2: CHILD CARE

34

Child Development at 2 Years Old (1 Month)


(recorded by parents or caregiver)
Yes

No

Child development
Removes clothes (ask)
Stacks 4 cubes
Points at 6 parts of body organs
Says 2 words together (ask)
Throws a ball

Food and nutrition


Food intake........................................................................................
Number of meal per day.............................................................meals
Eating crunchy/crispy snacks
Yes
No
Having soft drinks

Yes

No

Record of parents about the child and problems that require counseling

...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
Consult the doctor or health personnel if your 2-year-old child tends to exhibit
poor development or cannot speak 2 meaningful words together.

Teach the child about morality such as thoughtfulness, making merit,


giving alms to monks, praying to the Lord Buddha,
telling stories teaching moral and ethics.

PART 2: CHILD CARE

35

Service Activities for Children at 2 Years Old (1 Month)


(Recorded by health personnel)
Date of examination............................................
Weight............. kg. Length............ cm. Head circumference.........cm.
Nutritional status

...............................................................................................................
Physical check-up (if with doubts, check thoroughly)

...............................................................................................................
Additional check with the childs development in case with doubts.

...............................................................................................................
Problems with child raising and health, and behavioral problems

.................................................................................................................
Giving iron supplementation
Yes
No
Parental school arrangement
Yes
No
Advices given:
How to use MCH handbook
Giving the child 3 meals, allowing the child for food self feeding, and
drinking milk from the glass or box about 2-3 times/day.
Promoting child development in subsequent ages
Reading pictorial books with the child, and playing with the child
Accident prevention such as electric shock, scald, aspiration by food
particles, falling from the stairs.
Allowing the child to watch T.V. no more than 1 hour/day
Toilet training, give up disposable diapers.
Participation in religious activities.
Referral in case of abnormalities and for care and treatment
No
Yes, specify..................................

Do not allow your child to play computer games,


and parents do not play them in presence of the child.

PART 2: CHILD CARE

36

Child Development at 3 Years Old ( 1 Mounth)


(record by parents or caregiver)
Yes

No

Child development
Puts on T-shirt by him/herself (ask)
Stacks 8 cubes
Knows at least 2 adjectives
Stands on one leg for 1 second
Imitates in drawing a vertical line

Food and nutrition


Food intake........................................................................................
Number of meal per day..........................................................meals
Eating crunchy/crispy snacks
Yes
No
Having soft drinks

Yes

No

Record of parents about the child and problems that require counseling

...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
Consult the doctor or health personnel if your child tends to exhibit poor
development or delayed development for age.

Cannot follow simple instruction.

Parents play good role model without drinking alcohol, smoking, gambling,
insulting, using domestic violence.

PART 2: CHILD CARE

37

Service Activities for Children at 3 Years Old (1 Month)


(Recorded by health personnel)
Date of examination............................................
Weight............. kg. Length............ cm. Head circumference.........cm.
Nutritional status

.................................................................................................................
Physical check-up (if with doubts, check thoroughly)

.................................................................................................................
Additional check with the childs development in case with doubts.

.................................................................................................................
Autism screening result

.................................................................................................................
Emotional intelligence screening result

.................................................................................................................
Problems with child raising and health, and behavioral problems
Parental school arrangement
Yes
No
Advices given:
How to use MCH handbook
Giving the child 3 meals, no crispy and crunchy snacks and soda
drinks.
Promoting child development in subsequent ages
Reading pictorial books with the child, and playing with the child
Teaching the child to help him/herself.
Teaching the child to collect the toys every time after playing them.
Participation in religious activities.
Accident prevention such as electric shock, scald, aspiration by food
particles, falling from the stairs.
Allowing the child to watch T.V. no more than 1 hour/day.
Referral in case of abnormalities and for care and treatment
No
Yes, specify......................................

Do not allow your child to eat candies, soft drinks, crispy/crunchy snacks as they
are less nutritious, and cause tooth decay, feeling full and refusing to eat.

PART 2: CHILD CARE

38

Child Development at 4 Years Old (1 Month)


(recorded by parents or caregiver)
Yes

No

Child development
Dresses by him/herself (ask)
Copies a picture
Tells 4 colors
Stands on one leg for 3 seconds
Copies a circle

Food and nutrition


Food intake........................................................................................
Number of meal per day...............................................................meals
Eating crunchy/crispy snacks
Yes
No
Having soft drinks

Yes

No

Record of parents about the child and problems that require counseling

...............................................................................................................
...............................................................................................................
...............................................................................................................
...............................................................................................................
Consult the doctor or health personnel if your child exhibits delayed development
or nutritional disorder or tends to have poor development.

Train your child to do more things every by him/herself such as putting on


clothes, scooping rice, putting the dish into the basin, washing his/her dish,
cleaning up the bedroom.

PART 2: CHILD CARE

39

Service Activities for Children at 4 Years Old (1 Month)


(Recorded by health personnel)
Date of examination............................................
Weight............. kg. Length............ cm. Head circumference.........cm.
Nutritional status

.................................................................................................................
Physical check-up (if with doubts, check thoroughly)

.................................................................................................................
Urine exam
Eye exam
Hearing exam
Check blood pressure
Emotional intelligence screening................................................................
Additional check with the childs development in case with doubts

.................................................................................................................
Problems with child raising and health, behavioral problems

.................................................................................................................
Parental school arrangement
Yes
No
Advices given:
How to use MCH handbook
Giving the child 3 meals and 2 boxes of milk per day, no soda drinks
and crispy and crunchy snacks.
Promoting child development in subsequent ages
Reading pictorial books with the child, and playing with the child
Accident prevention such as drowning, electric shock, scald, falling
from the high, domestic toxicants.
Allowing the child to watch T.V. no more than 1 2 hours per day.
Effects of television on the child
Referral in case of abnormalities and for care and treatment
No
Yes, specif.................................

Teach Your child about disciplines such as eating on regular time,


reading and doing homework on regular time everyday.

1
2

Reference graph for head circumference, male 0-6 years

6 Age (year)

97
90
75
50
25
103

40

30

35

40

45

50

cm.

55

HEAD CIRCUMFERENCE GRAPH (male and female separated)

PART 2: CHILD CARE

30

35

40

45

50

55

cm.

1
2

Reference graph for head circumference, female 0-6 years

HEAD CIRCUMFERENCE GRAPH (male and female separated)

41
Age (year)

97
90
75
50
25
103

PART 2: CHILD CARE

PART 2: CHILD CARE

42

Guide to the Use of Child Nutritional Graph


(can be recorded by parents or guardian)
Child nutritional graph is used to continuously monitor the change of childs weight
and height whether the trends of childs growth follow the standard criteria. The
graphs are presented in 3 types:
1.Weight for age graph presents 5 levels of growth status:
1) Under standard weight refers to having malnutrition
malnutrition.
2) Relatively low weight refers to risk of having malnutrition
malnutrition, a warning sign,
if without appropriate care, overweight for age is likely.
3) Standard weight refers to well growth
growth. It should be promoted to maintain
the weight at this level.
4) Relatively high weight: refers to risk of having over standard weight
weight. It
should be check against the weight for height graph.
5) Over standard weight does not identify whether the child is obese
obese. It needs
to check for obesity against the weight for height graph.
2. Height for age graph presents 5 levels of growth status
status:
1) Short refers to having chronic malnutrition
malnutrition, reflecting inadequate food intake for a prolonged period or frequent illnesses, with minor or no increase of height,
affecting low intelligence, more frequent illnesses. It requires immediate improvement.
2) Relatively short refers to risk of having chronic malnutrition
malnutrition, a warning sign,
if without appropriate care, the height discontinues and the child is likely to become
short.
3) Standard height refers to well growth
growth, reflecting adequate food intake, so
it should be promoted to contiue at this level.
4) Relatively tall refers to very well growth
growth. It should be promoted to maintain
at this level.
5) Over standard age refers to excellent growth
growth. It should be promoted to
continue at this level.
3. Weight for height graph represents 6 levels of growth status:
1) Thin refers to having short term malnutrition
2) Relatively thin refers to risk of having malnutrition
malnutrition, a warning sign, if
without appropriate care, the weight will not increase or decrease to the thin level.
3) Proportionate refers to well growth
growth, reflecting appropriate weight for height.
The child should be promoted to continue at this level of growth.
4) Moderate refers to risk of having obesity
obesity, a warning sign, if without
appropriate care, the weight will increase to the level of initiating fat.
5) Initiating fat refers to the first degree of obesity
obesity. The child is likely to
become a fat adult in the future if without weight control.
6) Fat refers to the second degree of obesity
obesity. The child has highly inappropriate weight for height, with risk opportunity to having diabetes, hypertension,
hyperlipidemia, bowlegs, sleep apnea, and become even fatter adult in the future if
without weight control.

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43

44

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45

46

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47

48

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49

50

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51

52

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53

54

PART 3 ESSENTIAL KNOWLEDGE FOR SAFE AND QUALITY PREGNANCY

55

PART 3
ESSENTIAL KNOWLEDGE
FOR SAFE AND QUALITY PREGNANCY

Discomforts during pregnancy


Maternal practices during pregnancy
Minimum weight for pregnant women to give birth to a newborn of
2,500 grams. (VALLOP WEIGHT LOG)
Self care during pregnancy through pregnancy pathway
Minimum weight for pregnant women to give birth to a newborn of
>2,500 gram.
Advantage of the nutritional graph
Nutritional graph for pregnant woman
Nutrition for pregnant woman: Table for comparison of percentage
of standard BMI values (BMI 21 = 100)
Illustration of sets of food exchange for pregnant woman
Fetal development
Thalassemia
Risk opportunity to have a child with thalassemia
What is congenital hypothyroidism?
Prevention of mother-to-child transmission of HIV
Family planning
Self assessment and analysis of stress

PART 3 ESSENTIAL KNOWLEDGE FOR SAFE AND QUALITY PREGNANCY

56

Discomforts During Pregnancy


Morning sickness is commonly experienced in early period of pregnancy,
with nausea and vomiting in the morning. The symptoms can be improved by
mental adjustment, avoiding unfavorable food, eating small meal each time but
several times, or having soft food and warm drinks. The symptoms will
disappear at 4 months of gestation.
Vaginal discharge will commonly increase during pregnancy. Take a usual
bath, except if accompanied with itching and smelling, see the doctor.
Constipation is found in some pregnant women and can be lessen by
drinking more water and eating more vegetables and fruits, if not improved,
see the doctor.
Frequent urination is caused by the expansion of uterus which places more
pressure on the bladder. If experiencing burning pain or obstructed urinating,
see the doctor.
Fatigue and drowsiness is common early in pregnancy with feeling tired and
sleepy.
Varicose veins usually disappear after delivery. Always change your gesture
properly, avoid long period of walking or standing, sit with your feet elevated
for 15 20 minutes every day after walking or working, use legs support hose
to provide compression.
Stretch Masks should be applied gently with cream, avoid scratching.
Pigmentation or darken skin is due to the change of hormone. Try to avoid
sunlight. It will be faded after delivery.
Heartburn is caused by the stomach acid refluxing into the esophagus, and
delayed functioning of digestive system. Consult the doctor for the use of
antacid.