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Overview & Community Pediatrics

Overview
I. Lectures:
- Introduction and Community Pediatrics
- Growth & Development
- Genetics
- Nutrition
- Fluids & Electrolytes
- Normal Newborn
- Preventive Pediatrics
II. Ward Work (Preceptorial)
- History Taking
- Physical Examination

Definition:
Branch of Medicine which
- Deals with treatment of the child, his devt. and care
- Deals with diseases of children and their treatment
Whole of medicine applied to a distinct individual below 20
years of age

FACTS REGARDING PEDIATRIC POPULATION
Morbidity and mortality is higher since children are
vulnerable
A number of diseases, deficiencies or handicaps in children
may be carried on to adulthood
Sickness in children can cause much apprehension and
worry among parents consult more readily for the young
ones than for adults
Unique population:
- Biologic and physiologic characteristics
- Disease peculiarities and health problems
- Requires specific nutrients in adequate amounts
since the child is continuously growing and developing;
greater requirements
- Responds to environmental factors, to drugs and
medical procedures in a different manner

*Appendicitis- periumbilical/diffuse pain in children
*Medications are based on body weight per age



AGE GROUPS
- Perinatal Period from the 20
th
wk of gestation to the first
6 days after birth
- Neonatal Period first 28 days after birth
- Under Five:
Early Infancy <1 mo-1 yr
Later Infancy (Toddlers)
2 (Terrible twos) to 3 yrs
Pre-school 4 to 5 yrs
- School Age from 6 yrs (formal schooling)
- Adolescence 10 -19 yrs

* Modern Philippine Pediatrics started with the birth of the Philippine
Pediatric Society in 1947
* Total Philippine population: (1980) 48.1M; (1990) 60.7M; (1995)
68.6; (1999) 74.7M
* 49% of the total population in the Philippines are children/
predominantly young populationthus, a substantial burden of
dependency is placed on those who work
* 49% live in urban areas
* Population increased by 12.6 over the past 10 years
* Population growth rate increased by 2.32% (annual) one of the
highest rates in SE Asia
* New population policy (Phils.) 3 children per family; aims to
improve health by reducing infant, maternal, and early child mortality
and also the incidence of teenage pregnancy and early marriage

INFANT MORTALITY
Ten (10) Leading Causes, Philippines, 1995
(Source: National Statistics Office)
Causes Percentage
1. Pneumonias 37%
2. Respiratory Conditions of Fetus &
Newborn
24%
3. Congenital Anomalies 9%
4. Birth Injury and Difficult Labor 5%
5. Diarrheal Diseases 7%
6. Septicemia 6%
7. Meningitis
8. Avitaminosis and Other Nutritional Def. 5%
9. Other Diseases of the Respiratory
System

10. Measles










INFANT MORTALITY RATE



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Year Infant
mortality rate
Rank Percent
Change
Date of
Information
2003 24.98 106 2003 est.
2004 23.51 105 -5.88 % 2004 est.
2005 23.51 105 0.00 % 2005 est.
2006 22.81 105 -2.98 % 2006 est.
2007 22.12 103 -3.02 % 2007 est.
2008 21.2 104 -4.16 % 2008 est.
2009 20.56 103 -3.02 % 2009 est.
Infant mortality rate: total: 20.56 deaths/1,000 live births
male: 23.17 deaths/1,000 live births
female: 17.83 deaths/1,000 live births (2009 est.)


HIGHER NEONATAL MORBIDITY AND MORTALITY IN THE
FIRST WEEK
Infrequent and inadequate prenatal consultation reasons:
geographic, economic, ignorance
Majority are home deliveries (home [e.g. by hilot] 70%;
hospitals or lying-in clinics 30%)
Traditional birth attendants (TBAs) continue to play
important role in neonatal care (for at least 1 month)
*Adequate visits = not less than 3 visits
*Weight gain=25lbs
*Make baby cry at birth= do not spank instead, vigorous rubbing of
the back or sole of feet


UNDER-FIVE
(Provision of Low-cost Comprehensive Child Care)
Concerns:
I. Treatment of common childhood illnesses:
- ARI
- Diarrheas
- Malnutrition
- Micronutrient deficiency
*preventable, lamentable
*IMCI-program to treat childhood infections to bring down MR of
under 5 age group (CARI, CDD)

II. Primary prevention through:
- Growth surveillance (ht, wt, HC)
- Proper nutrition
- Immunization: 1BCG 3HepB 3DPT 3OPV 1MMR
- Promotion of Breastfeeding, Oral Rehydration Therapy,
Family Planning
- Environmental sanitation
- Counseling mothers on health matters, safety, and protection
of the childs psychosocial environment and how to set
priorities for health

III. Identification of at-risk children and prompt management of
recognized problems or diseases and its possible complications

IV. Promotion of parent-child relations







TEN LEADING CAUSES OF CHILD MORTALITY (1990)
1. Pneumonia 6. Heart disease
2. Measles 7. Malignant neoplasms
3. Diarrhea 8. Diphtheria
4. Accidents 9. Tuberculosis
5. Bronchitis 10. Malaria

* #s 1 6 = primary causes
* #s 7 - 10 + influenza (after TB in del Mundo) = secondary causes
* survival sensitive indicator of child survival and individual
progress
* child mortality rate (1990) 5.3 per 1000 children



SIGNIFICANT EARLY CHILD HEALTH INTERVENTION
PROGRAMS IN THE PHILIPPINES AND THEIR TRENDS (1997)

Expanded Program Immunization (EPI) 87.35% (1998)
Includes TB, DPT, polio, measles, neonatal tetanus, Hep
B, yellow fever
Launched by the DOH on July 12, 1976 (BCG for school
entrants)
80% goal by the Universal Children Immunization (UCI)
for 1990 attained earlier on 1989
National Immunization Days 3
rd
Wednesday of April
and May 1993, March 1994 and 1995
April 1993 95% coverage

ORS (oral rehydration salts) for diarrheas early 70s
(Bangladesh and India)
Diarrhea one of the top 3 leading causes of morbidity
and mortality among infants; one of the leading causes of
mortality and morbidity among the under-fives
*Gatorade/sports drink- should not be given to someone with
diarrhea since will cause osmotic diarrhea (sugar pulls water
out, aggravating the diarrhea)
*ORS- salts/electrolytes
NA at 75mmol lessens the duration of illness
Zinc-added

Breastfeeding promotion and Mother-Baby Friendly Hospitals
Initiative (MBFHI) 1992 Natl Demographic Survey showed that
breastfeeding is not common
August 10 Mother and Baby Friendly Hospital Week;
Proclamation #14 (Phils.)
rooming in; to promote mother-baby bonding
Milk Code

Control of Acute Respiratory Infection (CARI)


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Pneumonia major killer of infants and children in the
Phils.
1989: 28% infant deaths and 60% of all deaths between 1-
4 yrs

Micronutrient Awareness and Programs (1996-1997)
Micronutrients substances essential to the body yet
needed only in minute amounts; adequate intake is
important during period of rapid growth
Important for physical and cognitive development;
important in the production of enzymes, hormones, and
other materials that help to regulate growth, development,
activity and the immune system
National Micronutrient Operative Plan (1996-1998)
Iodine, Iron, Vit. A, Zinc, and Folate


THE PRIMARY HEALTH CARE APPROACH
Declared as key to the goal of health care for all by 2000
Essential health care made accessible to individuals and
people in the community by means acceptable to them
towards their full participation at a cost that the community
can afford, in a spirit of self-reliance and self-determination


COMPONENTS OF PRIMARY HEALTH CARE
Health education
Promotion of good and proper nutrition
Maternal and child care


COMMUNITY PEDIATRICS
The family physician, practitioner or pediatrician should:
Be community-oriented and community-involved
Deliver comprehensive or best possible health care to the
children in the community


ROLE OF THE PEDIATRICIAN IN THE COMMUNITY
The Pediatrician should be:
An educator
A consultant identify problem
A coordinator
A health planner
A counselor
A group worker


GUIDELINES FOR COMMUNITY SERVICES
1. Understand the community fully in terms of its
- Nature - Characteristics
- Capacities - Priority needs of the children
2. Be aware of the existing patterns of health care delivery and
possible alternative solutions
3. Obtain baseline data; encourage participation and involvement of
the local people in priority programs for children, from the very
early stages of planning to organization and implementation
4. Assist in training activities so that ultimately local people in the
community may be health educated and trained. This is
particularly important in most developing countries where there
is a paucity of health manpower resources
5. Include health activities as an integral part of community
development programs; enhance services that are not
dependent exclusively on outside aid so that innate capacities
of the community are developed


CHILDREN IN ESPECIALLY DIFFICULT CIRCUMSTANCES
(CEDC)
Neglected / abandoned
Those in situations of armed conflict
Street children
Children in hazardous occupations
Disabled


IMCI (Integrated Management of Childhood Illnesses, WHO
Department of Child & Adolescent Health, June 1999)
Broad strategy that focuses on the child as a whole
Aims to reduce child mortality and morbidity through
integrated case management of:
- Acute respiratory infection (ARI)
- Diarrhea
- Measles
- Malaria
- Malnutrition
Stresses prevention and the vital role of the environment and
child health
Emphasizes prevention of disease through:
- Immunization
- Improved nutrition
- Exclusive breast feeding
Implementation of IMCI involves three phases
-Introduction
-Early implementation
-Expansion
Success in reducing mortality in children requires more than
just adequate health systems and trained health staff and
personnel communities and families must be actively
involved and committed.

Millennium Development Goals by 2015
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development