6/3/2010 Screening in well baby clinic Dr. Abdulmoein Al-Agha, Ass. Professor & Consultant Pediatrician, KAUH & Erfan Hospital, Jeddah
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6/3/2010
Screening in well baby clinic
Dr. Abdulmoein Al-Agha,Ass. Professor & Consultant Pediatrician, KAUH &
Erfan Hospital, Jeddah
6/3/2010
Well baby clinic IS Not only for vaccinations and check –up for
fever & URTI !!!
6/3/2010
1. Growth assessments– Length, weight & head circumference
measurements should be taken with each visit– These measurements are plotted on growth charts
and are compared to previous and later markings to make sure the baby is growing as expected
2. Well baby clinic is an excellent place for Primary Prevention & Family Education especially on breast feeding & good nutrition
3. Immunization4. Assessments of the baby's reflexes and
neurological developments5. Visual & hearing assessment6. Systemic examinations to detect any childhood
diseases from earlier stages
Well baby clinic’s rules
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Growth assessments
Using height‐for‐age measurement to monitor growth as will as weight‐for‐ageUse CDC chart for this purposeRefer to specialist clinic as early as possible when a child's growth curve is abnormalEncourage parents to come for growth monitoring as they are dealing with the vaccination program
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Early detection of growth disorders !!
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What is normal infant growth?
1. Head circumferenceApproximately 35 cm at birthApproximately 47 cm at 1 year of ageUse charts to detect any abnormalities:– Large or small head
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What is normal infant growth?
2. Length/ heightLength at birth approximately 50 cmLength at 1 year = 75 cmDouble birth length by 4 years (100 cm)Use charts to detect any abnormalities:– Under/ over growth
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What is normal infant growth?3. Weight
Weight at birth = 2.5 -4 kg4-6 months: birth weight doubles1st year: birth weight triples2nd year: birth weight quadruplesGain rate:
– 1st month: 20-30 g / day– 1st year: 10 g / day
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Growth Charts are very important tool for detection any growth disorders
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Well baby clinic is an excellent place for Primary Prevention & Family
Education
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What are benefits of breastfeeding
Breast feeding has short and long term benefits:
Provides all essential energy and nutrientsProtection against infectious diseasesDecreases rates of infant mortalityDecreases rates of other health outcomesEnhances cognitive developmentEnhances normal psychosocial behaviorsReduces risk of development of autoimmune diseases e.g. type 1 DM & allergic diseases later on life !!!
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Breastfeeding encouragement
Please avoid adding formula feeding as much as possible !!Age of introduction of solid food at six months of age not at 4th. Months of ageIron & vitamin D supplements for breast -fed babies to prevent common diseases in our community e.g. rickets & IDA
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Prevention & Education will prevent common nutritional diseases in our
community !!!
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Important Prophylactic IssuesNot to introduce cow’s milk in first year of lifeTo encourage exclusive breastfeeding for first six months of life with emphasis on mother’s iron, vitamin D & calcium good intake during pregnancy & lactationIntroduction of iron containing foods at six months or to supplement oral iron (ferrous sulphate drops) prophylaxisIf not breastfeeding, use iron-fortified formula until one year of age After one year of life, limit cow’s milk consumption to 2 cups /day & encourage vegetables, fruits & meatToddlers: diversified diet rich in iron containing foods & vitamin C, avoid excessive juice intake; may give multivitamin containing iron
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Prevention of iron deficiency should be of paramount effort for all parties
caring for healthy childhood !!
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Hypochromic Microcytic RBCs
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Pallor
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Why should we prevent iron deficiency anemia?
Treatment of IDA with complete resolution of anemia does not correct all of the behavior effectsInfant & toddlers with IDA , in a long trial, reevaluated at age of 11-14y of age demonstrate functional impairment despite complete resolution of IDATheir behavior was characterized by parents as irritable, poor appetite, poor weight gain & problematic
(Lozoff et al, 2000)
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Rickets
bone disease that affects children, usually 6 to 24 months of age
caused by a lack of vitamin D (fish, liver, eggs, milk and exposure to sunlight
results in progressive softening & weakening of the bones’ structure
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Rickets
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Rickets
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Prevention of vitamin D deficiency
Increase sunlight exposureFor exclusive breast-feed, Vitamin D supplementation of 400- 800 IU dailyAsian children should take supplement until 5 years of ageThe potential importance of maintaining adequate vitamin D extend far beyond the prevention of rickets & osteomalacia
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ImmunizationsIndividual & series immunizations are started or continued at well-child visits (better to rename it, as well-child clinic because vaccination continues beyond first year of life !!)Family should be provided with a schedule so that they know how many injections to expect at each visit as well additional optional vaccinesPlease ask history of medications e.g. steroid or history of immunodeficiency prior of introduction of live – attenuated vaccines to avoid complications
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Developmental Screening
Developmental screening is a procedure designed to identify children who should receive more intensive assessment or diagnosis for potential developmental delays It can allow for earlier detection of delays & improve child health and well-being for identified children
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Key Concept
Development during the period of childhood is marked by steady, incremental changes in the cognitive, affective, and motor domains
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Risk Factors of developmental delay
Biological– Low birth weight– Prematurity– Micro/macrocephaly– CNS infection– Teratogens exposure
Environmental– Extreme poverty– Lack of permanent
housing– Parental substance
abuse– Teen parents
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Why developmental assessment?
Early detection of deviation in child’s pattern of developmentSimple & time efficient mechanism to ensure adequate surveillance of developmental progressDomains assessed in well baby clinic: – cognitive, motor, language, social / behavioral
and adaptive
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Gross Motor Skills
The acquisition of gross motor skills precedes the development of fine motor skillsBoth processes occur in a cephalocaudal fashion– Head control preceding arm & hand control,
Followed by leg and foot control
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Head Control
Newborn Age 6 months
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Sitting Up
Age 2 months Age 8 months
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Ambulation
13 month oldNine to 12-months
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Fine motor development
Newborn has very little control – Objects will be involuntarily grasped &
dropped without notice6 month old: palmar grasp – uses entire hand to pick up an object
9 month old: pincer grasp– can grasp small objects using thumb & forefinger
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Fine Motor Development
6-month-old
12-month-old
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Speech milestones1-2 months: coos2-6 months: laughs8-9 months babbles: mama/dada as sounds10-12 months: “mama/dada specific 18-20 months: 20 - 30 words (50% understood by strangers)22-24 months: two word sentences, >50 words, 75% understood by strangers30-36 months: almost all speech understood by strangers
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HearingBAER hearing test done at birthAbility to hear correlates with ability enunciate words properlyAlways ask about history of otitis media – ear infection, placement of PET – tubes in earEarly referral to ENT to assess for possible fluid in ears (effusion) to avoid speech delay Repeat hearing screening testSpeech therapist as needed
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Red Flags in infant developmentUnable to sit alone by age 9 monthsUnable to transfer objects from hand to hand by age 1 yearAbnormal pincer grip or grasp by age 15 monthsUnable to walk alone by 18 monthsFailure to speak recognizable words by 2 years
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Take Home messages
1) Well baby clinic IS Not only for vaccinations
2) Growth assessments are very important in every visit
3) Use CDC chart or Saudi local charts4) Growth Charts are very important tool for
detection any growth disorders5) Well baby clinic is an excellent place for
primary prevention & family Education
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Take Home messages
6) To encourage exclusive breastfeeding for first six months of life with emphasis on mother’s iron & calcium good intake
7) Not to introduce cow’s milk in first year of life8) Prevention & education will prevent common
nutritional diseases in community especially iron deficiency anemia & rickets (common in Saudi Arabia)
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Take Home messages
9) Prevention of iron deficiency & rickets should be of paramount effort for all parties caring for healthy childhood !!
10)For exclusive breast-feeding:– Vitamin D supplementation of 400- 800 IU
daily– Iron drops of 2-3 mg/ kg/ day
11)Development assessment is very crucial in the first five years of life
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Last Home Message!!!
Early detection of any childhood disorders will
prevent or minimize later adult handicapping
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