Lecture: "Structure and organization of medical care for children in kindergartens and schools."

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Lecturer Ph.D. G.M. MuldaevaDiscipline, "General medical practice"Specialty 051 301 "General Medicine"

course V

The purpose the lecture: To familiarize students with the basic principles, forms and methods of organizing medical supervision for children of preschool and school-age methodological approaches to the rehabilitation of children with disabilities in the

state of health.

• Plan lectures:• Planning and organization of health examinations of infants and preschool

children. Forms dispensary coverage of informal child. The volume and frequency of health examinations. Planning and organization of recreational activities.

• Medical control over the health of children 1 year of age. Preventive health care of young children. Clinical examination of children 1 year of life.

• Medical control in the preparation of children for admission to preschool, a period of adaptation.

• Implementation of differentiated (depending on the state of health, development and individual features of the child) to prepare children for entry into preschool institutions.

Plan lectures:• Allocation of children at risk of readiness for preschool institutions and

conduct of their rehabilitation. Improvement of children with disabilities in the state of health, and the run-up to DDU and adaptation period. Implementation of controls to ensure the right conditions within the family, and correction of closest approach to the conditions DDU.

• Making primary documents, including information about the individual characteristics of the child and appointments for a period of adaptation.

• Types of school facilities. Functional responsibilities of the school doctor and nurse. Reporting and records. Organization and equipment and medical equipment cabinet at school.

• Medical control in preparing children for school. Control over the organization in schools daily routine, food, exercise, tempering. Clinical examination of healthy children. Distribution by groups of schoolchildren's health. Sanitary - educational work with teachers, students, parents.

• Social significance of pre-school due to the fact that they have a family full assistance in educating the younger generation.

• For the organization of health care management of children in preschools and schools in children's clinics are organized preschool school offices, which include the entire medical staff of schools, a doctor and senior nurse preschool.

• Pre-school department is headed by the manager, whose office is entered if the state of child health clinics and schools in nine medical day care centers. When the number of physicians staffing schools and kindergartens from 6.5 to 9 can be entered rate instead of 0.5 head position as a doctor with the implementation of a 0.5 rate of medical burden. Head of school preschool room and the charge nurse working with different contract district pediatricians, doctors - specialists, as well as the District Board of Education, heads of pre-schools and principals, teen rooms clinics, medical and physical culture and tuberculosis dispensary, territorial SES, home health of Education.

• By the beginning of the school year preschool Head of school department is an action plan for improving health care for preschool and school children in the area of child health clinics, schedule medical examination, as well as in-depth examinations of institutions. These plans are consistent with the head of the pre-schools and school directors and approved by the chief expert on childhood clinic, which provides for inspection of medical specialists.

• After completion of in-depth examinations of the head to pre-school department receives the data analysis for each of their preschool and school. It summarizes their reports and the discussion on health care advice.

• At the head of the preschool department is headed by the school work to improve the skills of doctors and nurses kindergartens and schools. In addition, he directs the sanitary-educational work among parents, students, educators, teachers, and provides technical assistance in the organization of physical training and hardening of children.

• Head of the preschool school otdelenie6m supervise the honey. Services for children in schools and preschools, in turn conducts peer review of its various sections, paying attention to the quality of medical examination as a whole.

The states physicians in general to work in child care centers shall be established from the calculation:

pediatrician

• at 180-200 children in creches (nurseries nursery-gardens);

• 600 kindergarten children (corresponding groups in the nursery-gardens);

• at 200 schools.• For direct service to children in kindergartens

and schools provided post nurse to:• 100 children of kindergartens;• 700 schools.

Preparing children for pediatric area to enroll in preschool

• Special observations revealed that the duration of adaptation depends on age. Children coming to the nursery at the age of 5-6 months, get used to new conditions, because they have not yet perpetuate stereotypes that need to be changed. Quickly become accustomed to the nursery and children older than 1 year 8 Mon. 1 year 9 months. That although they have stable stereotypes, but it more "development." In particular, they have a mobility of nervous processes, which facilitates adaptation to changing conditions, they understand we are adults, they are easier to interest classes and toys. The most difficult is the process of adaptation in children between the ages of 5-6 months. Up to 1 year 7 Mon.-1year 8 months. Because by this time the children have formed a fairly stable habits. The baby at this age because of the low mobility of nervous processes and the weak active inhibition is unable to inhibit formation of new and old stereotypes, which causes a negative reaction.

• Particular attention should be paid to children with disabilities in physical development (more than 1 year), the manifestations of disharmony development lagging behind in the neuro-psychological development for more than 2 months, sickly, with manifestations of rachitism, anemia, allergies. These children may be taken in child care only after a recovery.

• Requires special attention the organization of immunization, since vaccination causes a temporary change in the reactivity of the body, enhances allergic reactions, reduction of resistance.

• What is important is a clear continuity of the district pediatrician and honey. child care workers.

Preparing children for pediatric area to enroll in preschool

• Preparing children to enroll in preschool (yaslii, kindergarten, child school) is a district doctor - a pediatrician, a precinct nurse, a medical assistant or nurse office a healthy child and consists of two main sections: general and specialized training.

• General preparation - this is an accepted systematic activities, ranging from the newborn period, children in the pediatric service area to ensure a harmonious, physical and neuropsychological development, optimal health and family education, which guarantees the right to prepare the child for entering preschool .

• Special training begins with a 3-month-old child, and includes the following activities:

• Monthly sanitary-educational work of the precinct pediatrician and medical staff office to a healthy baby with parents through thematic discussions on the proper physical training and preparation of children for admission to preschool;

• - Medical examinations of children for 2-3 months. Before enrolling in preschool at the local doctor, pediatrician, doctors, specialists, laboratory studies;

• - Sanitation and treatment of children depending on their level of health;

• - Prevention of acute diseases (SARS, influenza, etc.) for 1-2 months.

• Before enrolling in child care with the use of funds aimed at increasing non-specific immune defense mechanisms, including the holding of general and local tempering of activities, the introduction of elements of the breathing exercises and sports activities (at home), education of the child breathing through the nose, prescribing a course of ultraviolet irradiation, ascorbic acid preparations , vitamins, drugs hips, interferon;

• - Design documentation in accordance with the content of the preparation of the child in preschool: the record in the history of the child at the beginning and end of training, preparation of discharge summary for child care in a specific pattern with the mandatory recommendations of the local doctor for a period of adaptation on the treatment, nutrition, physical education , an individual approach, recreational and therapeutic activities for the prevention of acute disease exacerbations of chronic foci of infection and the background states.

• In the case of the disease the child may be sent to a children's group no earlier than two weeks after clinical recovery.

• Prohibited from conducting vaccinations for one month before the child enters preschool.

• Permission is granted admission to a child care facility without immunization, the first prophylactic vaccine in child care shall be appointed after the adaptation period, but not earlier than one month.

• The question of the direction in child care of children at "risk" as well as children with chronic diseases and congenital malformations are allowed to individually, depending on the status of each child, by commissioning and with appropriate professionals doctors.

A sample list of documents required for registration of a child in the nursery

• An extract from the history of the child (discount form 112);

• Information about immunizations or a duplicate registration form № 63;

• Results of the analysis of blood, urine, fecal helminths, scraping pernal ecteribioz warehouses, tank. culture of feces, throat swab for BV;

• Inspection specialists: a neurologist, ORL-doctor, podiatrist, optometrist, surgeon, dentist;

The main sections of the medical preschool establishment. Documentation. Preventive work.

• Performs inspection of newly enrolled in nursery children to the appointment of their complex medical and educational activities aimed at a favorable period of adaptation.

• Controls the conduct of routine vaccinations, performs preventive examinations of children to vaccination, following the receipt and expenditure of bacterial products, their storage conditions, periodically present during the vaccination, control of records of nursing administration of the vaccine in an individual child's card (Form № 026 U), paying attention to the date, type of vaccine, dose. Series, the shelf life of vaccine; monthly analyzes the implementation of preventive vaccination plan.

• Participates in periodic medical examinations of children, the rates of their physical development and health, and developing additional recreational activities for children "at risk", reports the head of the territorial department of preschool children's clinic on the health of children, their disease and the measures taken to prevent it.

• Examines the organization and quality of nutrition on menus - layouts, develops recommendations on the organization of child nutrition, appoint an individual power leads to correction of the indicators. Leads monthly accountability kalorazh.

• Oversees the organization of physical education of children, daily routine and training sessions, sanitation and anti modes of child preschool establishment, working to prevent injuries, accounting and analysis of all injuries among children.

Clinical work.

• Supervising the dispensary group of sick children, and appoints and controls the conduct of their anti-relapsing treatment, corrective and preventive actions, assigns children the necessary diagnostic tests and laboratory tests.

• Examining children for suspected acute illness and are in prison, giving them first medical aid in case of injuries, accidents and acute diseases, and takes measures to isolate and hospital sick children in hospital.

Organizational and methodological work

• Constantly working to improve their skills and qualifications of nursing staff, and conducts classes for medical and teaching staff for food service, recreational activities, diagnosis of diseases, sanitation and anti regime.

• Conducts sanitary-educational work with parents and preschool establishment staff.

• Lead set by the Ministry Health of USSR medical records.

Medical records DDU.

• Child Medical Card (Form number 026 U);• Map of immunization (form № 063 U);• Journal of infectious diseases registration (Form № 060 U), (3 years);• Emergency notification of infectious diseases, food poisoning,

unusual reaction to a vaccine (f. 058 U);• Check list of follow-up (form № 038 U);• Journal of Accounting health education (form № 308 U);• Book to record the health of institutions (f. № 308 U), (3 years);• Journal for Quality Control of the finished food;• Journal for the control of high quality perishable products entering

the catering department;• The magazine "Health".

Adaptation of children to preschool.

• The most crucial period for a child in preschool is the first days after admission, the so-called adjustment period. Many researchers found that most children suffer from it during the adaptation period. The largest share of SARS, transferred the child to stay in the nursery, occur within the first 6 months. Therefore, interventions to reduce child morbidity in the adaptation period is reduced primarily to the prevention of severe adaptation of the child, when you change the emotional state and disturbed behavior (worsens sleep, appetite, children refuse to play and communicate with both peers and adults, reduced speech activity, are lagging behind in the neuro-psychological development, etc.). This gives rise to changes in the autonomic nervous system reactivity in the system (reduction of the protective mechanisms of the body).

• At the light adaptation in violation of the behavior observed for 20-30 days. Slightly decreased appetite, the amount of food eaten increases to age norms for 10 days. Home baby sleep is not disturbed, and in preschool establishment, he is restored, usually within 7-10 days.

• Emotional state, speech activity, normalized relations with children, usually within 15-20 days. Relationships with adults almost never violated. Disease does not occur.

• Adaptation of moderate severity. With this degree of adaptation in the behavior of all violations of the pronounced and more durable. Sleep disturbance and appetite normalized, usually no earlier than 20-30 days. Contact with children in violation of an average of 20 days. Speech activity is not restored 20-40 days, the emotional state is unstable in the first month.

• There is a significant delay in motor activity, which recovered within 30-35 days. Relationships with adults are not violated. Acute illness with moderate adaptation occurs in the form of SARS, which proceeds without complications.

• For the serious adaptation is characterized by a significant duration (from 2 to 6 months. And more), and expressed the severity of symptoms. Moreover, children younger than 1.5 years of life, with a history of biological hazards plan and variations in health status before entering the pre-school, sick in the first 10 days after admission, then continue to be ill mapping 12 times or more within 1 year. The incidence is reduced by only 2-year stay in the institution.

• In older children (after 1.5 years), there is another form of severe adaptation, and there is inadequate supervision takes place, bordering on pre neurotic states. The child begins to lag behind in language development and play activities of 1.2 quarters (compared with age-norm).

• To prepare for disruptions in adaptation of children newly enrolled in preschool, you should take some corrective measures. First of all - it's organizational activities. Throughout the week, the group can take only a few new details. The regime should be gentle. Depending on the severity of negative emotions lead the child to preschool at different times, the term has gradually increased. In addition, prescribed herbal adaptogens. It is best to use Siberian ginseng. It mobilizes nonspecific protective factors reduces the incidence of viral respiratory infections, improves the appetite of the child possesses anti-stress effect. Siberian ginseng is assigned to the period of adaptation for 2-3 weeks 1-2 times per day for 1-2 drops for a year of life. In addition, you can assign Eleutherococcus Chinese magnolia vine.

The principles of follow-up of preschool children

• For mass preventive examinations of children in organized clinics are medical teams.

• In the medical team included: a pediatrician, ophthalmologist, neurologist, surgeon, otolaryngologist, prosthodontist, laboratory assistant, senior nurse preschool school department and the head of preschool school office.

• As the experience of conducting routine inspections team, looks around for a day about 60-80 children. Disadvantage - low efficiency of the team at a large load of doctors and lack of information from parents about children's health.

Advanced Medical Institute, St. Petersburg recommends that medical examinations of children in 4

stages:• Phase 1: survey of parents with the help of a specially designed

questionnaire to identify the complaints of the child.• Stage 2: a survey of all children nursing staff with the assistance

of teachers and educators of children's institutions with screening tests:

• Evaluation of physical development.• Determine whether the biological age of passport (for children of

preschool age is determined by three factors: an increase of age, increase growth in centimeters per year, compliance of milk and permanent teeth age).

• Assessing the level of neuro-psychological development.• Changes in blood pressure.• Detection of violations of the musculoskeletal system.

• Detection of color vision. For this purpose, a table polychromatic E.B. Ryabkina. In these tables, the circles of different colors, but the same intensity of color make up characters or numbers that are easily distinguished person with normal color vision - trichromats. Individuals with the disorder of the functions of characters (digits) may not recognize.

• Identification predmiopatii - test A.A. Malinevskogo (children with normal visual acuity). At the beginning of the visual acuity is determined, then the child brings to the eye lens:

• For children 5-8 years +1.0 D• 9 years +0.75• 10 years -0.5• Healthy school children of class 1 are in-depth examination of a

pediatrician at the end of the school year and during the year should be assessed as a dentist.

• Additional methods of examination are the same, only students grades 4 and 8 appointed by a blood test for sugar, and students of classes 7 and 8, is carried out x-ray examination.

• For the differential observations are examined by the children, depending on the state of health can be divided into 5 groups.

• Keep in mind that students who have attained the age of 15 years, surveys commission consisting of a pediatrician and medical specialists, and they passed into adolescence study. When you send a teenager's office is desirable that girls, especially being on dispensary, were examined by a gynecologist.

• By the beginning of the school year school physicians should be compiled monthly lists of students, teenagers, who during the year will be transferred under the supervision of teenage rooms. The lists must be certified by the director's signature and seal. One copy of the list passed to the head. Preschool children's clinic office, the other remains in school.

• At each 15-year-old pediatrician, together with the district school doctor prepares a transfer epicrisis, which is stored in the history of the child (F. № 112) and medical records of the child (f. № 026). In epicrisis fit past illnesses, data inspection specialists, laboratory data, information on preventive vaccination and a conclusion about the health of adolescents.

• School doctors to help physicians offices in the organization of adolescent health examinations of pupils 8-10 classes. Taking on the dispensary registration of students in 8-10 classes are filled f. 030.

• The main group. It includes children and young people without disabilities in the state of health or with minor variations of sufficient physical fitness. In this group classes on the curriculum of physical education in its entirety.

• The preparatory group - it includes children and teenagers, too, with minor deviations in health status, not without enough physical fitness.

• Classes are also conducted on the program of physical education in schools, but provided a more gradual development exercises, placing increased demands on the body.

• In an ad hoc group - includes children and adolescents with significant variations in health status, permanent or temporary nature, allowed for group lessons in school. Classes with this group of students for special programs are held with a differentiated approach to each student.

• In schools there are also groups of children, a temporary exemption from physical education.

Approximate dates of resumption of physical training after some acute diseases

• Angina-in 2-4 weeks• Bronchitis, acute catarrh of the upper respiratory tract, 1-3 weeks• Acute otitis-2-4 weeks• Pneumonia, pleurisy, 1-2 months• Influenza-2-4 weeks• Acute infectious disease, 1-2 months• Acute nephritis, 2 months• Hepatitis A - 8-12 months• Appendicitis (after surgery) - 1-2 months• Fracture of the bones of the extremities, 1-3 months• Concussion of the brain 2 months or more, up to a year.

• As already mentioned, the school doctor asks for release of students from the conversion and final exams, and taking an active part in his decision. The list of diseases that could be the basis for the release of secondary school students from exams.

• Every school physician shall report annually to summarize their work, analyze the mistakes, make recommendations for each individual child. Only then can the tremendous efforts spent on carrying out preventive work can bring tangible success.

Literatures• State Programme "Health of the Nation", Astana 1998.-84s.• Methodological recommendations for the clinical examination of the child

population. - Moscow, 1974.-88s.• Polyclinic pediatrics / ed. Prof. ET Dadambaeva - Almaty: Anuar, 1999.-196s.• Polyclinic pediatrics: Textbook. Benefit / EP Sushko, V. Novikov, ZE Petukhov

and others - MH.: Stitch. wk., 2000.-301s.• USSR Ministry of Health Order № 60 from January 19, 1983 "On further

improvement of outpatient care for children's population in cities."• Order of the Agency on the DMZ № 237 of April 24, 2000 "On prevention

and dynamic medical observation for certain categories of patients."• Guidelines for the district pediatrician / S. S. Shamsiev, N. Shabalov,

L.V.Erman.-Tashkent: Meditsina, 1990.-624s.• Clinical supervision of children in the clinic / Ed. K.F.Shiryaevoy.-Spb.: 1994.-

246s.

Control questions

• 1. Clinical examination of children 1 year of life.• 2. Medical control in the preparation of children

for admission to preschool.• 3. Differentiated training children to enroll in

preschool institutions.• 4 Types of school facilities.• 5. Functional responsibilities of the school

doctor and nurse. Reporting and records.