1、PRIMARY OF CHILD CARE AND INFANT FEEDING,Routine immunization Schedules, contraindications and reactions Breast feeding Advantages and contraindications Comparison of human and cows milk Technique of breast feeding and artificial feeding,Emphases of This Lesson,Children and adolescents represent a b
2、ig group of whole population,It is most vulnerable population!,A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. 健康是指生理、心理及社会适应三个方面全部良好的一种状况，而不仅仅是指没有生病或者体质健壮,HEALTH,WHO,What is the difference of Pediatrics from most other medical specialt
3、ies,?,What is the key points in pediatric history taking and examination,?,The childs age,late fetus:29-40w,embryo:0-12w,Fetus,middle fetus:13-28w,Infant period(0y),Perinatal stage: 28w of fetus-1w of life,Newborn: 0-28ds,Toddler period (1-2y),Preschool period- young child,(3-5y),School age period -
4、 old child (6-11y),Puberty teenager, adolescent,PRIMARY OF CHILD CARE,Primary of child care comprises efforts to avert rather than to cure disease and disability preventive medicine has been subdivided into primary, secondary and tertiary prevention,Secondary Prevention,Preventive Pediatrics,Primary
5、 Prevention,Tertiary prevention,Primary Prevention,Nutrition Immunizations Hand washing Parenting education Improvement of the environment,Primary Prevention,Community Primary Prevention Several measures to prevent disease at the community level have had enormous effects on childhood morbidity and m
6、ortality,accidents, homicide and nonfatal injuries Primary Prevention in the Pediatricians Office to foster the smooth, normal development of the child from infancy to adulthood to help ensure that each child achieves adult life as physically, intellectually, and emotionally intact as possible,Prima
7、ry Prevention,Basic requirement for almost every successful primary preventive measure in pediatrics is understanding the cause pathogenesis natural history of disease,Secondary Prevention,Physical examination Growth measurements Disease screening tests,Secondary Prevention,involves the recognition
8、and elimination of the precursors of disease and includes many screening programs such as those for elevated blood lead levels efforts designed to identify and reverse disease in its early stages such as a screening program for scoliosis in adolescents,Tertiary Prevention,Prevention of further disab
9、ilities due to chronic disordersPrevention acute problems in chronic disordersRegular monitoring of patient status,Tertiary Prevention,includes measures intended to ameliorate or arrest the disabilities arising from established disease physiotherapy to prevent contractures in patients with chronic n
10、eurologic disorders,Knowledge of the natural history of the disease and of the means to recognize and treat it are necessaryDefinition of the cause is not essential,In Contrast for Secondary or Tertiary Prevention,Prenatal Period,Sometime during the 3rd trimester about any of their problems or conce
11、rns Care in the newborn nursery The proposed schedule of visits Planned immunizations Desirability of breast feeding Living arrangements for the baby May be available at home during the 1st wk or 2 after birth.,Newborn Care,Physical examination within 24 hr after birth Prophylaxis for ophthalmia neo
12、natorum Single intramuscular dose of a vitamin K preparation A test for PKU should be done and T4 measured 10 to 15 ml of cord blood should be collected at birth and saved in the refrigerator, for 7 days for typing, Coombs testing, and other tests if needed,Newborn Care Follow-up,First routine follo
13、w-up visit depends on the status of the infant and the experience of the parents.An office visit at 3-4 wk after birthensures that feeding is going well provides answers to questions that have arisen identifies and solves minor problems reassures the parents.,Routine Immunization,The schedule for im
14、munization is that recommended for routine protection of children by the Committee on Infectious Diseases of the World Public Health Service For prevention of seven diseases in China,Routine Immunization,12/ 100,000,incidence of measles in China,2003,What is Routine Immunization?,Implies the “regula
15、r” delivery, i.e., known schedule Part of a larger plan Not time limited Goal to provide needed vaccines to all eligible persons and to successive birth cohorts,PV poliomyelitis vaccine,OPV:Oral Poliomyelitis Vaccine, a live, attenuated trivalent polio vaccine IVP: an inactivated (killed) trivalent
16、polio vaccine A full course of either vaccine protects the recipient against paralytic poliomyelitis almost without exception The 1st dose of OPV should be given at approximately 2 mo of age and the 2nd 1 mo later.,PV poliomyelitis vaccine,3rd dose at 4 mo of age is recommended ,close to the areas o
17、f high endemicity of poliomyelitis An additional dose:18 mo of age and another prior to school entry.,Ordinarily started at 3 mo of age Two additional doses are given at 1-2 mo intervals DPT and Td(diphtheria) should be given intramuscularly, preferably in the anterolateral thigh in young infants an
18、d either in the thigh or the deltoid in older children.,DPT Diphtheria Pertussis Tetanus Vaccine,MMR（MV） measles-mumps-rubella（measles ） vaccine,A live attenuated vaccine Be administered at 8 mo of age in China,Reactions to Vaccine,Local swelling and tenderness at the site of injection Slight fever
19、Irritability Neurologic reactions Transient rashes,Influenza A (H1N1) Vaccine,CONTRAINDICATIONS Hypersensitivity to eggs, neomycin, or polymyxin, or life-threatening reaction to previous influenza vaccination. WARNINGS AND PRECAUTIONS If Guillain-Barr Syndrome (GBS) has occurred within 6 weeks of pr
20、evious influenza vaccination, the decision to give Influenza A (H1N1) Vaccine should be based on careful consideration of the potential benefits and risks. Immunocompromised persons may have a diminished immune response to Influenza A (H1N1) Vaccine.,Contraindications to Vaccine,Pregnancy Immunocomp
21、romised / immunodeficiency Therapeutic immunosuppression An acute febrile illness,Delayed Immunization,Infants more than 2 mo but less than 14 mo of age without any immunization should be started on the same sequence of immunizations and intervals between doses as those recommended for young infants
22、.Children 14 mo-7 yr of age who have received no immunizations should receive DPT, OPV, and a tuberculin test at the 1st visit. All children should receive a dose of Td in early adolescence.When immunization is delayed, questions arise about the simultaneous administration of multiple antigens, such
23、 as giving DTP, OPV, and MMR at the initial visit.In all situations it should be borne in mind that an interval of at least 1 mo should be allowed between doses of the same or different vaccines when they are not given simultaneously.,FEEDING OF INFANTS,Successful infant feeding requires cooperative
24、 functioning between the mother and her baby Prompt establishment of comfortable, satisfying feeding practices contributes greatly to the infants and mothers emotional well-being Feeding time should be pleasurable for both mother and child,FEEDING OF INFANTS,Feedings should be initiated to maintain
25、normal metabolism and growth during the transition from fetal to extrauterine lifePromote maternal-infant bondingDecrease the risks of hypoglycemia, hyperkalemia, hyperbilirubinemia, and azotemia,Normal activity Alertness Suck Cry,FEEDING OF INFANTS,More mistakes are made by feeding the infant too m
26、uch than too little The schedule of initial feeding in a hospital is less important than the principle of unhurried beginning and patient assistance and support for the mother,FEEDING OF INFANTS Suggestions,The infant is taken to the mother for the 1st feeding at 10 A.M. or 6 P.M. Subsequent formula
27、 or breast feedings are given every 3-4 hr/day and night by the mother. Artificially fed infants should receive sterile water for the 1st feeding.since regurgitation and aspiration of this liquid are less likely to cause significant irritation of the respiratory tract The emptying time of the infant
28、s stomach may vary from 1-4 or more hr. Most healthy bottle-fed infants will want 6-9 feedings/24 hr by the end of the 1st wk of life.,FEEDING OF INFANTS Suggestions,Term infants:rapidly increase their intake from 30 ml to 80-90 ml every 3-4 hr prior to discharge at 4-5 days of life. Feeding well:th
29、e infant is no longer losing weight by 5-7 days and is gaining weight by 12-14 days. Many will not want a late evening feeding between 4 and 8 mo of age and will be satisfied with 3 meals a day by 9-12 mo.It is important to establish that babies cry for reasons other than hunger and need not be fed
30、every time they crySick infants are often uninterested in food The habit of offering frequent, small feedings or of holding and feeding to pacify all crying should not be cultivated,BREAST FEEDING,Breast feeding continues to have practical and psychologic advantages that should be considered when th
31、e mother selects the method for feedingHuman milk is the most appropriate of all available milks for the human infant since it is uniquely adapted to his or her needs,BREAST FEEDING Colostrum,The secretion of the breasts during the latter part of pregnancy and for the 2-4 days after delivery a deep
32、lemon yellow color, alkaline, and its specific gravity is 1.040-1.060.The total amount of colostrums secreted daily is 10-40 ml. Human or cow colostrum contains several times as much protein as mature breast milk and more minerals but less carbohydrate and fat. Human colostrum also contains some uni
33、que immunologic factors. After the first few days of lactation, colostrum is replaced by secretion of a transitional form of milk which gradually assumes the characteristics of mature breast milk by the 3rd or 4th wk.,BREAST FEEDING Colostrum,Human milk late in pregnancy and early after birth contai
34、ns more protein, calcium, and other minerals than later during nursing.,Colostrum,Mature milk,early,late,FatProtein lactose,BREAST FEEDING Advantages,Breast milk is the natural food for pull-term infants during 1st months of life. always readily available at the proper temperature and no time is req
35、uired in preparationfresh and free of contaminating bacteria so that the chances of gastrointestinal disturbances are lessened,BREAST FEEDING Advantages,Allergy and intolerance to cows milk are responsible for significant disturbances and feeding difficulties not seen in breast-fed infants diarrhea,
36、 intestinal bleeding, and occult melena ,“Spitting up,“ colic, and atopic eczema are less common in infants receiving human milk,BREAST FEEDING Advantages,Human milk contains bacterial and viral antibodies, including relatively high concentrations of secretory IgA antibodies Less respiratory and gas
37、trointestinal diseases in breast-fed infants Breast-fed infants of mothers with high antipoliomyelitis titers are relatively resistant to infection by the attenuated live poliomyelitis vaccine viruses,BREAST FEEDING Advantages,The growth of the mumps, influenza, vaccinia, and Japanese B encephalitis
38、 viruses can be inhibited by substances in human milk These ingested antibodies from human colostrum and milk may afford local gastrointestinal immunity against organisms that enter the body via this route. Macrophages are normally present in human colostrum and milk and may have the ability to synt
39、hesize complement, lysozyme, and lactoferrin. Breast milk is also a source of lactoferrin, the iron-binding whey protein,BREAST FEEDING Advantages,The stool of the breast-fed infant has a lower pH than that of the infant fed cows milk, and its bacterial content is predominantly of the lacto-bacillus
40、 group in contrast to a preponderance of the coliform group in artificially fed infants. Human milk contains a “growth factor“ which facilitates intestinal colonization by Lactobacillus bifidus. The intestinal flora of infants fed human milk may protect them against infections caused by some species
41、 of E. coli.,BREAST FEEDING Advantages,Milk from the mother whose diet is quantitatively adequate and properly balanced will supply the necessary nutrients, with the possible exception of vitamin D after several months and fluoride.Iron stores are sufficient for the 1st 6-9 mo in term infants. The i
42、ron of human milk is well absorbed by the infant; breast-fed infants may not require supplemental iron during the 1st yr, but their diets should be supplemented after 6 mo of age by the addition of cereal and meat or by administration of one of the ferrous iron preparations. Human milk contains suff
43、icient vitamin C for the infants needs, provided the mothers intake is adequate.,BREAST FEEDING Psychologic Advantages,The mother is gaining both a feeling of being essential and a sense of accomplishment The infant is afforded a close and comfortable physical relationship with the mother Breast fee
44、ding offers increased opportunity for close sensual contact between mother and infant studies suggest that early, and intimate tactile and visual contact are important in determining the quality of attachment and mothering which is provided the infant.,BREAST FEEDING Technique,The infant should be h
45、ungry at feeding time, and held in a comfortable, semisitting position for his or her enjoyment and for facilitation of eructation without vomiting The mother must be comfortable and completely at ease. The baby is supported comfortably with the face held close to the mothers breast by one arm and h
46、and while the other hand supports the breast so that the nipple is easily accessible to the infants mouth and yet does not obstruct the infants nasal breathing. The babys lips should be expected to engage considerable areola as well as nipple.,BREAST FEEDING Technique,The normal infant is equipped w
47、ith several reflexes, which are designed to make him a successful feeder from the breast. The most obvious of these reflexes are those concerned with the actual getting of food-rooting, sucking, swallowing, and satiety reflexes.if the infant is not hungry, he or she will not search for the nipple or
48、 suck. At the end of the nursing period the infant should be held erect over the mothers shoulder or on her lap to eructate swallowed air,to facilitate emptying of the stomach into the intestines and to lessen the chances of regurgitation.,BREAST FEEDING Contraindications,For the average, healthy, f
49、ull-term infant there are no disadvantages to breast feeding, provided the mothers milk supply is ample and her diet contains sufficient amounts of protein and vitamins. Infrequently, allergens to which the infant is sensitized may be conveyed in the milk. In such instances an attempt should be made
50、 to find the specific allergen and to remove it from the mothers diet; its presence rarely is a valid reason for weaning the baby.,BREAST FEEDING Contraindications,For the mother, there are few contraindications to breast feeding: Markedly inverted nipples Mastitis Acute infection in the mother Septicemia, nephritis, eclampsia, profuse hemorrhage, active tuberculosis, typhoid fever, and malaria are permanent contraindications to nursing Chronic poor nutrition, debility, severe neuroses, and postpartum psychoses,
