Child Health

Child Health revision cards.

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  • Created by: Isla
  • Created on: 05-05-13 16:21

1-Introduction to the Unit

How is health defined?

  • Medical Model: abscence of disease.
  • Holistic Model: state of well-being.
  • WHO 1946: 'State of complete physical, mental and social well-being...'
  • WHO 1984: '...satisfy needs and to change or cope with the environment...'

Health needs of:

  • In Utero Risks: maternal health/nutrition, maternal stress, infections, environmental toxins, drugs/alcohol, smoking 
  • Infants: health/nutrition, sensory stimulation, attachment, stable environment, sleeping-position/room temp./air quality, hygeine, immunisations
  • Toddlers: accident prevention, immunisations, developmental screening, motor development, social skills, language
  • Pre-school: safety, nutrition, self-care skills, toilet-training
  • School Age Children: self-care skills, nutrition, sleep, exercise
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2 - Newborn Infants and Early Infant Feeding

  • Immediate needs of the baby: keep warm and dry, skin to skin contact, breast-feeding, assessment, monitoring

Breast-feeding

  • Advantages for baby: contains growth factors / high quality balanced food / confers immunity / protects against allergies / less likely to be overweight / protects against GI and respiratory infections / increased intelligence / reduced risk of middle-ear and urinary tract infections / reduced risk of neonatal necrotising enterocolitis.
  • Advantages for mother: reduced risk of breast and ovarian cancer / regain figure more quickly / reduced risk of osteoperosis and hip fracture / contraception
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3 - Infant Feeding, Weaning and Childhood Diet

  • WHO - exclusive breast-feeding to 6 months
    • BUT window at 4-6 months where baby more likely to try new foods - against WHO advice.
  • 9 months - introduce different tastes and textures
    • ALSPAC - most mothers introduce solids by 4 months.
      • Earlier introduction to solids makes obesity more likely.
      • If solids introduced after 10 months, greater feeding difficulties at 15 months.
  • Healthy Start Vouchers - for milk, fresh fruit and veg., forumula (free vitamin drops)
  • Birth to Five
    • Important for baby to eat with family - interaction/inclusion.
    • Babies generally know when they have eaten enough.
    • Avoid giving babies salt, sugar and honey.
    • Under ones should have full-fat milk only - reduced fat ok in cooking for under 5s.
    • By 1-year should use free-flow cup to learn to sip not ****.
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4 - Developmental Pathways and Impacts on Dvlpt

Effects:

  • Latency - factors in early life that have lifelong impact.
  • Pathway - early life factors directing child on to different courses.
  • Cummulative - accumulation of advantage / disadvantage.
  • Bronfenbrenner's Ecological Model - External factors interact with a child features to produce health outcome.

Flaherty et al. (2006)

  • Exposure to abuse and household dysfunction leads to poor health in adulthood:
    • cancer / liver disease / skeletal fractures / chronic lung disease / ischemic heart disease
    • smoking / suicide / depression / obesity / drug abuse / alcoholism / teen pregnancy / sexual risk behaviours / STDs
  • One adverse exposure doubles chance of poor health, 4 triples chance.
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5 - Child Health Promotion

  • Things That Impact on a Child's Health - poverty / diet and weight / pecking order in larger families / exercise / birth injury / environmental factors / pre-natal factors / access to healthcare / genetic disease / lifestyle / relationships / education.
  • Universal vs. Targeted Screening.
  • Absolute risk - what is my % chance of getting it?
  • Relative Risk - how many times more likely are those at risk to get it?

Healthy Child Programme

  • Immunisation
  • Promote breast-feeding and nutrition
  • Play and development
  • Awareness of environmental factors
  • Delivery: Personal Child Health Record / Children's Centres / GP Surgeries / Multi-disciplinary teams - health visitors, midwives, children's centre staff.
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6 - Childhood Injury Prevention

  • 2 million children a year in A+E from unintentional injury.
  • Cost of treating severe scald - £250,000.
  • Economic factors: space to play / affording safeguards / appropriate supervision / access to services / education and awareness.
  • Number of unintentional injuries has fallen: better car design / technological advances / fewer children play on roads / people more aware / change in government / legislation and enforcement.

Drago (2005)

  • Boys experience more burns and scalds than girls:
    • males more exporatory / taller at most ages than girls so can reach surfaces.
  • Age plays a factor: mobility / height / younger children more likely to play in kitchen - need supervision.
  • Prevention - use back burners on hob / turn pan handles inwards / regulate bath water temperature / remove table cloths / hot drinks in centre of table.
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7 - Over and Under Nutrition in Children

  • WHO Growth Standars 2006:
    • Description of optimal growth.
    • Data from breast-fed infanct of non-smoking mothers.
    • Affluent countries.
  • Faltering growth - weight falls below height by 2 centiles for over 2 measurements or weight centile falls across more than 2 centiles over time.
    • Across all socio-economic groups - normally medical cause.
  • Wasting - low weight for height.
  • Stunting - low height for age.
  • Adiposity - dip and rise in BMI - if it happens early, obesity more likely.
  • 22 million children overweight worldwide.
    • In the UK 22% boys and 28% girls.
  • Overweight: BMI 91st centile.
  • Obese: BMI 98th centile.
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8 - Immunisation and Prevention of Infection

  • Clean water and immunisation are 2 public health interventions with greatest impact.
  • Aims of immunisation: give protections /long-lasting immunity / interrupt spread.
  • Passive immunisation - anti-toxins and immunoglobin, immediate antibodies eg. tetanus.
  • Active immunisation - antigens simulate antibody production, live/inactivated.

Live Vaccines

  • Advantages - strong immune response / local and systemic immunity / long-lasting single dose.
  • Disadvantages - bad for immunosuppressed patients / poor stability - organism could die and be ineffective / interference by viruses or vaccines and passive antibody.

Inactivated Vaccines

  • Advantages - constituents clearly defined / stable / unable to cause the infection.
  • Disadvantages - need several doses / local reactions common / adjuvant needed
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8 - Immunisation Schedule 2012

  • 2 months - Diptheria Tetanus Pertussis (DTaP) / Inactivated Polio (IPV) / Haemophilus Influenzae B (Hib) / Pneumococcal 13 valent (PCV).
  • 3 months - DTaP / IPV / Hib / Meningococcus C (MenC)
  • 4 months - DTap / IPV / Hib / PCV / MenC
  • 12 months - MenC / Hib
  • 13 months - PCV / MMR
  • 3 1/4 - 4 years - DTap / IPV / MMR
  • 11/12 years - HPV Vaccine for girls.
  • 14 - 16 years - Diptheria Tetanus Polio (dt) / IPV

REACTIONS

Local: normally with non-live, pain, redness, swelling at injection site. up to 60%
Systemic: normally with live, fever, headache, loss of appetite. 2/3%
Allergic: anaphylaxis / severe systemic. 1 in a million

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9 - Developmental Problems/Disability

  • Impairment: abnormality of a structure or function.
  • Disability: functional consequence.
  • Handicap: social consequence.

Medical Model - Minority group issue / Impariment groups / Categorical.

Social Model - Continuum / Everyone may have a disability / Applies to nearly all.

Disability Groups - Physical, motor, mobility / Sensory / Cognitive / Psychiatric / Systemic disease, chronic illness.

Hodge (2005)

  • Diagnosis can be disabling.
  • Parents can have an agenda for diagnosis - put mind at ease / labeling / get support

Shakespeare and Watson (2002)

  • 'Disability as social oppression not the form of impairment.'
  • Social model denies difference, denies plural identities.
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10 - Common Illnesses & Acutely Unwell Children

  • In general practice per 1000 per year:
    • Upper respiratory infections: 0-4yrs = 900, 5-14yrs = 398
    • Lower respiratory infections: 0-4yrs = 198, 5-14yrs = 82
    • Asthma: 0-4yrs = 9, 5-14yrs = 12
  • Reasons for rise of some illnesses: drug resistance / immigration? / AIDs
  • Reasons for fall of some illnesses: rising standards of living / higher incidence = higher natural immunity?
  • Why has asthma increased? Air pollution / cigarette smoking / indoor air quality / genetics / diet and obesity.
  • Symptoms of meningitis: headache / high-pitched cry / dislike of bright lights / stiff neck / temperature / rash.
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11 - Child Dvlpmt, Atchmt & Maternal Depression

  • Leave baby or pick it up? - Learn to regulate emotions or facilitate attachment?
  • 4-7 months - preference for mum.
  • 9 months - secure base / object permanence ie. understanding mum will come back.

Attachment Styles:

  • Secure
  • Insecure - anxious
  • Insecure - avoidant
  • Maternal depression can affect attachment even before birth: reduced attentional bias to distressed infants / reduced feelings of 'wanting to comfort' / reduced maternal responses after birth.
  • Interventions: infant massage / parental guidance / video feedback.
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12 - Psych. Aspects of Life Lmtng/Thrtng Cndtns

  • Chronic Condtion: last more than 3 mths / cannot be cured / treatment aimed at reducing negative effects eg. asthma / sickle cell anaemia / migraines.
  • Life-limiting Condition: no reasonable hope of cure / child or young person will die / sometimes progressive deterioration.
  • Life - threatening Condition: curative treatment feasible but can fail eg. cancer.
  • STATS: 31% under 18s have a chronic condition / 5852 deaths per year (2002-05)
  • Impact on Child: disrupted attachment - caregiver associated with pain? / increased risk of mental illness / striving for a normal lfie - teen risk-taking behaviour / reduced opportunities.
  • Impact on Parents: increased stress / financial pressures / reduced career opportunities / impact on physical health / increased risk of mental health issues / 'emotional roller coaster'.
  • Impact on Siblings: disrupted attachment . increased risk of mental illness / ambivalent feelings towards ill sibling and parents / isolation / reduced opportunities / protective of parents at cost to self?
  • Factors affecting ability to cope: feelings of distress / resources / support / resilience.
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13 - Vulnerable Children

  • Stats:
    • All children in UK: 11 million
    • Vulnerable Children: 4 million
    • Children in Need: 3-400,000
    • Looked After Children: 53,000
    • On Child Protection Register: 32,000
  • High risk groups: children with disabilities or chronic illnesses / abused and neglected / 'looked after' by LA / living with DV / refugees and asylum seekers / travelling families / parents with mental health problems - learning difficulties, chronic health problems, drug & alcohol use.
  • Poverty means more likely to: be born early / be born too small / die in the 1st year of life / die from accidents in childhood / die earlier as adults.
  • Travelling families: poor life expectancy / infant mortality 1.5-2 x settled community / many chronic illnesses / smoking very common / poor nutrition.
  • Outcomes for Looked After Children: 40% no quals. at 16 / 1/3 experience homelessness / 50% have a mental health problem / 50% care leavers unemployed.
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14 - Child Protection is Everybody's Business

  • 4 types of abuse: physical / emotional / sexual / neglect.
  • Parental issues that my increase risk: substance misuse / DV / MH issues / learning difficulties / young parents / own experiences of parenting.
  • No legal age for when you can leave a child home alone.
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15 - Global Child Health

  • Millenium Development Goals:
    • Eradicate extreme poverty and hunger.
    • Achieve universal primary education.
    • Promote gender equality.
    • Reduce child mortality by 2/3, 1990-2015.
    • Improve maternal health - reduce maternal mortality by 3/4.
    • Combat big 3 - HIV/AIDs, malaria and TB.
    • Ensure environmental sustainability.
    • Global partnership for development.
  • Top 5 killers: diarrhoeal disease/ Acute Respiratory Infection/ Malaria/ Measles/ Malnutrition.
  • Integrated management of Childhood Illness (IMCI) - under 5s / reduce - death, illness, disability / promote growth & development / preventative & curative elements.
  • Risk Factors: access to healthcare - significant drop in attendance if more than 3 hours away / percieve health needs / conflict & instability eg. Iraq, Afghanistan, Ethiopia.
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