PREVENTIVE PEDIATRIC

CONCEPT OF PREVENTIVE PEDIATRIC (Concept of Preventive Pediatric).

Most of the causes of diseases seen in children are preventable. Child health care mainly emphasizes on preventive care.

Preventive care means prevention of diseases, promotion, maintenance and restoration of health and simultaneously promoting child’s physical, mental and social well-being towards positive health.

Preventive pediatrics is a branch of medicine which deals with preventive aspects in children and can be considered as the first clinical subject of preventive and social medicine which deals with preventive services.
In proactive pediatrics, work is done to prevent rather than cure disease.

Preventive pediatrics are broadly classified as follows.

Antenatal Preventive Pediatric
Post Metal Preventive Pediatric
Social Preventive Pediatrics

Antenatal Preventive Pediatric (Antenatal Preventive Pediatric).

In this branch of preventive pediatrics, the antenatal mother is cared for and given proper care so that her unborn child can be healthy and fit. By giving proper intervention to the mother during this time, many problems can be prevented in the children.

The care given to the mother during this period is as follows.

The mother should have a proper nutritional diet and a balanced diet during this time so that the nutritional needs of her and her unborn child can be met.

During the antenatal period it is necessary to take precautions to avoid any infection and to take care for the prevention of communicable diseases.

During the antenatal period, it is necessary to explain to the mother about breast feeding, antenatal exercise, delivery preparation, mother craft training etc.

Postnatal Preventive Pediatric (Postnatal Preventive Pediatric).

If mother and child are taken special care during the postnatal period, the child can be prevented from many problems. Postnatal preventive pediatric care includes the following.

During this period the mother should give the child exclusive breast feeding. The mother should be specifically advised to give colostrum to the baby.

Giving proper guidance to the mother for the immunization of the child and persuading the child to undergo complete immunization can prevent many diseases.

Explain to the mother that as the age of the child increases, the child is prone to many accidents. So to convince the mother to prevent these accidents and to minimize the risk factor.

Persuading the mother to visit the health care setup to periodically check the growth and development of the child.

After the baby is five to six months old, complementary feeding and weaning diet should be given and information about its principles should be given.

Social Preventive Pediatric (Social Preventive Pediatric).

The principles of social medicine should be applied in pediatrics to promote the growth and development of the child and help in the socialization process of the child.

In this branch of pediatrics, the child’s family members and surrounding environment can be made favorable and the child’s behavior can be worked for normal and proper development.

The following points are required to be considered for these services.

Healthy and happy parents play an important role in a child’s growth and development.
Keeping the house and surrounding environment clean and healthy.
Children are given special focus on the issues of play, recreation, love, affection, safety, security etc.
Special provision of educational opportunity should be made to the child.

About all the above points special importance should be given in preventive pediatrics. So that the child can be saved from many physical, mental and social problems and his growth and development can be normalized.

Due to these services, mortality and morbidity rates in children can also be reduced. Preventive pediatric services are of great importance in pediatrics.

AIMS OF PREVENTIVE PEDIATRIC

Aims of Preventive Pediatrics.

Prevention of disease.
To promote physical, mental and social wellbeing.
Early diagnosis and early treatment to prevent complications.
Prevent premature death.

PREVENTIVE PEDIATRICS SERVICES.

ORS therapy
Growth monitoring and immunization
Promotion of breast feeding
Nutritional supplementation
Regular health check up
Prevention and Control of Diarrheal Diseases and Various Infectious Diseases.
Promoting institutional delivery.
Providing supplemental nutrition to antenatal mother and postnatal mother.
Provide fluoridated drinking water and iodized salt.
Providing health education.

• LEVEL OF PREVENTIVE PEDIATRIC (Level of Preventive Pediatric).

The three main levels of preventive pediatric services are as follows.

1. Primary level (Primary level).

At this level mainly measures are taken to prevent or prevent diseases. In which the disease-causing pathogens are destroyed or the child’s resistance is increased so that he can avoid any disease.

The following points are taken into consideration for primary prevention.

Vaccination against any preventable diseases.
By providing healthy food and balance diet.
By exercising.
By maintaining a healthy relationship between parents and children.
By taking steps to prevent disease.

2. Secondary level.

At this level, the disease is diagnosed at the earliest and effective treatment is provided immediately.

The following measures are considered for secondary prevention.

Early diagnosis of any health problem using different diagnostic methods.
Early treatment of health problems with proper treatment.

3. Tertiary Level.

Disability and complications are minimized by taking appropriate measures after disease at this level.

The following measures are taken into consideration for functioning at the tertiary level.

To prevent complications of existing diseases by appropriate measures.
To improve the functions of the child which are limited due to disability and to increase his capacity.

• Immunization (Immunization)..

Immunization is a very important service in preventive pediatric services. By giving vaccine, specific protection is developed against specific diseases.

Immunization provides specific protection against diseases seen as dangerous infections in children such as poliomyelitis, diphtheria, pertussis, measles, rubella, hepatitis B, pneumonia, viral diarrhea etc., which are particularly responsible for mortality and morbidity in children.

Immunization in children produces immunity to specific diseases, and protects children from specific diseases or infections.

The following immunization schedule is followed under Universal Immunization Program.

Vaccine type
Cold chain

Cold chain equipment
AEFI
Immunity
Hypersensitivity

• Under Five Clinic (Under Five Clinic).

Children are a high risk group for developing any disease. Especially children under five years of age are vulnerable and special risk group for getting any diseases or infections.

In developing countries, the death rate is high among children under the age of five.
Among the causes of mortality and morbidity in children, prematurity, low birth weight (LBW), acute respiratory infection (ARI), diarrhoea, infectious diseases and accidents are the major causes.

The Under Five Clinic focuses on all types of preventive services as well as nutritional surveillance, health education and treatment for children under the age of five.

The concept of Under Five Clinic is derived from Well Baby Clinic. It provides all types of comprehensive health care services for children below five years of age.

The majority of causes of mortality and morbidity in children under five are preventable. So all these types of services are provided by Under Five Clinic in the form of a triangle symbol as follows.

1. Care in Illness.

Under 5 Clinic services provide immediate care and treatment to any child under five years of age during any illness or illness.
In which any disease or illness is diagnosed early and proper care is given.
All care related to children is provided on an institutional basis and when necessary, referral services are also used to refer the child for further treatment.

2. Adequate Nutrition.

During the developing period of the child it is very essential for him to get a proper nutritious diet for his normal growth and development.

A baby should be exclusively breastfed from birth to six months. A suitable weaning diet should then be provided.

In order to prevent Protein Energy Malnutrition (PEM) and anemia, rickets and different types of nutritional deficiency disorders in children, they should get a proper nutritional balance diet.

3. Immunization…

Immunization is a very important service in preventive pediatric services. By giving vaccine, specific protection is developed against specific diseases.

Immunization provides specific protection against diseases seen as dangerous infections in children such as poliomyelitis, diphtheria, pertussis, measles, rubella, hepatitis B, pneumonia, viral diarrhea etc., which are particularly responsible for mortality and morbidity in children.

Immunization in children produces immunity to specific diseases, and protects children from specific diseases or infections.

4. Family Planning (Family Planning).

During the Under Five Clinic programme, mothers should be counseled and guided about family planning and its methods and services so that they can better focus on their children’s health and well-being.

5. Health Education (Health Education).

These are very essential and highly needed services of Under Five Clinic. In which mothers and fathers are given health education on every aspect of their children’s care.

It provides health education on every aspect of disease prevention, health promotion, normal growth and development, best feeding, nutritional balance diet, periodic assessment, immunization, hygiene and cleanliness.

All the above services are provided under Under Five Clinic.

These clinics are usually run in villages, backward areas and remote areas.

The clinic is managed by a trained health worker and also conducts home visits and provides comprehensive home care to children under 5 years and mothers during home visits.

• Accidents in Children (Accident in Children)..

Accidents are a leading cause of death in children. It creates an emergency condition in children.

Accident means any unexpected and unplanned event that causes injury or damage and is an instantaneous action is called an accident.

Such accidents are common in developing countries and overcrowded areas where children are not given enough attention and because there is not enough space in the house, the same room is used for sleeping, sitting and cooking.

Generally, a baby above six months is moving from one place to another and due to the continuous increase in his movement power, he becomes a high risk of accidents.

In children, their coordination and judgment skills are not developed enough, so it makes children more prone to accidents.

Common causes for Accidents.

Usually due to the ignorance of the parents, it is mainly an accidental event.

Accidents are commonly seen due to lack of past experiences and insufficient knowledge.

As the mobility of children increases with increasing age, accidents also happen due to their hyper active nature.

Accidents also happen because children cannot perceive or understand dangerous or harmful situations.

Due to overcrowded areas and lack of facilities for play and recreation, children play at home so accidents happen.

Apart from this, such accidents also happen due to negligence.

Common childhood Accidents.

Drowning in which a child may fall into any water-filled space within the house or drown by falling into any water-filled area around the house.

Burns and scalds Burns can occur from fire during cooking and from any hot object falling or sticking on the skin.

Getting anything stuck in eyes, ears, nose or throat. Such injuries can be caused by small parts of children’s toys and any loose objects in the house.

Falldown injury A child may fall while standing up and walking. Falls down stairs, and falls and injuries while lying on a bed are common injuries.

Bruises or cuts on the skin. Such injuries can occur due to falling and being hit by any object.

poisoning. If any non-edible items in the house come within the reach of the child, the child may eat them and there are chances of poisoning.

Bite or bite injury. A child can be bitten or stung by any snake, scorpion, insect.

Get an electrical shock. Electric shocks can be caused by electrical wiring and electrical appliances.

A fracture, dislocation or sprain. These types of injuries can occur when a child falls.

Suffocation or suffocation. This type of injury can occur due to the child’s head getting stuck somewhere and any object wrapped around the neck.

Crus injury. These types of injuries can occur due to the child’s hands, feet and fingers getting stuck anywhere.

Sports injury. Falling and tripping injuries are common during sports.

Road Traffic Accident. Child accidents can be caused by road traffic accidents and vehicle accidents among others

All the above accidents happen in children.

Injuries like falls, electric shocks, burns, foreign body entrapment, drowning etc. are common during the infancy period.

Toddler and preschool children are more prone to fall down injuries, sports injuries, road traffic accidents etc.

• Measures for Accident Prevention.

Giving information about Safe Environment to the parents of the child so that they can take special care for things that harm the children.

Explain to the parents that as the child gets older, his movement capacity will increase and he becomes high risk for any accident.

Persuade the parents not to leave the child alone at any time and to keep the child under constant supervision.

Staying with the child and assisting him during every activity time of the child.

Explain about taking care that electrical plugs and wiring are not exposed in the house.

Explain that the child’s toys do not have any small parts that fall off and any other objects in the house are not of a type that can come into the hands of a small child so as to reduce the risk of foreign body inhalation.

Please ensure that no sharp objects are exposed or lying in the house.

Make sure that hot items or cooking utensils are kept out of the child’s reach.

Explain specifically that water vessels are not full and water tanks are not open around the house and in the house.

Encouraging the child to play in an open space or field for sports with super vision. Explain not to play sports in home environment.

Keep any cords or long objects that could entangle the child out of reach.

Never put any inedible and poisonous items in food containers and keep all these items under lock and key out of reach of children.

If any container is filled with inedible items, label it with danger and explain to the child.

Mother and father should be given special education for prevention of accidents and safe environment for the child. So that mortality and morbidity due to accidental injuries in children can be reduced.

• Breast Feeding (Breast Feeding)..

Human milk is ideal for all over growth and development of the baby.
Breast milk is a natural, ready-made, available food for baby feeding. which the baby receives directly from the female human breast through shaking. It is called breast feeding.
Breast feeding is also called the lactation process.

Exclusive breast feeding.

After the birth of the baby, he should be exclusively breastfed till the age of six months. Apart from this, no liquid or food is given is called exclusive breast feeding.

Physiology of Lactation

Lactation means the act of milk production. After the birth of the child, the mother gives the child complete nutrition through breast feeding. The physiology of this action of lactation can be described as follows.

Breast tissue of the mother consists of lobes and lobules. Small alveoli and ducts are located in the lobules. These tiny alveoli are connected to the lactiferous duct and the lactiferous duct opens into the areola.

Each nipple has approximately 20 lactiferous duct openings.
These alveoli secrete the secretion of milk colostrum during the second and third trimesters of the mother’s pregnancy.

After the delivery of the baby, the placenta is removed and the levels of estrogen and progesterone decrease. Along with this, the level of prolactin hormone increases. These changes initiate the act of lactation. Which is responsible for secretion of milk from breast tissue.
Apart from this, the secretion of milk from the breast is mainly based on the mechanical stimulation caused by the baby shaking the mother’s breast.

Two reflexes are mainly important in the process of milk secretion which are as follows.

Milk producing reflex..
When the baby is feeding on the mother’s breast, it shakes and due to its shaking action, the nerve endings on the areola of the mother’s breast are stimulated and it gives impulses to the hypothalamus. These impulses from the hypothalamus reach the anterior pituitary gland and the anterior pituitary gland increases the secretion of prolactin hormone into the blood. Thus, the increase in the secretion of prolactin hormone leads to the production of more milk by the breast tissue. As the baby shakes more, more prolactin hormone is produced and more milk is secreted.

Milk ejection reflex..
This is also called let down reflex.
When this is done by the baby shaking, the nerve endings of the breast stimulate the posterior pituitary gland through the hypothalamus to secrete more oxytocin hormone. The oxytocin hormone contracts the myoepithelium cells surrounding the alveoli within the breast and compresses the alveoli. Due to which the milk comes to the areola of the nipple through the lactiferous duct. In this way the milk is ejected from the duct.
Both the above refluxes are stimulated by the baby sucking the mother’s breast and the process of lactation is maintained…

Advantages of Breast Feeding (Advantages of Best Feeding).

Breastfeeding develops a psychological bond between mother and baby.

Human milk is available for the baby only as per the body temperature requirement.

Milk is fresh and sterile and free from contamination directly into the baby’s mouth.

Human milk is ideal if it is readily available.

Breast milk is a safe and protective food.
There is perfect food for infants.

Meets the total nutrient requirement for the baby for the first six months.

It is very important for baby’s brain growth because breast milk contains high amount of lactose and galactose.

Breast milk contains vitamins, minerals, electrolytes and water which are essential for the maturation of the infant’s intestinal system.

Breast milk provides a facility that increases the absorption of calcium so that the baby’s bone growth is good.

Breast milk is easily digested.

Breast milk contains all the essential nutrients that a baby needs.

Breast milk protects the baby from infection and deficiency.
Breast milk is already prepared.
Breast feeding is a method of family planning, breast feeding is a natural contraception that has a major effect on population for developing countries.

It prevents children from diarrhea and also has laxative action.

Breast feeding has no dangerous allergic effects.

Breast feeding can save time and money and energy.

Breast feeding helps in building a healthy relationship between mother and child.

Chances of conception decrease during lactation.

Best feeding helps in involution of uterus (i.e. bringing uterus to pre-pregnant state).

Breast feeding reduces the chances of sunstroke, gastrointestinal infections and ectopic eczema.
And the chances of scurvy and rickets are also reduced.

Breast feeding reduces the chances of breast cancer.

Breast milk contains IgA and IgM macrophages, lymphocytes, lysosomes, etc. due to which diarrhea and acute respiratory infections can be prevented in babies.
And prevents against malaria and viral and bacterial infections.

Breast milk protects against conversion, hypocalcemia, tetanus, deficiency of vitamin E and zinc.

Exclusive breast feeding can prevent malnutrition in children.

Breastfeeding increases the intelligence of the baby, and gives the baby a sense of security (due to the infant-mother bond).

The chances of illness in the child are reduced.

Breast feeding reduces the chances of postpartum hemorrhage (excessive bleeding from the genital tract after delivery).

Chances of ovarian cancer are also reduced.

Helps in reducing the excess fat that is stored in the mother during pregnancy.

Technique of breast feeding (Technique of breast feeding). Or
Principles of Breast Feeding (Principles of Best Fitting)..

Maternal preparations for breastfeeding should begin during the antenatal period. In which improving the nutritional status of the mother, examination of the mother’s breast, etc. If the nipple of the mother’s breast is inverted or flat, to correct it. Breast feeding training should be started in the antenatal period itself.

A mother’s willingness to breastfeed a child is very important. She should be psychologically prepared to feed the baby.

Explain to the mother that she should have milk, juice or adequate fluids before breastfeeding.

He should clean his hands, breast and nipple area before feeding.

The mother should be physically and emotionally relaxed and in a comfortable position.

Breast feeding can be given in any position. Mother and baby need to be comfortable.

Breastfeeding is usually best done in the sitting position. In which the mother should give complete support to the child and should be placed on her lap. The child’s body should get complete support. The baby’s head should be positioned in such a way that it faces the mother’s breast. The mother can fold part of the baby’s leg with part of her axilla.

Keeping the baby’s head against the mother’s breast. Positioning the baby in such a way that the head should be supported by one hand of the mother.

The baby’s cheek (cheek) and lip part should be touched with the nipple part of the mother’s breast to stimulate the routine reflex and encourage the baby for breast feeding.

If the breast is full or to properly arrange the nipple in the baby’s mouth, with the help of the thumb and first finger, hold the areola part in a U shape and place the nipple on the baby’s mother so that the baby can attach well.

Breast feeding is given until one breast is empty of complete milk. Alternative best no is then used during feeding.

During the early stages of best feeding, the baby may fall asleep during feedings. So the mother should wake up the child by gently touching the back of the child’s ear and the sole of the foot.

Breast feeding should be given according to the baby’s demand. Generally best feeding should be given six to eight times during the day and two to three times during the night.

During best feeding, baby swallows air along with milk. So after feeding, the baby should be kept in an upright position on the side of the mother’s solder, so that due to the pressure on the abdomen of the baby, excess air is removed through the mouth and nose. It is called belching. By doing this, the baby can be prevented from getting abdominal colic pain.

After breastfeeding, the mother should place the baby on the right side of the abdomen.

Technique for proper Latch On…or
Technique for Good Attachment (Technique for Good Attachment).

Baby’s mouth should be wide open.

His Chin (beard) part should be touching the lower part of the mother’s breast.

The baby’s lower lip should curve outwards towards the lower areola and the upper lip should cover the nipple completely.

A small part of the areola of the upper part of the breast should be visible while the lower part of the areola is not visible. In this way, the baby should cover part of the complete areola with the mouth, not just the nipple.

Signs for Adequate Breast Feeding

Baby sleeps well after taking breast feeding.

The child passes clear urine six to eight times during the day.

The child passes yellow colored watery stool four to eight times during the day.

After two weeks of birth, the baby’s weight continues to increase.

Problems of Breast Feeding (Problems of Best Feeding)

Factors hindering best feeding are as follows.

During best feeding there are various other problems including mother or baby which causes breast feeding to be obstructed which are as follows.

1. Inverted nipple.
   The nipple part of the mother’s breast is either flat or it curves inwards. It is called inverted nipple or flat nipple. Due to this type of nipple, normal breast feeding cannot be given to the baby.
   Whenever a mother is diagnosed with an inverted or flat nipple, it should be treated immediately.
   Ask the mother to pull and roll the nipple outward.
   Take a series of ten mL and ask the nipple to be pulled outward with pressure. This series is also called Nirmala series. With the help of this, the nipple can be corrected in a short time and breast feeding can be started well.

2. Shore nipple..
   That is, getting silver (ulcer) on the nipple or cracked nipple is a painful condition. In which the child cannot be breastfed normally by the mother.
   In the management of this condition, the proper breast feeding technique should be explained to the mother and the mother should be told to maintain proper breast and nipple hygiene. Applying hind milk at the end of breast feeding on the part with sore nipple or cracked nipple so that the part can heal quickly. Keep this part of the nipple open so that it gets enough air.
3. Breast engorgement…
   When the mother does not breastfeed the child soon or the child does not breastfeed, then breast engorgement is seen due to the overflow of breast milk. Baby cannot be properly breast fed.
   Explain proper breast feeding technique to the mother.
   Give warm compress on breast to mother.
   Analgesics medicine to relieve pain if required by the mother.
   Explain the method of expressing and expressing breast milk by milk pump or manually and feeding the baby with the help of a bowl spoon.

4. Breast abscess..
   When pus formation occurs due to infection or inflammation of breast tissue, it is called breast abscess.
   This is a painful condition. In this condition the baby should not be breast fed.
   Analgesics and antibiotic medicine should be given to the mother for treatment of this condition.
   If necessary, an incision should be made on the side of the breast and drainage should be done outside.
   Breast milk should be started on the breast of the other side .

Also, some babies do not breastfeed, so give the mother the right position and explain the technique of attaching the baby well.
Making the child feel a comfortable environment.
Give breast feeding when the baby is hungry.
Give breast feeding only when the baby is awake and not asleep.

It is necessary to take care of all the above things while giving breast feeding, if there is any problem then breast feeding cannot be done effectively.

Types of Breast Milk

Breast milk is an excellent source of nutrition for an infant. It makes its growth and development very good. Also, breast milk has many benefits.

The properties of breast milk are similar to cow’s (COW) milk.
It is ideal food for infants.

This breast milk is typed as follows.

1. Colostrum.

Dark yellow milk is secreted from the breast for the first two to three days after delivery. It is called colostrum.

The nutritional value of this breast milk is very high. It is rich in proteins, antibodies, immunoglobulins.

This breast milk is very important in maintaining the baby’s immunity and protecting it from many infections.

It is a low secreted breast milk and this type of breast milk is seen in the first two to three days.

2. Transition Milk (Transition Milk).

This milk is secreted for about two weeks after colostrum milk.

The amount of protein and immunoglobulins in this milk decreases and the amount of fat and sugar increases.

Colostrum and transition milk during exclusive breastfeeding can reduce the ratio of infection and neonatal mortality and morbidity.

3. Fore Milk.

The milk that comes at the beginning of breast feeding is called fore milk. This milk has high fluid content and low fat content.

This milk is rich in sugar, protein, vitamins, minerals and water.
This milk is important to satisfy the baby’s thirst.

4. Hind Milk.

The milk secreted later in the later stage after fore milk in breast feeding is called hind milk. This milk is full of fat.

This milk is important to satisfy the baby’s hunger. Due to this milk, energy supplement is mainly done in the child.

Since the baby’s appetite is satisfied due to giving hind milk, it can sleep comfortably, and it can have healthy growth and development.

According to the principles of breast feeding, the baby should get fore milk and hind milk at every best fitting. For this, complete breast feeding should be done in one session until the mother’s breast is completely empty.

• Artificial Feeding (Artificial Feeding).

When human milk is not available for any reason, feeding the baby through another preparation is called artificial feeding.

Artificial feeding should be given only when breast milk cannot be given for any reason.

Artificial feeding is given even when breast feeding is contraindicated.

Artificial feeding can be given to the mother when enough breast milk is secreted.

Artificial feeding can be given when the mother is not willing to give best milk due to modern life style or social pressure.

Artificial feeding can be given when the mother has died.

Following are the choices made in artificial feeding.

Dry Milk (Powder Milk)
Cow’s (cow) milk
Buffalo (buffalo) milk.

The following methods can be used to give artificial feeding.

1. Bowl and spoon feeding
2. Cup feeding or spoon feeding
3. Bottle fitting
4. Avoid gastric or gavage feeding.

Bowl and spoon feeding.

This method is a very good feeding method in babies. In which breast milk or prepared milk can be given to the baby with the help of bowl and spoon.

This method is very useful when the baby cannot suck properly, there is prematurity.

In this method, feeding is given with the help of a spoon after giving a proper position to the child.

Baby’s position should be correct while feeding through spoon. Also it should be seen that the child does not get injured by the spoon.

From the corner of the mouth, the baby is fed slowly through a spoon.

2. Cup feeding or spoon feeding.

This is also a very good feeding method for artificial feeding. In which after preparing the milk preparation in a cup or paella, the baby is fed directly by mouth through the cup or paella.

In this cup or pelada, feeding is given by making a gentle and soft touch on the margin of the baby’s lips.

Check that there is not too much pressure on the child’s lips or mouth and feeding should be given slowly as the child swallows. If over feeding is given, there is a possibility of exhalation in the baby.

3. Bottle feeding.

This is a popular method for artificial feeding. In which after preparing the milk it is filled in a bottle. Feeding is done by closing the bottle’s teat and placing the rubber nipple-like part in front of the bottle in the baby’s mouth.

While feeding through this method, the size of the front teat ie the hole of the cap should be proper. It should not be too small or too big. So that the child can be fed in a proper flow.

Principles Of Artificial Feeding (Principles of Artificial Feeding)..

Articles used for artificial feeding such as bottles, teats, bowls, spoons or bowls must be properly sterilized or boiled before and after use.

If articles used for artificial feeding are of rubber, special care should be taken not to damage their structure or material while boiling or sterilizing.

If the articles used in artificial feeding are not properly cleaned, there are chances of infection, indigestion etc. related to the gastrointestinal tract in the child.

It is very important to wash hands before preparing artificial feeding and before giving it to the baby.

Maintain proper hygiene while preparing artificial feeding and do not over dilute or under dilute the milk.

Preparations prepared for artificial feeding should be used fresh. Store in refrigerator if additional feeding preparation. Maximum storage can be done up to 24 hours.

Before feeding the baby, if the baby’s diaper is damaged, change it and give it a proper and completable position.

While giving artificial feeding, special care should be taken to avoid mouth injury and aspiration.

While introducing artificial feeding, introduce from the corner side of the baby’s mouth. Gently introduce feed when baby opens mouth.

After feeding keep baby in up right position and do burping.

Do not force-feed the baby if he is asleep or not ready to be fed.

Gently clean the baby’s mouth after feeding.

Place the baby in right lateral position after feeding.

During artificial feeding, take special care not to over-feed or under-feed the child and keep monitoring its weight interval.

• Naso Gastric Feeding (Naso Gastric Feeding or Gavaj Feeding)…

In this method of artificial feeding, a tube is placed through the nose or mouth to the stomach. Then the breast milk or formula milk is delivered through this tube directly to the baby’s stomach. This method is called gavaj feeding or najo gastric feeding.

Indications for giving nazo gastric feeding.

The child is hospitalized

Infants with low birth weight and infants with low shaking reflex are initially fed by this method.

Having problems like cleft lift, cleft palate

The child has any type of oral cavity, esophagus, or throat problem.

During hospitalization, neonates are specially fed by this method.

position.

The child is given supine position.
While placing the gastric tube, the child should be placed in supine position, the head should be elevated and the extremities should be restrained as necessary.

Equipments required..

Nasogastric feeding tube of appropriate size as determined by the age of the child.
syringe
Breast milk or formula milk
Stethoscope
Water
Adhesive tape etc.

Procedure Steps..

Explain the complete procedure to the child’s parents and take their consent.

Place the child in a supine position, extend the head backwards, then restrain the extremities.

Take the nazo gastric tube and measure it from the opening of the nose to the tragus of the ear and take a rough measurement of how much nazo gastric tube is to be inserted by measuring from the tragus to the sternum.

Then insert nose to naso gastric tube and check its normal position in stomach by different methods like stethoscope, water bowl, series to aspiration etc. test.

Fixing it with adhesive tape after confirming its position in the stomach.

Then take a series of appropriate size and separate its barrel from the piston and attach the barrel to the end portion of the tube and feed it first in a small amount. Then gradually feed the fixed amount.

Then give the baby left lateral position.

Flush the tube with plain water and record and report everything.

• Weaning (Weaning).

Breast feeding alone is sufficient to meet the nutritional requirement of the baby till the age of six months, but as the nutritional requirement of the baby increases after the age of six months, it is necessary to give additional supplementary food to prevent nutritional deficiency.

Weaning is the process of gradually shifting the baby from breast feeding to family diet.

The weaning process does not mean that breastfeeding stops, but breast feeding is continued with additional food to meet the needs of the baby during the weaning process.

Winning food should be fresh and hygienic, easy to prepare and not too costly. To select food which is easily digestible for the baby as winning food. Choosing a winning food is one that is high in energy and low in calories. While selecting food, the religion and culture of the child and mother should be kept in mind and a balanced diet should be given so that all types of nutrition can be obtained.

Weaning food is always introduced starting with liquid, semi-solid and finally solid food and gradually the child is shifted to the family diet.

The food given in the winning diet can be selected as follows.

Liquid food.

Fruit and vegetable soups can be given.

Semi solid food.

Grind all kinds of food in it like fruits, boiled vegetables, potatoes, cereals, pulses, rice etc.

Solid food.

All home cooked food is provided in it. All items like chapati, sabji, rice, idli, biscuit etc. can be given.

Principles related to Weaning Administration (Principles related to Weaning Administration).

A child should start weaning within a period of six months. Weaning food is a new change for the baby, so following principles should be considered for weaning food to be administered well.

All the items given in the winning food must be prepared at home. Also the best feeding is kept continuous and the above supplementary diet is started as a weaning diet.

While introducing any weaning food the amount is kept low initially and the amount is gradually increased.

Start one weaning food at a time, test the baby first when introducing any new food and continue with that test. If the baby rejects any new food, it does not mean that the baby is not comfortable with that food. Mother should introduce the same food frequently to the baby so that he can adjust to his test.

When starting any new food, start during the day. In the beginning, keep the amount small, give only two or three times a day. Gradually increase its amount so that any allergy or intolerance can be identified.

When introducing any new food, start when the baby is hungry, but don’t force it.

Do not add any new food more than once so that any allergic reaction or intolerance can be identified.

Keep observing the child while giving the weaning food. After giving any specific food, if any diarrhea, indigestion, abdominal pain, skin rashes, allergic reaction, psychological problems etc. are noticed then it should be taken into consideration.

Starting the weaning too late or too early can cause problems for the child to start the weaning date at the right time.

If the child is not started on weaning diet even after six months of age then the child may show symptoms of malnutrition so weaning should be started on time.

Feeding Problems (Feeding Problems)…

Breastfeeding is considered the best food for a baby up to six months. Then the winning diet is started.

Many feeding related problems are seen in babies who are taking artificial feeding or who are started on weaning diet, which are as follows.

There are chances of abdominal pain, indigestion due to the child not being able to digest any food.

There are also chances of the child having diarrhea vomiting or regurgitation.

Problems like under-feeding or over-feeding are commonly seen due to improper feeding amount of the child.

Malnutrition and nutritional deficiencies can also be seen.

• Nursing Role and Responsibilities in Preventive Pediatrics.

Pediatric population being a high risk group may increase common health problems, mortality and morbidity in this age group. So many diseases and illnesses can be prevented due to providing health care facility on preventive aspect. So that normal growth and development of children can be promoted and their full potential can be developed.

The nursing role and responsibility in preventive pediatrics starts with the health promotion of the girl child. Because this girl child is a future mother. So proper care should be taken right from the childhood period and if proper care is taken till the adolescent period then she can become a healthy mother and give birth to a healthy child in the future.

Special care of mother should be taken during antenatal period, she should be given proper care and mother craft training during this period.

Providing proper intranatal care to the mother can prevent many injuries and hazards to the newborn.

Along with proper postnatal care, proper promotion of breast feeding and mother education is provided to prevent illness in children.

Explain specifically to the mother about immunization and prevention of diseases caused by it.

Providing all health education about nutrition to the mother, including exclusive breast feeding for six months, followed by weaning, balance diet, fitting practices, food hygiene and explaining the importance of nutrition for prevention of mal nutrition.

Providing health education on personal hygiene, hand washing, environmental sanitation, safe water supply, prevention of accidents, promotion of health, prevention of communicable and infectious diseases and family planning services.

Explain to take institutional care for prevention and proper treatment of diseases found in children.

Provide information about all National Health Programs and explain how to avail them.

To promote good health habits and related home remedies to maintain children’s health.

To implement the new trends of pediatric nursing in health care and provide necessary guidance and health education to the parents accordingly.