🚼📈 Toddler – Growth and Development (1–3 Years)

📘 Essential for Pediatric Nursing, Child Health, and Growth Monitoring

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🔰 Definition:

A toddler is a child between 1 to 3 years of age, characterized by rapid motor, cognitive, and emotional development. It is a critical period for language acquisition, independence, and social behavior shaping.

✅ Also known as the “I can do it myself” stage.

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🧭 Growth in Toddlers:

📏 Parameter	🧒 Expected Values
🟩 Weight	Increases ~2–3 kg/year; weight at 2 years ≈ 4x birth weight
🟨 Height	Increases ~12 cm/year; ~90 cm by 3 years
🟧 Head Circumference	Growth slows; brain is 80% of adult size by 3 years
🟥 Teeth	All 20 deciduous teeth usually erupt by 2.5–3 years

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🧠 Developmental Milestones in Toddlers:

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🟩 Gross Motor Skills:

🕒 Age	🚶‍♂️ Milestone
12–15 months	Walks without support
18 months	Climbs stairs with help
24 months	Runs, kicks ball, walks up stairs alone
3 years	Rides tricycle, jumps, balances briefly

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🟨 Fine Motor Skills:

🕒 Age	✋ Milestone
15 months	Scribbles with crayon
18 months	Builds tower of 2–4 blocks
2 years	Turns pages, starts drawing lines
3 years	Draws circle, feeds self with spoon

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🟧 Language Development:

🕒 Age	🗣️ Milestone
12–15 months	Says 2–3 words with meaning
18 months	10+ words vocabulary
2 years	2–3 word sentences (“Want milk”)
3 years	Asks questions, knows name and age

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🟥 Social & Emotional Development:

🕒 Age	😊 Milestone
1–2 years	Temper tantrums, attachment to caregiver
2–3 years	Imitates adults, parallel play begins
3 years	Begins to share, identifies self in mirror

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📋 Cognitive Development (Piaget’s Stage):

• Sensorimotor (ends at 2 years): Learns through senses and actions
• Preoperational Stage begins (~2 years):
  🔹 Symbolic thinking
  🔹 Egocentrism
  🔹 Imitative play

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⚠️ Red Flags in Toddler Development:

• No walking by 18 months
• No clear words by 2 years
• Not using 2-word phrases by 2.5 years
• Loss of previously gained skills
• No interest in interaction or play

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👩‍⚕️ Nurse’s Responsibilities:

• Perform growth monitoring (weight, height, MUAC)
• Plot on growth chart
• Screen developmental milestones
• Counsel parents on nutrition, play, safety
• Educate on toilet training, behavioral guidance
• Reinforce immunization schedule (e.g., DPT booster, MR-2)

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📚 Golden One-Liners for Quick Revision:

• 🟢 Toddler = 1–3 years
• 🟡 Weight at 2 years ≈ 4x birth weight
• 🟠 All 20 teeth appear by 2.5–3 years
• 🔴 Parallel play is typical at 2–3 years
• 🟣 Red flag: No walking by 18 months

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✅ Top 5 MCQs for Practice:

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Q1. At what age does a child usually ride a tricycle?
🅰️ 1 year
🅱️ 2 years
✅ 🅲️ 3 years
🅳️ 4 years
Answer: ✅ (c)

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Q2. What is the expected vocabulary at 18 months?
🅰️ 2–3 words
🅱️ No words
✅ 🅲️ 10+ words
🅳️ Full sentences
Answer: ✅ (c)

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Q3. A 2-year-old builds a 4-block tower. This is:
🅰️ Gross motor
✅ 🅱️ Fine motor
🅲️ Language skill
🅳️ Emotional development
Answer: ✅ (b)

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Q4. The Piaget stage for toddlers is:
🅰️ Formal operational
🅱️ Concrete operational
✅ 🅲️ Sensorimotor to Preoperational
🅳️ Cognitive inference
Answer: ✅ (c)

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Q5. Which of the following is a red flag in a 2-year-old?
🅰️ Scribbling
🅱️ Using 2-word phrases
✅ 🅲️ No speech
🅳️ Temper tantrum
Answer: ✅ (c)

🍽️👶 Toddler – Nutrition Counseling (1–3 Years)

📘 Essential for Pediatric Nursing, IMNCI, Community Health Nursing & Growth Monitoring

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🔰 Definition:

Nutrition counseling for toddlers is the process of educating and guiding caregivers on how to provide a balanced, age-appropriate diet that supports healthy growth, development, and immunity during the toddler years (1–3 years).

✅ It includes meal planning, behavior management, and addressing feeding challenges.

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🧭 Key Nutritional Needs of Toddlers:

🧒 Nutrient	📌 Recommended Daily Intake	🍲 Sources
🟩 Calories	~1000–1200 kcal/day	Energy-dense foods: cereals, fats, pulses
🟨 Proteins	1.2–1.5 g/kg body weight	Milk, eggs, legumes, meat, paneer
🟧 Calcium	500–600 mg/day	Milk, curd, paneer, green leafy vegetables
🟥 Iron	9–10 mg/day	Green veggies, jaggery, ragi, dates
🟦 Vitamin A	400 mcg/day	Carrot, papaya, mango, egg yolk, milk
🟪 Zinc & Iodine	Essential for immunity, brain development	Meat, dairy, iodized salt

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🍴 Meal Frequency and Pattern (IYCF Guidelines):

🧒 Age	🍛 Meals + Snacks
1–2 years	3 main meals + 1–2 nutritious snacks
2–3 years	3 meals + 2 snacks; portion sizes slightly increase

🟢 Continue breastfeeding till 2 years or more, if possible.

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📋 Key Principles of Toddler Nutrition Counseling:

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🟩 1. Balanced Diet:

🔸 Include all 5 food groups: cereals, pulses, fruits & vegetables, milk, fats
🔸 Avoid junk foods, excessive sugar, and salt

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🟨 2. Food Consistency:

🔸 Start with mashed/soft foods
🔸 Gradually shift to family food by 2 years

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🟧 3. Meal Timing & Routine:

🔸 Offer meals at fixed times
🔸 Avoid force-feeding; follow responsive feeding

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🟥 4. Portion Control:

🔸 Small servings with repeated offers
🔸 Use colorful bowls/spoons for attraction

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🟦 5. Hygiene & Safety:

🔸 Wash hands before feeding
🔸 Avoid choking hazards (whole grapes, nuts)

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🟪 6. Behavioral Management:

🔸 Toddlers may be picky eaters
🔸 Be patient; avoid using food as reward or punishment

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🚫 Common Feeding Mistakes:

❌ Mistake	⚠️ Impact
Force feeding	May cause food aversion
Giving junk food/snacks too often	Leads to obesity or nutrient deficiency
Replacing meals with milk or juice	Leads to iron deficiency
Not supervising eating	Risk of choking

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👩‍⚕️ Nurse’s Role in Toddler Nutrition Counseling:

• Assess growth parameters (weight, height, MUAC)
• Educate caregivers on balanced diet and feeding techniques
• Monitor meal frequency and diversity
• Provide age-appropriate food demonstration
• Encourage continued breastfeeding
• Identify signs of malnutrition or feeding disorders
• Counsel during VHNDs, immunization days, and home visits

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📚 Golden One-Liners for Revision:

• 🟢 Toddlers need ~1000–1200 kcal/day
• 🟡 Protein = 1.2–1.5 g/kg body weight
• 🟠 Offer 3 meals + 2 snacks daily
• 🔴 Never force-feed or bribe during meals
• 🟣 Gradual shift to family food by 2 years

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✅ Top 5 MCQs for Practice:

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Q1. Recommended number of meals/snacks for a toddler (1–3 years):
🅰️ 1 meal/day
🅱️ 2 meals
✅ 🅲️ 3 meals + 2 snacks
🅳️ 6 meals
Answer: ✅ (c)

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Q2. Which is an energy-dense food suitable for toddlers?
🅰️ Lettuce
🅱️ Boiled water
✅ 🅲️ Khichdi with ghee
🅳️ Plain bread
Answer: ✅ (c)

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Q3. One major nutritional problem in toddlers due to excess milk intake is:
🅰️ Diarrhea
🅱️ Obesity
✅ 🅲️ Iron deficiency anemia
🅳️ Diabetes
Answer: ✅ (c)

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Q4. Responsive feeding means:
🅰️ Force-feeding child until full
🅱️ Ignoring child cues
✅ 🅲️ Feeding when child shows hunger cues
🅳️ Delaying meals
Answer: ✅ (c)

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Q5. Ideal time to shift toddler to family food is by:
🅰️ 6 months
🅱️ 1 year
✅ 🅲️ 2 years
🅳️ 4 years
Answer: ✅ (c)

🚫🍽️ Feeding Disorders in Toddlers (1–3 Years)

📘 Essential for Pediatric Nursing, Community Health, IMNCI & Child Psychology

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🔰 Definition:

Feeding disorders in toddlers refer to persistent difficulties in eating or feeding behaviors that lead to inadequate nutritional intake, impaired growth, and affect social and emotional development.

✅ These are not just picky eating, but behavioral or developmental problems requiring clinical attention.

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🧭 Common Feeding Disorders in Toddlers:

🛑 Disorder	📋 Description
🟥 Food Refusal / Picky Eating	Refuses to eat certain foods/textures; eats very small variety
🟧 Food Neophobia	Fear of trying new foods (common around 18–24 months)
🟨 Feeding Aversion	Avoids eating due to negative experiences (e.g., choking, force-feeding)
🟦 Rumination Disorder	Regurgitates and re-chews/swallow food repeatedly
🟩 Avoidant/Restrictive Food Intake Disorder (ARFID)	Lack of interest in eating; no body image issue, but nutritional risk
🟪 Post-traumatic Feeding Disorder	Feeding problem after trauma like NG tube, choking, abuse

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⚠️ Warning Signs of Feeding Disorders:

• Eating very little for more than 1 month
• Weight loss or poor weight gain
• Refuses entire food groups (e.g., no solids at all)
• Coughing/choking/gagging during meals
• Long mealtimes (>40 mins)
• Extreme tantrums or distress around feeding
• Repeated vomiting or food expulsion

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🧠 Causes of Feeding Disorders:

🧬 Category	🔎 Examples
🧩 Biological	Prematurity, GERD, food allergies, oral-motor delay
🧠 Psychological	Anxiety, trauma, parent-child conflict
👨‍👩‍👧 Environmental	Poor feeding routine, distractions, inconsistent caregivers

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🍽️ Impact of Feeding Disorders:

• Malnutrition or obesity
• Delayed growth and development
• Iron/Vitamin deficiencies
• Emotional and social withdrawal
• Increased hospital visits and parental stress

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👩‍⚕️ Nursing Assessment Tools:

• 24-hour food recall
• Weight-for-age, MUAC, growth chart analysis
• Feeding observation during meals
• Parental interview (timing, routines, behaviors)
• Identify any sensory or motor dysfunction

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🛠️ Management Strategies (Multidisciplinary):

✅ Approach	📋 Details
🟩 Behavioral Counseling	Positive reinforcement, avoid force-feeding
🟨 Dietary Counseling	Age-appropriate food advice; introduce variety gradually
🟧 Parent Education	Responsive feeding, setting routines, managing tantrums
🟥 Speech/Feeding Therapy	For oral-motor delays, gag reflex issues
🟦 Medical Management	Treat GERD, nutritional deficiencies, refer for psychiatric help

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🩺 Nurse’s Role in Feeding Disorder Management:

• Screen toddlers for growth and feeding delays
• Educate parents on responsive feeding practices
• Demonstrate structured feeding routines
• Support during mealtime behavior shaping
• Refer to pediatrician, nutritionist, or therapist as needed
• Document and monitor growth & improvement regularly

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📚 Golden One-Liners for Revision:

• 🟢 Feeding disorder ≠ picky eating → persistent & affects growth
• 🟡 ARFID = refusal to eat without body image concern
• 🟠 Force-feeding is a major cause of food aversion
• 🔴 Red flag: choking, vomiting, no solids at 18 months
• 🟣 Nursing care includes growth monitoring + parent counseling

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✅ Top 5 MCQs for Practice:

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Q1. Which of the following is NOT a true feeding disorder?
🅰️ Food refusal
🅱️ Rumination disorder
🅲️ Avoidant/restrictive intake
✅ 🅳️ Normal picky eating phase
Answer: ✅ (d)

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Q2. Feeding aversion is most commonly caused by:
🅰️ Sweet food
✅ 🅱️ Negative feeding experiences like force-feeding
🅲️ Parental love
🅳️ Overeating
Answer: ✅ (b)

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Q3. A toddler with ARFID:
🅰️ Has body image concerns
🅱️ Eats a variety of foods
✅ 🅲️ Has no body image concern but refuses food
🅳️ Is always overweight
Answer: ✅ (c)

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Q4. One red flag in toddler feeding is:
🅰️ Refusing spinach occasionally
✅ 🅱️ No solid food intake by 18 months
🅲️ Playing with food
🅳️ Preferring only milk at night
Answer: ✅ (b)

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Q5. Role of a nurse in feeding disorder includes:
🅰️ Feeding the child forcefully
✅ 🅱️ Counseling parents & referring for therapy
🅲️ Avoid growth monitoring
🅳️ Offering chocolates as reward
Answer: ✅ (b)

🚽👶 Toilet Training in Toddlers (1–3 Years)

📘 Essential for Pediatric Nursing, Child Development, and Community Health Nursing

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🔰 Definition:

Toilet training is the process of teaching a toddler to control bowel and bladder functions and to use the toilet or potty independently.

✅ Ideal age to begin: 18–24 months, but readiness varies per child. Most achieve daytime control by 2–3 years.

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🧭 Types of Toilet Training:

🚾 Type	📝 Description
🟩 Bowel Training	Learning to pass stool in toilet/potty
🟨 Bladder Training	Gaining control over urination
🟧 Daytime Training	Usually achieved by 2.5–3 years
🟥 Nighttime Training	May take longer; complete by 4–5 years

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📌 Signs of Readiness for Toilet Training:

✅ Physical Readiness	✅ Cognitive/Emotional Readiness
Can stay dry for 2+ hours	Understands simple instructions
Regular bowel movement pattern	Shows interest in toilet habits
Able to sit, walk, remove clothes	Communicates need to go
Discomfort with dirty diaper	Imitates adults/siblings using toilet

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🧠 Principles of Effective Toilet Training:

1. Start when child is ready – Not based on age alone
2. Make it positive & stress-free
3. Use child-friendly potty seats
4. Encourage regular toilet routine (after meals, waking)
5. Praise success, avoid scolding for accidents
6. Teach handwashing after every toilet use
7. Be consistent and patient

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⚠️ Common Challenges & Solutions:

❌ Challenge	✅ Solution
Refusal to sit on potty	Use toys/books for distraction
Fear of flushing sounds	Desensitize slowly, praise calm behavior
Constipation	High-fiber diet + fluids
Accidents	Reassure and retry; don’t punish
Regression during illness/change	Give time, maintain routine

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👩‍⚕️ Nurse’s Role in Toilet Training Guidance:

• Educate caregivers on readiness signs
• Guide in establishing a routine
• Reinforce positive reinforcement techniques
• Counsel for constipation management
• Support parents during regression or anxiety
• Promote hygiene and safety practices

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📚 Golden One-Liners for Quick Revision:

• 🟢 Toilet training starts around 18–24 months
• 🟡 Bowel control is usually achieved before bladder
• 🟠 Nighttime control may take until 4–5 years
• 🔴 Scolding for accidents leads to regression/fear
• 🟣 Nurse must assess child’s readiness + parent education

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✅ Top 5 MCQs for Practice:

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Q1. Ideal age to begin toilet training is:
🅰️ 12 months
✅ 🅱️ 18–24 months
🅲️ 6 months
🅳️ 4 years
Answer: ✅ (b)

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Q2. Which is a physical sign of toilet training readiness?
🅰️ Plays alone
✅ 🅱️ Stays dry for 2 or more hours
🅲️ Walks by 6 months
🅳️ Says complete sentences
Answer: ✅ (b)

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Q3. A child should be scolded after an accident. True or False?
🅰️ True
✅ 🅱️ False
Answer: ✅ (b)

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Q4. What helps promote toilet training success?
🅰️ Forceful approach
🅱️ Ignoring attempts
✅ 🅲️ Praise and positive reinforcement
🅳️ Punishment
Answer: ✅ (c)

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Q5. Which of the following is usually achieved first in toilet training?
🅰️ Nighttime bladder control
✅ 🅱️ Bowel control
🅲️ Full independence
🅳️ Urination on demand
Answer: ✅ (b)

🚧🧒 Prevention of Accidents in Children (Under-Five Focus)

📘 Essential for Pediatric Nursing, Community Health, IMNCI & Child Safety Counseling

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🔰 Definition:

Accident prevention in children refers to all measures and strategies taken to avoid unintentional injuries (like falls, burns, poisoning, drowning, etc.) especially among children below 5 years who are naturally curious, active, and unaware of danger.

✅ Accidents are the leading cause of morbidity and mortality in toddlers and preschoolers.

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🧭 Common Accidents in Children (1–5 Years):

⚠️ Type of Accident	📝 Examples
🟥 Falls	From bed, stairs, furniture, windows
🟧 Burns/Scalds	Hot liquids, fire, electrical appliances
🟨 Poisoning	Medicines, kerosene, bathroom cleaners
🟩 Choking & Aspiration	Small objects, nuts, toys, coins
🟦 Drowning	Buckets, bathtubs, open tanks, pools
🟪 Cuts & Injuries	Sharp tools, broken glass, accidents while playing
⬛ Electrical injuries	Exposed wires, inserting objects into sockets

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📌 Why Are Children More Prone to Accidents?

• Poor risk perception
• Active exploration (curious phase)
• Small height and poor coordination
• Lack of adult supervision
• Inappropriate home or play environment

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🛡️ Preventive Measures by Type:

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🟥 Falls:

• Use crib guards, window grills, safety gates
• Keep floors dry and non-slippery
• Avoid high beds or elevated surfaces for toddlers

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🟧 Burns/Scalds:

• Keep hot liquids, iron, heaters out of reach
• Install safety covers on stoves
• Educate caregivers on first aid for burns

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🟨 Poisoning:

• Store medicines, cleaning agents in locked cupboards
• Avoid refilling chemicals in drink bottles
• Teach use of “poison” labels

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🟩 Choking & Aspiration:

• Avoid small toys, grapes, peanuts, coins
• Do not feed solid food forcefully or in lying position
• Teach Heimlich maneuver basics to caregivers

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🟦 Drowning:

• Never leave child unattended near water
• Cover buckets, tanks, wells securely
• Use baby-safe bath tubs

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🟪 Electrical Hazards:

• Use socket covers
• Keep wires and appliances out of reach
• Educate child through age-appropriate stories/pictures

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👩‍⚕️ Role of Nurse in Accident Prevention:

• Teach parents during VHNDs, immunization days
• Promote home safety checks
• Conduct injury prevention sessions in anganwadis
• Distribute educational materials with visuals
• Demonstrate first aid measures
• Support community injury surveillance programs

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📚 Golden One-Liners for Quick Revision:

• 🟢 Falls are the most common home accidents in toddlers
• 🟡 Kerosene poisoning is common in low-income households
• 🟠 Supervision is the best prevention
• 🔴 Cover all electrical sockets and sharp edges
• 🟣 Prevention = safe environment + caregiver education

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✅ Top 5 MCQs for Practice:

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Q1. The most common cause of home accidents in toddlers is:
🅰️ Drowning
✅ 🅱️ Falls
🅲️ Electrical injury
🅳️ Poisoning
Answer: ✅ (b)

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Q2. The best way to prevent kerosene poisoning is:
🅰️ Put in glass bottles
🅱️ Keep it open in the kitchen
✅ 🅲️ Store in original containers with label and lock
🅳️ Tell child it’s juice
Answer: ✅ (c)

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Q3. Which of the following helps prevent choking in children?
🅰️ Feeding while lying down
✅ 🅱️ Avoiding small hard foods like nuts
🅲️ Offering grapes whole
🅳️ Using pacifier always
Answer: ✅ (b)

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Q4. What is a safe way to prevent burns at home?
🅰️ Leave hot tea on table
✅ 🅱️ Keep hot liquids out of child’s reach
🅲️ Give child matches to play
🅳️ Teach fire tricks
Answer: ✅ (b)

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Q5. Nurse’s primary responsibility in accident prevention is to:
🅰️ Administer oxygen
🅱️ Punish parents
✅ 🅲️ Educate caregivers and promote safety
🅳️ Call police
Answer: ✅ (c)

🎒📈 Preschooler – Growth and Development (3–6 Years)

📘 Essential for Pediatric Nursing, Child Health, and Community Health Exams

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🔰 Definition:

A preschooler is a child between 3 to 6 years of age, a stage marked by physical refinement, language explosion, imaginative play, and development of self-concept and social skills.

✅ It’s also the pre-academic stage, laying the foundation for school readiness.

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🧭 Physical Growth in Preschoolers:

📏 Parameter	🧒 Expected Changes
🟩 Weight	Gains ~2 kg/year; average weight at 5 years ≈ 18–20 kg
🟨 Height	Grows ~5–6 cm/year; ~100 cm at 3 yrs, ~110 cm by 5 yrs
🟧 Body Proportion	Slender body, decreased baby fat, increased muscle
🟥 Teeth	All 20 primary teeth fully erupted

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🧠 Developmental Milestones in Preschoolers:

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🟩 Gross Motor Skills:

🕒 Age	🏃 Milestone
3 years	Jumps, rides tricycle, climbs stairs
4 years	Hops on one foot, throws ball overhead
5 years	Skips, balances on one foot, catches ball

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🟨 Fine Motor Skills:

🕒 Age	✋ Milestone
3–4 years	Copies circles, opens jars
4–5 years	Draws simple human figures
5–6 years	Ties shoelaces, prints some letters

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🟧 Language Development:

🕒 Age	🗣️ Milestone
3 years	Speaks in 3–4 word sentences
4 years	Asks lots of “why” questions
5 years	Tells simple stories; uses future tense

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🟥 Social and Emotional Development:

🧠 Skill	💡 Milestone
Social interaction	Cooperative play, follows rules
Emotional control	Begins managing anger/frustration
Imaginative play	Pretends to be animals, superheroes, etc.
Self-concept	Identifies self as boy/girl, by name & age

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🧩 Cognitive Development (Piaget: Preoperational Stage)

• Egocentric thinking (but gradually reducing)
• Magical thinking (believes in fantasy)
• Learns through symbols and pretend play
• Can classify objects by shape and color

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👩‍🏫 Moral & Psychosocial Development:

📘 Theory	🧠 Stage
Erikson	Initiative vs. Guilt (3–6 years)
Kohlberg	Preconventional Morality

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⚠️ Red Flag Signs (3–6 years):

• Speech not understood by strangers by 4 years
• No interest in social interaction
• Inability to hop or use stairs by 5 years
• No imaginative play
• Aggressive or withdrawn behavior

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👩‍⚕️ Nurse’s Role in Preschool Growth Monitoring:

• Regular growth chart plotting
• Developmental screening using milestone checklists
• Counsel parents on play, discipline, school readiness
• Identify delays and refer early
• Educate about balanced nutrition & safety

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📚 Golden One-Liners for Revision:

• 🟢 Preschooler = 3 to 6 years
• 🟡 All 20 milk teeth are present
• 🟠 Speech should be clear and fluent by 5 years
• 🔴 Cognitive stage = Preoperational (symbolic thinking)
• 🟣 Psychosocial stage = Initiative vs. Guilt

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✅ Top 5 MCQs for Practice:

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Q1. At what age does a child typically begin to skip or hop?
🅰️ 2 years
🅱️ 3 years
✅ 🅲️ 5 years
🅳️ 6 months
Answer: ✅ (c)

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Q2. The developmental stage of Erikson for preschoolers is:
🅰️ Autonomy vs Shame
✅ 🅱️ Initiative vs Guilt
🅲️ Industry vs Inferiority
🅳️ Trust vs Mistrust
Answer: ✅ (b)

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Q3. What is a red flag at 4 years of age?
🅰️ Imaginative play
✅ 🅱️ Unclear speech to strangers
🅲️ Drawing a person
🅳️ Asking “why” questions
Answer: ✅ (b)

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Q4. Which skill is a fine motor milestone in a 5-year-old?
🅰️ Running
🅱️ Hopping
✅ 🅲️ Tying shoelaces
🅳️ Skipping
Answer: ✅ (c)

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Q5. A 4-year-old child should be able to:
🅰️ Ride a bicycle
✅ 🅱️ Copy a cross or draw stick figures
🅲️ Speak only 1–2 words
🅳️ Remain silent in groups
Answer: ✅ (b)

🏫👶 Day Care Centre

📘 Essential for Community Health Nursing, Pediatric Nursing & NHM Child Welfare Programs

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🔰 Definition:

A Day Care Centre (DCC) is a structured childcare facility where infants and young children (usually 6 months to 6 years) are provided safe supervision, nutrition, play, education, and rest while their parents are at work.

✅ It serves as a support system for working mothers, especially in urban, rural, and semi-urban areas.

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🧭 Objectives of a Day Care Centre:

• Provide safe and stimulating environment for children
• Support early childhood care and development (ECCD)
• Offer nutritious meals and health monitoring
• Promote socialization and school readiness
• Enable women empowerment through work participation

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🏢 Types of Day Care Centres:

🏷️ Type	📋 Description
🟩 Government-operated DCC	Under ICDS, NHM, urban local bodies
🟨 Anganwadi-cum-DCC	Anganwadi centres functioning as day care too
🟧 Corporate/Institutional DCC	Set up by factories, hospitals, offices etc.
🟥 Private DCC	Privately run, often fee-based
🟦 Community-based DCC	Operated by NGOs, SHGs in rural/urban areas

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🧒 Key Services Offered by a Day Care Centre:

• ✅ Safe shelter & supervision (usually 9 am–5 pm)
• ✅ Nutritious meals/snacks (as per ICDS norms)
• ✅ Rest/sleep arrangements
• ✅ Age-appropriate play and learning
• ✅ Health check-ups and growth monitoring
• ✅ Toilet training & personal hygiene promotion

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🍽️ Nutrition in DCC (As per ICDS Guidelines):

🍛 Age Group	🥗 Meal Provision
6 months–3 years	Energy: 500 kcal/day, Protein: 12–15 g/day
3–6 years	Energy: 500–700 kcal/day, Protein: 20 g/day
Supplements	Vitamin A, iron–folic acid (weekly), deworming

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👩‍⚕️ Role of Nurse / Health Worker in DCC:

• Monitor growth (weight, MUAC, height) of children
• Ensure timely immunization & health check-ups
• Educate caregivers on nutrition, hygiene, parenting
• Identify children with developmental delay or illness
• Conduct first aid and emergency care
• Support health records and documentation

---

🧹 Standards & Requirements for Day Care Centre (GoI Guidelines):

✅ Component	📌 Minimum Requirement
🏠 Space	5 sq. ft per child, clean & ventilated
🛏️ Sleeping facilities	Mats/cots with proper bedding
🍲 Kitchen area	Hygienic food preparation space
🚽 Toilets & handwashing	Child-sized or adapted facilities
🧑‍🏫 Staff	1 caregiver per 10–15 children
📋 Records	Attendance, feeding, health, immunization logs

---

📜 Important National Initiatives:

• Rajiv Gandhi National Crèche Scheme
• ICDS Day Care for working mothers
• POSHAN Abhiyaan – ECCE strengthening
• Maternity Benefit Act (Section 11A): Mandates DCC in establishments with ≥50 employees

---

📚 Golden One-Liners for Quick Revision:

• 🟢 Day Care Centre supports working mothers and early child care
• 🟡 1 DCC caregiver per 10–15 children recommended
• 🟠 Nutrition = 500–700 kcal + 12–20g protein/day
• 🔴 Toilet training and hygiene promotion are key services
• 🟣 Nurse plays vital role in growth monitoring + referral

---

✅ Top 5 MCQs for Practice:

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Q1. Day Care Centre primarily supports:
🅰️ Elderly
✅ 🅱️ Children of working mothers
🅲️ Teenage girls
🅳️ Medical patients
Answer: ✅ (b)

---

Q2. Recommended energy intake for a 3–6-year-old in DCC is:
🅰️ 200 kcal
🅱️ 400 kcal
✅ 🅲️ 500–700 kcal
🅳️ 1000 kcal
Answer: ✅ (c)

---

Q3. Minimum staff–child ratio in a DCC is:
🅰️ 1:5
✅ 🅱️ 1:10 to 1:15
🅲️ 1:20
🅳️ 1:50
Answer: ✅ (b)

---

Q4. Which Act mandates DCC in workplaces with 50+ employees?
🅰️ RCH Act
🅱️ POCSO Act
✅ 🅲️ Maternity Benefit Act
🅳️ Child Labour Act
Answer: ✅ (c)

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Q5. One of the nurse’s roles in a Day Care Centre is:
🅰️ Office record keeping only
✅ 🅱️ Growth monitoring & health check-ups
🅲️ Selling medicines
🅳️ Legal advice
Answer: ✅ (b)

🧑‍⚕️📚 Role of Patient in Sex Education

📘 Essential for Community Health Nursing, Adolescent Health, and Health Education Topics

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🔰 Definition of Sex Education:

Sex education is a lifelong learning process that provides knowledge, attitudes, values, and skills related to sexuality, relationships, gender identity, reproductive health, and rights.

✅ It helps in preventing STDs, unplanned pregnancies, and promoting respect and consent.

---

🧭 Who is the “Patient” in Sex Education?

In this context, the “patient” refers to any individual (adolescent, adult, parent, or guardian) receiving sex education or health care related to sexual and reproductive health.

The patient is not just a passive recipient but plays an active role in understanding, applying, and spreading accurate sex-related knowledge.

---

🧠 Key Roles of Patient in Sex Education:

---

🟩 1. Active Learner:

• Seek factual and scientific knowledge about sex, reproduction, and gender
• Clarify doubts with qualified health professionals
• Participate in school or community-based sex education programs

---

🟨 2. Self-Advocate:

• Ask about safe sex practices, contraception, or STIs during doctor visits
• Be aware of own rights related to consent, privacy, reproductive health
• Refuse myths and misinformation (e.g., from peers or social media)

---

🟧 3. Responsible Decision-Maker:

• Practice safe sex (use of condoms, consent, spacing methods)
• Undergo regular health checkups, screenings (e.g., Pap smear, HIV testing)
• Maintain hygiene and mutual respect in relationships

---

🟥 4. Peer Educator (in some settings):

• Share correct information with peers (especially in adolescent programs)
• Dispel myths like “sex causes acne” or “pregnancy can’t happen first time”
• Be a role model by practicing responsible sexual behavior

---

🟦 5. Parental Role (if the patient is a parent):

• Communicate openly with children on age-appropriate sex education
• Create a safe environment to discuss puberty, menstruation, consent
• Seek help from health workers for adolescent counseling

---

⚠️ Challenges Patients Face in Sex Education:

❌ Barrier	💡 Example
Social taboo & embarrassment	Hesitation to ask about condoms or STI symptoms
Misinformation from peers	Belief in myths like “pill causes infertility”
Gender discrimination	Girls being denied information
Lack of access to education	No classes, no health talks in remote areas

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👩‍⚕️ Nurse’s Role in Empowering the Patient:

• Provide clear, accurate, non-judgmental information
• Use visual aids, models, and charts for better understanding
• Maintain privacy and confidentiality
• Encourage questioning and active participation
• Promote use of youth-friendly services and IEC material

---

📚 Golden One-Liners for Revision:

• 🟢 Patients must be active learners, not passive recipients
• 🟡 Sex education reduces teen pregnancy and STD risk
• 🟠 Informed patients make safe and respectful choices
• 🔴 Patient’s role includes awareness, consent, and advocacy
• 🟣 Nurses must support confidential and inclusive education

---

✅ Top 5 MCQs for Practice:

---

Q1. One of the key roles of a patient in sex education is to:
🅰️ Avoid asking questions
✅ 🅱️ Seek factual and scientific knowledge
🅲️ Depend on myths
🅳️ Refuse to attend sessions
Answer: ✅ (b)

---

Q2. A patient who uses condoms and spacing methods is showing:
🅰️ Passive learning
🅱️ Denial behavior
✅ 🅲️ Responsible decision-making
🅳️ Aggressive health-seeking
Answer: ✅ (c)

---

Q3. Which of the following hinders a patient’s participation in sex education?
🅰️ Nurse counseling
🅱️ Confidentiality
✅ 🅲️ Social stigma
🅳️ Government support
Answer: ✅ (c)

---

Q4. A patient can act as a peer educator by:
🅰️ Avoiding discussions
🅱️ Promoting myths
✅ 🅲️ Sharing correct information
🅳️ Encouraging unsafe practices
Answer: ✅ (c)

---

Q5. The nurse can best help patients in sex education by:
🅰️ Avoiding the topic
🅱️ Refusing questions
✅ 🅲️ Giving respectful and accurate answers
🅳️ Scolding them
Answer: ✅ (c)

🎒📈 School-Age Child – Growth and Development (6–12 Years)

📘 Essential for Pediatric Nursing, Child Health & Community Health Nursing

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🔰 Definition:

A school-age child is between 6 to 12 years of age, a phase marked by steady physical growth, refined motor skills, increasing cognitive ability, and development of social and moral understanding.

✅ Known as the “latent phase” of growth (between early childhood and adolescence).

---

📊 Physical Growth Parameters:

📏 Parameter	📌 Expected Growth
🟩 Weight	Gains ~2–3 kg/year
🟨 Height	Grows ~5–6 cm/year
🟧 Teeth	Begins to lose milk teeth; permanent teeth erupt (~6 yrs onward)
🟥 Body Composition	Leaner, muscular, better coordination

---

🧠 Developmental Milestones in School-Age Children:

---

🟩 Gross Motor Development:

🕒 Skill	🧒 Examples
Balance improves	Skipping rope, riding bicycle
Strength & endurance ↑	Participates in sports, swimming, outdoor games
Coordination improves	Hops, jumps, throws & catches with control

---

🟨 Fine Motor Development:

🖍️ Skill	🧒 Examples
Writing & drawing improves	Writes neatly, colors within lines, uses scissors
Daily tasks independence	Buttons clothes, ties shoelaces, uses cutlery

---

🟧 Cognitive Development (Piaget: Concrete Operational Stage):

• Logical thinking and problem-solving
• Understands concept of time, cause-effect, numbers
• Can classify, serialize, conserve (e.g., volume, weight)
• Begins to understand others’ perspectives (less egocentric)

---

🟥 Language and Communication:

• Vocabulary increases to 2000+ words
• Forms complex sentences, uses jokes and riddles
• Communicates clearly and understands instructions

---

🟦 Psychosocial Development (Erikson: Industry vs. Inferiority):

✅ Positive Outcome	⚠️ Negative Outcome
Learns new skills, builds self-esteem	Feels failure if not praised or encouraged

• Peers become important for social development
• Learns to follow rules, take turns, cooperate

---

🟪 Moral Development (Kohlberg: Conventional Stage):

• Understands right vs wrong based on approval
• Wants to follow rules and be “good”
• Begins understanding justice, fairness, honesty

---

⚠️ Red Flag Signs (Needs Referral):

• No progress in academic performance
• Frequent bedwetting after 6 years
• Aggressive or withdrawn behavior
• Not keeping personal hygiene
• Difficulties with motor coordination

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👩‍⚕️ Nurse’s Role in School-Age Growth & Development:

• Monitor growth via school health programs
• Screen for vision, hearing, nutritional status
• Educate parents on healthy habits, exercise, hygiene
• Counsel for bullying, behavioral problems, learning issues
• Promote sex education, safety, balanced diet

---

📚 Golden One-Liners for Quick Revision:

• 🟢 School-age = 6–12 years
• 🟡 Cognitive stage = Concrete operational (logical)
• 🟠 Psychosocial = Industry vs. Inferiority
• 🔴 Permanent teeth start erupting by 6 years
• 🟣 Child seeks peer approval, social belonging

---

✅ Top 5 MCQs for Practice:

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Q1. A child begins to develop logical thinking in which stage?
🅰️ Preoperational
✅ 🅱️ Concrete operational
🅲️ Formal operational
🅳️ Sensorimotor
Answer: ✅ (b)

---

Q2. The psychosocial stage of school-age child is:
🅰️ Trust vs. Mistrust
🅱️ Initiative vs. Guilt
✅ 🅲️ Industry vs. Inferiority
🅳️ Identity vs. Role confusion
Answer: ✅ (c)

---

Q3. At what age do permanent teeth begin to erupt?
🅰️ 3 years
🅱️ 5 years
✅ 🅲️ 6 years
🅳️ 12 years
Answer: ✅ (c)

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Q4. Which behavior is normal in a 7-year-old child?
🅰️ Egocentric play
🅱️ Parallel play
✅ 🅲️ Cooperative play
🅳️ Symbolic play
Answer: ✅ (c)

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Q5. Logical and concrete thinking begins in:
🅰️ Adolescence
✅ 🅱️ School-age
🅲️ Toddlerhood
🅳️ Infancy
Answer: ✅ (b)

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🛌💤 Rest & Sleep in School-Age Children

🔰 Importance:

• Supports growth hormone secretion
• Enhances learning and memory
• Maintains mental and emotional balance

⏰ Recommended Sleep Duration:

🧒 Age	🕒 Hours of Sleep/Day
6–12 years	9 to 11 hours per night

✅ Nursing Advice to Parents:

• Create a fixed bedtime routine
• Avoid screens 1 hour before sleep
• Use a quiet, dark, and safe sleeping environment

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🤸‍♂️🏃‍♀️ Physical Exercises & Activity

🔰 Importance:

• Promotes muscle strength, coordination, flexibility
• Prevents childhood obesity
• Enhances social skills via team games

⚽ Recommended Activity:

• At least 1 hour of moderate to vigorous physical activity per day
• Include running, swimming, cycling, skipping, games

✅ Tips for Healthy Physical Development:

• Limit screen time to < 2 hours/day
• Encourage outdoor play and structured games
• Ensure hydration and balanced diet

---

🦷🪥 Dental Health in School-Age Children

🔰 Importance:

• Prevents caries, malocclusion, gum disease
• Supports nutrition and speech development

🪥 Oral Hygiene Practices:

• Brush teeth twice a day (fluoridated toothpaste)
• Flossing once daily (as age-appropriate)
• Dental check-up every 6 months
• Avoid excessive sweets, sticky foods, and soda

⚠️ Common Dental Problems:

• Dental caries
• Gingivitis
• Tooth malalignment

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🧠📚 Sex Education in School-Age Children (8–12 years)

🔰 Importance:

• Prepares for puberty, hygiene, and body changes
• Prevents abuse, misinformation, shame
• Builds respect and personal boundaries

🧒 Age-Appropriate Topics:

📅 Age	📘 Topics Covered
6–8 years	Body parts, privacy, good touch–bad touch
9–12 years	Puberty changes, menstruation, hygiene, self-care

👩‍⚕️ Nurse/Parent Role:

• Use correct anatomical terms
• Encourage open discussion without judgment
• Reinforce personal safety and consent
• Provide child-friendly IEC materials

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📚 Golden One-Liners for Quick Revision:

• 🛌 Sleep required for 6–12 yrs = 9–11 hours
• 🤸‍♂️ Physical activity = 1 hour/day minimum
• 🦷 Brush teeth twice daily + dental visit every 6 months
• 🧠 Sex education teaches body awareness + safety from abuse

---

✅ Top 5 MCQs for Practice:

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Q1. Recommended sleep duration for school-aged children is:
🅰️ 6 hours
🅱️ 8 hours
✅ 🅲️ 9–11 hours
🅳️ 12–14 hours
Answer: ✅ (c)

---

Q2. Which one is a sign of poor dental hygiene?
🅰️ White teeth
🅱️ No cavities
✅ 🅲️ Gingivitis and plaque
🅳️ Good breath
Answer: ✅ (c)

---

Q3. Physical activity recommended for a school-age child is:
🅰️ 20 minutes
🅱️ 30 minutes
✅ 🅲️ At least 60 minutes
🅳️ 90 minutes only on weekends
Answer: ✅ (c)

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Q4. The purpose of sex education in school children is to:
🅰️ Promote early relationships
🅱️ Encourage fear
✅ 🅲️ Educate about puberty, privacy, protection
🅳️ Restrict questions
Answer: ✅ (c)

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Q5. Which of the following is true about rest in school-aged children?
🅰️ 5–6 hours are enough
✅ 🅱️ Helps growth and brain function
🅲️ Sleep is not important
🅳️ Only needed after play
Answer: ✅ (b)

🏃‍♂️🤸‍♀️ Physical Exercises & Activity in School-Age Children (6–12 Years)

📘 Essential for Pediatric Nursing, Growth & Development, and School Health Services

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🔰 Definition:

Physical exercise and activity refers to any planned or spontaneous bodily movement that enhances or maintains physical fitness, supports mental well-being, and promotes healthy growth and development.

✅ For school-age children, physical activity should include a mix of structured play, free movement, sports, and recreational activities.

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🧭 WHO/ICMR Guidelines:

🧒 Age Group	🕒 Recommended Activity
5–17 years	At least 60 minutes/day of moderate to vigorous physical activity
🏃‍♂️ Activities include:	Brisk walking, cycling, swimming, running, dancing, sports

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💪 Benefits of Regular Physical Activity:

🩺 System	✅ Benefits
🟩 Musculoskeletal	Stronger bones & muscles, improved coordination
🟨 Cardiovascular	Healthy heart and circulation
🟧 Respiratory	Increased lung capacity
🟥 Neurological & Cognitive	Enhances concentration, memory, academic performance
🟦 Psychosocial	Boosts confidence, reduces stress and anxiety

---

⚽ Types of Physical Activities for School-Age Children:

🏷️ Type	📝 Examples
🟢 Aerobic Activities	Running, skipping, swimming, cycling
🟡 Strengthening	Climbing, tug-of-war, resistance games
🟠 Bone-loading	Hopping, jumping, skipping rope
🔵 Coordination Activities	Dance, yoga, martial arts

---

⚠️ Barriers to Physical Activity:

• Excessive screen time (TV, mobile, video games)
• Lack of safe play areas or parks
• Academic pressure limiting play time
• Parental overprotection
• Unhealthy peer influence or bullying

---

✅ Nurse’s Role in Promoting Physical Activity:

• Educate children & parents on the importance of daily exercise
• Promote play-based learning and reduce sedentary habits
• Encourage schools to organize physical education periods
• Conduct BMI and fitness assessments in school health programs
• Provide age-appropriate activity charts and posters

---

🧠 Tips for Parents and Teachers:

• Set screen time limits (< 2 hours/day)
• Be a role model (exercise together as family)
• Provide safe, open play spaces
• Encourage team games to promote social skills
• Avoid over-competition; focus on enjoyment and movement

---

📚 Golden One-Liners for Revision:

• 🟢 At least 60 mins/day of activity is recommended for children
• 🟡 Physical activity = better brain, bones, heart, and behavior
• 🟠 Lack of exercise → obesity, anxiety, poor sleep & academic delay
• 🔴 Nurses should advocate for physical fitness in schools
• 🟣 Play is essential for healthy physical and emotional growth

---

✅ Top 5 MCQs for Practice:

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Q1. WHO recommends how much physical activity daily for school-age children?
🅰️ 30 minutes
🅱️ 45 minutes
✅ 🅲️ 60 minutes
🅳️ 90 minutes
Answer: ✅ (c)

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Q2. Which of the following is NOT an aerobic activity?
🅰️ Running
🅱️ Skipping
✅ 🅲️ Watching TV
🅳️ Cycling
Answer: ✅ (c)

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Q3. One benefit of daily exercise in school-age children is:
🅰️ Obesity
✅ 🅱️ Improved concentration
🅲️ Poor social skills
🅳️ Delayed growth
Answer: ✅ (b)

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Q4. What is a common barrier to physical activity in children?
🅰️ Playgrounds
🅱️ Family support
✅ 🅲️ Excessive screen time
🅳️ PE period in school
Answer: ✅ (c)

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Q5. Nurses can promote physical activity by:
🅰️ Limiting outdoor time
🅱️ Ignoring BMI
✅ 🅲️ Conducting fitness assessments & health talks
🅳️ Encouraging mobile games
Answer: ✅ (c)

🦷 Dental Health in School-Age Children (6–12 Years)

📘 Essential for Pediatric Nursing, School Health Services & Growth Monitoring

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🔰 Importance:

Dental health is vital during school age because:

• Permanent teeth begin to erupt (~6 years)
• Risk of caries, malocclusion, and gingivitis increases
• Poor oral hygiene affects nutrition, speech, and self-esteem

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🧭 Common Dental Issues in School-Age Children:

⚠️ Problem	📝 Description
🟥 Dental caries	Tooth decay due to sugar, poor brushing
🟧 Malocclusion	Misaligned teeth/jaws
🟨 Gingivitis	Gum inflammation due to plaque
🟩 Fluorosis	Mottled enamel from excess fluoride

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🧼 Preventive Practices:

✅ Practice	📌 Details
🪥 Brushing	Twice daily, use fluoridated toothpaste
🧵 Flossing	Once daily, from ~8 years onward
🦷 Dental check-ups	Every 6 months
🚫 Diet	Avoid sticky sweets & sugary drinks
💧 Water	Use fluoridated drinking water

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👩‍⚕️ Nurse’s Role in Promoting Dental Health:

• Conduct dental camps & oral check-ups in schools
• Teach brushing techniques using models
• Educate on early signs of cavities/gum problems
• Encourage fluoride use and proper diet
• Refer to dentist if needed

---

📚 Golden One-Liners:

• 🦷 Permanent teeth begin to erupt at 6 years
• 🪥 Brushing must be done twice a day
• 🔍 Dental check-up: every 6 months
• 🚫 Avoid excess sweets and soft drinks

---

✅ Top 3 MCQs – Dental Health:

---

Q1. At what age do permanent teeth begin to erupt?
✅ 🅰️ 6 years
🅱️ 3 years
🅲️ 12 years
🅳️ 9 months
Answer: ✅ (a)

---

Q2. A child should visit a dentist every:
🅰️ Week
🅱️ 3 years
✅ 🅲️ 6 months
🅳️ When there’s pain only
Answer: ✅ (c)

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Q3. Main cause of dental caries is:
🅰️ Protein-rich food
✅ 🅱️ Sugary, sticky food
🅲️ Fluoride
🅳️ Water
Answer: ✅ (b)

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🧠 Sex Education in School-Age Children (8–12 Years)

📘 Essential for Adolescent Health, Mental Health & Reproductive Health Topics

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🔰 Why Important in This Age Group?

• Onset of puberty begins around 8–12 years
• Children are curious and may be misinformed
• Prepares them for body changes, hygiene, and safety
• Reduces risk of abuse, embarrassment, and myths

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📘 Age-Appropriate Sex Education Topics:

🧒 Age	📘 Topics to Cover
6–8 years	Anatomy (basic), good touch/bad touch, personal space
9–12 years	Puberty changes, menstruation, hygiene, emotions, safety

---

🧑‍⚕️ Correct Approach:

• Use scientific and simple language
• Maintain privacy, respect, and comfort
• Focus on values, decision-making, respect
• Encourage questions without shame or fear

---

👩‍⚕️ Role of Nurse/Educator:

• Conduct age-appropriate sessions in schools
• Counsel parents to communicate openly
• Help children understand consent, privacy, puberty
• Distribute IEC material (pamphlets, videos, flip charts)

---

🚫 Common Myths to Correct:

❌ Myth	✅ Fact
Menstruation is dirty	It is a normal biological process
Puberty only happens to girls	It happens in both genders
Talking about sex encourages it	It helps prevent risky behavior

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📚 Golden One-Liners:

• 🧠 Sex education begins around 8–9 years
• 🧼 Focus is on hygiene, privacy, safety, and body changes
• 🚫 Avoid myths and fear-based teaching
• ✅ Promote respect, consent, accurate information

---

✅ Top 3 MCQs – Sex Education:

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Q1. Purpose of sex education in school-age children is to:
🅰️ Encourage early sex
✅ 🅱️ Promote awareness about puberty and hygiene
🅲️ Scare children
🅳️ Avoid body knowledge
Answer: ✅ (b)

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Q2. Teaching about ‘good touch and bad touch’ should start at:
✅ 🅰️ 6–8 years
🅱️ 13 years
🅲️ Adulthood
🅳️ After marriage
Answer: ✅ (a)

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Q3. Which of the following is appropriate for sex education in 9–12 years?
🅰️ Family planning
🅱️ Pregnancy complications
✅ 🅲️ Puberty changes and hygiene
🅳️ Detailed intercourse discussion
Answer: ✅ (c)

🧑‍🎓📈 Adolescent – Growth and Development (10–19 Years)

📘 Essential for Pediatric, Community & School Health Nursing

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🔰 Definition:

Adolescence is the transitional stage between childhood and adulthood, defined by the WHO as 10–19 years. It is characterized by physical, emotional, cognitive, and social development, along with the onset of puberty and reproductive maturity.

✅ Subdivisions:

• 🟢 Early adolescence: 10–13 years
• 🟡 Middle adolescence: 14–16 years
• 🟠 Late adolescence: 17–19 years

---

🧭 Key Domains of Adolescent Development:

---

🟩 1. Physical Development (Puberty):

🧒 Boys	👧 Girls
Enlargement of testicles	Breast development (thelarche)
Growth of pubic/facial hair	Pubic hair, menstruation (menarche)
Voice deepening	Widening of hips
Growth spurt (13–15 yrs)	Growth spurt (10–12 yrs)

✅ Girls usually mature 2 years earlier than boys.

---

🟨 2. Cognitive Development (Piaget: Formal Operational Stage):

• Develop abstract and logical thinking
• Ability to reason hypothetically
• Increased capacity for problem-solving and planning
• Begin to think about future goals and moral values

---

🟧 3. Psychosocial Development (Erikson: Identity vs Role Confusion):

✅ Positive Outcome	⚠️ Negative Outcome
Develops a strong sense of self-identity	Confusion, low self-esteem
Explores personal beliefs & career options	Peer pressure, emotional instability

---

🟥 4. Emotional and Social Development:

• Increased independence and self-awareness
• Strong influence of peer groups
• Development of crushes, romantic interests
• Mood swings common due to hormonal changes
• Desire for privacy and personal space

---

🩺 Health Concerns in Adolescents:

🩹 Physical/Behavioral	🧠 Mental/Psychosocial
Nutritional problems (anemia, obesity)	Depression, anxiety, identity crisis
Risky behavior (smoking, alcohol)	Peer pressure, bullying
Menstrual problems (girls)	Low self-esteem, body image issues
Acne, body odor	Aggressive behavior or withdrawal

---

👩‍⚕️ Nurse’s Role in Adolescent Development:

• Promote Adolescent Friendly Health Services (AFHS)
• Provide counseling on nutrition, hygiene, mental health, sexuality
• Support menstrual hygiene and reproductive health
• Screen for behavioral issues, substance abuse, depression
• Educate on peer pressure, social media safety, body image

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📚 Golden One-Liners for Revision:

• 🧠 Cognitive stage = Formal operational
• 🧍‍♂️ Psychosocial stage = Identity vs Role Confusion
• 🩸 Menarche = Onset of first menstruation, ~10–13 years
• 🧍‍♀️ Growth spurt occurs earlier in girls than boys
• 🧑‍⚕️ Nurse provides confidential, respectful, and holistic care

---

✅ Top 5 MCQs for Practice:

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Q1. WHO defines adolescence as the age group:
🅰️ 12–18 years
✅ 🅱️ 10–19 years
🅲️ 14–21 years
🅳️ 9–16 years
Answer: ✅ (b)

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Q2. The major developmental task in adolescence is:
🅰️ Trust development
🅱️ Autonomy
✅ 🅲️ Identity formation
🅳️ Industry
Answer: ✅ (c)

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Q3. Puberty in girls usually begins with:
🅰️ Menarche
✅ 🅱️ Breast development
🅲️ Pubic hair
🅳️ Mood swings
Answer: ✅ (b)

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Q4. Which Piaget stage applies to adolescents?
🅰️ Preoperational
🅱️ Concrete operational
✅ 🅲️ Formal operational
🅳️ Sensorimotor
Answer: ✅ (c)

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Q5. One key physical change in boys during adolescence is:
🅰️ Menarche
🅱️ Breast growth
✅ 🅲️ Deepening of voice
🅳️ Early menopause
Answer: ✅ (c)

🌀🧑‍🦱 Adaptation to Puberty (10–19 Years)

📘 Essential for Adolescent Health, School Nursing & Health Counseling

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🔰 Definition of Puberty:

Puberty is the biological process of physical, hormonal, and sexual maturation that transforms a child into a reproductively capable adolescent.

✅ It typically begins between:

• Girls: 8–13 years
• Boys: 9–14 years

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📈 Changes During Puberty:

💡 System/Aspect	🔄 Changes
🟩 Physical	Growth spurt, body shape changes, voice deepening, acne, menstruation/ejaculation
🟨 Hormonal	Increased estrogen (girls), testosterone (boys)
🟧 Cognitive	Development of abstract thinking and reasoning
🟥 Psychosocial/Emotional	Mood swings, self-consciousness, need for identity and peer approval

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🧠 What is Adaptation to Puberty?

Adaptation means how adolescents cope with and adjust to these physical, emotional, and social changes, and how they integrate these changes positively into their self-identity and behavior.

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🧭 Key Aspects of Healthy Adaptation:

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🟩 1. Understanding Body Changes:

• Awareness of normal growth patterns (e.g., menstruation, wet dreams, height changes)
• Accepting individual variation in timing
• Avoiding comparisons with peers

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🟨 2. Hygiene & Self-Care:

• Regular bathing, changing undergarments
• Menstrual hygiene in girls (pads, disposal, changing frequency)
• Skincare (acne prevention), oral hygiene

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🟧 3. Emotional Adjustment:

• Coping with mood swings, anxiety, and self-image issues
• Managing peer pressure and expectations
• Building emotional intelligence & confidence

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🟥 4. Social & Peer Adaptation:

• Forming healthy friendships & communication skills
• Respecting privacy, consent, boundaries
• Identifying and resisting negative influences (e.g., substance use, bullying)

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🟦 5. Reproductive & Sexual Health Awareness:

• Understanding fertility, contraception, STIs
• Learning about consent and safe relationships
• Differentiating between myths vs scientific facts

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👩‍⚕️ Nurse’s Role in Puberty Adaptation:

• Conduct adolescent-friendly health sessions in schools
• Provide counseling on hygiene, menstruation, emotional health
• Distribute IEC materials (charts, booklets, pads, posters)
• Identify adolescents with psychosocial or behavioral issues
• Encourage open communication with parents and caregivers

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🧠 Tips for Caregivers/Teachers:

• Normalize discussions about puberty without embarrassment
• Encourage questions and correct myths gently
• Teach respect for body, privacy, and emotional wellbeing
• Offer gender-sensitive education to both boys and girls

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📚 Golden One-Liners for Revision:

• 🟢 Puberty = Physical + Emotional + Sexual Maturation
• 🟡 Adaptation = Positive coping with puberty changes
• 🟠 Mood swings are normal due to hormonal fluctuation
• 🔴 Nurses play a key role in counseling and hygiene education
• 🟣 Peer support and open communication help reduce stress

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✅ Top 5 MCQs for Practice:

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Q1. Puberty begins in girls typically between the ages of:
🅰️ 5–8 years
✅ 🅱️ 8–13 years
🅲️ 14–18 years
🅳️ 10–20 years
Answer: ✅ (b)

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Q2. Mood swings during puberty are due to:
🅰️ Poor upbringing
✅ 🅱️ Hormonal changes
🅲️ Vitamin deficiency
🅳️ Sleep only
Answer: ✅ (b)

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Q3. Menstrual hygiene includes:
🅰️ Reusing old cloth without cleaning
✅ 🅱️ Using sanitary pads and changing every 4–6 hrs
🅲️ Avoiding bathing
🅳️ Isolating girls
Answer: ✅ (b)

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Q4. Wet dreams in boys during puberty are:
🅰️ A disease
🅱️ Abnormal
✅ 🅲️ A normal part of puberty
🅳️ Need hospitalization
Answer: ✅ (c)

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Q5. Role of a nurse in puberty adaptation includes:
🅰️ Scolding adolescents
✅ 🅱️ Providing emotional support and education
🅲️ Ignoring questions
🅳️ Restricting health info
Answer: ✅ (b)

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🩸👧 Menstrual Hygiene

📘 Essential for Pediatric Nursing, Adolescent Health, School Health & Community Health Nursing

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🔰 Definition:

Menstrual hygiene refers to safe and hygienic practices used by girls and women during menstruation to manage menstrual flow in a clean, private, and healthy way.

✅ It includes use of clean absorbents, regular changing, proper disposal, cleaning of genitalia, and awareness of menstrual health.

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🧭 Why Menstrual Hygiene is Important?

• Prevents Reproductive Tract Infections (RTIs)
• Promotes school attendance and self-confidence
• Reduces shame, stigma, and myths
• Enhances overall reproductive and mental health

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🩺 Key Practices for Menstrual Hygiene:

✅ Practice	📋 Details
🟩 Use of clean absorbents	Sanitary pads, tampons, menstrual cups (avoid dirty rags)
🟨 Changing absorbent every 4–6 hrs	Prevents bacterial growth and odor
🟧 Washing genital area	With clean water and mild soap once/twice daily
🟥 Handwashing before/after changing	To prevent infections and contamination
🟦 Proper disposal	Wrap pad in paper, dispose in bin or incinerator, not flushed
🟪 Bathing during periods	Encouraged; keeps body clean and fresh

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🚺 Menstrual Disorders Requiring Attention:

• Dysmenorrhea – Painful menstruation
• Menorrhagia – Heavy bleeding
• Oligomenorrhea – Infrequent periods
• Amenorrhea – Absence of menstruation after puberty

👉 Should be referred to a healthcare provider if persistent.

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👩‍⚕️ Role of Nurse in Menstrual Hygiene Management (MHM):

• Educate girls in schools, anganwadis, VHNDs
• Demonstrate use of sanitary products (e.g., pads, cups)
• Promote distribution of free/low-cost sanitary pads under schemes
• Encourage emotional support, bust myths and taboos
• Refer in case of abnormal bleeding, pain, or psychological issues
• Involve parents/teachers for community awareness

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📜 Government Initiatives on MHM:

🏛️ Program	📌 Key Features
🟢 Rashtriya Kishor Swasthya Karyakram (RKSK)	Adolescent health, including MHM awareness
🟡 Menstrual Hygiene Scheme (MoHFW)	Distribution of sanitary pads to girls in rural areas
🟠 Swachh Bharat – WASH in Schools (WinS)	Access to clean toilets and safe disposal facilities

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📚 Golden One-Liners for Revision:

• 🟢 Pads should be changed every 4–6 hours
• 🟡 Poor hygiene causes RTIs and UTIs
• 🟠 Menstrual cups are reusable for up to 5–10 years
• 🔴 Nurses play a key role in menstrual education & counseling
• 🟣 Menstrual Hygiene Scheme offers low-cost pads to rural girls

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✅ Top 5 MCQs for Practice:

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Q1. How often should a sanitary pad be changed?
🅰️ Once a day
✅ 🅱️ Every 4–6 hours
🅲️ After 12 hours
🅳️ Only when it’s full
Answer: ✅ (b)

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Q2. Which infection is commonly caused by poor menstrual hygiene?
🅰️ Tuberculosis
🅱️ Asthma
✅ 🅲️ Reproductive Tract Infection (RTI)
🅳️ Dengue
Answer: ✅ (c)

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Q3. What is the correct method of disposing a used sanitary pad?
🅰️ Flush it in toilet
🅱️ Throw it openly
✅ 🅲️ Wrap and dispose in covered bin/incinerator
🅳️ Bury in garden
Answer: ✅ (c)

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Q4. Menstrual Hygiene Scheme is launched by:
🅰️ Ministry of Education
✅ 🅱️ Ministry of Health and Family Welfare
🅲️ WHO
🅳️ UNICEF
Answer: ✅ (b)

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Q5. Role of nurse in menstrual hygiene includes all except:
🅰️ Counseling girls
🅱️ Referring menstrual disorders
✅ 🅲️ Spreading myths
🅳️ Providing sanitary products
Answer: ✅ (c)

🥗🧠 Nutritional Guidance & Sex Education in Adolescents (10–19 Years)

📘 Essential for School Health, Adolescent Health, ARSH, and Community Nursing

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🥗 Part 1: Nutritional Guidance in Adolescents

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🔰 Why Important?

• Adolescence is the second most rapid growth period after infancy
• Nutritional needs increase due to:
  • Growth spurts
  • Onset of menstruation (girls)
  • Increased physical activity
  • Developing muscle mass (boys)

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🍽️ Key Nutrients & Their Importance:

🧪 Nutrient	🔍 Function in Adolescents	🍲 Sources
🟢 Protein	Body building, tissue repair	Milk, eggs, dal, meat, paneer
🟡 Iron	Prevents anemia, supports menstruation (girls)	Jaggery, leafy greens, ragi, dates
🟠 Calcium	Bone development, teeth	Milk, curd, ragi, sesame
🟣 Folic Acid & B12	RBC production, prevents neural issues	Green leafy vegetables, eggs
🔴 Zinc & Iodine	Immunity & brain development	Seafood, iodized salt, seeds

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🍛 Dietary Recommendations:

• Eat 3 main meals + 2 healthy snacks/day
• Include 5 food groups: Carbohydrates, Proteins, Fats, Vitamins, Minerals
• Drink at least 6–8 glasses of water/day
• Avoid junk food, soft drinks, processed snacks
• Girls must be monitored for iron-deficiency anemia

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👩‍⚕️ Nurse’s Role in Adolescent Nutrition:

• Conduct BMI and anemia screening
• Educate on balanced diet and local nutritious foods
• Promote Weekly Iron Folic Acid Supplementation (WIFS)
• Support girls during menstruation-related dietary issues
• Involve parents and teachers in counseling sessions

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📚 Golden One-Liners – Nutrition:

• 🟢 Adolescents need high protein, calcium, and iron
• 🟡 Girls are more prone to iron deficiency anemia
• 🟠 Avoid junk food and empty calories
• 🔴 Encourage local and seasonal foods

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✅ Top 3 MCQs – Nutrition:

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Q1. The most common nutritional deficiency in adolescent girls is:
🅰️ Vitamin C
✅ 🅱️ Iron
🅲️ Zinc
🅳️ Iodine
Answer: ✅ (b)

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Q2. Weekly iron-folic acid tablets are given under:
🅰️ JSY
✅ 🅱️ WIFS
🅲️ RKSK
🅳️ ICDS
Answer: ✅ (b)

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Q3. Adolescents should avoid:
🅰️ Fruits
🅱️ Green vegetables
✅ 🅲️ Soft drinks & chips
🅳️ Milk
Answer: ✅ (c)

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🧠 Part 2: Sex Education in Adolescents

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🔰 Why Important?

• Prepares adolescents for puberty, relationships, reproductive health
• Prevents misinformation, abuse, STIs, early pregnancies
• Promotes safe, respectful, and informed decision-making

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📘 Age-Appropriate Topics:

📅 Age	📘 Topics Covered
10–12 years	Puberty, body changes, hygiene, privacy, safety
13–15 years	Emotions, relationships, consent, basic reproduction
16–19 years	Contraception, STIs, sexual rights, gender sensitivity

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🗣️ Core Components of Effective Sex Education:

• Anatomy & Puberty awareness
• Consent & respect for boundaries
• Menstrual and reproductive hygiene
• Prevention of STIs and HIV/AIDS
• Contraceptive knowledge
• Debunking myths and taboos

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👩‍⚕️ Nurse’s Role in Adolescent Sex Education:

• Organize Adolescent Health Days in schools/communities
• Provide age-appropriate, scientific, and non-judgmental information
• Collaborate with teachers and counselors
• Offer confidential counseling services
• Distribute IEC materials (charts, booklets, menstrual kits)

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📚 Golden One-Liners – Sex Education:

• 🟢 Begins as early as 10 years with basic puberty education
• 🟡 Focus = consent, hygiene, prevention
• 🟠 Adolescents must be taught to say NO to unsafe touch
• 🔴 Sex education is a tool to empower, not encourage early activity

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✅ Top 3 MCQs – Sex Education:

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Q1. Sex education in schools should begin at around:
🅰️ 18 years
✅ 🅱️ 10–12 years
🅲️ After marriage
🅳️ 5 years
Answer: ✅ (b)

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Q2. Which of the following is a key message in sex education?
🅰️ Shame associated with body
✅ 🅱️ Respect, safety, consent
🅲️ Promote early sex
🅳️ Avoid talking about body parts
Answer: ✅ (b)

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Q3. A nurse’s role in sex education includes:
🅰️ Judging adolescent behavior
✅ 🅱️ Offering facts with privacy and respect
🅲️ Ignoring emotional concerns
🅳️ Promoting myths
Answer: ✅ (b)

🧠👪 Sex Education & Role of Parents in Adolescent Health Promotion (10–19 Years)

📘 Essential for School Health, Adolescent Health (ARSH), and Community Health Nursing

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🧠 Part 1: Sex Education in Adolescents

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🔰 Definition:

Sex education is a structured learning process that provides scientific, age-appropriate, and culturally sensitive information related to sexual development, reproductive health, relationships, and safety.

✅ Focuses on body awareness, hygiene, emotions, respect, and protection.

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🧭 Why Adolescents Need Sex Education:

✅ Benefits
Helps understand puberty changes
Prevents STIs, HIV, unplanned pregnancy
Builds awareness on consent & boundaries
Corrects myths & misinformation
Encourages respect and responsible behavior

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📚 Key Topics Covered by Age Group:

📅 Age	📘 Topics Covered
10–12 years	Body changes, menstruation, hygiene, good touch/bad touch
13–15 years	Emotions, peer pressure, consent, respect, reproduction basics
16–19 years	Contraception, STI prevention, gender identity, relationships

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👩‍⚕️ Nurse’s Role in School/Community:

• Conduct age-appropriate awareness sessions
• Encourage Q&A without embarrassment
• Offer confidential counseling
• Collaborate with parents, teachers & ASHAs
• Distribute IEC material: flip charts, models, handbooks

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📚 Golden One-Liners – Sex Education:

• 🟢 Begins with puberty education (10–12 yrs)
• 🟡 Consent, hygiene, STI awareness = core components
• 🟠 Respect and privacy are key messages
• 🔴 Sex education does not promote early activity, but prevents risk

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✅ Top 3 MCQs – Sex Education:

Q1. At what age should sex education ideally begin?
🅰️ After marriage
✅ 🅱️ 10–12 years
🅲️ At 18 years
🅳️ At 5 years
Answer: ✅ (b)

Q2. One main aim of adolescent sex education is to:
🅰️ Promote early relationships
✅ 🅱️ Prevent abuse and increase body awareness
🅲️ Avoid reproductive knowledge
🅳️ Stop communication
Answer: ✅ (b)

Q3. One important topic in adolescent sex education is:
🅰️ Political rights
🅱️ Industrial labor
✅ 🅲️ Menstrual hygiene and body changes
🅳️ Business studies
Answer: ✅ (c)

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👪 Part 2: Role of Parents in Health Promotion of Adolescents

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🔰 Definition:

Health promotion in adolescence means guiding and supporting youth to achieve physical, mental, emotional, and social well-being through positive choices and knowledge.

✅ Parents are the first educators and protectors in adolescent health.

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🧭 Key Roles of Parents:

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🟩 1. Open Communication:

• Create a safe space to discuss puberty, emotions, relationships
• Answer questions honestly without shaming
• Encourage discussion of peer pressure and stress

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🟨 2. Nutritional Guidance & Lifestyle:

• Provide balanced meals and discourage junk food
• Encourage physical activity and sports
• Ensure regular health check-ups & vaccinations

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🟧 3. Menstrual & Reproductive Health Support (for girls):

• Teach proper hygiene practices
• Provide sanitary products
• Remove stigma or shame around menstruation

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🟥 4. Moral and Emotional Support:

• Teach decision-making, coping skills, and values
• Offer emotional support during mood swings or self-image issues
• Monitor for signs of depression, anxiety, or risky behavior

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🟦 5. Supervision & Guidance:

• Supervise internet use, friends, outings
• Set healthy boundaries around mobile use and relationships
• Guide about substance abuse and cyber safety

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👩‍⚕️ Nurse’s Role in Supporting Parents:

• Train parents on adolescent needs and communication techniques
• Encourage non-judgmental listening
• Provide parental education sessions during VHNDs/school meetings
• Promote awareness on WIFS, RKSK, ARSH programs

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📚 Golden One-Liners – Parent’s Role:

• 🟢 Parents = First counselors for adolescents
• 🟡 Support must be open, non-judgmental, informative
• 🟠 Strong parent-child relationship = less risky behavior
• 🔴 Silence → Misinformation from peers/social media

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✅ Top 3 MCQs – Role of Parents:

Q1. One best way parents can support adolescent health is:
🅰️ Avoiding discussions
✅ 🅱️ Encouraging open communication
🅲️ Giving punishments
🅳️ Ignoring mood swings
Answer: ✅ (b)

Q2. Providing healthy food and exercise habits is a part of:
🅰️ Hygiene
✅ 🅱️ Lifestyle guidance
🅲️ Politics
🅳️ Literacy
Answer: ✅ (b)

Q3. A parent’s failure to talk about menstruation may lead to:
🅰️ Better learning
✅ 🅱️ Shame and misinformation
🅲️ More independence
🅳️ Physical strength
Answer: ✅ (b)

👩‍⚕️🧑‍🎓 ARSH – Adolescent Reproductive & Sexual Health Programme

📘 Essential for Adolescent Health Nursing, RKSK, School Health & Community Nursing

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🔰 Definition:

ARSH (Adolescent Reproductive and Sexual Health) is a government initiative under the National Rural Health Mission (NRHM) launched in 2006, aiming to improve the reproductive, sexual, and general health of adolescents (10–19 years).

✅ It emphasizes access to information, counseling, and adolescent-friendly services to reduce risks like early pregnancy, STIs, HIV/AIDS, malnutrition, and unsafe abortion.

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🧭 Objectives of ARSH Programme:

🎯 Goal	📌 Focus Area
🟢 Improve knowledge and behavior	Menstruation, safe sex, delay marriage, contraception
🟡 Prevent adolescent morbidity and mortality	Anemia, RTIs/STIs, early pregnancy, substance abuse
🟠 Promote gender equity	Respect, consent, non-discrimination
🔴 Strengthen adolescent-friendly services	Clinics, helplines, peer education

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🏥 Services Offered Under ARSH:

✅ Service	📋 Details
🟩 Adolescent Friendly Health Clinics (AFHCs)	Counseling, check-ups, referral services
🟨 Weekly Iron Folic Acid Supplementation (WIFS)	IFA tablets for anemia prevention in girls/boys
🟧 Menstrual Hygiene Scheme (MHS)	Free/low-cost sanitary pads, menstrual awareness
🟥 Peer Educator Programme	Community-level peer educators (Saathiya/mitra)
🟦 Referral & linkage to higher centers	For RTIs/STIs, mental health, reproductive issues

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📘 Target Group:

🧑‍🦱 Category	📅 Age Group
Adolescents (boys and girls)	10–19 years
Both in-school & out-of-school adolescents

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👩‍⚕️ Role of Nurse/Health Worker in ARSH:

• Conduct adolescent health days and school sessions
• Provide confidential counseling and referrals
• Distribute IFA tablets, sanitary pads
• Maintain ARSH service registers and reports
• Promote gender sensitivity, life skills & healthy behaviors
• Work with ASHA, ANM, peer educators

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💡 Key Topics Covered Under ARSH Counseling:

• Puberty & body changes
• Menstrual hygiene
• Reproductive health & contraception
• Consent, gender identity & respect
• Prevention of STIs/HIV/AIDS
• Mental health and substance abuse

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📜 ARSH is Now Part of:

✅ RKSK (Rashtriya Kishor Swasthya Karyakram) – Launched in 2014 to broaden focus beyond ARSH
Includes 6 key themes:

1. Nutrition
2. Sexual & reproductive health
3. Mental health
4. Substance misuse
5. NCDs (e.g., obesity, hypertension)
6. Injuries & violence (including gender-based)

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📚 Golden One-Liners for Revision:

• 🟢 ARSH launched in 2006 under NRHM
• 🟡 Provides adolescent-friendly health clinics & counseling
• 🟠 Covers 10–19 years, both boys and girls
• 🔴 Focus areas = menstruation, STIs, mental health, gender equity
• 🟣 Now integrated under RKSK (since 2014)

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✅ Top 5 MCQs for Practice:

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Q1. ARSH services are targeted at which age group?
🅰️ 5–10 years
✅ 🅱️ 10–19 years
🅲️ 18–30 years
🅳️ 0–6 years
Answer: ✅ (b)

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Q2. Which of the following is a major service under ARSH?
🅰️ Cataract surgery
✅ 🅱️ Menstrual hygiene education
🅲️ Tuberculosis DOTS
🅳️ BCG vaccine
Answer: ✅ (b)

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Q3. Peer educators under ARSH are known as:
🅰️ Health officers
✅ 🅱️ Saathiya
🅲️ Panchayat mitra
🅳️ Counselor
Answer: ✅ (b)

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Q4. ARSH was integrated into which expanded program in 2014?
🅰️ JSY
🅱️ ICDS
✅ 🅲️ RKSK
🅳️ RCH
Answer: ✅ (c)

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Q5. One key objective of ARSH is to:
🅰️ Promote early marriage
🅱️ Avoid adolescent education
✅ 🅲️ Reduce adolescent morbidity & risky behavior
🅳️ Prevent immunization
Answer: ✅ (c)

💊🩸 WIFS – Weekly Iron and Folic Acid Supplementation Programme

📘 Essential for School Health, Adolescent Health (ARSH/RKSK), and Nutritional Deficiency Programs

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🔰 Definition:

WIFS (Weekly Iron and Folic Acid Supplementation) is a national program launched by the Ministry of Health and Family Welfare (MoHFW) in 2013, aimed at preventing Iron Deficiency Anemia (IDA) among adolescents (10–19 years) through weekly IFA supplementation and biannual deworming.

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🧭 Objectives of WIFS Programme:

🎯 Goal	📌 Details
🟢 Prevent and control anemia	Among school-going and out-of-school adolescents
🟡 Increase hemoglobin and improve productivity	Enhance learning and physical stamina
🟠 Improve nutritional and hygiene practices	Promote healthy behaviors and menstrual hygiene

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👧👦 Target Group:

Group	Age
🏫 School-going adolescents	6th to 12th std (10–19 yrs)
🏡 Out-of-school adolescents	Via Anganwadi Centres (AWCs)

✅ Both boys and girls are covered under WIFS.

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💊 Supplementation Guidelines:

🔹 Group	💊 Dose	🕐 Frequency
Girls & Boys (10–19 yrs)	1 IFA blue tablet/week (60 mg Iron + 500 mcg Folic Acid)	Every Monday or Thursday
Deworming	Albendazole 400 mg twice a year (Jan & July)	Supervised in schools/AWCs

✅ IFA tablets should be chewed or swallowed after meals.

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🧼 Additional Services Provided:

• Nutrition & hygiene education sessions
• Menstrual hygiene education for adolescent girls
• Screening for anemia and referral if needed
• Promotion of handwashing and deworming

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📦 Key Components of WIFS:

📌 Component	📋 Details
🟩 Weekly IFA tablet	Delivered in schools and anganwadis
🟨 Deworming Day	Jan & July – biannual nationwide activity
🟧 Counselling sessions	On diet, hygiene, menstruation, anemia
🟥 Reporting & Monitoring	Through ANMs, teachers, ASHAs, and health staff

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👩‍⚕️ Role of Nurse/ANM/ASHAs:

• Ensure IFA tablet supply and stock maintenance
• Supervise weekly distribution in schools/AWCs
• Organize deworming campaigns and monitor compliance
• Provide counseling to adolescents and parents
• Refer severely anemic cases to PHCs
• Maintain WIFS registers and monthly reports

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📚 Golden One-Liners for Revision:

• 🟢 WIFS launched in 2013
• 🟡 Covers adolescents aged 10–19 years
• 🟠 Weekly IFA = 1 blue tablet/week after meals
• 🔴 Deworming = Albendazole 400 mg twice/year (Jan & July)
• 🟣 Implemented via schools + Anganwadi Centres

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✅ Top 5 MCQs for Practice:

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Q1. The WIFS program was launched in the year:
🅰️ 2007
🅱️ 2010
✅ 🅲️ 2013
🅳️ 2018
Answer: ✅ (c)

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Q2. What is the composition of one WIFS IFA tablet?
🅰️ 30 mg Iron + 100 mcg FA
✅ 🅱️ 60 mg Iron + 500 mcg FA
🅲️ 100 mg Iron + 5 mg FA
🅳️ 400 mg Iron + 200 mg FA
Answer: ✅ (b)

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Q3. How often should Albendazole be given under WIFS?
🅰️ Monthly
🅱️ Weekly
✅ 🅲️ Twice a year
🅳️ Daily
Answer: ✅ (c)

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Q4. WIFS program targets which age group?
🅰️ 6–9 years
✅ 🅱️ 10–19 years
🅲️ 1–5 years
🅳️ 20–30 years
Answer: ✅ (b)

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Q5. The WIFS program is implemented through:
🅰️ Hospitals only
🅱️ Clinics
✅ 🅲️ Schools and Anganwadis
🅳️ TV Programs
Answer: ✅ (c)