At least 4 times in infancy, it is recommended to be at 3, 6, 8, 12 months old respectively; Children under 3 years old are treated at least twice a year with an interval of 6 months. The time is 1.5 years old, 2 years old, 2.5 years old and 3 years old. Children over 3 years old at least 1 time every year. The health examination can adjust the examination time and increase the examination times according to the children's personal situation, combined with the inoculation time or the actual situation in the region.
Health examination should be carried out before vaccination, and the medical environment should be arranged so that children can have a physical examination before vaccination. The time for each health examination shall not be less than 5 ~ 10 minutes.
(2) the contents of health examination
1. Consultation
(1) feeding and diet history: feeding mode, food conversion (supplementary food addition), food types, times and quantity of meals, eating behavior and environment, addition of nutritional supplements, etc.
(2) Growth and development history: previous physical growth and psychological and behavioral development.
(3) Living habits: sleeping, excreting, sanitary habits, etc.
(4) Allergy history: Allergy history of drugs, food, etc.
(5) Illness: Illness between two health examinations.
2. Physical measurement
(1) weight
1) Preparation before measurement: the zero point of the scale should be corrected before each weight measurement. Children take off their coats, shoes, socks and hats, empty their urine and urine, and babies take off their diapers. Pay attention to keep the room warm in winter, let the children wear only underwear, and accurately weigh the clothes.
2) Measurement method: When measuring, children should not touch other objects. When measuring with lever weighing scale, the weight placed should be close to the child's weight, and the traveling hammer should be adjusted quickly to make the lever at the middle level, and the readings displayed by the weight and the traveling hammer should be added; When weighing with an electronic scale, read the data after it is stable. Remove the weight of clothes when recording. The weight record is in kilograms (kg), accurate to 1 digit after the decimal point.
(2) Length (height)
1) Preparation before measurement: Measure the length of children aged 2 and below, and measure the height of children aged 2 and above. Children should take off their coats, shoes, socks and hats before measuring their height.
2) Measurement method: When measuring the body length, the child lies on his back in the center of the measuring bed, the assistant centers his head, the top of his head touches the headboard, and his ears are at the same level. The surveyor stands on the right side of the child, holds the child's knees with his left hand to straighten his legs, and moves the pedal with his right hand to touch the heels of both feet. Pay attention to the consistency of readings on both sides of the measuring bed, and then read.
When measuring height, stand up straight, keep your eyes straight ahead, hold out your chest, hang your arms naturally, keep your heels together, keep your toes about 60 degrees apart, keep your heels, hips and shoulders in contact with the column at the same time, and keep your head in the middle position, so that the measuring board can contact your head. Read the numbers marked on the post perpendicular to the measuring board. Your eyes should be parallel to the numbers marked on the post. Children's body length (height) is recorded in centimeters (cm) to the decimal point 1 bit.
(3) Head circumference
Children take a sitting or supine position. The measurer is located on the right or in front of the child. Fix the zero point of the soft ruler on the upper edge of the right eyebrow arch of the head with the thumb of the left hand, and make the soft ruler close to the scalp through the occipital tuberosity and the zero point of the upper edge of the left eyebrow arch. Girls should loosen their braids. Children's head circumference is recorded in centimeters (cm) to the decimal point 1 bit.
Step 3 have a physical examination
(1) General situation: Observe the child's mental state, face, expression and gait.
(2) Skin: yellow staining, pallor, cyanosis (lips, nail bed), rash, bleeding spot, ecchymosis, hemangioma, flushing or erosion appear at the skin folds such as neck, armpit, groin and buttocks.
(3) Lymph nodes: the size, number, texture, activity and tenderness of superficial lymph nodes in the whole body.
(4) Head and neck: whether there is square skull and skull softening, the size and tension of the anterior fontanel, cranial suture, special face, limited neck movement or neck mass.
(5) Eyes: whether there is any abnormality in appearance, conjunctival congestion secretion and nystagmus. Whether the baby is watching or following the situation.
(6) Ears: whether there is any abnormality in appearance and whether there is any abnormal secretion in the ear canal.
(7) Nose: whether there is any abnormality in appearance and secretion.
(8) Oral cavity: whether there is cleft lip and palate, and whether the oral mucosa is abnormal. Whether the tonsils are swollen, the number of deciduous teeth, the presence of dental caries and the number of dental caries.
(9) Chest: whether the appearance of the chest is symmetrical, whether there is funnel chest, chicken breast, ribbed beads, costal cartilage groove, etc. The heart auscultates whether there is arrhythmia and heart murmur, and whether there is abnormal breathing sound in the lungs.
(10) Abdomen: Check the size of liver and spleen for abdominal distension, hernia, lump and tenderness.
(1 1) External genitalia: Check the position and size of testicles for abnormalities, scrotal edema and lumps.
(12) Vertebral limbs: Whether the spine has scoliosis or kyphosis, whether the limbs are symmetrically deformed, and screening for hip dysplasia can be conducted if conditions permit.
(13) nervous system: symmetry, range of motion and muscle tension of limbs.
4. Psychological and behavioral development monitoring
Every time a baby has a health check-up, it is necessary to monitor the development according to the sports development index of the Child Growth and Development Monitoring Table, regularly understand the psychological and behavioral development of children, and find out the children with developmental deviations in time. Children's psychological and behavioral development screening can be carried out in conditional areas.
5. Laboratory and other auxiliary inspections
(1) Routine examination of hemoglobin or blood: children of 6-9 months 1 time, children of 0-6 years old 1 time.
(2) Hearing screening: At the age of 6, 12, 24, and 36 months, children with high risk factors of hearing loss were screened 1 time with portable hearing assessment instrument and screening otoacoustic emission instrument.
(3) Vision screening: Children are screened once a year with an international standard eye chart or a standard logarithmic eye chart from the age of 4.
(4) Other examinations: Conditional units can carry out urine routine, dietary nutrition analysis and other examination items according to the specific situation of children.
(3) Health assessment
1. Physical development assessment
(1) evaluation index
Weight/age, length (height)/age, head circumference/age, weight/length (height) and body mass index (body mass index)/age.
(2) Evaluation method
1) data table method
① Deviation method (standard deviation method)
Based on the median (m), plus or minus the standard deviation (SD) can be used to evaluate the body growth. Five-level division and three-level division can be adopted (table 1).
Table 1 classification method Classification < m-2sdm-2sd ~ m-1SD m1SD m+1SD m+2sd > M+2SD five-level lower middle upper middle upper three-level lower middle upper ② percentile method
Taking the 50th percentile (P50) of the reference population as the reference value, the 3rd percentile is equivalent to the median of the deviation method minus 2 standard deviations, and the 97th percentile is equivalent to the median of the deviation method plus 2 standard deviations.
2) Chart method
Taking children's age or body length (height) as the abscissa and growth index as the ordinate, we can draw a chart, so as to understand children's growth intuitively and quickly. Through follow-up, we can clearly see the growth trend and change, and find the phenomenon of growth deviation in time.
Description: Make a line perpendicular to the abscissa with age or body length (height) as the point, and then make a line perpendicular to the ordinate with weight, body length (height), measured head circumference or body mass index as the point. The intersection of the two lines is the position or level of children's weight, body length (height), head circumference and body mass index in the graph.
(3) Evaluation content
1) Growth level: refers to the position of a single child in other groups of the same age and gender, which is the current growth level of the child (Table 2).
2) Symmetry: including body symmetry and body symmetry. Weight/length (height) can reflect the proportional relationship between children's body shape and various parts of the human body (Table 2).
Table 2 Percentile Standard Deviation Method of Growth Level and Symmetry Measurement Evaluation Index Weight/Age -P3-M-2SD Low Weight and Length (Height)/Age -P3-M-2SD Growth Retardation Weight/Length (Height) ▎ P3 𗣸 M-2SD emaciation P85 ~ P97m+1SD ~ M By observing the growth speed of children vertically, we can grasp the growth trajectory of individual children.
① Normal growth: Compared with the reference curve, children's own growth curve rises in parallel with the reference curve, representing normal growth.
② Malgrowth: Compared with the reference curve, children's own growth curve rises slowly (insufficient growth: the growth value is positive, but lower than the reference speed standard), is flat (no growth: the growth value is zero) or drops (the growth value is negative).
③ Overgrowth: Compared with the reference curve, children's own growth curve rises faster (the growth value exceeds the reference speed standard).
2. Psychological and behavioral development assessment
Children's growth and development monitoring table is used to monitor the psychological and behavioral development of infants. If a certain sports development index fails to pass the right side of the arrow, psychological and behavioral development screening or referral is needed.
(4) Guidance
1. Feeding and Nutrition advocate breastfeeding, guide parents to make scientific food conversion, balance dietary nutrition, cultivate children's good eating behavior, and pay attention to food safety. Prevent the occurrence of common nutritional diseases, such as protein-energy malnutrition, nutritional iron deficiency anemia, vitamin D deficiency rickets and overweight/obesity in children.
2. Physical growth tells the importance of regularly measuring children's weight, body length (height) and head circumference, feeding back the evaluation results, and guiding parents to correctly use the Monitoring Chart of Children's Growth and Development for growth and development monitoring.
3. Children's psychological and behavioral development should be predicted according to their developmental age, so as to promote their psychological and behavioral development.
4. Injury prevention attaches importance to the prevention of child injuries, and provides prevention guidance for drowning, falling injuries and road traffic injuries according to the characteristics of child injuries in different regions and different age groups.
5. Disease prevention guide parents to actively prevent common diseases such as digestive tract and respiratory tract in children, vaccinate on time, strengthen physical exercise, and cultivate good hygiene habits.
(5) Referral
1. Register children with low weight, growth retardation, emaciation, obesity, nutritional iron deficiency anemia and vitamin D deficiency rickets and transfer them to the management of nutritional diseases of children.
2. Register and refer children whose psychological and behavioral development screening results are suspicious or abnormal.
3. In any of the following circumstances, it shall be referred unconditionally for diagnosis and treatment:
(1) The skin has rashes, erosions, bleeding spots, swollen lymph nodes and tenderness.
(2) The head circumference is too large or too small, the tension of the anterior fontanel is too high, the neck movement is limited or the neck nodule.
(3) Abnormal eye appearance, overflowing tears or pus, conjunctival congestion, nystagmus, and abnormal vision screening for children over 4 years old.
(4) Abnormal secretions and dental caries in the ears and nose.
(5) The hearing screening is unqualified.
(6) Heart murmur, arrhythmia and abnormal breathing sounds in the lungs.
(7) Hepatosplenomegaly with abdominal mass.
(8) Scoliosis or kyphosis, asymmetry of limbs, abnormal mobility and muscle tension, suspected hip dysplasia.
(9) Abnormal genitalia, undescended testis, scrotal edema or lump.
In the health examination, all cases that cannot be handled should be referred. (a) children's health inspectors should receive professional and technical training.
(2) Medical and health institutions that carry out children's health examination shall be equipped with children's weighing scale, measuring bed, height meter, soft ruler, stethoscope, flashlight, disinfection tongue depressor, hearing and vision screening tools, children's growth and development monitoring chart (table) and necessary laboratory inspection equipment.
1. Weighing should use lever scales or electronic scales, with a maximum weighing of 60kg and a minimum dividing value of 50g.
2. The measuring bed is used to measure the body length of children under 2 years old, and the minimum dividing value is 0. 1cm.
3. The height meter is used to measure the height of children over 2 years old, and the minimum score is 0. 1cm.
4. The flexible ruler has no flexible flexible ruler, and the minimum dividing value is 0. 1cm.
5. Hearing screening tools Portable hearing assessment instrument and screening otoacoustic emission instrument.
6. Vision screening tool International standard eye chart or standard logarithmic eye chart light box.
(3) Pay attention to the cleanliness of testing tools and hands during inspection to prevent cross infection; Maintain an appropriate indoor temperature; Check gently, pay attention to medical safety and avoid potential injuries.
(four) master the correct monitoring and evaluation methods of children's growth and development, especially the description and interpretation of growth and development curves, and find the deviation or abnormality of growth and development at an early stage. Children with referral indications should explain the situation to their parents and refer them in time.
(five) to provide scientific parenting knowledge and related skills guidance for children's nutrition, feeding, psychological and behavioral development, disease and injury prevention; Feedback the results of physical examination in time and follow up the children with growth deviation or disease.
(six) the use of a unified health checklist, carefully fill in one by one, to ensure the integrity and continuity of data collection, and included in the children's health records. performance index
1.0 ~ 6-year-old children's health care coverage rate = (the number of children aged 0 ~ 6 who received 1 and above this year/the number of children aged 0 ~ 6 this year) × 100%.
2. Systematic management rate of children under 3 years old = (number of qualified children under 3 years old/number of children under 3 years old in this area) × 100%.
Hemoglobin detection rate of children aged 3.0 ~ 6 years = (number of children aged 0 ~ 6 years in the jurisdiction/number of children aged 0 ~ 6 years in the jurisdiction to be detected) × 100%.
(2) Disease indicators
1.5 anemia prevalence rate of children under 5 years old = (anemia prevalence rate of children under 5 years old/number of hemoglobin detection of children under 5 years old) × 100%.
2. Low weight rate of children under 5 years old = (number of children under 5 years old with low weight/number of children under 5 years old with weight examination) × 100%.
Growth retardation rate of children under 3.5 years old = (number of children under 5 years old with growth retardation/number of children under 5 years old with length/height check) × 100%.
The emaciation rate of children under 4.5 years old = (emaciation number of children under 5 years old/physical examination number of children under 5 years old) × 100%.
Obesity rate of children under 5.5 years old = (number of obese children under 5 years old/number of children under 5 years old for physical examination) × 100% 1.0 ~ 3 years old boy's length (height)/age, weight/age percentile standard curve (omitted).
2.0-3 years old boy's head circumference/age, weight/length standard percentile curve (omitted)
Standard curve of body mass index (BMI)/age percentile for boys aged 3.0-7 (omitted)
Standard curves of body length (height)/age and weight/age percentile for girls aged 4.0-3 years (omitted)
Standard percentile curves of head circumference/age, weight/length for girls aged 5.0-3 years (omitted)
Standard curve of body mass index (BMI)/age percentile for girls aged 6.0-7 (omitted)
7.0-2 years old boy height/age and weight/age standard deviation numerical table (omitted)
8.2-7 years old boy height/age and weight/age standard deviation numerical table (omitted)
Numerical table of head circumference/age standard deviation of boys aged 9.0-5 (omitted)
10. numerical table of standard deviation of male students' weight/length (omitted)
1 1. Numerical table of standard deviation of boys' weight/height (omitted)
12.0 ~ 7 years old boy body mass index (BMI)/age standard deviation numerical table (omitted)
13.0 ~ 2 years old girl height/age, weight/age standard deviation table (omitted)
14.2 ~ 7 years old girl height/age, weight/age standard deviation numerical table (omitted)
15.0 ~ 5 years old girl head circumference/age standard deviation numerical table (omitted)
16. numerical table of standard deviation of female students' weight/length (omitted)
17. numerical table of standard deviation of female students' weight/height (omitted)
18.0 ~ 7 years old girl body mass index (BMI)/age standard deviation numerical table (omitted)