(a) Health checkup time
At least 4 times in infancy, recommended at 3, 6, 8 and 12 months of age, respectively; at least 2 times a year for children aged 3 years and below, each time at an interval of 6 months, at the time of 1 and a half, 2, 2 and a half and 3 years old; and at least 1 time a year for children aged 3 years and above. Health checkups can be appropriately adjusted according to the individual child's situation, in conjunction with the time of vaccination or the actual situation in the region, and the number of checkups can be increased.
Health checkups need to be conducted before vaccination, and the environment should be arranged in such a way that it is easy for children to have a physical checkup first, followed by vaccination, and the time for each checkup should not be less than 5 to 10 minutes.
(2) Content of the health examination
1. Consultation
(1) Feeding and dietary history: feeding style, food conversion (supplemental food), food variety, meal frequency and quantity, dietary behavior and environment, and addition of nutrient supplements.
(2) Growth and development history: previous physical growth, mental and behavioral development.
(3) Lifestyle habits: sleep, defecation, and hygiene habits.
(4) Allergy history: allergies to drugs, food, etc.
(5) Illnesses: illnesses between health checkups.
2. Physical measurements
(1) Body weight
1) Preparation for measurement: The zero point of the scale needs to be corrected before each weight measurement. Children remove outer clothing, shoes, socks, hats, empty urine and feces, infants remove diapers. In winter, it is important to keep the room warm and let the children wear only a single pair of pants, weigh and remove the weight of the clothes accurately.
2) Measurement method: Children should not touch other objects during measurement. When using a lever-type scale for measurement, the weights placed should be close to the child's weight and the hammer should be adjusted quickly so that the lever is centered horizontally and the readings shown by the weights and the hammer are added together; when using an electronic scale for weighing, the readings should be taken after the data have stabilized. The weight of clothing should be removed when recording. The weight is recorded in kilograms (kg) to 1 decimal place.
(2) Length (Height)
1) Preparation for measurement: Children aged 2 years and below were measured for length, and children aged 2 years and above were measured for height. Children should take off their outer clothes, shoes, socks and hats before measuring their length (height).
2) Measurement method: When measuring length, the child lies on his/her back in the center of the measuring bed, and the assistant holds his/her head upright, with the top of his/her head touching the headboard and both ears at the same level. Measurement of the right side of the child, the left hand holding the child's two knees to make the legs straight, the right hand to move the foot plate to make it contact with the heel of the feet, pay attention to the two sides of the measuring bed readings should be consistent, and then read the number.
When measuring height, you should take a standing position, look straight ahead with both eyes, chest up, arms hanging down naturally, heels together, toes apart about 60 degrees, heels, hips and two shoulder blades between the three points of contact at the same time with the column, the head to maintain the center position, so that the measuring board and the top of the head point of contact, read the measuring board vertically intersected with the number of scales on the column, the line of sight should be parallel to the number of scales on the column. The length (height) of the child is recorded in centimeters (cm) to 1 decimal place.
(3) Head circumference
The child was placed in a sitting or supine position, and the measurer was located on the right side of the child or in front of the child. The zero point of the tape measure was fixed on the right side of the head at the upper edge of the arch of the eyebrow with the thumb of the left hand, and it was returned to the zero point by the occipital bone and the upper edge of the arch of the eyebrow on the left side to keep the tape measure close to the scalp, and the girl should loosen the braid of her hair. The head circumference of the child was recorded in centimeters (cm) to 1 decimal place.
3. Physical examination
(1) General condition: observe the child's mental state, face, expression and gait.
(2) Skin: any yellowish stain, pallor, cyanosis (lips and mouth, nail beds of fingers and toes), rash, hemorrhagic spots, petechiae, hemangiomas, and any flushing or vesiculation in the folds of the skin of the neck, armpits, inguinal area, buttocks and so on.
(3) Lymph nodes: size, number, texture, mobility, and tenderness of superficial lymph nodes throughout the body.
(4) Head and neck: the presence of square skull, cranial softness, fontanel size and tension, cranial sutures, the presence of special facial features, limited neck movement or neck mass.
(5) Eyes: any abnormal appearance, conjunctival congestion and secretion, nystagmus. Whether the infant has gaze and retrospective vision.
(6) Ears: whether there is any abnormality in appearance, and whether there is any abnormal secretion from the ear canal.
(7) Nose: any abnormal appearance, any abnormal secretion.
(8) Oral cavity: whether there is cleft lip and palate, whether there is any abnormality of oral mucosa. Whether the tonsils are enlarged, the number of milk teeth, the presence of dental caries and the number of caries.
(9) Chest: whether the shape of the chest is symmetrical, whether there is funnel chest, chicken chest, rib beading, cartilage groove, etc., whether there is arrhythmia and heart murmur on cardiac auscultation, and whether there is any abnormality in the breath sounds of the lungs.
(10) Abdomen: any abdominal distension, hernia, mass, tenderness, check the size of liver and spleen.
(11) External genitalia: any deformity, scrotal edema, mass, check testicular position and size.
(12) Spine and limbs: whether the spine has scoliosis or posterior protrusion, whether the limbs are symmetrical, whether there are deformities, and developmental hip dysplasia screening if possible.
(13) Neurologic: symmetry of limb activity, mobility and muscle tone.
4. Mental and behavioral development monitoring
Every time infants and young children undergo health checkups, they need to be monitored for development according to the motor development indicators of the child growth and development monitoring charts, and they should be regularly informed of children's mental and behavioral development, so that children with developmental deviations can be detected in a timely manner. Conditional areas can carry out children's mental and behavioral development screening.
5. Laboratory and other auxiliary examinations
(1) hemoglobin or blood routine examination: children 6-9 months of age once, children 1-6 years old once a year.
(2) Hearing screening: for children with high risk factors for hearing loss, a portable audiometric evaluator and a screening otoacoustic emitter are used, and hearing screening is performed once for children at 6, 12, 24, and 36 months of age.
(3) Vision screening: Children are screened for vision once a year starting at age 4 years using an international standardized vision chart or a standard logarithmic vision chart light box.
(4) Other examinations: Conditional units can carry out urine routine, dietary nutrition analysis and other examination programs according to the specific conditions of children.
(3) Health Evaluation
1. Physical Growth Evaluation
(1) Evaluation Indicators
Weight/age, length (height)/age, head circumference/age, weight/length (height) and body mass index (BMI)/age.
(2) Evaluation methods
1) Data table method
①Divergence method (standard deviation method)
The median (M) as the base value plus or minus the standard deviation (SD) was used to evaluate the physical growth, and it can be used in the five-grade division method and three-grade division method (Table 1).
Table 1 Grade division method Grade <M-2SD M-2SD to M-1SD M±1SD M+1SD to M+2SD >M+2SD Five grades Lower Middle Lower Middle Middle Upper Middle Upper Three grades Lower Middle Upper ②Percentile method
The 50th percentile (P50) of the reference population was taken as the baseline value, and the 3rd percentile value corresponded to the median for the method of deviation minus 2 standard deviations, and the 97th percentile value is equivalent to the median of the deviation method plus 2 standard deviations.
2) Curve diagram method
Taking the child's age or length (height) as the horizontal coordinate and the growth index as the vertical coordinate, a curve diagram is drawn, so as to understand the child's growth situation intuitively and quickly, and the growth trend and changes can be clearly seen through tracking observation, so that the phenomenon of deviation in growth can be detected in time.
The method of depiction: make a line perpendicular to the horizontal coordinate of the age or length (height) point, and then make a line perpendicular to the vertical coordinate of the weight, length (height), head circumference measurements or BMI value for the point, and the point of intersection of the two lines will be the age of the children's weight, length (height), head circumference, BMI in the position or level of the graph, which will be consecutively more than the weight, length (height), head circumference, BMI depiction of the graph, will be consecutively more than the weight, length (height), head circumference, BMI, head circumference, BMI, Head circumference, BMI, the child's weight, length (height), head circumference, BMI growth trajectory or trend is obtained by connecting multiple consecutive depictions of weight, length (height), head circumference, BMI.
(3) Evaluation content
1) Growth level: the position of an individual child in the population of the same age and sex, the current level of growth of the child (Table 2).
2) Proportionality: This includes body proportionality and stature proportionality, which can be reflected by weight/length (height) as the proportionality of the child's body shape and the parts of the human body (Table 2).
Table 2 Evaluation of growth level and proportionality Indicator Measurement Evaluation Percentile method Standard deviation method Weight/age ﹤P3 ﹤M-2SD Low weight Length(height)/age ﹤P3 ﹤M-2SD Stunted growth Weight/length(height) ﹤P3 ﹤M-2SD Wasting P85～P97 M+1SD～M+2SD Overweight ﹥P97 ≥M+2SD Obesity Head circumference/age ﹤P3 ﹤M+2SD Age ﹤P3 ﹤M-2SD too small ﹥P97 ﹥M+2SD too large 3) Growth rate: By tracing and connecting the measurements at different ages of an individual child into a curve on the growth chart and comparing them with the reference curve in the growth chart, it can be judged that the growth rate of the child at this time is normal, poor or too fast. Longitudinal observation of a child's growth rate can capture an individual child's own growth trajectory.
①Normal growth: compared with the reference curve, the child's own growth curve and the reference curve parallel to the rise is normal growth.
② poor growth: compared with the reference curve, the child's own growth curve rose slowly (insufficient growth: growth value is positive, but lower than the reference rate standard), flat (no growth: growth value of zero) or decline (growth value of negative).
3) Excessive growth: the child's own growth curve rises rapidly compared to the reference curve (growth values exceed the reference rate standard).
2. Evaluation of mental and behavioral development
The child growth and development monitoring chart is used to monitor the mental and behavioral development of infants and young children. If an indicator of motor development is not passed by the age of the month to the right of the arrow, screening or referral for psychobehavioral development is required.
(D) Guidance
1. Feeding and Nutrition Promote breastfeeding, guide parents to scientific food conversion, balanced dietary nutrition, cultivate children's good eating behavior, 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, overweight/obesity and so on.
2. Physical growth To inform the importance of regular measurement of children's weight, length (height) and head circumference, to provide feedback on the results of the assessment, and to guide parents in the correct use of the growth charts for growth and development monitoring.
3. Mental and Behavioral Development Provide anticipatory guidance according to the child's developmental age to promote the child's mental and behavioral development.
4. Injury prevention We emphasize the prevention of injuries to children, and provide guidance on the prevention of drowning, fall injuries and road traffic injuries according to the characteristics of injuries to children in different areas and at different ages.
5. Disease prevention Guiding parents to actively prevent children's digestive tract, respiratory tract and other common diseases, inoculate on time, strengthen physical exercise, and cultivate good hygiene habits.
(E) Referral
1. Register children with low weight, growth retardation, wasting, obesity, nutritional iron deficiency anemia and vitamin D deficiency rickets and refer them to the management of nutritional diseases in children.
2. Registration and referral of children with suspicious or abnormal results of child mental and behavioral development screening.
3. Those who have one of the following conditions and are not eligible for diagnosis and treatment should be referred:
(1) Skin rashes, vesicles, hemorrhagic spots, etc., and enlarged lymph nodes with pressure pain.
(2) Head circumference is too large or too small, fontanel tension is too high, neck movement is limited or neck mass.
(3) Abnormal eye appearance, tear or pus spillage, conjunctival congestion, nystagmus, infants who do not gaze or follow their eyes, and abnormal visual acuity screening in children over 4 years of age.
(4) Abnormal discharge from ears and nose, dental caries.
(5) Failed hearing screening.
(6) Heart murmur, arrhythmia, and abnormal lung breath sounds.
(7) Enlarged liver and spleen, palpable abdominal mass.
(8) Scoliosis or retroversion of the spine, asymmetry of the limbs, abnormal mobility and muscle tone, and suspected developmental hip dysplasia.
(9) External genital malformations, undescended testes, scrotal edema or masses.
Any condition found during the health examination that cannot be managed should be referred. (i) Child health examiners shall be trained in specialized techniques.
(ii) Health care institutions conducting child health examinations are required to be equipped with child weight scales, measuring beds, height gauges, soft rulers, stethoscopes, flashlights, sterilized tongue depressors, hearing and vision screening kits, child growth and development monitoring charts (tables), and the necessary equipment for laboratory tests.
1. Body weight scale The weight measurement should be done by lever-type body weight scale or electronic body weight scale, with the maximum weighing capacity of 60kg and the minimum index value of 50g.
2. Measuring beds For the measurement of the length of children aged 2 years old and below, with the minimum index value of 0.1cm.
3. Height gauge For the measurement of the height of children aged 2 years old and above, with the minimum index value of 0.1cm.
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4. Soft tape measure Non-stretchable soft tape measure with a minimum graduation value of 0.1cm.
5. Hearing screening tools Portable audiometric evaluation device, screening otoacoustic emission device.
6. Vision screening tools International standard vision chart or standard logarithmic vision chart light box.
(3) Pay attention to the cleanliness and hygiene of the testing tools and hands during the examination to prevent cross-infection; maintain the appropriate room temperature; examine the movement gently and pay attention to medical safety to avoid the potential for injury.
(4) Knowledge of proper methods of monitoring and evaluating children's growth and development, especially the depiction and interpretation of growth curves, and early detection of growth deviations or abnormalities. Children with referral indications should be explained to their parents and referred in a timely manner.
(v) Provide guidance on scientific parenting knowledge and related skills for children's nutrition, feeding, mental and behavioral development, and disease and injury prevention; provide timely feedback on the results of physical examinations, and conduct tracking and follow-up visits for children with growth deviations or diseases.
(6) Using a unified health examination form, filling in each item carefully, ensuring the completeness and continuity of data collection, and incorporating them into children's health records. (I) Indicators of work
1. Health care coverage rate of children aged 0-6 years = (number of children aged 0-6 years who received one or more physical examination in the jurisdiction in the year/number of children aged 0-6 years in the jurisdiction in the year) × 100%
2. Systematic management of children under the age of 3 years = (number of children under the age of 3 years who were qualified for systematic management in the jurisdiction in the year/number of children under the age of 3 years in the jurisdiction in the year) × 100%
3. 100%
3. Hemoglobin examination rate of children aged 0-6 years = (number of children aged 0-6 years in the jurisdiction who were examined for hemoglobin/number of children aged 0-6 years in the jurisdiction who should be examined for hemoglobin) × 100%
(ii) Disease indicators
1. Anemia prevalence rate of children under the age of 5 years = (number of children under the age of 5 years who were examined for anemia/number of children under the age of 5 years who were examined for hemoglobin) × 100%
(ii) Disease indicators
2. Prevalence of anemia in children under 5 years of age = (number of children under 5 years of age with anemia/number of children under 5 years of age screened for hemoglobin) × 100%
2. Prevalence of low birth weight in children under 5 years of age = (number of children under 5 years of age with low birth weight/number of children under 5 years of age screened for weight) × 100%
3. Prevalence of stunted growth in children under 5 years of age = (number of children under 5 years of age with stunted growth/number of children under 5 years of age screened for length/height) × 100%
4. Prevalence of wasting in children = (number of children under 5 years of age who are wasting/number of children under 5 years of age who are examined)×100%
5. Prevalence of obesity in children under 5 years of age = (number of children under 5 years of age who are obese/number of children under 5 years of age who are examined)×100% 1. Standardized curve of percentile of length/height/age and weight/age for boys aged 0-3 years (omitted)
2. Head circumference/age and weight/height in boys aged 0-3 years (omitted)
3. Head circumference/height in boys aged 5-3 years (omitted) Head circumference/age, weight/length percentile standardized graph for boys aged 0 to 3 years (omitted)
3. Body mass index (BMI)/age percentile standardized graph for boys aged 0 to 7 years (omitted)
4. Head circumference/age, weight/length percentile standardized graph for girls aged 0 to 3 years (omitted)
5. Head circumference/age, weight/length percentile standardized graph for girls aged 0 to 3 years (omitted)
5. Head circumference/age, weight/length percentile standardized graph for girls aged 0 to 3 years (omitted)
6. Length percentile standardized graph (omitted)
6. Body mass index (BMI)/age percentile standardized graph for girls aged 0-7 years (omitted)
7. Length/age, weight/age standardized deviation value table for boys aged 0-2 years (omitted)
8. Height/age, weight/age standardized deviation value table for boys aged 2-7 years (omitted)
9. Table of values of head circumference/standard deviation for age for boys aged 0-5 years(omitted)
10. Table of values of standard deviation for weight/length for boys(omitted)
11. Table of values of standard deviation for weight/height for boys(omitted)
12. Table of values of standard deviation for body mass index (BMI)/age for boys aged 0-7 years(omitted)
13. Table of values of length/age, weight/age for girls aged 0-2 years(omitted)
14. Table of values of length/age, weight/age standard deviation for girls aged 0-2 years (omitted)
15. Table of standard deviation values of height/age, weight/age for girls aged 0-7 years(omitted)
14. Table of standard deviation values of height/age, weight/age for girls aged 2-7 years(omitted)
15. Table of standard deviation values of head circumference/age for girls aged 0-5 years(omitted)
16. Table of standard deviation values of weight/length for girls (omitted)
17. Table of standard deviation values of weight/height for girls (omitted)
18. (Omitted)
18. Table of standard deviation of body mass index (BMI)/age for girls aged 0-7 years (Omitted)