What is included in the prophylactic medical examination of the child population. Organization of medical care for preschool children. Clinical examination. The procedure for medical examination of children of different ages

24.08.2020 Navigators

The first stage of clinical examination of children includes several interrelated periods:

The first period - antenatal protection of the fetus, is carried out by the district pediatric service in contact with the obstetrician-gynecologist of the antenatal clinic.

In this period, the main task is to organize continuity in the activities of the antenatal clinic and the children's polyclinic, which should be carried out in the form of constant information received by the children's polyclinic about each pregnant woman taken under supervision. For this, such forms of work as school for a young mother and antenatal care (at 28 and 32-36 weeks of pregnancy) are used. Antenatal care is usually performed by a local nurse. The pediatrician conducts patronage of pregnant women with a normal pregnancy at an appointment at the clinic, and with an unfavorable pregnancy and a burdened history at home. It should be noted that with the second patronage, carried out at 32-36 weeks of pregnancy, future mother must receive the necessary information on the care and organization of the child's living conditions. Birth healthy child is to a certain extent an indicator of the effectiveness and quality of antenatal prophylaxis.

The second period is dynamic observation of the newborn, which is carried out by the district pediatrician in conjunction with the nurse. An assessment of the characteristics of the course of pregnancy and childbirth in the mother, early postnatal ontogenesis, i.e. identification of the child's possible belonging to the risk group. Already with the first patronage of a newborn, it is possible to predict to a certain extent the state of health of the child and prescribe appropriate corrective and health-improving measures in accordance with the state of health of the child and the risk group. During the first patronage, it is also advisable to collect a genealogical history in order to carry out, according to indications, timely laboratory research methods. The tasks and goals of dynamic observation of a newborn are to give the mother a certain system of knowledge, taking into account the specific conditions of the family, her health literacy in raising a healthy child and preventing diseases.

The third period is monthly dynamic monitoring of the child during the 1st year of life. It should be remembered that the physical and neuropsychic development, as well as the level of the child's health in the first 3 months of life, can be an indicator of the effectiveness and quality of observation during the neonatal period. When assessing the quality of observation during the first year of life, it is necessary to attach great importance to a comprehensive assessment of the level of development and state of health at the ages decreed for a child of this period of life: 3, 6, 9 and 12 months. The doctor, making a conclusion about the state of health of the child in these age periods, writes a milestone epicrisis, which reflects the development and health of the child over the past period, assesses the level of his physical development, for which he uses local standards for determining the harmony of development, it is important to assess the level of neuropsychic development ... The fact of the presence or absence of diseases at the time of examination, as well as the frequency and duration of acute diseases suffered by the child in the previous quarter, is of decisive importance for assessing the state of health.

The frequency and duration of diseases indirectly reflect the state of reactivity of the child's body.

The fourth period is dynamic observation of a child aged 1 to 7 years. As you know, such observation is carried out by the district pediatrician in the event that the child does not attend a preschool institution, but is brought up in a family. At the age of 5-7 years, this examination is combined with a comprehensive examination before entering school. Research results recent years indicate the need for examination of children aged 3 and 5 years in order to prevent chronic diseases by all specialists: ENT, ophthalmologist, orthopedic surgeon, neuropathologist, dentist, speech therapist.

For all children before school age a comprehensive assessment of the state of health is of great importance. In children of the 2nd and 3rd year of life, neuropsychic development is necessarily assessed. Since the local doctor, due to the limited time, cannot assess the neuropsychic development of the child at the reception and the polyclinic, this function is assigned to the nurse of the healthy child's office. The data of this assessment should be entered into the "History of the Child's Development" so that the doctor at the reception, drawing up his comprehensive opinion, could take into account the indicators of the child's neuropsychic development. Thus, during the first 7 years of life, the child is under the supervision of the district pediatric service and specialists of the children's polyclinic.

It should be noted that the state of health of a child upon admission to school is an indicator of the quality and effectiveness of such monitoring.

Children who have abnormalities in health or disease at any period are taken under the differential supervision of a local doctor or specialist doctor. For this, the child is assigned the necessary complex of medical and recreational measures, that is, the third stage of medical examination is carried out.

Having received the necessary data, the district pediatrician conducts a comprehensive assessment of the child's health status with the definition of a health group, which gives a broader picture of the health status of each child and the contingent of observed children as a whole, than just a diagnosis. In addition, it allows you to identify the "threatened" contingent of children. In a comprehensive assessment of the child's health, the following are taken into account:

§ the presence or absence of chronic (including congenital pathology);

§ functional state of organs and systems;

§ resistance and reactivity of the organism;

§ the level and harmony of physical and neuropsychic development.

As a result of scientific research carried out in children's medical and preventive institutions in a number of territories of the country, 5 health groups have been proposed. Group I includes healthy children; to group II - healthy, but with a risk of pathology; to groups III, IV and V - chronically ill children in a state of compensation, subcompensation and decompensation of the pathological process.

Children of the I group of health should be observed at the usual times established for preventive examinations of healthy children. Medical appointments for children of this group include preventive, general health and educational activities.

Children of group II health with a risk of pathology need special attention pediatrician, since preventive and therapeutic measures, carried out in a timely and purposeful manner, give the greatest effect in preventing the formation of chronic pathology in them. The terms of observation for this group of children are set by the doctor individually for each child in accordance with the degree of risk in relation to the formation of chronic pathology, the severity of functional abnormalities and the degree of resistance. Frequently ill children, as well as children who have suffered acute pneumonia, Botkin's disease, etc., belong to the II health group, during the period of convalescence they are taken under special control. Medical appointments for children of this group include not only preventive, educational and general health-improving measures, but also special health-improving measures. Medical and recreational activities for children of the II health group are prescribed not only by a pediatrician, but also by specialist doctors.

Children of III, IV, V health groups are under dispensary supervision by a pediatrician and appropriate specialists and should receive the necessary treatment depending on their pathology. The unification of children into homogeneous health groups allows for the provision of differentiated services for the contingents of children and for more rational planning of medical care.

The organization of medical control over the state of health of schoolchildren provides for annual preventive examinations, which are carried out in stages: the first stage - screening studies, the second stage - examination of children selected using tests; the third stage - examination by specialists of schoolchildren, sent by the school doctor for a consultation. These principles of organizing mass medical examinations provide not only an increase in the efficiency of the examinations themselves, but also an improvement in the organizational approaches of medical care for students. In particular, they help to increase the role of nurses in monitoring the health status of children; rational use of the working time of the school doctor and specialist doctors for differentiated monitoring of the health status of schoolchildren; wider implementation of treatment and prophylactic measures among children with initial forms of deviations.

All children with deviations in development and health are taken on dispensary records, and for each of them a “dispensary observation control card” is entered. In addition to the child care doctor, these children are monitored by specialist doctors of the polyclinic and district pediatricians. The timing of their examinations depends on the severity and course of the pathological process.

In preschool institutions and schools by forces medical professionals these institutions and the children's polyclinic should be provided with conservative treatment of chronic diseases of the ENT - organs, teeth sanitation, corrective gymnastics and physiotherapy exercises.

The school doctor, together with the administration and teachers, draws up a comprehensive plan for preventive and therapeutic and recreational activities, which provides for the organization of a rational educational and work regime, nutrition, physical education, hardening procedures, and the fulfillment of sanitary and hygienic requirements. The plan is discussed at the pedagogical council and approved by the director of the school, as well as the head of the children's clinic in the area of operation of which the school is located.

The staff of preschool institutions and schools face great tasks to widely promote medical and pedagogical knowledge among parents, organizing practical assistance to families in solving problems of physical education of children, reducing morbidity. In this regard, it is of particular importance to involve children in regular physical education, sports, and tourism.

Successful clinical examination largely depends on the accurate design and maintenance of medical records. The main document containing all information on clinical examination is "Medical card of an outpatient patient" (form 025 / y), "History of the child's development" (form 112 / y), "Card of registration of medical examination" (form 131 / y) and "Control card of dispensary observation" (f.030 / y).

Send your good work in the knowledge base is simple. Use the form below

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

Posted on http://www.allbest.ru/

Introduction

2.2 The role of a nurse in dispensary registration

Conclusion

Bibliography

Appendix

Introduction

The relevance of the work lies in the fact that the first year of a child's life is very important for his development and further development of health. In this regard, a special program is provided, which includes a mandatory examination by doctors of children under 1 year old. Its main task is to prevent a disease or to start treating an already existing problem with the health or development of children in a timely manner.

Per last decade In the state of health of children, stable negative trends have formed - the prevalence of risk factors for the formation of health and development, an increase in morbidity and disability.

The solution to the problem of preserving and strengthening the health of children from 0 to 18 years old is possible only with the organization of constant monitoring of the state of their health and development, the regular implementation of complex medical and health-improving and rehabilitation measures.

In order to assess the growth, development and health status of a child in the first year of life, there is a clinical examination in Russia - a clear schedule for examining children by specialists and conducting certain analyzes and studies. The purpose of medical examination of children under one year old is simple and understandable - to prevent the development of various diseases, because if you "catch" them at the very beginning, you can significantly reduce, or even completely eliminate possible negative consequences.

The purpose of the course work is to consider the role of a nurse in dispensary registration of children under one year old.

Research objectives:

Determine the scheme of prophylactic medical examination of children;

Consider a planned clinical examination in the first year of life;

Investigate the importance of prophylactic medical examination for the health of the child;

Analyze the role nurse in carrying out medical examination.

The object of the research is the organization of dispensary observation in the GBUZ SK "City Children's Hospital" in Pyatigorsk.

The subject of the research is the prophylactic medical examination of children under one year old.

Research methods.

Study of special and scientific literature,

Analysis and synthesis of the obtained data,

Conducting research.

Structure of the work: The work consists of an introduction, two chapters, a conclusion, a bibliography and annexes. The competence substantiates the relevance of the topic of the course work, its goals, objectives, subject and object of research.

The first chapter of the course work "Theoretical issues of clinical examination of children" examines the scheme of medical examination of children, explores the planned medical examination in the first year of life, the importance of medical examination for the health of the child.

In the second chapter, "The role of a nurse in conducting clinical examination", the work on medical examination of children of the first year of GBUZ SK "GDB in Pyatigorsk" is analyzed, the role of a nurse in dispensary observation is determined.

The conclusion summarizes the results of the study, summarizes the conclusions that reflect the work done.

medical examination health nurse

Chapter 1. Theoretical issues of prophylactic medical examination of children

1.1 Scheme of clinical examination of children

Clinical examination is a system of work of health care institutions, the basis of which is prevention, previously active detection of diseases and complex treatment a child in an outpatient clinic, hospital, sanatorium.

The main task of clinical examination of sick and healthy children is primary prevention, which includes not only medical measures, but also the implementation of broad sanitary and hygienic measures in order to protect the environment, as well as the formation of a healthy lifestyle, the widespread introduction of physical culture and sports, hygienic education and upbringing. children.

Clinical examination or a system of regular observation of children is the basis of health care. Dispensary in pediatrics is understood as a harmonious system of organizational and therapeutic measures carried out by medical workers, which consists in systematic monitoring of healthy children with appropriate preventive measures to ensure the optimal development of the child and the prevention of diseases.

In the event of an acute illness, the dispensary observation period provides for the treatment of a sick baby until complete recovery. In chronic forms of pathology, active dynamic observation is carried out in order to prevent exacerbations and improve the health of the little patient.

The whole complex of preventive measures at the site, together with the pediatrician, is carried out by the local nurse, the nurse of the healthy child's office and the nurse of the vaccination room. Medical specialists and laboratory assistants take part in the prophylactic examination of healthy children.

Dispensary observation of unorganized children after the end of the neonatal period is carried out by the local pediatrician at preventive appointments.

Children visit the children's clinic in strictly regulated terms:

In the first year of life - monthly, and children from risk groups should be examined more often;

In the second year of life - once a quarter;

In the third year - once every 6 months;

In the fourth, fifth, sixth years of life - once a year in the month of his birth.

The main task of a pediatrician during a preventive examination is to determine the level of health and development, to identify the presence of deviations in the child's health, and to prescribe corrective measures. For a high-quality preventive examination, it is recommended to use the following sequence of actions:

Investigate the state of health according to the accepted criteria;

Conduct a comprehensive assessment of health status with the definition of a health group, risk group;

To issue an epicrisis in the development history (card) of the child.

Before the preventive examination in the child's clinic at home, a nurse visits the child and finds out how the pediatrician's recommendations were followed, the mother's complaints, the nature and characteristics of the child's feeding. During the examination, attention is paid to the color of the skin and mucous membranes, physiological functions, the neuropsychic development of the child, and the peculiarities of his behavior are assessed.

In the first year of life healthy child must be examined:

At 1 month - an orthopedist, neuropathologist;

By the 3rd month - an ophthalmologist, surgeon, otolaryngologist,

At 9 months old by a dentist;

Children from risk groups are examined by specialists earlier. The same specialists examine the child even at the age of one.

At the age of 3 months (according to indications earlier), a general analysis of blood and urine is performed. At the age of 1 year, these studies are repeated, supplementing them with a study of feces for eggs of worms.

So, the registration of the annual medical examination is a systematic (2 times a year) census of children living in the territory served by a medical and preventive institution. To take into account the general medical examination, an accounting form is filled out, approved by the Ministry of Health of the Russian Federation, in which the dates of medical examinations, laboratory and X-ray examinations, and the diagnosis are entered. Children in the first three years of life are examined by a pediatrician differentially, the frequency of examinations depends on the age and state of health of the child at birth. In the CRH of district hospitals in the absence of doctors, specialists in pathology childhood, children are examined on maternity terms by specialist doctors serving the adult population.

1.2 Planned clinical examination in the first year of life

In accordance with the Order of the Ministry of Health and social development RF of April 28, 2007 N 307 "On the standard of dispensary (preventive) observation of a child during the first year of life" defines the standards for routine examinations of children under one year old.

Immediately after the birth of the baby, a neonatologist examines. He checks reflexes, evaluates the condition of the mucous membrane, listens for breathing and heartbeat. All these activities are aimed at early detection of any pathologies.

Further, if everything is in order, the baby is washed, processed and dressed (swaddled). On the 4th day in healthy children and on the 7th day in premature babies, blood is taken from the heel for a screening test. It allows you to timely identify a number of serious genetic diseases:

cystic fibrosis;

phenylketonuria;

congenital hypothyroidism;

galactosemia;

adrenogenital syndrome.

If the child is healthy, then the mother does not receive a notification. But if for any of the listed diseases the baby falls into a risk group, the parents (sometimes the children's clinic) are notified of the need for a second examination.

Observation of generic certification is divided into 2 stages.

I period: from 1 month. up to 6 months

II period: from 6 months. up to 12 months

Surveys are carried out every 3 months.

V Russian system health care has clear rules: as soon as the child is born, information about this event is transmitted to the children's clinic at the place of residence. Therefore, immediately after discharge from the hospital, the local pediatrician and nurse should come to the baby. They come to the house every day until the 10th day, then, as a rule, once a week - they examine the baby's umbilical wound, clarify how the jaundice subsides. Of course, another important goal of such visits is to teach the mother to take care of the baby, to give recommendations on hardening, breastfeeding and hygiene.

Throughout the first year of a baby's life, visits to the clinic are monthly. For the convenience of parents, on the "baby day" (held weekly) during the hours of the pediatrician's appointment, a neurologist, ophthalmologist, orthopedic surgeon work in parallel with him. These are the main specialists who should show the baby on time.

In a month, the child visits the clinic for the first time, where he must be examined by a pediatrician, neurologist, ophthalmologist and orthopedic surgeon.

The pediatrician evaluates weight gain, height, measures the circumference of the head and chest, assesses the condition and size of the fontanelles. The doctor checks the hearing, evaluates the skin, and answers the mother's questions about care and feeding. Also, the pediatrician writes out directions for research - a general analysis of blood, urine, ultrasound of internal organs.

The neurologist checks the child's psychomotor development, reflexes and evaluates the child's muscle tone. The doctor also assesses the condition of the fontanelles and cranial sutures, gives direction to neurosonography, that is, ultrasound of the brain.

A surgeon and orthopedist examines the baby for an inguinal or umbilical hernia, congenital clubfoot and torticollis, as well as hip dysplasia and skeletal disorders. At the end of the examination, the doctor prescribes a referral for ultrasound of the hip joints.

In boys, it is imperative to check the testicles (prolapse, dropsy) and urethral abnormalities.

The optometrist checks the patency of the lacrimal canals, visual acuity and fundus of the baby.

At this age, the child comes for a routine examination to the pediatrician, who weighs and measures the baby, assesses his development.

A three-month-old baby, as usual, is examined by a pediatrician, as well as a neurologist assessing psychomotor development. If necessary, the doctor will prescribe a referral for a massage or a swimming pool.

4 and 5 months.

All the same routine examination by a pediatrician with control of weight, height, head and chest circumference, the condition of fontanelles and reflexes.

At six months, the child already knows a lot, he has grown up, begins active movements and switches to a new diet - complementary feeding is introduced. It is at this age that it is necessary to pass a small medical commission, which consists of a neurologist, cardiologist, ENT doctor and ophthalmologist.

The neurologist determines the psychomotor development of the child, controls reflexes. The optometrist determines the predisposition to the development of myopia and detects the presence of strabismus.

The ENT doctor assesses the hearing, examines the baby's nose and ears (whether there are any inflammations or developmental abnormalities). Be sure to tell mom about their proper hygiene, about the prevention of colds and inflammatory diseases. If hearing impairment is suspected, the doctor gives a referral to an audiologist.

The cardiologist examines the baby to identify defects and other pathologies of the cardiovascular system. If necessary, the doctor can give a referral for an EKG and an echocardiogram.

7 and 8 months.

At this age, the child will have another consultation with a pediatrician. In addition to assessing growth and development, the doctor can answer the mother all questions regarding nutrition and the introduction of new complementary foods.

9 months.

In addition to the next routine examination by a pediatrician, the child needs consultations of a neurologist (assessment of the child's psychomotor development), an orthopedist (development of the hip joints, spine) and a pediatric dentist (control of teething, their growth, as well as recommendations on hygiene and oral care).

10 and 11 months.

At this age, the mother brings the baby to the clinic for a scheduled examination by a pediatrician.

12 months.

In a year, the child needs to be examined not only by a pediatrician, but also by a number of specialists. 12 months is a serious milestone, we are already faced with an adult who can pronounce a few words, has teeth, a lot of foods in the diet, can walk and has a considerable amount of a wide variety of skills.

The neurologist assesses the skills acquired during the year, speech and psychomotor development, muscle tone. An important point- examination of fontanelles, their condition is informative for the general neurological picture.

The orthopedist controls the physical development of the child, the correctness of the development of the spine and the formation of the foot. A pediatric dentist examines the teeth for caries (unfortunately, it occurs even in such babies) and assesses the formation of the bite.

The ENT doctor checks the ear, throat and nose, and the ophthalmologist determines the presence / absence of deviations in visual acuity from the age norm.

Of course, you need to do a general analysis of urine and blood. If necessary, specialists can prescribe additional studies.

Thus, observing the schedule of medical examination of children in the first year of life, you can "keep your finger on the pulse" and, if any disease appears, immediately begin treatment.

1.3 The importance of medical examination for the health of the child

It is difficult to overestimate the importance of prophylactic medical examination for a child's health. Regular observation by key specialists will allow you to monitor the state of the child's body, identify diseases at the very initial stage and successfully treat them, preventing exacerbations.

The dispensary method of serving children, developed by Russian pediatricians, is the most important section of the work of children's polyclinics and feldsher-obstetric centers.

The first year of a child's life is a particularly crucial period. How a child grows and develops at this time largely determines his future health and development. The tasks of the prophylactic medical examination of children during the first year are dynamic monitoring of their development and timely implementation of health-improving measures, preventive examinations of all children (once a month during the year) in order to identify early forms of the disease, active dynamic monitoring of children with deviations from the norm. health.

Mass preventive examinations of healthy children of the first year of life are aimed not only at detecting and treating the disease, but also identifying a predisposition to it, and preventing the possibility of developing the disease in the future.

The factors predisposing to many diseases in children in the first year of life include aggravated pregnancy (early and late toxicosis, impaired uteroplacental circulation, infections, chemical and physical factors) and aggravated labor (prematurity, postmaturity, rapid and prolonged labor, use obstetric benefits, long anhydrous period, caesarean section, etc.).

Predisposing factors are also a violation of the principles of feeding (early improper mixed and artificial feeding, lack of a diet, late and incorrect introduction of additional nutritional factors, vitamins, complementary foods), defects in care (disturbance of sleep and wakefulness, insufficient stay in the fresh air) and upbringing, insufficient attention to hardening measures or their absence.

Nurses or paramedics should carry out a great health educational work, explaining to mothers the importance for the child of the correct regimen, feeding and tempering.

Clinical examination of healthy children in the first year of life, in addition to monthly preventive examination, consists of consultations, orthopedists at 1, 6 and 9 months, in consultation with an ophthalmologist at 1 month. At 3 or 6 months. a blood test should be done to check for anemia. At 1 year old, the child is examined by an ophthalmologist, orthopedist, neuropsychiatrist, blood and urine tests should be done. Anthropometry (measurement of body weight, height, chest and head circumference) should be carried out monthly, and psychophysical development should be noted.

Children with anemia, rickets, chronic nutritional disorders, exudative and lymphatic diathesis, who have suffered acute respiratory and intestinal diseases and pneumonia, as well as children with birth trauma and premature babies should be taken under special dispensary observation.

Mid-level medical workers need to carry out a lot of organizational and sanitary and educational work to eliminate the causes of anemia (among them - feeding defects, care, frequent acute infectious diseases), to improve and normalize care and regimen, correction of nutrition (protein of animal origin, vitamins, trace elements).

Children with chronic eating disorders (malnutrition and overweight) are examined once every 2-3 weeks. Nursing workers should carry out a great deal of sanitary and educational work with their parents to identify and eliminate the causes leading to dystrophies (defects in care and feeding, frequent illnesses, birth defects, etc.).

Children with constitutional abnormalities (exudative and lymphatic diathesis) are observed once a month, they should be consulted with specialists - a dermatologist and an allergist. These children undergo blood and urine tests, scatological examinations 2 times a year, and monitor the dynamics of body weight.

Children who have had an acute respiratory illness up to 3 months, who are ill with them again and who have had pneumonia up to 1 year, are under dispensary observation for up to 1 year. They are examined in the first half of the year 2 times a month, in the second - 1 time in 2 months.

During the observation period, health-improving activities are carried out taking into account background diseases, including physiotherapy, physiotherapy exercises and restorative therapy. Consultations with an otorhinolaryngologist, nasopharyngeal sanitation are carried out. Hardening procedures are of great importance. The criterion for the effectiveness of monitoring is a decrease in the frequency of relapses and recurrences of pneumonia and acute respiratory infections. Removal from the register of children who have suffered pneumonia and are ill again is carried out 10-12 months after clinical and radiological recovery.

Children who have undergone an acute intestinal disease are observed 1 time in 2 - 3 weeks, taking into account the stool, the dynamics of the increase in body weight. Stool tests for intestinal flora, scatological examination, and blood tests are carried out. They are removed from the register when dysentery is transferred after 1 month, when salmonellosis is transferred - after 3 months, subject to negative bacteriological tests.

Children with intracranial birth trauma during the neonatal period should be examined by a neuropathologist, according to his appointment, treatment is carried out, if necessary, consultations of an ophthalmologist, surgeon, and otorhinolaryngologist are organized. In the first half of the year, they are examined once every 2 weeks, in the second - once every 3 months. A neuropsychiatrist examines children 1 time in 2 - 3 months, an ophthalmologist - 1 time in 6 months. The criterion for the effectiveness of joint observation and treatment with a neuropathologist is the absence of progression and restoration of impaired functions. Preventive vaccinations and deregistration are carried out only at the conclusion of a neuropsychiatric specialist.

Premature babies and twins weighing 2-2.5 kg are observed weekly in the 1st month, at the age of 1-6 months - once every 2 weeks, in the second half of the year - once a month. At the 1st month of life, consultations of a surgeon, orthopedist, neuropathologist, ophthalmologist are recommended.

In the conclusion of the first chapter of the course work, it should be said that properly organized dispensary observation of children in the first year of life, early detection, timely and correct treatment of various pathologies in them is a powerful factor in healing child population; dispensary observation noticeably improves the health indicators of children not only in the first year of life, but also at an older age.

Chapter 2. The role of a nurse in conducting clinical examination

2.1 Work on prophylactic medical examination of children of the first year of GBUZ SK "GDB of Pyatigorsk"

The work is carried out in accordance with the Decree of the Government of the Russian Federation of November 29, 2007. No. 987, by Orders of the Ministry of Health and Social Development of the Russian Federation of January 19, 2007 No. 50, No. 33 of January 15, 2007 and No. 307 of April 28, 2007.

Distribution Commission works Money received on coupons 3-1 and 3-2 generic certificates between categories of medical personnel. The Commission holds monthly meetings on the distribution of funds in accordance with the actual workload of employees, meetings are drawn up in minutes. On the basis of the protocols, an order for the institution is issued.

Organizational and methodological work and control of GBUZ SK "GDB of Pyatigorsk" are being carried out on the issuance of coupons 3-1, 3-2 of generic certificates in accordance with the instructions, notebooks for registering coupons, registers of generic certificates.

The analysis of the correctness of registration of coupons 3-1, 3-2 is carried out. Every ten days, after 6 months of dispensary observation, the child's completed coupons are handed over to the statistics office.

Every month, an application is submitted to the State Institution of the Stavropol Regional Branch of the Social Insurance Fund of the Russian Federation for the transfer of funds to the State Budgetary Healthcare Institution of the Children's Hospital of Pyatigorsk to pay for medical care provided to children of the first year of life for the first and second 6 months of dispensary observation.

Organized the formation of an invoice for payment with the attachment of coupons of generic certificates and the register of coupons of generic certificates on a monthly basis.

The register of coupons of generic certificates is provided to the regional branch of the FSS. In 2015, invoices were issued for generic certificates in the amount of 3,807 OOO rubles (including 2,947,021.49 rubles for wages and 859,978.51 rubles. for taxes).

On the basis of GBUZ SK "City Children's Hospital" in Pyatigorsk, the second stage of neonatal and audiological screening is carried out for children who have obtained positive or questionable results of the first stage. In 2015, within the framework of the second stage of neonatal screening at the request of the neonatal screening laboratory in Stavropol, 66 children were examined for hereditary diseases, 4 cases of the disease were identified and confirmed, for which a consultation of regional specialists was provided in a timely manner, the necessary nutrition was prescribed and treatment in full ...

In 2015, as of 12/14/2015, as part of the second stage of audiological screening among children who did not undergo audiological screening in the maternity hospital, or who have risk factors, 596 children were examined; 6 cases of hearing loss were identified, all children were sent on time for consultation and treatment to regional specialists - audiologists.

In 2015, the implementation of one of the most important directions of the national project "Health" - medical examination of children under one year old continued.

To implement it, the Stavropol Regional Fund for Compulsory Medical Insurance (SKFOMS) has concluded 32 contracts with health care institutions to finance the costs associated with the medical examination of this category of children.

Due to the lack of the necessary licensed types of medical activity in some medical organizations, medical organizations entered into 89 contracts for the missing types of activities to meet the standard of clinical examination.

Table 1 - The incidence of the child population up to 1 year

Nosology	Morbidity	Morbidity per 1000 children



Including OKI
Endocrine system diseases
Diseases of the blood and hematopoietic
Diseases nervous system
Diseases of the eye
Vxa diseases
Respiratory diseases
Diseases of the digestive system
Diseases of the genitourinary system
Individual states
perinatal period
Congenital malformations

The incidence of children under one year of age for 3 years has a tendency to decrease (in 2015 by 10% compared to 2014). The incidence of the endocrine system (by 20%), the nervous system and congenital malformations (by 18%) increased slightly, and eye diseases (by 8%) increased less significantly. There is a significant decrease in respiratory diseases (by 10%) and individual conditions of the perinatal period (by 13.5%).

At a stable level - the incidence of ENT organs, the digestive system, the genitourinary system. In the structure of morbidity, respiratory diseases are still in the first place -8%, in the second place are individual conditions of the perinatal period 13%. These indicators correspond to the national average.

Rice. 1. Results of the clinical examination in 2015

Despite a number of difficulties in carrying out prophylactic medical examinations: the closure of inpatient institutions and the transfer of these children to other institutions, the absence of licensed types of medical activities in almost all medical organizations, in 2015 the number of children who underwent prophylactic medical examinations increased.

This became possible in connection with the joint organizational work of specialists from the SKFOMS, the Ministry of Health of the Territory, medical institutions, the constant updating of the lists of children under one year old, the monitoring of the composition of inpatient institutions of this category of children in order to identify new persons who have not undergone medical examination and repeated examinations in these institutions.

As a result of the annual medical examination of children under one year old, in 2015 the number of healthy children and children in need of preventive measures increased.

Rice. 2. Indicators of medical examination

During each routine examination, the pediatrician must clarify the anamnesis, analyze data on past diseases, changes in feeding, social conditions for the period from the previous examination, and identify complaints. At the reception, the child takes anthropometric measurements (body weight, length, head and chest circumference). The level and harmony of physical development is assessed by centile tables.

2.2 The role of a nurse in dispensary observation

The work of an outpatient clinic, which is a children's clinic, is built according to the district principle. Children in the pediatric area are served by a pediatrician and a nurse - from the moment the child is discharged from the hospital until it is placed under the supervision of a doctor in the adolescent office.

The district nurse systematically monitors the development of healthy children at home, together with the doctor, she conducts preventive reception of healthy children; monitors the implementation of the doctor's prescriptions for the prevention of rickets. Together with the doctor, she plans monthly preventive vaccinations, prepares for them if necessary, calls children to the clinic and evaluates the post-vaccination reaction.

Prepares children for admission to preschool institutions; controls the direction of children for examination by narrow specialists and laboratory examination. She also deals with the issues of rational feeding of children, the organization of anti-epidemic measures and the sanitary and hygienic education of parents and children, conducts dynamic monitoring of children from risk and recovery groups.

When providing medical care to acutely ill children, as prescribed by a doctor, a nurse injects drugs, carries out the necessary procedures and takes smears; monitors the patient's condition.

On certain days of the week, healthy children of the 1st year of life are admitted to the clinic. The nurse takes information about who to invite to the appointment from the work plan of the district pediatrician; notifies parents in advance, issues coupons for an appointment with a specialist doctor and a referral for taking tests to the laboratory.

The local nurse is the primary assistant to the pediatrician at the reception. Her responsibilities include preparing the office, after which she brings the children's development histories from the registry. During a prophylactic appointment, it regulates the flow of patients. Conducts anthropometry, gives advice on nutrition, leads targeted conversations, teaches parents the skills and elements of massage and gymnastics, helps the doctor with documentation, issues referrals for tests, draws up documents for free food and medicines, writes prescriptions under the supervision of a doctor.

Patronage of children under 1 year old is carried out based on their health group. The number of patronages is determined by the local doctor. The first patronage of a newborn is performed by a local nurse together with a doctor in the first 3 days after discharge from the hospital.

In the first week of a healthy newborn, the nurse examines twice, and then weekly for the first month. The local pediatrician draws up a plan for such observation. Children from the risk group and with pathology are examined unscheduled. In the 1st half of the year, the child is examined by the nurse once every 2 weeks, in the 2nd half of the 1st year of life - once a month.

Children at risk or registered as children of a socially dangerous situation should be patronized by a district nurse in the first place.

Let's list some basic documents, the maintenance of which is the responsibility of the district nurse: a notebook for keeping records of work at home of the district (patronage) nurse (form No. 116 / y), the history of the child's development (f. No. 112 / u); medical certificate for a disabled child since childhood (form number 080 / y), outpatient operations log (form number 069 / y), preventive vaccination card (form number 063 / y), register of infectious diseases (form number 060 / y), a book for recording doctor's home calls (f. no. 031 / y), a logbook of procedures (f. no. 029 / y), a log of referrals for consultation and auxiliary offices (f. no. 028 / y), an extract from the history child development (f. No. 027 / y), a coupon for an appointment with a doctor (f. No. 025-4), a statistical coupon for registering final (specified) diagnoses (f. No. 025-2), a card for making an appointment with a doctor (f. No. 040 / y), a diary of the work of the nursing staff of the polyclinic (f. No. 039 / u), a card for the registration of medical examination (f No. 131 / u).

The main task of the district nurse is to carry out preventive work in order to form a healthy child and provide medical assistance to sick children at home as prescribed by a doctor.

To solve this problem, a nurse performs a wide range of activities:

Conducts antenatal care for pregnant women in his territorial area, actively identifies violations of the well-being of a pregnant woman and promptly informs the obstetrician-gynecologist of the antenatal clinic and the district pediatrician about it;

Together with the district doctor-pediatrician, he visits newborns in the first two to three days after discharge from the maternity hospital;

Provides systematic observation of healthy and sick children;

Monitors the implementation of medical appointments by parents;

She plans to carry out preventive vaccinations for children who do not attend preschool institutions, invites children to be vaccinated at the clinic;

Carries out work on the timely organization of medical examinations of children registered with dispensaries;

Performs medical procedures prescribed by a doctor at home;

Provides assistance to the doctor during medical examinations of children (conducts anthropometry, writes out prescriptions, certificates, referrals, disability certificates, discharges, monitors the order of admission);

Conducts conversations with parents at the site and in the clinic on the development and upbringing of a healthy child and the prevention of diseases;

Carries out work on the preparation of a public sanitary asset at the site, together with which it carries out measures aimed at preventing injuries to children at the site; cleanliness raids, organizes meetings of the population with a doctor.

To carry out preventive work with healthy young children, an office for preventive work with children (office of a healthy child) is organized as part of the children's polyclinic. For work in it in a polyclinic serving up to 10 thousand children, 1 position is provided, over 10 thousand children - 2 positions of nurses for preventive work with healthy children.

The main task of a healthy child's office is to teach parents the basic rules of raising a healthy child (regimen, nutrition, physical education, hardening, care, etc.) in order to prevent diseases and deviations in the physical development of a child.

Conclusion

Prophylactic medical examinations are regular examinations and examinations of the body that are necessary to maintain health. Dispensary examination of young children is especially important, since it is at this stage that possible identified problems can be eliminated and it is easier to do this while the baby is small than later.

The primary care of a newborn child is carried out together with a nurse for the first three days after discharge from the maternity hospital. When the first child is born in the family, it must be visited on the first or second day after discharge. During his first medical and nursing patronage of a newborn, the pediatrician finds out the presence of risk factors in the anamnesis: collects a biological history (course of pregnancy, childbirth, early neonatal period), social history (family composition, material, living and sanitary conditions), as well as hereditary history. Conducts a thorough examination of the child, evaluates the neuropsychic and physical development, the presence of deviations in the state of health. Based on a comprehensive assessment of the data obtained, it determines the health group, if necessary, assigns the child to a particular risk group.

The nurse gives advice on care, feeding, teaches the mother the elements of massage, gymnastics, hardening, formalizes her patronage in the history of development and invites the mother to an appointment with the pediatrician. During each routine examination, the pediatrician must clarify the anamnesis, analyze data on past diseases, changes in feeding, social conditions for the period from the previous examination, and identify complaints. At the reception, the child takes anthropometric measurements (body weight, length, head and chest circumference). The level and harmony of physical development is assessed by centile tables.

According to the data of the nurse's patronage and from the conversation with the parents, according to the indicators of neuropsychic development, a group of CPD is exhibited, and the child's behavior is assessed. After an objective examination, the doctor makes a diagnosis: "healthy", "threatened by any pathology" (risk group), or "sick" (diagnosis), and also indicates the health group from the first to the fifth, the risk group.

At the reception of the mother, recommendations are given on the regimen, on rational feeding, the type of hardening procedures and the upbringing of the child. In addition, the child can be prescribed a course of vitamin D, iron supplements, etc. The issue of preventive vaccinations is being resolved, and if there are contraindications, a medical recusal is issued. Sanitary and educational work is carried out with parents. All data are entered into the development history in the form of unified records.

Bibliography

1. State program of the Russian Federation "Development of health care" // Collegium of the Ministry of Health of Russia. - M., 2012 .-- 66 p.

2. Legislative support of reforms in healthcare in Russia // Problems of legislative support of compulsory health insurance in the Russian Federation: analytical bulletin. - M., 2011. - No.? 229. - S. 7? 9

3. Izmerov NF National system of occupational medicine as the basis for maintaining the health of the working population of Russia // Healthcare of the Russian Federation. - 2014. - No.? 1. - S. 7? 8

5. Mukhina SA, Tarnovskaya II Theoretical foundations of nursing: textbook. - M., 2011 .-- 368 p.

6. Mylnikova L.A. Prevention and control of noncommunicable diseases and injuries: WHO approaches // Health. - 2012. - No.? 10. - S. 55? 61

7. Public health and health care: Textbook for universities / Ed. Yu. P. Lisitsyna. - M., 2011 .-- 668 p.

8. Organizational approaches to improve the activities of nurses of medical and preventive institutions at the regional level (guidelines) / Z. A. Korenchuk, M. A. Podduzhnaya, B.C. Sheludko, Sh. A. Biktaev. - Perm, 2010 .-- 72p.

9. Fundamentals of nursing / ed. S. I. Dvoinikova. - M., 2013 .-- 336 p.

10. Pavlov Yu. I. Nurse with a higher education as an organizer of medical examination (on the issue of expanding the range of professional application of graduates of the Federal High School of Higher Education) // Main nurse. - 2013. - No.? 2. - S. 10? 12

11. Potapov A. I. Only healthy Russia can become strong // Health of the Russian Federation. - 2014. - No.? 2. - S. 3? 7.

12. Guide for paramedical workers / ed. Yu. P. Nikitin, V. M. Chernysheva. - M., 2010 .-- 955 p.

13. Guidelines for prophylactic medical examination of the adult population for specialists with secondary medical education / ed. V. V. Uyba. - Novosibirsk, 2009 .-- 288 p.

14. Modern organization of nursing: tutorial/ ed. Z. E. Sopina. - M., 2010 .-- 576 p.

15. Stupakov IN, Zaichenko NM Problems of high mortality in the Russian Federation // Health. - 2014. - No.? 4. - S. 13? 20.

16. Takhtarova Yu. N. Improving the organization of the activities of nurses (structural and functional aspect): author. diss ... cand. honey. sciences. - M., 2009 .-- 22 p.

17. Cheltsova AA, Kamynina NN Foreign experience of standardization of nursing activity // Nurse. - 2011. - No.? 8. - S. 20? 22.

18. Shchepin OP, Medic VA Public health and health care: Textbook - M., 2011. - 592 p.

Appendix

Special time table for the next trip with the baby to the doctor

Child's age	Pediatrician	Medical specialists	Objectives of the inspection
Newborn	Immediately after the child is discharged from the hospital, the district pediatrician and nurse come to the house. The frequency of patronage visits by a doctor is at least 4 times (on the 1st, on the 2nd day after discharge from the hospital, on the 10th and 20th days) per month. Additionally, a nurse visits the child.		· Diagnosis and assessment of the condition of the newborn; · Talking to the baby's mom about the benefits of breastfeeding.
	· A survey of parents about the child's condition over the past period; · Weighing a child, measuring growth, volume of the head, chest, fontanelles, thermometry; · General examination of the skin and visible mucous membranes, navel; · Assessment of the physical and mental development of the child; referral for additional examinations, referral for examination to other specialist doctors, the choice of the most effective method treatment. From the second month to six months, consultations with a pediatrician will be monthly.	neurologist	· Diagnostics of the functional state of the body, neuropsychic development (CPD); · Collection of information and assessment of the child's behavior; · Allocation of risk groups for deviations in behavior.
		pediatric orthopedic surgeon	· Diagnostics of the general physical development of the child, structural features of his skeleton and musculoskeletal system;
		ophthalmologist	· Determination of acuity by the reaction of fixation on the object; · Examination of muscles (eye movements in different directions), lacrimal ducts (patency of the lacrimal canals), eyelids (usefulness of opening and closing the eyelids), as well as the fundus.
	Scheduled monthly pediatrician consultation	neurologist	· Diagnostics and assessment of the functional state of the body; · Non-drug (massage, gymnastics, swimming pool) and drug methods for correcting deviations in health and development (if any).
6 months	Scheduled monthly pediatrician consultation	neurologist	· Determination of the level of psychomotor development of the child, which corresponds to a particular development zone.
		ophthalmologist	· Control of the dynamics of refraction of the eye (compare the newly obtained and primary data of this study). If there is a shift towards minus refraction, then perhaps there is a predisposition to the development of myopia; · Detection of strabismus.
		otorhinolaryngologist (ENT)	· Audit of the organ of hearing - · if necessary, the appointment of drug therapy.
		cardiologist	· Examination for the purpose of timely detection of heart defects, rheumatism, diffuse connective tissue diseases, arthritis and other pathologies of the cardiovascular system in a child.
9 months	Scheduled monthly pediatrician consultation	pediatric dentist	· Detection of diseases of the mucous membrane: candidiasis, stomatitis; · Control of eruption and growth of teeth;
		neurologist	· If necessary.
		pediatric orthopedic surgeon	· If necessary.
12 months	Scheduled monthly pediatrician consultation	neurologist	Mental assessment, speech development child, neurological status.
		pediatric orthopedic surgeon	· Control of the physical development of the baby; · Checking the correctness of the formation of the foot.
		pediatric dentist	· Identification of possible dental diseases, including children's caries, which occurs due to improper diet or some children's habits.
		otorhinolaryngologist (ENT)	· Checking the ear, throat, nose; If necessary, washing and processing of the tonsils, nasopharynx, suction of mucus from the nose, washing of the ear canals.
		ophthalmologist	· Identification of deviations in visual acuity from the age norm; · Identification of previously unnoticed congenital diseases, such as cataracts and glaucoma, latent inflammatory processes.

Posted on Allbest.ru

...

Clinical examination of orphans and children left without parental care

Clinical examination is a set of measures, including a medical examination by doctors of several specialties and the application of the necessary examination methods, and is carried out in relation to orphans and children left without parental care, including those adopted (adopted), taken under guardianship (guardianship), in the reception or a foster family, with the exception of orphans and children left without parental care, staying in inpatient institutions

Medical examinations of minors:

one). Examinations by doctors:

pediatrician,

neurologist,

ophthalmologist,

doctor - pediatric surgeon,

otorhinolaryngologist,

obstetrician-gynecologist,

traumatologist-orthopedist,

children's psychiatrist (up to the age of 14),

doctor - pediatric urologist-andrologist,

pediatric dentist (from the age of 3),

doctor - pediatric endocrinologist (from the age of 5),

adolescent psychiatrist (from the age of 14).

Boys undergo a medical examination by a pediatric urologist-andrologist, and girls by an obstetrician-gynecologist.

2). Clinical blood test.

3). Clinical analysis of urine.

4). Study of blood glucose levels.

5). Electrocardiography.

6). Fluorography (from the age of 15).

7). Ultrasonography:

Abdominal organs,

Thyroid gland (from 7 years old),

Reproductive organs (from 7 years old),

The hip joints are performed for children of the first year of life in the absence of information about the passage in the history of the child's development.

eight). Neurosonography is performed for children of the first year of life in the absence of information about the passage in the history of the child's development.

Clinical examination of orphans and children in difficult life situations

Clinical examination is carried out annually in order to early (timely) identify pathological conditions, diseases and risk factors for their development, as well as in order to form groups of health status and develop recommendations for orphans and children in difficult life situations staying in inpatient institutions.

The most important link in the clinical examination of the child population is the organization of medical (prophylactic) examinations. In clinics, there are 3 groups of children subject to preventive examinations:

Children under 7 years of age who do not attend preschool institutions;

Children attending preschool institutions;

Pupils.

It is advisable to carry out preventive examinations of children in the form of a three-stage screening:

Stage I - pre-medical;

Stage II - pediatric;

Stage III - specialized.

On the pre-medical stage laboratory and instrumental studies, anthropometry, questionnaires, measurement of blood pressure, visual acuity, dynamometry are organized.

On the pediatric stage a clinical examination by a pediatrician is carried out with an analysis of the data of the pre-medical examination and an assessment of the child's health. For those entering school, as well as school-age children, this stage has the character of a medical and pedagogical one. Teachers and psychologists take part in its conduct in order to assess the psychological status, functional readiness and adaptation to learning. The results of this stage are formalized by a joint medical and pedagogical opinion.

On the specialized stage medical examination is carried out by a team of specialist doctors. Upon completion of preventive examinations, a comprehensive assessment of the child's health is carried out. The peculiarity in the work of the children's polyclinic is that all sick children with acute diseases are monitored by the district service at home. The clinic receives mainly healthy children suffering from chronic diseases, as well as repeated patients with infectious diseases (without acute events) and convalescents. Carrying out preventive medical examinations of children in municipal polyclinic institutions is guaranteed by the state and is free of charge, which is provided for by the Program of state guarantees for the provision of free medical care to the population.

Parents have the right to choose a medical institution for the medical examination. In this case, the information and results of the medical examination must be submitted to the institution where the main medical record is located - "development history baby". This is the main accounting and operational medical document of children's medical and preventive institutions, designed to register data from medical supervision, as well as medical and preventive measures taken. This document is legally binding. Based on it, expert decisions are made regarding the state of health. child.

If a preventive medical examination is carried out before registering a child in a kindergarten or school, then the results of the examination and all information about the state of health are entered into the "medical record baby for educational institutions of preschool, primary general, basic general, secondary (complete) general education, institutions of primary and secondary vocational education, orphanages and boarding schools. " This document is kept at an educational institution ( kindergarten, then at school) until the child reaches 17 years of age.

If during a preventive medical examination at baby a disease is detected, then in order to make an accurate diagnosis, the doctor prescribes additional examinations (consultations of narrow specialists, laboratory, instrumental examinations). The scope of examinations is determined in accordance with diagnostic standards approved by the relevant orders of the Ministry of Health and Social Development of the Russian Federation.

Children with chronic pathology also undergo a medical examination at a certain time. Such children are under dispensary supervision, the algorithm of which, the frequency of examinations, a list of specialists, diagnostic procedures are determined by the relevant regulatory documents.

Preventive medical examinations of children attending educational institutions, including preschool ones, are organized by the administration of the educational institution and medical personnel attached to this institution. It is possible to carry out a medical examination in a clinic, directly at a school or kindergarten, depending on the available possibilities. The option is determined by the administrations of the polyclinic and educational institution.

Preventive medical examinations are voluntary. The need for a certificate of health baby upon admission to any educational institution is determined by departmental regulations, which contradicts the Federal Law. The Federal Law states that none of the reasons, like the absence of a certificate of the completed medical examination, can be a reason for refusing to admit baby to an educational institution, including a nursery, a kindergarten.

However, parents should understand that constant dynamic monitoring of the child's health is carried out primarily in the interests of the child himself, since it makes it possible to identify and treat diseases at an early stage, as well as prevent the development of chronic diseases.

Of great importance in the activities of the children's polyclinic is vaccination work, the procedure for which is determined by the relevant orders of the Ministry of Health and Social Development of the Russian Federation.

Preventive vaccinations are carried out for children in vaccination rooms at children's clinics. Children attending educational institutions are vaccinated at these institutions. Vaccinations at home are strictly prohibited.

Children attending preschool institutions and schools must notify their parents in advance about the day of upcoming preventive vaccinations. All children on the day of vaccination are examined by doctors taking into account anamnestic data and thermometry. For children with relative contraindications, vaccinations should be carried out according to an individual scheme, according to the recommendations of the relevant specialists.

Acute infections and non-infectious diseases, exacerbations of chronic diseases are considered temporary contraindications for vaccination. Scheduled vaccinations are carried out 2-4 weeks after recovery. For mild acute respiratory infections, vaccination is carried out immediately after the temperature has returned to normal.

The timing of vaccination is determined by the National Calendar of Preventive Vaccinations.

The local nurse on the day after vaccination should visit the child at home to find out the nature of the reaction to it. The nurse informs the district pediatrician about the results of these visits and records the data on the child's reaction to the vaccination in the Child Development History (f. 112 / y). Accounting and control over preventive vaccinations is carried out using the "Card for recording preventive vaccinations" (form 063 / y), which is filled in for each newborn and each child who has arrived in the area of the children's polyclinic. Currently, the "Vaccination Certificate" is being introduced into healthcare practice.

A vaccination card file is formed from the "Preventive vaccination records" in the children's polyclinic. An important section of the organization of vaccination work in a polyclinic is a complete and timely registration of children to be vaccinated and living in the area of operation of the children's polyclinic. To this end, in October-November of each year, the district nurses, by way of door-to-door rounds, specify the number of children on the site. The lists compiled as a result of this work are verified against the Child Development Stories and the Vaccination Card. Hygienic education and training on site should be closely related to the treatment and prevention work of the doctor and nurse and should be carried out according to plan. Unlike a polyclinic for adults, the structure of a children's polyclinic includes a department for organizing medical care for children and adolescents in educational institutions and a department for medical and social assistance.

Plan of preventive examinations (prophylactic medical examination) of children from 0 to 1 year old

Plan of preventive examinations (prophylactic medical examination) of children from 1 to 17 years old

1 - 2 years	pediatrician - once a quarter
2 years	pediatrician, otolaryngologist, ophthalmologist, neuropathologist, dentist, gynecologist (synechiae, inflammation) for girls, urologist (cryptorchidism, phimosis) for boys	general blood test (CBC), general urine analysis (OAM), feces for eggs, worms, scraping for enterobiasis
2-3 years	pediatrician once every 6 months
3 years	pediatrician, surgeon, orthopedist, otolaryngologist, ophthalmologist, neuropathologist, dentist, speech therapist, dermatologist	UAC, OAM, feces for eggs, worm, scraping for enterobiasis
5-6 years old
6-7 years old	similar to examinations and examinations at 3 years
7-8 years (end of grade 1)	pediatrician, surgeon, orthopedist, otolaryngologist, ophthalmologist, neuropathologist, dentist, gynecologist (synechiae, inflammation) for girls, urologist (cryptorchidism, phimosis) for boys	UAC, OAM, feces for eggs, worm, enterobiasis, scraping for enterobiasis
9-10 years old (grade 5)	pediatrician, surgeon, orthopedist, otolaryngologist, ophthalmologist, neuropathologist, dentist, endocrinologist, gynecologist (for girls)	ECG, OAK, OAM, general analysis of feces, feces for eggs, worm
11-12 years old (grade 7)	pediatrician, surgeon, orthopedist, otolaryngologist, ophthalmologist, neuropathologist, dentist, endocrinologist, gynecologist (for girls), urologist (for boys)	UAC, OAM, general analysis of feces, feces for eggs, worm
14-15 years old (grade 9)	similar to examinations and examinations at 11-12 years old
15-16 years old (grade 10)	similar to examinations and examinations at 11-12 years old + fluorography (FLG)
16-17 years old (grade 11)	similar to examinations and examinations at 11-12 years old + FLG

Before a child enters a kindergarten, educational or sports institution, he needs to undergo a complex of medical examinations - screening. Clinical examination of children in 2018 can be carried out for every child, however, more detailed diagnostics are not intended for everyone. What is included in the screening, and what is the order of the procedure?

What is prophylactic medical examination

This is a set of measures aimed at identifying and preventing the development of various diseases in all groups of the population. Screening consists of preventive medical examinations, doctors' consultations, studies that are carried out at a person's age. Since 2013, adult and children's medical examination has become part of the compulsory health insurance system.

Where and when it takes place in 2018

Free examination is carried out in the city clinic. Parents need to take the child to a medical institution at the place of temporary or permanent registration and study. When you can get screened, ask the children's clinic. From January 2018, the schedule of medical examination of different age groups will be known. It is necessary to make an appointment with a doctor in advance through the registry of a healthcare institution or via an electronic terminal.

Why do you need a medical examination

Timely diagnostics allows for early date identify a dangerous disease, conduct appropriate therapy. There are pathologies that are asymptomatic at the initial stage. The sooner the disease is detected, the faster it heals. Medical examination of children is a necessary set of procedures that should not be neglected. Timely identification of risk factors for pathology is sometimes more important than direct treatment at an advanced stage. Clinical examination of the child population is aimed at this.

Healthy children

Often, during screening, a specialist discovers conditions under which a certain disease may develop. If you adjust your lifestyle, you can really avoid a pathological condition. For example, if you are prone to obesity, you need to change your diet and add physical activity. Parents already know about this, but if the doctor backs up his recommendations with test results and outlines all the "prospects" of obesity, mom and dad will take the problem more seriously.

Medical examination of children and a number of preventive measures significantly reduce the percentage of development of the most common non-infectious diseases in the population aged 1-17 years. These include:

stomach ulcer and duodenal ulcer, gastritis, enterocolitis, gastroenteritis;
intestinal pathology, gallbladder;
diabetes;
curvature of the spine, flat feet;
hearing problems, vision;
helminthic invasions.

Disabled children

In-depth free examinations are prescribed for children with congenital or acquired chronic diseases that have led to disability. Additional medical examinations are needed to monitor the state of health, prevent deterioration, and respond in a timely manner to deviations. Dispensary observation of children helps to choose the most effective therapy and to achieve success in the treatment or maintenance of a stable condition.

Sports medical examination of children

Medical examination of minors is necessary for those who plan to compete. Ideally, the sports clinical examination of children in 2018 should be passed by everyone who attends sports sections and receives a high load. The children are carefully examined by a sports doctor and specialists according to their age. Additionally, such studies can be carried out:

ECG on a stationary bike;
Ultrasound of the heart;
X-rays of light.

It is very important to see what happens to the heart under stress. Detailed screening identifies cardiovascular, respiratory problems or risk factors. If there are no deviations in health, you can continue sports activities. If problems are found, additional tests and examinations are assigned, on the basis of which a conclusion is made whether the child can receive high-intensity loads.

Professional examinations of children and adolescents by order of 1346н

The Ministry of Health has adopted an order that defines the procedure for medical examination. In 2018, in-depth screening is prescribed for boys and girls aged 1, 3, 6, 7, 10, 14-17 years old. For a free preventive examination, you must present a compulsory health insurance policy (MHI). Stages of medical examination:

Visit to the pediatrician. The specialist measures height, weight, some body parameters, asks about the child's well-being. Writes out directions for tests, tells which doctors you need to go through.
Donating blood, urine, passing examinations required by age.
Visiting multidisciplinary doctors.

Specialists carry out preventive, preliminary and periodic medical examinations. The first are carried out at established age periods to identify pathologies and risk factors. Preliminary examinations are required upon admission to educational institutions. Periodic consultations are necessary for dynamic monitoring of the state of health. Clinical examination of children in 2018 is different for different age groups.

Children of the first year of life

The babies are closely monitored. A scheduled appointment with a pediatrician is carried out monthly. In-depth clinical examination of children under one year old is carried out at 1.3, 6, 12 months. Babies need to go through the following doctors:

Neurologist. Evaluates the neuropsychic state of the child.
Children's surgeon. Examines the genitals for phimosis, prolapse and dropsy of the testicles, reveals hernia, joint dysplasia.
Ophthalmologist. Reveals visual impairment.
Traumatologist-orthopedist. Examines the musculoskeletal system.
Children's dentist. Assesses the condition of the gums, teeth, bite, frenum.
Otolaryngologist. Detects ENT pathology.
Child psychiatrist. Needed by kids with suspicions of mental abnormalities.

Clinical examination of children in the first year of life includes various studies: neonatal and audiological screening, ultrasound of the abdominal cavity, hip joints, neurosonography, general blood and urine tests, examination of glucose levels, feces for ovipositor and enterobiasis, ECG. What kind of doctors need to go through the established age period, the district pediatrician will inform.

Clinical examination of preschoolers

From one year to two years, routine pediatrician appointments are carried out once every three months. From two to three years old, parents bring their children to the doctor every 6 months. At two years old, the baby additionally visits only a pediatric dentist, and at three he undergoes a full medical examination. The list of doctors remains the same as for the one-year-old age, with the addition of an obstetrician-gynecologist for girls and a pediatric urologist-andrologist for boys.

At 4 and 5 years old, a preschooler goes through only a pediatrician and a pediatric surgeon, takes general blood and urine tests. At the age of 6, the list of doctors expands slightly: a neurologist, an ophthalmologist, and a dentist are added. Seven-year-old children will again have to undergo in-depth screening according to the list of doctors as for three-year-old babies. Additionally, an ECG, ultrasound of the abdominal organs, heart, thyroid gland, and reproductive organs is prescribed.

In kindergarten

Preschool institutions organize medical examinations themselves. Parents sign a paper that allows medical examination. Not all doctors go to kindergarten. To meet with some, you need to visit the clinic at the place of registration or study. If the specialists who have received in the kindergarten have questions, they call the parents. Often, such examinations are formal in nature, since doctors are a short time you need to take a large number of children.

At school

The student must pass specialists annually. Clinical examination of adolescents takes place without the participation of parents - the school class is collected and taken to the clinic. They say what kind of doctors you need to go through. Screening is quick, often superficial. Medical examination at school will make sense if each parent leads their child individually. The list of doctors at 7 years old is the same as for three-year-olds, at 10 years old the gynecologist and andrologist are excluded from the list.

Doctors by age:

8, 9, 13 years old: pediatrician;
11 years old: pediatrician, surgeon, ophthalmologist;
12 years old: pediatrician, gynecologist / urologist-andrologist;
14-17 years old: in-depth medical examination, the list of doctors is determined by age. An endocrinologist, adolescent psychiatrist is added to the standard list.

Video

🔴 Children's clinical examination. Clinical examination of children in the clinic "Family Doctor"