Conducting clinical examination of the child population. Features of children's medical examination. What is the prophylactic examination

21.09.2020 Notes

Preschool institutions- kindergartens, day nurseries, kindergartens - state institutions for the protection of infancy and childhood of an open type, of a therapeutic and prophylactic, recreational and educational nature for children aged 1.5 to 7 years.

Approximate standards for the number of children:

In the nursery 180-200 children

There are 600 children in the desk garden

In schools - 2000 per 1 pediatrician

Clinical examination:

Healthy children (prophylactic medical examination at the prescribed time)

Infant age (up to 1 year):

early neonatal 1 month - first three days after discharge 2 times a month

late neonatal

postneonatal once a month.

From 1 to 3 years old - early childhood

In the second year - 1 time in half a month

On 3rd-1 every six months

3-7 years old-preschool 1 time per year

special emphasis at 6 years old, ml school age (prepubertal)

up to 15 years old - puberty

15-18 years old - adolescent

Clinical examination of children preschool age :

Children under 1 year old are examined by a pediatrician monthly. At 1 month, a neurologist's examination, audiometry, ultrasound of the hip joints is required.

At the age of 1, in addition to a pediatrician, children are examined by a surgeon, orthopedist, neuropathologist, otolaryngologist, ophthalmologist, dentist, speech therapist.

For young children (up to 3 years old), preventive examinations by a pediatrician are carried out:

1 time per quarter - for children aged 1 to 2 years;

1 time in 6 months - for children aged 2 to 3 years.

With the preparation of milestone epicrises in 1 year 6 months; at 2 y. 6 months and dispensary epicrisis once a year (2, 3, 4, 5 years).

At the age of 2, in addition to the pediatrician, children are examined by an otolaryngologist, ophthalmologist, neuropathologist, and dentist.

At the age of 3 - surgeon, orthopedist, otolaryngologist, ophthalmologist, neuropathologist, dentist, speech therapist.

Information about preventive examinations at the prescribed time is entered in the form 026 / y-2000, sections 6.1; 6.2; 6.3.

According to the order of the Ministry of Health and the Ministry of Defense of the Russian Federation No. 186/272 dated June 30, 1992, the decreed

terms of examination of preschool children (from 3 to 7 years):

At 3 years old, before entering the preschool educational institution

At 5-6 years old, one year before entering school

At 6-7 years old, in the year of entering school (spring-summer).

With the obligatory examination of all specialists (pediatrician, surgeon, orthopedist, otolaryngologist, neuropathologist, ophthalmologist, dentist). Speech therapist, psychiatrist, psychologist - according to indications.

The main institution for preschool children (from 2 to 7 years old) is a nursery-kindergarten (currently, in some cases, a nursery and Kindergarten exist separately).

The children's polyclinic is responsible for treatment and prophylactic work; compliance with the sanitary and hygienic regime in the preschool children's institutions of the district. Before entering the nursery-kindergarten, children undergo a comprehensive examination. Only healthy children are admitted to the nursery-kindergarten. For children with physical and mental developmental defects, for patients with chronic diseases, specialized day nurseries are organized. The child is in the nursery from 10 to 14 hours a day. For children whose parents work night and evening shifts, for children of single and large mothers, round-the-clock five-day nurseries are organized, from which parents take their children only on weekends.

The doctor and the nurse conduct systematic observation of the physical and neuropsychic development of children, the vaccinations, the implementation of the sanitary and hygienic regime. Children from 1 to 3 years old are systematically examined once every 3 months and once a year - a preventive examination , deworming, oral cavity sanitation. The results of the observation of the child and the data of the examinations are entered into the individual card of the child.

The doctor and nurse of preschool institutions devote a special place to the fight against infectious diseases. Every child who comes from home is carefully examined by a nurse every day upon admission to a child care facility, and in case of suspicion of an infectious disease, he is placed in an isolation ward.

Registration of visits by children to institutions is carried out daily by a nurse or a nurse-educator. An analysis of the physical development of children, morbidity, mortality and terms of use by children of each place in the year is carried out annually (planned employment - 300 days).

Medical workers of preschool institutions systematically inform educators and the children's polyclinic about the physical and neuropsychic development of children.

Baby preschool institutions:

Nursery - 120-180 children, kindergarten - 600 children for one pediatrician,

1. Preschool institutions of general type

2. Center for preschool education

3. Complex of preschool education

4. Educational complex

5. Preschool with first grades

6. Small preschool institutions

7. Preschool combined with staff housing

8. Family kindergarten

9. Walking groups

10. Round-the-clock duty group of short-term supervision.

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 stored in 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 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). Registration 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 the site should be closely related to the medical and preventive work of the doctor and nurse and run as planned. 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

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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 of a nurse in conducting clinical 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 examination 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 entire range of preventive measures at the site, together with the pediatrician, is carried out by the local nurse, the office nurse healthy child and a nurse in 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, a nurse visits the child at home 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, into 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.

The Russian healthcare system has clear rules: as soon as a 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 infant for an inguinal or umbilical hernia, congenital clubfoot and torticollis, as well as hip dysplasia and skeletal abnormalities. 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 is the examination of the 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 of the first year of life, early detection, timely and correct treatment of various pathologies in them is a powerful factor in the improvement of the 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 some medical organizations necessary licensed types of medical activities, in order to fulfill the standard of clinical examination, medical organizations entered into 89 contracts for the missing types of activities.

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.

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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.

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The goals of children's medical examination: forewarned is forearmed

What is a children's "sore"? An unpredictable phenomenon? Or is there still an opportunity to meet childhood ailments fully armed? Modern medicine provides this opportunity. It is for this purpose that a system of children's medical examination has been introduced in health care, which implies regular preventive examinations and examinations of young patients - starting from the first days of their life and ending with the stage of transfer to an "adult" polyclinic.

As you know, not all diseases manifest themselves immediately - especially in children. younger age who are unable to explain in detail to parents and doctors what worries them. Therefore, the main task of clinical examination is to identify latent pathologies, as well as a predisposition to them. In addition, the doctor must assess the compliance of the physical and psychological development of the baby with age norms and, if necessary, give recommendations to parents on how to correct this or that deviation. There is no need to be afraid of this, because all children grow at their own individual pace, the most important thing is not to miss a serious illness hiding under the guise of imaginary well-being.

The main document governing the passage of children's medical examination is the order of the Ministry of Health of the Russian Federation of December 21, 2012. No. 1346n. The procedure for examining the child is indicated there - with a list of specialists, types of tests and procedures recommended depending on age, and all the necessary papers that the pediatrician draws up following the results of this event. It is important to know that every citizen of Russia has the right to free medical examination, but can, at its discretion, undergo it privately in any clinic that has the appropriate license.

From the order, parents of school-age children can find out on what principles "health groups" are formed for physical education, and what examinations the child will undergo as part of school medical examinations.

What are our children sick with?
Experts note that most often in everyday practice, pediatricians are faced with such diseases as various types of manifestations of allergies, bronchial asthma and, of course, acute and chronic colds. Often, doctors identify in their wards overweight- a consequence of malnutrition in the family, as well as a decrease in vision, which is naturally explained by excessive enthusiasm for various gadgets and prolonged viewing of films, programs and videos.

When does a child need to undergo the procedure?

There is nothing shameful in showing your baby to doctors more often - but it is important to observe the frequency of in-depth examinations as part of a children's medical examination. So, in the first year of life such an event should take place every three months: along with the pediatrician, the patient will be examined by a neurologist, pediatric surgeon, orthopedist and ophthalmologist. Scheduled visits are held monthly.

Large-scale research awaits crumbs upon reaching 12 months : during this period, he will undergo the first electrocardiography, and in addition to the main specialists (neurologist, ophthalmologist, orthopedic surgeon, pediatrician), the children's dentist, ENT and psychiatrist will make their conclusions.

Further up to three years no "major" examinations - if doctors and parents have no good reason to be concerned - are not expected. From one year to two the baby will need to be shown to the doctors four times, from two to three years - just twice. At 3 years old - another comprehensive examination with the participation of a pediatric gynecologist and urologist-andrologist, as well as a speech therapist and a psychologist: this is necessary to assess the child's readiness to attend kindergarten.

Then until the school itself - it is permissible to take the child to the clinic for examination once a year. A few months before the first call the health of the future first-grader will again be assessed by narrow specialists, and diagnostic procedures will help to identify possible chronic diseases. After that, the expanded medical examination is carried out at 10, 14, 15, 16 and 17 years old ... Such increased attention of doctors in last years before coming of age is explained by the importance of the transitional age, when the adolescent's body undergoes numerous internal and external changes.

How the prophylactic medical examination program is formed

Why at each certain age period the child is examined by different doctors and what determines the "set" of tests that he has to pass? Thinking over the prophylactic medical examination program, doctors started from the statistics of pathologies, which are more often detected at each stage of the body's development, and what key changes in the results of laboratory and instrumental examination methods allow making conclusions about possible deviations from the norm.

For example, most hearing problems in children are detected in the first year of life, so at this time doctors repeatedly conduct audiological screening for them. But to assess the development of the reproductive system in the absence of obvious malformations before the onset of three years, as a rule, is inappropriate - for this reason, the gynecologist and urologist are involved in clinical examination only at this age.

Despite the fact that each dispensary examination has its own program, if any diseases are detected in the baby, it can be significantly expanded and supplemented. Now, when many developmental disorders are diagnosed at the stage of intrauterine development, doctors have the opportunity to adjust the approach to child management, depending on the situation. So, crumbs with abnormalities in the structure of the heart regularly visit a pediatric cardiologist, and babies with neurological symptoms are examined by a neurologist more often than others.

The procedure for medical examination of children of different ages

Do not be afraid that you, as a parent, will forget to show your child to one of the specialists: the local pediatrician will monitor the implementation of the prophylactic program. He is obliged to remind you in time that the time has come for the next detailed examination and to issue referrals to doctors' offices and for tests.

Usually, a medical examination can be completed in 1-2 days (depending on how long it will take to prepare the test results), but there are no strict requirements: you have the right to visit all doctors without haste. Another thing is that in accordance with the law, the total duration of the main stage of clinical examination in a polyclinic should not exceed 10 days, and if necessary, undergo additional clarifying procedures in other medical institutions - 30 days. This means that doctors cannot delay the examination, even referring to the absence of narrow specialists in the field or long queues for examinations. In such cases, you can complain about the violation of the rules to the chief doctor of the clinic, to the insurance company or to the local health department.

Finally - let's once again clarify at what age and why to undergo a children's clinical examination:

0 to 3 years old

Tasks to be solved : to assess compliance with the age norms of the physical and mental development of the baby, to diagnose congenital malformations in time.
Peculiarities : emphasis - on examinations by a pediatrician and a neurologist.
: pediatrician, neurologist, pediatric surgeon, ophthalmologist, orthopedist, otorhinolaryngologist, psychiatrist (for children over a year old), pediatric dentist.
Basic analyzes : screening tests for congenital diseases (in the maternity hospital), hearing tests, ultrasound of the abdominal cavity, heart and hip joints, neurosonography, blood and urine tests.

From 3 to 7 years old

Tasks to be solved : preparing the child for the visit kindergarten and schools, monitoring the treatment of previously diagnosed diseases.
Peculiarities : identification and correction of speech disorders, assessment of mental development, stress resistance, readiness for classes in a team.
Which doctors are supposed to visit : during this age period, children are additionally examined by a psychologist and speech therapist, as well as a gynecologist and urologist. Do not forget that before school, every child must receive a certificate in the form 026 / y, which includes the conclusions of a surgeon, speech therapist, neurologist, ENT specialist, dermatologist, psychologist, ophthalmologist, dentist and pediatrician, as well as test results and information about vaccinations.

School age

Tasks to be solved : monitoring the impact of training loads on health and tracking the dynamics of puberty.
Peculiarities : during this period, some children are prescribed an in-depth examination by an endocrinologist and an ophthalmologist, and the definition of a health group will help to choose a suitable sports load for the child.
Visiting which doctors and which tests are expected : v school years Students should be examined by a pediatrician, neurologist, gastroenterologist, ENT, ophthalmologist, orthopedist, dentist, psychologist and endocrinologist, gynecologist or urologist. Sometimes blood tests for hormones may be required. From the age of 15, schoolchildren are shown fluorography of the chest organs.

Few of us like to visit hospitals - and even children, most of them, are anxious about people in white coats. However, the realities of modern life are such that disease prevention is a profitable alternative to their treatment. WITH early years instilling in the baby the idea that you need to go to the doctor in order to make sure that everything is in order means teaching him to take a responsible attitude to health in adulthood.