WELL BABY CLINICS AND IMMUNIZATION

1. WELL BABY CLINICS AND IMMUNIZATION Dr\ LotfyFahmyIssa

2. Intended learning outcomes • By the end of this lecture you should be able to: 1- Define well baby and well baby clinics. 2- Classify baby according to age. 3- Know importance of caring of this age groups. 4- Know components of well baby clinics. 5- Define objectives of well baby clinics. 6- Assess baby growth. 7- Define immunization. 8- Define types of immunization. 9- Know immunization schedules. 10- Know cold chain

3. WELL BABY CLINICS • Definition: • It is a specialized target oriented health care set up ie: clinic of under 6 years children within the existing facilities of PHCC. • It deals with the total well being of children and family. • They provide safety low cost health care. • It provides promotive, preventive, curative and rehabilitative health services for children.

4. AGE GROUPS OF CHILDREN • From one day to below 6 years. • It divided into : • 1- Infancy (up to one year). • 2- Preschool age (1 year to 6 years)

5. Importance of caring this age groups • 1- Child health care is considered one of the most important elements of primary health care and family practice. • 2- Represent large % of population (about 15% of total population. • 3- More susceptible to high mortality. • 4- More vulnerable and needs proper monitoring of growth and development. • 5- Difficult accessibility. • 6- Needs special care for early detection and management of any preventable and treatable diseases. 7- Introducing high quality and evidenced based health care for babies healthy babies healthy community

6. OBJECTIVES OF WELL BABY CLINICS 1- Health education 2- Adequate nutrition 3- Immunization 4- Care in illness 5- Rehabilitations

7. OBLIGATORY HEALTH EDUCATION IN RELATION TO WBC 1- Importance of attending WBC according to schedules. 2- Breast feeding and children feeding. 3- Demonstrate child feeding ( methods and timing). 4- Weaning practices. 5- Artificial feeding when indicated. 6- ORT. 7- Nutritional problems.

8. SCHEDULES OF WBC VISITS AT PHCC Well baby care visits should be side by side with vaccinations schedules with some modifications as follow: First year: 6 visits (after delivery, 2 months, 4 months, 6 months, 9 months and 12 months). After one year: 7 visits ( 1.5 year, 2 years, 2.5 years, 3 years, 3.5 years, 4 years and 4.5 years)

9. COMPONENTS OF WBC A- Resources and structures ( Manpower and places). B- Process and procedures (Examination) for well baby and sick baby. C- Outcomes (results).

10. MANPOWER 1- Trained physicians 2- Trained females nurse midwives 3- Basic qualifications

11. EXAMINATIONS 1- Weight, height, head circumference and temperatures 2- General appearance of child 3- Fontanels, ears (hearing defect, otitis media), eyes (squint and glucoma) 4- Lips (anemia and cleft palates) 5- Muscles and genitalia 6- Development ( tones, milestones according to age, reflexes)

13. EXAMINATIONS (CONT.) 1- Measures the weight and height at all visits. 2- Measures HC in children up to 24 months of age 3- Measures the blood pressure in children 3 years and older 4- Plot measurement on growth chart to demonstrate normal growth 5- Investigate significant deviation if child growth crosses multiple percentile line on growth chart.

14. GROWTH 1- WEIGHT: A-Normal values At birth: 3-3.5kg First week: loss about 10% of birth weight and then return First 4 months: increase 3\4 kg\month Second 4 months: increase 1\2 kg\month Third 4 months: increase 1\4kg\month After the first year (age in years in 2 +8= weight in kg B- Abnormal: - Underweightif less than 5 centiles - Overweightif more than 95 centiles

15. GROWTH CHART (BOYS)

16. GROWTH CHART (GIRLS)

17. 2- HEIGHT\ LENGHT: • A- Normal value • At birth: 50 cm • First year: 75 cm • Second year: 90 cm • Third year: 97 cm • after that: 5 cm \year • B- Abnormal: • 1- Short stature: if less than 5 centiles • 2- Acromegaly: if more than 95 centiles

18. GROWTH CHART (BOYS)

19. GROWTH CHART (GIRLS)

20. 3- HEAD CIRCUMFERENCE: A- Normal values: At birth: 35 cm First 3 months: increase 2 cm\month After 3 months: 1 cm\month till the end of first year At 6 months:44 cm Increase 10 cm increase for the rest of life B- Abnormal: 1- Microcephaly 2- Hydrocephalaus

21. 4- MILESTONES: A- Normal AND ABNORMAL: Smiling 4-6 weeks Teething 6 +1 2 months delayed if more than 8 months Setting without support 6-7months delayed if more than 10 months Walking 11-15 months delayed if more than 18 months Says a single word 10-15months delayed if more than 18 months Speaks in phrase 18-28 months delayed if more than 30 months

22. One of the important services offered by well-baby clinics is the provision of immunizations ( vaccination) for childhood diseases such as diphtheria, pertussis, tetanus, polio, Haemophilusinfluenzae type b, hepatitis B, measles, mumps, rubella, and varicella

23. What is vaccine? Vaccines are microbial agents or antigen products that stimulate the immune response.

24. Types of Vaccines 3 types of microbiological preparations are used for generation of protective immune Response: • Inactivated Vaccines • Live, Attenuated Vaccines • Toxoids

25. Types of Vaccines • Inactivated Vaccines :Produced by killing the microorganism with chemicals or heat • Live, Attenuated VaccinesThe organism is grown under special laboratory conditions that cause it to lose its virulence • ToxoidsA toxoid is an inactivated toxin produced by a microbe.

26. Immunization schedule: • ID = Intra-dermal • IM = Intramuscular • SC = Subcutaneous • HBV =Hepatitis B vaccine • HAV = Hepatitis A vaccine • IPV = Inactivated polio vaccine • MMR=Mumps,Measles,Rubella • HIb=Haemophylusinfluanza type B • DPT =Diphtheria, Pertussus, Tetanus • PCV =Pneumococcal conjugated vaccine

27. Immunization schedule

29. Cold Chain system Definition: • It is all the people and equipments necessary to keep vaccines safe throughout their transfer from the manufacture to the child. Cycle of vaccine transfer: • Manufacturer → Airport→ central vaccine store→ regional vaccine store → district store → health center → consumer

30. Components of the cold chain 1- Refrigerator 2- Cold Box 3- Vaccine carriers 5- Ice packs

31. Arrangement of vaccines in the refrigerator

32. Arrangement of vaccines in the refrigerator • Freezer → Ice packs and ice cups • Top shelf → oral polio + measles • Middle shelf →BCG + DPT+ TT+ Hepatitis B+ thermometer • Bottom shelf → colored water bottle for keeping temperature in electric power failure

33. Rules for keeping vaccines in the refrigerator • Arrange vaccines with air spaces in between • Check the temp. everyday by the thermometer • The optimum temp is 0ºC - 8ºC • No vaccines in freezer or in the door • No food or drink put in the refrigerator • N.B.: (Toxoids are damaged by freezing) • Keep the refrigerator door shut and use a lock

34. How can the cold chain be broken? • Vaccines left in the airport for longtime without refrigeration • Power failures can damage vaccines in electric refrigerators • leaving the vaccines in direct sunlight during an immunization session

35. How to keep vaccines cold during the immunization session? • An insulated pot & ice box used to keep the vaccine & diluents cold • Sit in a cool place away from the sun • BCG & measles vaccine are damaged by sunlight (Usually put in colored vials (brown)) 

36. How to identify failure of the vaccines • Expiry date • Colour change for polio vaccine • Shaking test: DPT vaccine spoiled by freezing → on shaking→ turbidity→ if left for 30 min a sediment is formed in the bottom of the bottle

37. OUTCOMES 1- Early detection of preventable and treatable health problems. 2- Promotion of physical and psychological development 3- Reduction of morbidity. 4- Reduction of mortality.

38. Thank you