Features of children's medical examination. Organization of medical examination of children The concept of medical examination of the child population

In our country, medical examination of the entire child population is carried out. The peculiarity of the medical examination of children is that the fight for the health of the child practically begins before his birth (prenatal care for a pregnant woman).
Further observation of children is carried out in accordance with age groups in preschool, school and other children's groups (boarding schools, special kindergartens and schools, etc.).
The Soviet health care and education system developed special regimes for the education and health of children aimed at creating a healthy generation of Soviet people.
Children in the first month of life are examined at least 3 times by a nurse and 2 times by a doctor (usually at home). This allows you to identify signs of congenital pathology, defects and developmental anomalies, consult a specialist and begin correcting the defects and anomalies according to indications.
Children in their first year of life are examined monthly by a local pediatrician. Children are received in the room healthy child, specially equipped with visual forms of propaganda that make it possible to teach the mother the rules of hygiene, feeding, hardening, etc. In the first year of life, the child is given many preventive vaccinations.
By the end of the first year, the child had already erupted teeth, the formation of which occurred in the antenatal period. There is convincing evidence that children born to mothers with extragenital diseases (rheumatism, tuberculosis, hypertension, nephropathy, etc.) or who suffered toxicosis during pregnancy, children born prematurely, who suffered purulent-septic diseases during the neonatal period who received antibiotics, etc., have an increased risk of developing defects of hard dental tissues in the form of hypoplasia and aplasia. Diagnosis of these defects and developmental anomalies is possible by the end of the first year of life.
In a timely manner Taken measures make it possible to prevent the development of caries in places of defectively developed tissues, and then its complications.
At the end of the first year of life, an epicrisis is written in the history of the child’s development using data obtained from laboratory research and examination of the child by other specialists.
The child’s individual card (form No. 112) in the first epicrisis must contain a dentist’s note about the number of teeth that have erupted, their position and the condition of the hard tissues. Parents should be given advice on individual care for their child’s oral cavity and when to contact the dentist to prevent dental diseases. If a pathology is detected, the child must be taken for treatment and clinical observation by a dentist; a plan for complex therapy and the use of preventive measures must be approved with the pediatrician (see “Medical examination of children from birth to four years of age”). Order No. 770 of August 20, 1986 provides for annual examinations of the child by a dentist.
Children aged three years and older are examined once a year, in the month the child is born. At the same time, mandatory laboratory research blood, urine, feces. The participation of the dentist in examining children of these ages is described in the chapter “Medical examination of children before school age».
The pediatrician examines children in the fifth year of life once a year. In addition to the pediatrician, the child must be examined by other specialists: otolaryngologist, ophthalmologist, dentist,
orthopedic surgeon, speech therapist and neuropsychiatrist. The child is preparing to go to school. A dental examination, if performed for the first time, is late for up to 70% of children during this period. Such examinations only allow us to identify and, before the child enters school, treat the most severe form of dental caries: complicated forms, remove damaged teeth, and some correction of deviations in the development of the jaws.
Based on the examination of the child, all pediatric specialists, including pediatric dentists, make entries in the child’s individual development chart and formulate recommendations.
At school, an in-depth examination of children is carried out annually by the school doctor with the participation of specialists.
During these examinations, anthropometry, spirometry, dynamometry, blood pressure measurement, determination of visual and hearing acuity are carried out, and according to clinical indications - functional tests of cardio-vascular system, as well as the necessary laboratory and instrumental studies. The sequence of examination is such that it involves examination first by specialist doctors, and finally by the school doctor. The school doctor determines the level of physical development of schoolchildren and their health group.
The participation of dentists in conducting preventive examinations is necessary. Dentists often believe that at the same time it is necessary to carry out sanitation of the oral cavity, but this is wrong. The task of medical examinations is to identify pathology and determine the level of physical development of schoolchildren. According to the recommendations of the Institute of Hygiene for Children and Adolescents, during a comprehensive assessment, it is excluded along with body length, annual increases in body weight, ossification of the hand, and the development of secondary sexual characteristics, the number of erupted permanent teeth [Stromskaya E. P. et al., 1974].
Based on the above, the participation of the dentist in medical examinations should include filling out paragraph 10 of the child’s individual card (form No. 26) in the following sequence: the number of erupted permanent teeth, the presence of caries and the degree of its activity (I, II, III degree), the state of the bite, if there is a malocclusion, it should be indicated actively effective causes and risk factors in their progressive development, assess the condition of the periodontium and the hygienic index.
It is these data that form the basis for determining the child’s physical development and health group.
The pediatrician classifies children with dental caries in the third degree of activity into the third health group, and children with a formed malocclusion that causes impairment in biting and chewing food - into the second health group.
Since the prevalence of dental diseases in children is high, the amount of work on sanitation of the oral cavity is large, the dentist does not have to participate in the examinations, but enters his data into Form No. 26 as a special examination and sanitation of the oral cavity is carried out in the dental office.
The dentist must carefully examine a child with a referral from a pediatrician or other pediatric specialist, provide treatment and record a detailed dental diagnosis in the dispensary observation card, indicate the activity of the development of the process, formulate an individual treatment and treatment program. preventive measures procedures, frequency of repeat examinations, etc. Contact between the pediatrician and the dentist when observing children with general pathology should be carried out in the manner of double differentiated control.

In our country, medical examination of the entire child population is carried out. The peculiarity of medical examination of children is that the fight for the health of the child practically begins before his birth. Prenatal patronage, actively introduced into the practice of Soviet health care, led to the fact that last years mothers of 80-85% of newborns received prenatal care (A. S. Boytsova, 1974).

Further observation of children is carried out in accordance with age groups in preschool, school and other children's groups (boarding schools, special kindergartens and schools, etc.). The Soviet health care and education system developed special regimes for the development, education and health of children, aimed at creating a healthy generation of Soviet people.

Children in the first month of life are examined at least 3 times by a nurse and 2 times by a doctor (usually at home). This allows you to identify signs of congenital pathology, defects and developmental anomalies, consult a specialist and begin correcting the defects and anomalies according to indications.

Children in their first year of life are examined monthly by a local pediatrician. Children are received in a healthy child’s room, specially equipped with visual forms that allow the mother to be taught the rules of hygiene, feeding regimen, hardening, etc. In the first year of life, the child is given many preventive vaccinations.

By the end of the first year, the child had already erupted teeth, the formation of which occurred in the antenatal period. There is convincing evidence that children born to mothers with extragenital diseases (rheumatism, tuberculosis, hypertension, nephropathies, etc.) or who suffered toxicosis during pregnancy, children born prematurely, who suffered purulent-septic diseases during the neonatal period, who received antibiotics, etc., have an increased risk of developing hard tissue defects in the form of hypoplasia and aplasia. Diagnosis of these defects and developmental anomalies is possible by the end of the first year of life.

Timely measures taken can prevent the development of caries and then its complications.

At the end of the first year of life, an epicrisis is written in the history of the child’s development using data obtained from laboratory research and examination of the child by other specialists.

In the child's developmental history (Form No. 112), the first epicrisis must contain a dentist's note about the number of teeth that have erupted, their position and the condition of the hard tissues. Parents should be given advice on individual care for the child’s oral cavity and when to contact the dentist to prevent dental diseases. If a pathology is detected, the child must be taken for treatment and clinical observation by a dentist; a plan for complex therapy and the use of preventive measures must be approved with the pediatrician (see “Medical examination of children with dental caries”).

Starting from the age of three, children are examined once a year, in the month the child is born. At the same time, mandatory laboratory tests of blood, urine, etc. are provided.

The pediatrician examines children in the fifth year of life once a year. In addition to the pediatrician, the child must be examined by other specialists: an otorhinolaryngologist, an ophthalmologist, a dentist, an orthopedic surgeon, a speech therapist and a neuropsychiatrist. A dental examination, if performed for the first time, is late for 70% of children during this period. Such examinations allow treatment of identified pathologies and correction of identified developmental deviations before the child enters school.

In the seventh year of life, the child is preparing to enter school. In the individual child development chart, all pediatric specialists make their notes based on the examination of the child and formulate recommendations (form No. 26, approved by the USSR Ministry of Health 16/VII 1945).

At school, an in-depth examination of children is carried out annually by the school doctor with the participation of specialists.

During these examinations, anthropometry, spirometry, dynamometry, blood pressure measurement, determination of visual and hearing acuity are carried out, according to clinical indications - functional tests of the cardiovascular system, as well as the necessary laboratory and instrumental studies. The sequence of examination is such that it involves examination first by specialist doctors, and finally by the school doctor. The school doctor determines the level of physical development of schoolchildren and their health group.

The participation of dentists in this work is necessary. Dentists often believe that it is necessary to sanitize the oral cavity at the same time. This approach to the dentist’s role in preventive examinations is incorrect. The task of medical examinations is to identify pathology and determine the level of physical development of the student. According to the recommendations of the Institute of Hygiene of Children and Adolescents of the USSR Ministry of Health, as criteria for the physical development of children and adolescents in a comprehensive assessment, along with body length, annual body weight gain, ossification of the hand, and the development of secondary sexual characteristics, the number of erupted permanent teeth is put forward (E. P. Stromskaya et al., 1974).

Based on the above, the dentist’s participation in medical examinations should include filling out paragraph 10 of the child’s individual card (form No. 26) in the following sequence: the number of erupted permanent teeth, the presence of caries and the degree of its activity (compensated, sub- and decompensated form); the state of the bite, in the presence of an anomaly, indicating the active causes and risk factors, the condition of the periodontium and the hygienic index.

It is these data that form the basis for determining the child’s physical development and health group. Information that a child needs treatment for malocclusion or sanitation of the oral cavity is brought to the attention of the local dentist serving the children of this school.

Dentists are involved in the medical examination of children with a number of chronic diseases, such as rheumatism, nephropathies, diseases of the gastrointestinal tract, chronic tonsillitis, etc. A sick child with a referral from a pediatrician or other pediatric specialist is obliged to carefully examine, treat and record a detailed dental diagnosis on the dispensary observation card, indicating the activity of the development of the process (caries, gingivitis, periodontal disease), the severity of the pathology (anomalies and malocclusions), the number of permanent teeth that have erupted, and the hygienic index. It is also necessary to justify the frequency of dental examinations at the dentist. It should be emphasized that all children in the area are under dispensary observation by the dentist; this group is observed with a special frequency, taken into account when selecting children for dispensary registration. A child referred by a pediatrician must be examined and sanitized. Contact between a pediatrician and a dentist when observing children burdened with general pathology should be carried out in the manner of double differentiated control.

Children suffering from chronic diseases or at risk of their progression should be under regular supervision of specialists. For this purpose, the legislation provides for dispensary observation of minors.

Every child, depending on their membership in a particular health group, has the right to treatment, rehabilitation and preventive procedures. Their minimum and maximum frequency should not exceed the legally approved norms. We will talk about what dispensary observation of children is and how it is implemented in this article.

What is this procedure and what are its features?

Dispensary observation of children is the exercise of regular monitoring of the health of Russian citizens who have not reached the age of majority, who have chronic diseases, functional disorders and similar conditions. Its goal is the timely diagnosis of emerging complications of pathologies, their further therapy and rehabilitation, as well as the adoption of preventive measures to prevent exacerbations.

If, in the case of clinical examination, absolutely all categories of children are subject to regular examinations, then clinical observation has a specific focus - patients who are already registered with previously identified diseases. The following categories of children fall under regular medical supervision:

• With chronic ailments of a non-infectious nature, as well as those belonging to a risk group for their development;
• WITH chronic diseases infectious type, as well as those who have suffered similar illnesses or are carriers of their pathogens;
• Those who are at the recovery stage based on the results of treatment of acute diseases (including poisoning, injuries).

Dispensary observation of minors is regulated by the norms of the Federal Law “On the Fundamentals of Protecting the Health of Citizens of the Russian Federation” No. 323-FZ, adopted by the State Duma on November 21, 2011. The procedure is also prescribed in the provisions of the order of the Ministry of Health, registered under No. 1348n dated November 21, 2012.

The procedure for dispensary admission of a child

The procedure for a dispensary appointment consists of several stages, the results of which are necessarily entered into the patient’s medical record and in the future are the main indicators for prescribing any treatment or preventive measures. So, the procedure consists of the following steps:

1. Preliminary examination of the patient and analysis of his complaints, if any.
2. Assignment, completion and evaluation by a specialist of the results obtained laboratory tests, instrumental research.
3. Establishing diagnosis.
4. Determining the order of treatment, rehabilitation and recreational activities.
5. Preventive consultation with the patient and his representative (parent, guardian, etc.) regarding precautions to avoid complications of the disease, as well as the sequence of actions in emergency situations.

Dispensary observation is carried out by employees of the medical institution within which the child is provided with primary health care, pediatricians, specialized doctors, and paramedics of the FAP. All information about the patient’s health status based on the results of the examination must be provided to him, as well as to his parent or other legal representative.

What groups of clinical observation of children exist?

To carry out dispensary observation of children with chronic diseases and pathologies, all patients are divided into separate categories. The frequency of routine medical examinations depends on membership in one of them. The following health groups for minors are distinguished:

• Group I – children, physically and mentally healthy;
• Group II – minors who do not have chronic diseases, but with functional disorders in the body who are carriers of pathogens, as well as those who have suffered severe or moderately severe diseases of an infectious nature;
• Group III – children who have chronic illnesses, are in remission and prone to infrequent exacerbations;
• Group IV - minors who have chronic diseases in the active stage, as well as in remission, but with a tendency to frequent exacerbations;
• Group V – children with chronic illnesses of a severe nature, which are always in the active stage, characterized by constant complications and rare clinical remission.

Representatives of group I must undergo regular comprehensive medical examinations within the time frames specified in the regulations of the legal acts discussed above, depending on age. The health status of children belonging to group II is monitored by pediatricians annually. For groups III, IV, V, depending on the course of the disease, doctors can prescribe an individual schedule of systematic examinations (from once every 2 weeks, month, quarter to once every six months).

How are children with diabetes and chronic diseases monitored?

If a child suffers from diabetes mellitus, he must be examined by an endocrinologist at least once a month (depending on the course of the disease - and more often). It is planned to take tests for the portion glucosuric profile and the level of glucose in the blood. Also, routine monitoring by an ophthalmologist and neurologist is mandatory for the child, the frequency of which is at least 2 times a year. If there are indications, an examination with other specialized doctors may be prescribed. For the purpose of comprehensive diagnosis and inpatient therapy, in particular cases, hospitalization of a minor is appropriate. Regular sanatorium treatment is recommended for these categories of people.

Dispensary observation of children with chronic diseases is carried out by pediatricians and specialized specialists from children's clinics, as well as hospitals where inpatient therapy is or has been carried out. When registering a child, the doctor makes a note in the development history and the card for the dispensary patient (forms No. 112/u and No. 30/u, respectively).

Depending on the type of disease, an observation plan is developed annually, which notes the timing of examination by a pediatrician and specialists, dates of tests, as well as a list of necessary therapeutic, preventive and rehabilitation activities. After each year of dispensary registration, the doctor is obliged to draw up an epicrisis, assess in it the nature of the course of the disease and the effectiveness of the control methods used.

The desired outcome is the subsequent deregistration of the child. If the doctor decides to continue monitoring his medical condition, a plan must be drawn up to next year. The results of the procedures applied and possible deregistration from the dispensary must be discussed at the general council of the children's clinic.

Conclusion

Dispensary observation is carried out for children with chronic and other diseases with the aim of their prevention, qualified and timely treatment. There are several groups of dispensary observation, in accordance with which examination activities are carried out and treatment plans are drawn up.

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

Children under 7 years of age who do not attend nurseries 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 pre-medical stage Laboratory and instrumental studies, anthropometry, questioning, blood pressure measurement, visual acuity, and dynamometry are organized.

On pediatric stage A clinical examination by a pediatrician is carried out with analysis of pre-medical examination data and assessment of the child’s health status. For those entering school, as well as school-age children, this stage is of a medical-pedagogical nature. Teachers and psychologists take part in its implementation in order to assess the psychological status, functional readiness and adaptation to learning. The results of this stage are documented in a joint medical and pedagogical report.

medical care to the population. Parents have the right to choose medical institution for a 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 treatment and preventive institutions, intended for recording medical observation data, as well as the treatment and preventive measures taken. This document has legal force. Based on it, expert decisions regarding health status are made medical institution 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 the educational institution ( kindergarten, then at school) until the child reaches 17 years of age.

If, during a preventive medical examination, medical institution If a disease is detected, then in order to make an accurate diagnosis, the doctor prescribes additional examinations (consultations 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 pathologies also undergo a medical examination at certain times. Such children are under dispensary observation, the algorithm of which, the frequency of examinations, the list of specialists, and diagnostic procedures is determined by the relevant regulatory documents.

Preventive medical examinations children attending educational institutions, including preschools, are organized by the administration of the educational institution and medical personnel assigned to this institution. It is possible to conduct a medical examination in a clinic, directly at a school or kindergarten, depending on the available capabilities. The implementation option is determined by the administration of the clinic and educational institution.

Preventive medical examinations are voluntary. The need for a health certificate medical institution upon admission to any educational institution, it is determined by departmental regulations, which contradicts the Federal Law. IN Federal Law it is stated that none of the reasons, as well as the absence of a certificate of a completed medical examination, can be a reason for refusal of admission medical institution to an educational institution, including a nursery, 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, as it makes it possible to identify and treat diseases on the child’s body. early stages, as well as preventing the development of chronic diseases.

Of great importance in the activities of a children's clinic 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 in these institutions. It is strictly forbidden to vaccinate at home.

Parents must be notified in advance about the day of upcoming preventive vaccinations for children attending preschool institutions and schools. All children are examined by doctors on the day of vaccination, taking into account anamnestic data and thermometry. Children with relative contraindications should be vaccinated according to an individual schedule, according to the recommendations of relevant specialists.

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

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

Plan of preventive examinations (dispensary examinations) for children from 0 to 1 year

Plan of preventive examinations (dispensary examinations) for children from 1 year to 17 years

Clinical examination- method of active dynamic monitoring of healthy persons, united by common physiological characteristics or working conditions; patients suffering from chronic diseases, most often leading to temporary disability, disability, mortality, or who have suffered some acute diseases; persons with risk factors.

This method is aimed at preventing diseases, actively identifying them in the early stages and timely implementation of therapeutic and recreational measures. Medical examination of the population has now turned from a method of operation of individual institutions into a system of operation of all treatment and preventive institutions in the country. Each of them, in accordance with the profile of its work, carries out clinical examination of various groups of the population and certain groups of patients.
The main purpose of medical examination consists of preserving and strengthening the health of children, increasing life expectancy through systematic monitoring of their health, studying and improving the health of their lives, wide implementation of a complex of socio-economic, sanitary and hygienic, preventive and therapeutic measures.
Methods for conducting medical examinations of healthy and sick people are basically the same.

Clinical examination of healthy people must ensure correct physical development, improve health, identify and eliminate risk factors for various diseases through widespread public and individual social and medical activities.

Clinical examination of patients must actively identify and treat the initial forms of diseases, study and eliminate the causes that contribute to their occurrence, prevent exacerbation of the process and its progression on the basis of constant dynamic monitoring and carrying out therapeutic, health-improving and rehabilitation measures.

The main objectives of medical examination of the population are:

1. determination of the health status of each individual by annual examination and health assessment taking into account age, gender and professional characteristics;

2. differentiated active dynamic observation of healthy people; persons with risk factors and patients; a gradual transition from observation of individuals to family observation;

3. identifying and eliminating the causes of diseases; assistance in eliminating bad habits and provision healthy image life;

4. timely implementation of therapeutic and recreational activities;

5. improving the quality and efficiency of medical care to the population through interconnection and continuity in the work of all types of institutions, wide participation of doctors of various specialties, introduction of new organizational forms, further technical support and the use of computers.

Stages of clinical examination:

First stage. Planning work on medical examination of the population: conducting a population census in the area, identifying a list of people subject to active dynamic observation in a medical institution, determining the priority of invitations to medical examinations and an individual examination program.

Second phase. Examination on appeal and during preventive examinations. Carrying out diagnostic and treatment measures, assessing health status, determining the health group.

Third stage. An active invitation to receive patients who are under dispensary observation, to carry out therapeutic, health-improving and rehabilitation activities. Assessment of the quality of medical examination.

Based on health status, all examined residents are divided into three groups of dispensary observation.