Fitness and healthy lifestyle 

Criteria for the health of preschool children. Comprehensive assessment of the health status of children and adolescents. Health groups

Health status is determined by growth and development. Growth and development is a change in anatomical and morphological indicators, i.e. body length and weight, proportions of individual parts of the body, transverse and volumetric dimensions, changes in physiological systems, tissues and organs - i.e. functional direction in the age aspect. Growth and development are interconnected, dependent on each other; from the environment; social hygiene; school; food hygiene; work and rest; physical culture and sports. Periods of increased growth are replaced by periods of increased development, differentiation of tissues and systems, and vice versa. This is the so-called heterochrony - the difference in timing of the two phases of a single process, the harmony of which depends on external and internal factors.

Hygienic aspects of the health of children and adolescents begin with preventive medicine at the stage of planning and conception, gestation and childbirth, a whole range of measures for the protection of motherhood and childhood. These are antenatal clinics, maternity hospitals, social protection - prenatal and post-maternity leave, transfer to safe and easy work, incentives and rewards for early registration in antenatal clinic, for childbirth. Genetic counseling, monitoring, monitoring of intrauterine development, preventive recommendations on a woman's lifestyle, her nutrition, movement, and rest. In the mother's body, the third circle of blood circulation of the embryo and fetus is formed, first of all, everything good and bad comes to them, the priority of a new life.

Modern hygienic aspects of the growth and development of children and adolescents must begin with the term valeology. Valeo - hello since the birth of a new life. All diseases of children's legs enter adulthood. The level and quality of health depends on many well-controlled factors, both genetically determined and external forces of nature, lifestyle and the help of preventive medicine. The whole interconnected complex of physical, mental and moral health is formed and nurtured not only by the surrounding biological and social world, but also by the person himself.

Health is the highest good. Scientific and technological progress reduces the share physical labor and increases its intensity, intellectual and mental load, reduces physical activity. Three whales of physical, mental and moral health - nutrition, movement, protection. Nutrition is increasingly becoming refined, high-calorie, poor or devoid of biologically active substances. The lack of sleep protection gives rise to neurotic and asthenoneurotic conditions. Motor hunger increases the deformation of the musculoskeletal system.

Health- the integral indicator is formed from the following components: somatic, physical, emotional, personal, moral, mental, spiritual, mental, social.

To assess the health of children and adolescents, it is necessary to use at least four criteria, namely: 1) the presence or absence of chronic diseases at the time of examination; 2) the level of achieved physical and neuropsychic development and the degree of its harmony; 3) the level of functioning of the main body systems; 4) the degree of resistance of the body to adverse effects.

From a hygienic point of view, the assessment of the state of health based on the totality of all four signs deserves the most attention.

These goals are met by the method of comprehensive assessment and distribution of children and adolescents into health groups.

In accordance with the proposed scheme, children and adolescents, depending on the totality of health indicators, are divided into five groups.

First group - these are persons who do not have chronic diseases, who rarely fell ill during the observation period, who have a normal, age-appropriate physical and neuropsychic development(health, no deviations).

Second group- it is made up of children and adolescents who do not suffer chronic diseases, but having functional and morphological abnormalities, often ill - 4 times a year or more - or a long-term one disease - more than 25 days (healthy, with functional abnormalities and reduced resistance).

Third group- unites persons with chronic diseases or with congenital pathology in a state of compensation, with rare and not severe exacerbations of a chronic disease, without a pronounced violation of general well-being (patients in a state of compensation).

Fourth group- persons with chronic diseases, congenital malformations in a state of subcompensation, with violations of the general condition and well-being after an exacerbation, with a prolonged period of convalescence after acute intercurrent diseases (patients in a state of subcompensation).

Fifth group- includes persons with severe diseases in a state of decompensation, with significantly reduced functionality (patients in a state of decompensation). As a rule, such patients do not attend general institutions for children and adolescents and are not covered by mass examinations.

Children and adolescents classified as different groups health, need a differentiated approach in the development of a complex of therapeutic and preventive measures. For persons belonging to the first health group, educational, labor and sports activities are organized without any restrictions in accordance with the existing programs of the educational process. The pediatrician or therapist of the teenage office conducts a preventive examination at the usual (scheduled) time. At the same time, medical appointments consist of the usual general health measures that have a training effect on the body.

Children and adolescents in the second health group (sometimes called the risk group) require more attention from doctors. The fact is that this contingent needs a complex of health-improving measures, the timely implementation of which is most effective in preventing the development of chronic pathology in childhood and adolescence. Of particular importance are hygienic recommendations for increasing the body's resistance by non-specific means: optimal physical activity, hardening by natural factors of nature, rational daily routine, additional fortification of food products.

Children and adolescents assigned to the third, fourth and fifth health groups are under dispensary observation by doctors of various specialties in accordance with the existing methodological recommendations for medical examination of the child population.

Patients receive the necessary therapeutic and preventive care, due to the presence of one or another form of pathology and reduced compensation. In children's and adolescent institutions, a sparing day regimen is created for them, the duration of rest and night sleep is lengthened, the volume and intensity of physical activity is limited, etc. If necessary, patients with chronic diseases or who have birth defects development is sent to special children's and adolescent institutions, where, taking into account the characteristics of the pathology, treatment and education are purposefully carried out.

In the Republic of Belarus, a targeted program is being implemented to preserve the health of students.

The program "Somatic Health" is held under the motto of primary hygiene prevention "I know how not to get sick." The main activities in this program are: systematic medical examinations of children (September, May) with the distribution of children into medical groups to organize the correct distribution of physical activity on the body. Four medical groups for physical culture classes have been defined: basic, preparatory, special medical group and therapeutic physical culture. At the same time, a series of lectures is held for parents and students, educators, and teachers.

The program "Physical Health" sets as its main task the diagnosis of the physical condition of children, their physical development and health.

Health criteria:

    for the mental - I want, I want;

    for physical and somatic - I can;

    for the moral - I must.

Health signs:

    behavior motivation;

    indicators of growth and development;

    resistance to the action of damaging factors;

    specific and nonspecific resistance;

    functional state and reserve capabilities of the organism;

    the level of moral and volitional qualities;

    the presence or level of the disease, developmental defects.

Health monitoring is carried out by LPO. Children's clinics, teenage rooms conduct in-depth medical examinations with the involvement of various specialists.

Modern principles of health differentiation make it possible to conduct a comprehensive individual and collective assessment of the health of children and adolescents, screening tests, social and hygienic monitoring, to identify risk factors and consequences of the Chernobyl accident.

Healthy child. Comprehensive assessment health status of children


The main indicator of the effectiveness of measures to protect children's health is the level of health of each child. Health is not only the absence of diseases and injuries, but also harmonious physical and neuropsychic development, the normal functioning of all organs and systems, the absence of diseases, and sufficient ability to adapt to unusual conditions environment, resistance to adverse effects.


The state of health of the child is examined using the main criteria, which are determined during each preventive examination of the decreed age groups. The following signs are taken into account: 1. Deviations in ante-, intra-, early postnatal periods.2. The level and harmony of physical and neuropsychic development.3. The functional state of the main organs and systems.4. Resistance and reactivity of the body.5. The presence or absence of chronic (including congenital) pathology.


Assessment of physical development is an important prognostic indicator of a person's health status. Such an assessment allows us to identify groups that are at risk, and this, in turn, plays a role important role for the diagnosis and prevention of various diseases. Often a low level of physical development is considered main reason diseases. In turn, chronic diseases cause deterioration in physical development. Physical development is natural process gradual formation and changes in the forms and functions of the body. On the other hand, it is the degree of maturation at each life span.


There are three phases of the process of physical development: - Increasing its level (up to 25 liters) - Relative stabilization (up to 60 liters) - Gradual decrease physical abilities person.


Physical development is influenced by three groups of factors: biological (heredity), climatic and geographical (climatic and meteorological conditions in different climatic and geographical zones), social (conditions of material life, labor and learning activities, content physical education). But it is erroneous to consider the characteristic of physical development only for linear and weight indicators. His adequate assessment requires taking test results into account functionality organism. In each class, three groups of students can be distinguished: accelerators (children who have biological age ahead of the passport age) medians (children whose biological age corresponds to the passport one) and retordants (children whose passport age is ahead of the biological age). This fact must be taken into account when determining the physical development of children and when selecting and dosage. exercise(accelerates have an increased incidence).


The level of functioning of the main body systems. The level of functioning of the main systems of the body is a criterion that characterizes the health of children and adolescents from the standpoint of the morphological and functional maturity of the body, taking into account age-related characteristics. Some children may show functional disorders in the absence of disease. The reasons for such deviations are very diverse: a rapid growth rate in certain age periods (6-7 years old; 11-13 years old (girls) and 13-15 years old (boys)), which leads to a discrepancy between the structure and functions of organs; unfavorable family and living conditions; excessive mental and physical exercise etc. When evaluating functional state great attention is given to the determination of the functional state of the cardiovascular system, respiratory and nervous systems. Sleep, appetite, mood, emotional condition, communication with other children, features of assimilation educational material and so on..


Assessment of the functional state of body systems is carried out using clinical methods, as well as with the help of functional tests (tests of Martinet, Stange-Gene, Letunov, PWC170). Determination of the group for physical education is carried out according to the in-depth medical examination.


IN high school children and adolescents are usually divided into three groups of physical education. The main group of physical education includes children and adolescents who do not have deviations in the state of health or have minor deviations and sufficient physical fitness. Classes for physical culture are carried out according to the curriculum in the subject in full, and the delivery of control standards is carried out with a differentiated assessment. TO preparatory group include children and adolescents with deviations in health and sufficiently physically prepared, as well as children of convalescents. Physical education classes are held according to the curriculum with the obligatory observance of the principles of gradualness and continuity. TO ad hoc group include children and adolescents with significant deviations in the state of health of a temporary or permanent nature. Physical education classes are held according to specially developed differentiated programs and exercise therapy programs.


level physical fitness A significant level of correlation between indicators of somatic health of children and adolescents with the results motor tests characterizing strength (hands and deadlift), speed, general endurance and speed-strength capabilities). This fact can be used to improve the level of children's health by influencing individual components of physical fitness by means of physical education.


the degree of body resistance to adverse factors. The degree of body resistance is determined by the number and duration transferred by a child acute diseases (or exacerbations of chronic) per year. Acute respiratory viral diseases (ARVI) are most common among preschool and younger children. school age. Acute childhood infections chicken pox, rubella, mumps, measles, etc.), acute gastrointestinal diseases, allergic reactions occupy a significant share in the structure of childhood morbidity. According to statistics, the most common diseases among children are respiratory diseases (up to 50%) and systematic acute respiratory viral infections (90%), which indicates a decrease in the body's resistance to adverse environmental factors. According to the number of acute illnesses suffered per year, children are divided into three groups: 1 - those who have never been sick; 2 - those who fell ill episodically (1-3 times during the year); 3 - those who were sick often (4 rubles or more). The absence of acute diseases during the year or their episodic nature indicates a good resistance of the child's body.


the presence or absence of chronic diseases. According to the Ministry of Health, about 90% of school-age children have health problems. Over the past 5 years, there has been a 41% increase in children belonging to a special medical group


A comprehensive health assessment allows you to form groups that bring together children with the same state of health, taking into account all of the above indicators. Group I - healthy children with normal indicators functional development of all systems that rarely get sick (up to 3 times a year) with normal physical and neuropsychic development, do not have significant deviations in history. Group II - risk group: subgroup A - children with risk factors according to biological and social history; subgroup B - children with functional abnormalities, with initial changes in physical and neuropsychic development, often get sick, but do not have chronic diseases. III, IV and V groups - children with chronic diseases: III group - the state of compensation: rare exacerbations of chronic diseases, rare acute diseases, normal level bodily functions; Group IV - the state of subcompensation: frequent (3-4 times a year) exacerbations of chronic diseases, frequent acute diseases (4 times a year or more), deterioration of the functional state of various body systems; Group V - a state of decompensation: significant functional deviations ( pathological changes organism; frequent severe exacerbations of chronic diseases, frequent acute diseases, the level of physical and neuropsychic development corresponds to age or lags behind it).


The distribution of children by health groups makes it possible to identify individuals with risk factors for the development of pathological changes, children with initial forms of diseases and functional abnormalities, and develop a set of measures to protect and strengthen their health, prevent chronic diseases.


A comprehensive assessment of the child's health status is carried out during initial visit child after her discharge from the hospital to get an idea of ​​the baseline health status. In the future, the assessment of the health status of children of the 1st and 2nd years of life is carried out quarterly, children of the 3rd - at the end of each six months. With several diagnoses, the health group is established according to the main diseases. In the process of monitoring a child, the health group may change depending on the dynamics of the level of health status.


First of all, this applies to children and adolescents belonging to the second health group: children - convalescents; children who often and for a long time get sick; children with a general delay and disharmony of physical development both due to overweight body, and due to its deficiency without endocrine pathology; children with posture disorders, flat feet; children with functional changes in the cardiovascular system; myopia, caries, hypertrophy of the palatine tonsils II degree, allergic reactions, increased thyroid gland I and II degrees, asthenic syndrome, etc.


Children of the I health group should be observed at the usual times established for preventive examinations healthy children. For them, preventive, educational and general health measures are carried out. Children of health group II deserve closer attention of pediatricians, because preventive and therapeutic measures can contribute to the transition of children from this group to group I. Children of this group are observed and healed by individual plan, which is compiled according to the degree of risk of developing chronic pathology, the severity of functional abnormalities and the degree of resistance. Children of groups III, IV and V are under the supervision of pediatricians and specialists in accordance with " methodological recommendations for conducting clinical examination of the child population" and should receive necessary treatment depending on the presence of a particular pathology.


Features of the examination of children of different ages When examining a child, it is necessary to remember three mandatory conditions: - Find contact with the child and his parents; - Provide optimal conditions lighting and temperature; - Provide comfortable position for the doctor and his individual protection against possible infection


FEATURES OF THE PERIOD OF THE NEWBORNITY Early neonatal period - lasts from the ligation of the umbilical cord to 7 days (168 hours). This is the most crucial period for the adaptation of the child. At this time, pulmonary respiration appears, the pulmonary circulation begins to function. This period is characterized transition states (physiological jaundice, sexual crisis, uric acid infarction, physiological catarrh skin, etc.). Diseases of newborns may occur due to intrauterine development disorders. During this period, developmental anomalies, fetopathy, hereditary diseases, hemolytic disease, asphyxia, birth trauma, aspiration, infection of the child. In the first day of life, purulent-septic diseases, bacterial lesions of the intestine and respiratory tract. In the early neonatal period aseptic conditions must be provided to protect the child from infection, the optimal temperature regime.


Late neonatal period (lasts from 8 to 28 days of life). During this period, the newborn is at home. Particular attention is paid to the feeding of the child, the nature of lactation in the mother, and the weight of the child is monitored. Most important criteria well-being of the child is the dynamics of body weight and the state of neuropsychic development. During this period, analyzers, coordination of movements are intensively developing, conditioned reflexes, there are emotional and tactile contact with Mother.


BREASTING PERIOD (lasts from 29 days of life to 1 year). During this period, the adaptation of the child is completed, the mother breastfeeds the child, intense physical, neuropsychic, motor and intellectual development child. Problems arise rational nutrition, the introduction of timely correction, complementary foods. functional immaturity digestive system leads to frequent intestinal diseases various etiologies. Metabolic disorders are manifested, rickets and anemia occur in children. Against the background of anatomical and physiological features of the respiratory system in infants bronchiolitis and pneumonia often occur. In that age period are used various means and hardening methods (massage, gymnastics, water procedures). IN infancy prophylactic vaccinations.


The main method of prevention in pediatrics is medical examination of healthy children. By 1997, pediatricians observed children from birth to 15 years of age, and now - up to 18 years. During the medical examination, a comprehensive health assessment is carried out with the definition of a health group. Accordingly, the volume and nature of recreational and medical measures children with a certain pathology or a tendency to it. IN modern conditions clinical examination is the main form of work of children's polyclinics. Clinical examination is carried out both on the basis of age and depending on the diseases that the child has.


Dispensary supervision by the local pediatrician is subject to the following contingents of the child population: - All children in the neonatal period; - Children of the 1st year of life; - Children from risk groups; - Children older than 1 year of age who do not attend preschool institutions; - Children with chronic diseases


Medical examination of children of 1 year of age The task of preventive examinations of children of 1 year of age is to organize an appropriate regimen and rational feeding - prevention of rickets, infectious diseases, detection and treatment of congenital pathology. In the first year of life, a healthy child should be examined by a pediatrician 14 times, including in the clinic - 12 times with mandatory inspection orthopedist, ophthalmologist, neurologist and other specialists. The district nurse visits the child at home once a month. medical supervision for the development of the child is carried out taking into account individual characteristics V different periods 1 year of life. For children of the first 3 months, it is important: discharge from the hospital, adaptation to new living conditions, the beginning of the first walks, the prevention of rickets, the prevention and treatment of hypogalactia, the organization of rational feeding, the prevention of malnutrition.


Clinical examination of children 1 year of age From 3 to 6 months Special attention for preventive vaccinations, the introduction of nutrition correction and complementary foods. At the age of 6 to 9 months, it is necessary to carry out the prevention of respiratory tract infections, intestinal diseases and trauma. The period from 9 to 12 months coincides with weaning, expansion of the diet, vaccination. The district pediatrician writes down his observations of the child in milestone epicrises (3, 6 and 9 months). At the end of 1 year after clinical examination, carrying out anthropometric measurements, laboratory research (general analysis blood and urine), analysis preventive vaccinations and past illnesses during the year, draws up an epicrisis with an assessment of physical, neuropsychic development and a plan for further observation and improvement of the child in the next period.


Clinical examination of the child population includes the following activities 1) regular medical examinations with carrying out the established volume of laboratory and instrumental studies; 2) determination and assessment of the state of health in order to identify children with risk factors; 3) additional examination of sick children who need it, using all modern methods diagnostics; 4) detection of diseases on early stages with the subsequent implementation of a complex of necessary medical and recreational activities and dynamic monitoring of the health of children.


The district pediatrician is responsible for carrying out all stages of the medical examination of the child population in his area and monitors its implementation. A nurse bachelor helps him in this task. For each child who is subject to dispensary observation, a "Control card" is created. dispensary observation"(Form No. 030 / y). Along with the performance of signaling functions (control of dispensary visits), this card also reflects data on the health status of children of different age groups. These data help the doctor in conducting dispensary observation, observing the terms of the examination, urgent medical and recreational The control chart should be, first of all, an operational document in the work of a doctor.


Thank you for your attention!

The concept of the health of children and adolescents should be understood as a state of complete socio-biological and mental well-being, harmonious, age-appropriate physical development, a normal level of functioning of all organs and systems of the body and the absence of diseases.

Children, depending on the state of health, can be classified as following groups health.

Group I - healthy children with normal, age-appropriate physical and neuropsychic development, without functional and morpho-functional deviations.

Group II - children who do not suffer from chronic diseases, but have functional or morphofunctional deviations, convalescents, with a general delay in physical development without endocrine pathology, as well as children with low level body immunoresistance - often (4 times or more per year) or for a long time (more than 25 calendar days for one disease) sick.

Group III - children suffering from chronic diseases in remission (compensation).

Group IV - children suffering from chronic diseases in the stage of subcompensation.

Group V - children suffering from chronic diseases in the stage of decompensation, children with disabilities.

1) characteristics of the health of the child population, obtaining statistical slices of health indicators and the number of relevant health groups;

2) comparative comparison of groups of children in different groups, educational institutions, different territories, in time;

3) assessing the effectiveness of preventive and curative work for children medical institutions based on the transition of children from one health group to another;

4) identification and comparison of the effect of risk factors affecting the health of children and adolescents;

5) determining the need for specialized services and personnel.

The main groups of statistical indicators used to characterize public health the contingent of children and adolescents are the following:

1) medical and demographic criteria;

2) physical development;

3) distribution of children by health groups;

4) morbidity;

5) data on disability.

Physical development is an integral indicator (index) of the sanitary and hygienic well-being of the child population. There are 3 groups of main factors that determine the direction and degree of physical development:

1) endogenous factors (heredity, intrauterine effects, prematurity, birth defects, etc.);

2) natural and climatic factors of the habitat (climate, terrain, as well as atmospheric pollution, etc.);

3) socio-economic and socio-hygienic factors.