Physical development of preschool children. And play a lot. Average cognitive activity

08.05.2019

The development of the child is predetermined by the genetic program of ontogenesis implemented in specific environmental conditions. Growth provides genetic regulation, controlling the synthesis of hormones, growth regulators, receptors to them. Altitutically controlled development is almost completely controlled by the human genome, although various external environmental factors operating through the maternal organism can make changes to the program of individual development of the embryo and fetus. External environmental factors can have both positive and negative impacts on the growing organism. The factors regulating the growth of the fetus belongs to the placenta. Growth hormone is considered chorionic somatommotropin. CO 2 half of pregnancy in regulation of growth and development takes part hormones (insulin).

In the postnatal period, hormones contributing to the growth is a somatotropic pituitary hormone (STG), thyroid hormones and insulin. Growth hormone stimulates hondrogenesis, and thyroid hormones are more affected by osteogenesis.

The most active child grows in the first 3 years. For 1 year, its growth increases by 25 cm, for 2 - by 12-13 cm, for 3 years - 7-8 cm, for the first 3 years - about 40-45 cm.

Doubling the length of the child's body takes place by 4 years.

Periods of "stretching" are observed at the age of 5-7 years and 12-15 years (there are differences in boys and girls).

The body weight doubles to 4.5-5 months, and by 9-10 months. - triples.

The periods of "rounding" are observed at the age of 9 months. - 3 years old and in a publ. In parallel with age, the proportions of the body are changed, while the legs are most intensely, their length increases 5 times, the body is 3 times, and the head is 2 times (Fig. 1).

As a result of neuro-humoral regulation disorders, the overall delay in growth and development can develop - nanism (cerebral, pituitary, thyreogenic). In some cases, hereditary-constitutional deviations of growth and development are observed. External factors affecting growth and development include nutrition, education, ecology, presence or absence of disease. The unfavorable effect of external factors can manifest itself in somatogenic or psychosocial nanice.

Evaluation of physical development is possible by different methods. The most modern of them is the assessment of the central tables. Central distributions are most strictly and objectively reflect the distribution of signs among healthy children. The practical use of these tables is extremely simple and convenient. The centers columns show the quantitative boundaries of the feature in a certain share or percentage (valuable) of children of this age and gender. At the same time, for medium or conditionally normal values, values \u200b\u200bare made in the range from 25 to 75 centles.

Each measuring feature (growth, body weight, chest circumference, head circle) can respectively be placed in "its" area or "its" corridor of the centenary scale in the corresponding table. No calculations are made. Depending on where this "corridor" is located, it is possible to formulate an estimated judgment and take a medical solution. At the same time, the following options are possible (Table 2)

table 2

Feature Coridal Corridors

Area or "Corridor"	Characteristic area	Estimation, doctor tactics
	Region "Very low values" (up to 3 centles)	No more than 3% of healthy children, special counseling, survey
	Low values \u200b\u200barea (from 3 to 10 centles)
	The region "values \u200b\u200bbelow average" (from 10 to 25 centles)	15% of healthy children
	Region "average values" (from 25 to 75 centles)	50% of healthy children and therefore most characteristic of this age - sexual group
	Region "Values \u200b\u200babove average" (from 75 to 90 centles)	15% of healthy children
	The area "quantities" (from 90 to 97 centles)	7% of healthy children. In the presence of other deviations in a state of health and development, counseling and examination is shown.
	Region "Very High Values" (from 97 centles)	Not more than 3% of healthy children. The probability of pathological changes is quite high, special counseling, examination

Definition of somatotype

it is carried out according to the sum of the corridors (body length + breast ok + body weight).

3 somatotype:

microsomatic - Fri below average (amount to 10)
mesomatic - FR average (amount from 11 to 15)
macroSomatic - Fri above average (from 16 to 21)

Definition of harmony

Harmonious - if the difference between corridors between any two of the three indicators does not exceed 1.
Disharmonic - difference 2.
Sharply disharmonious - exceeds 3.

For example:

E. girl, 7 years old. Growth -127 cm - corridor 4, body weight - 27 kg - 4 corridor, breast ok - 60 cm - 4 corridor, their amount is 12 - macromatic somatotype. Harmonious development.

Estimation of body weight

If in 3-5 corridor - the norm. 1 and 2 corridor - mass deficiency. 6 and 7 corridor - excess mass.

Conclusion According to the central tables we will analyze on our example:

Girl e., Date of measurement: 01/01/2017. Age 7 years. Growth - 127cm (4), body weight - 27 kg (4), Breast OC - 60 cm (4), head head-54cm (4).
Mesosomatic type, with normal mass, harmonious development.

Empirical Formulas and Tables

The mass of a duplicate newborn baby is 2700-4000 g, length - 46-56 cm, head circumference - 34-36cm, breast circle - 32-34 cm.

In the first 4 days, the physiological loss of body weight occurs, it does not exceed 6% of the mass at birth, due to the predominance of catabolic processes, fluid deficit, loss of water with breathing, through the skin, with a meconium, urine. By 7 days, the restoration of the lost mass occurs.

Giving body weight and growth in children of the first year of life, we define on the Kislyakovskaya table.

Empirical formulas for calculating anthropometric data in children of the first year of life

Head Circle: At 6 months is 43 cm, for each month to 6 months, 1.5 cm is subtracted, if more than 6 months are added 0.5 cm.

Breast Circle: At 6 months is 45 cm, for each month to 6 months, it is subtracted 2cm, if more than 6 months are added 0.5 cm.

Empirical formulas for calculating anthropometric data in children older than the year

Body Length from 1 to 10 years:

Baby length of a child of 4 years - 100 cm.
For every year up to 4 years old by formula 100 - 8 (4-N)
Body length over 4 years then 100 + 6 (n - 4)

Body Length from 11 to 15 years:

Baby length of a child at 8 years - 130 cm.
For each year to 8 years, 7 cm is deducted.
For each year, more than 68 years is added 5 cm.

Body mass from 2 to 11 years:

10.5 + 2 (N -1), where 10.5 kg is the middle mass of the child in 1 year.
Body mass of 5 years - 19 kg.
For every year up to 5 years, 2 kg is deducted.
For each year, more than 5 years is added 3 kg.

Body mass from 12 to 15 years: 5n - 20

Chest circumference from 2 to 15 years:

At 10 years - 63 cm.
Up to 10 years: 63 - 1.5 (10-N)
Older 10 years: 63 + 3 (n - 10)

Head circle from 2 to 15 years:

at 5 years - 50 cm
for every year up to 5 years, we subtract 1 cm
for each year, more than 5 years is added 0.6 cm.

Evaluation of FR premature children in the first year of life

The sigmal and percency table is used.

Vertical - indicators of mass, diens, circles of head and chest, horizontally - its gestational age. If the intersection point of these lines is located between the R25-50-75 curves, the indicator corresponds to the norm, if p10 is 25 and 75-90, then the indicators are higher and below average.

Observation of the physical development of children

It is known that physical development along with other indicators of children is a significant indicator of the state of the health of children. The state of physical development depends on congenital features, as well as on environmental conditions in which the body is growing and formed. To conduct examination of the physical development of children, in particular anthropometry, prepared medical workers should be allowed, since the technique and methods of anthropometric measurements require certain knowledge and practical skills.

The measurement of the children of the first year of life is carried out in the position lying horizontal growth. The child is placed on the back in such a way that the head is tightly touched by the top of the header to the transverse bar. The head is installed in a position in which the lower edge of the orphanage and the top edge of the ear goat are located in one vertical plane. The assistant fits the baby's head tightly. Legs should be straightened by a slight presses of the left hand on the baby's knees. The right hand is applied to the movable plate of the growth tightly to the heels, bending the feet to the straight corner. The distance between the fixed and the mobile strip will correspond to the growth of the child.

Growth measurement in children over a year is held in the standing position by Rostometer. The child becomes on the platform of the header with his back to the vertical rack, in a natural, straightened position, touching the vertical rack heels, buttocks, inter-opaque region and a population, hands are omitted along the body, heels together, spokes apart. The head is set in a position in which the lower edge of the orphanage and the top edge of the ear goat is in one horizontal plane. The movable bar is applied to the head without pressing.

The determination of body weight in young children is carried out on scales with the maximum allowable load to 20 kg. Initially, the diaper is weighed. It is placed on the tray of the scales, so that the edges of the diaper do not breathe from the tray. The child is placed on a wide part of the tray head and a shoulder belt, legs on a narrow tray. If the child can be planted, it is planted on a wide part of the tray with buttocks, legs on a narrow part. Placing the child on the scales and removes with them only with the closed of the scale of the scales, standing is not on the side, but right on the side of the scales. Weight readings are counted on the other side of the weights where there are notches or cutting (the bottom weight must be placed only in the on the bottom, the score of the notches). After recording weight, the weights are put on zero. To determine the weight of the child, it is necessary to subtract the weight of the diaper from the testimony of the scales.

Weighing children up to one year in preschool institutions is carried out every 10 days, from 1 to 3 years - once a month.

The measurement of the busty circumference is made by a centimeter rubberized ribbon in a state of quiet respiration (pause, and older children when inhaling and exhale). The tape is superimposed from behind - at the corners of the blades, and in front - at the level of the lower edge of the nipples.

In addition to anthropometric measurements, the muscle tone is noted, the tissue tutor, the nature of the fatteration, etc. It should be determined by the thickness of the subcutaneous layer, it is not necessary on a single site, but in various places (on the chest between the nipple and sternum, on the stomach - at the navel level, On the back - under the blades, on the limbs - on the outer surface of the thigh and shoulder, on the face - in the cheek area). Depending on the thickness of the subcutaneous layer, they talk about the normal, excess and insufficient deposition of fat. Attention is drawn to uniform (throughout the body) or uneven distribution of the subcutaneous layer.

The definition of a soft tissue turgora is carried out by squeezing with large and index fingers of the right hand of the skin and
All soft tissues on the inner surface of the thigh and shoulder, while perceived the feeling of resilience or elasticity, called the tour. If the tour is reduced, then the feeling of lethargy or decrees is determined.

The muscle tone is determined by passive bending
and extension of the upper and lower extremities. According to the degree of resistance, which occurs in passive movements, as well as on the consistency of the muscle tissue, determined to the touch, judges the muscle tone. In healthy children, the tone and mass of muscles on symmetric places should be the same.

These descriptive features are assessed by severity as "small", "medium", and "big".

Individual assessment of physical development is based on comparison of its anthropometric data with regional regions developed by the method of regressive analysis. The use of regulatory or dental tables allows the differentiated characteristic of the physical, child development, and allocate children who need constant control and consultation of a specialist.

The lag in physical development may be due to a number of reasons that need to identify a preschool doctor. The hereditary constitutional factor has a certain meaning. More often the cause of unsatisfactory physical development is chronic infections and intoxications, primarily rheumatism, tonsilogenic cardiopathy, chronic pyelonephritis, hypothyroid nanism. On the launch can only be said if the growth rate is more than 10% lower than the standard.

A detailed examination of the child allows you to identify the features of its skin, the lymphatic apparatus, the bone system. Children's preschool children can identify scoliosis or a funnel-shaped chest. Timely detection of this pathology prevents the development of disability in the future. All children are suspected of the pathology of the musculoskeletal system, should be aimed at consulting an orthopedist, a corrective gymnastics is shown.

age	boys		girls		pulse	breath	hell
age	weight	height	weight	height	pulse	breath	hell
1 year	11,5-13,8	82-87	11,7-13,5	80-87	120-125	35
2 year old	12-14	85-92	11,8-14,0	82-90	110-115
3 year	13,8-16	92-99	13,6-16	91-99	105-100	28
4 year	15,8-18,5	98-107	14,5-17,5	95-108	100-106
5 years	17,6-21,7	105-116	16,9-19,9	98-112	100
6 years	19,6-24,2	111-121	18,8-23,8	111-116	90-96	26
7 years	21,6-28,2	118-139	21,8-27,4	118-129	85-90
8 years	80-87
9 years	80-85
10 years	78-75	20
12 years	75-72
13 years	72-82
14 years	72-76	17

age		floor.		Level of physical development
				Tall		Above medium average			Below the average		low
1		2		3		4 5			6		7
Body mass
3g.	small .. L.		18,7>		18,6-17,3		17,2-14,1	14,0-12,6		12,5<
vir.		18 , 5>		18,4-16,9		16,8-13,8	13.7-12,4		12,3<
3g.	mal. .		19,1>		19,0-17,8		17,4-14,7	14,6-13,1		13,2<
6 months .	vir.		18,7>		18,6-17,7		17,6-14,2	14,6-13,3		12,9<
4g.	mal.		19,6>		19,5-18,3		18,2-15,3	14,1-13,0		13,8<
vir.		18,9>		18,8-17,5		17,4-14,7	15,2-13,9		13,5<
4g.	mal. .		21,2>		21,1-19,7		19,6-16,0	14,6-13,6		14,3<
6 months.	vir. .		20,4>		20,3-18,3		18,2-15,7	15,9-14,4		14,1<
5 years	mal. ..		22,9>		22,8-21,0		20,9-16,8	15,6-14,2		14,8<
vir.		21,9>		21,8-20,2		20,1-16,6	16,7-14,9		14,9<
5 years	mal. ..		23,9>		23,8-22,1		22,0-18,1	16,5-14,9		16,1<
6mis.	vir.		23,8>		23,7-21,8		21,7-17,6	18,0-16,2		15,5<
6 years	mal. ..		25,0>		24,9-23,2		23,1-19,5	17,5-15,6		17,5<
vir.		25,9>		25,8-23,5		23,4-18,6	19,4-17,6		16,1<
6 years	mal.		26,7>		26,6-24,7		24,6-20,3	18,5-16,2		18,2<
6 months ..	vir.		27,5>		27,4-24,9		24,8-19,7	19,6-17,6		17,5<

Height of the body
3g.	small ..	108>	107-104	103-93		92-88		87<
vir.	107>	106-102	101-91		90-86		85<
3g.	small ..	109>	108-105	104-96		95-91		90<
6 months.	vir.	108>	107-104	103-94		93-90		89<
4g.	small ..	111>	110-107	106-99		98-94		93<
vir.	110>	109-106	105-98		97-94		93<
4g.	small ..	114>	113-110	109-102		101-97		96<
6 months.	vir.	1IZ\u003e	112-109	108-101		100-96		95<
5 years	small ..	117>	116-113	112-105		104-101		100<
vir.	1I6\u003e	115-113	112-105		104-102		101<
5p.	small ..	120>	119-117	116-108		107-104		103<
6 months.	vir.	120>	119-116	115-108		107-103		Ї02.<
6 years	small ..	124>	123-121	120-112		111-108		107<
vir.	124>	123-120	.119-111		110-107		106<
6 years	small ..	128>	127-124	123-115		114-111		110<
6 months.	vir.	127>	126-123	122-114		113-109		108<
Chest circle
3g.	small ..	59>	58-56		55-50		49-47	46<
vir.	58>	57-55		54-49		48-47	46<

Indicators of the development of children of preschool

Age

1. Methods of research and assessment of the health of children and adolescents

2. Methods of research and assessment of the physical development of children and adolescents

3. Hygienic assessment of the organization of physical education in children's institutions

4. Hygienic foundations of the educational process in children's institutions.

5. Diagnosis of child readiness for school education

6. Hygiene educational process in secondary school

According to WHO (1990), the health status of children is one of the most pressing issues around the world. Its importance is largely due to the progressive deterioration in the state of the environment. The child's body, which is in the development process, is more influenced both favorable and not favorable factors, more quickly and sharply respond to environmental change. When studying the influence of various factors, it is important to determine their complexes of impact, and also to find out how when they are combined, the influence of each factor is modified. The integral result of the environmental impact on the children's population is the level and quality of children's health. The pediatrician must be able to identify these two indicators, determine the state of health dip.

Health is a criterion --------- Relationships of the children's body with the environment. It is formed under the influence of a complex complex of biological, environmental and social factors.

Therefore, for hygienists, the closest in spirit is the definition of health adopted by the WHO charter "Health is a state of complete physical, spiritual and social well-being, characterized by dynamic equilibrium of the body with the environment, as well as the absence of diseases and physical defects in it."

Health, as a measure of vitality, the ability of the body to optimal functioning, is characterized in this case not only by the absence of clinically pronounced symptoms of diseases, but also the lack of initial manifestations, presence of presets, and so-called "small pathology", often at the level of functional, easily reversible changes indicating a decrease in the overall resistance of the body to the effects of adverse environmental factors.

Defaped according to the results of demographic studies of health (morbidity, mortality, disability, etc.) is only the visible vertex of iceberg, the underwater part of which is prepactable (donozological) states, reflecting the stages of movement from health to the disease. The study of these states as the basis for determining the "level" health of a healthy child is the subject of hygienic diagnostics ("hygienic monitoring") studying the environment, health and connection between them. It is the health of the team that acts in this case by the criterion of the donozological diagnosis, the "marker" of the negative impact of the medium per person, the criterion of the effectiveness of all preventive work carried out by the sanitary and epidemiological service authorities.

To bring the primary prevention to the main task - an increase in the life expectancy of people, hygienic diagnostics, having 3 objects of research (health, habitability, their relationship), is designed to identify the stages of health scales

Full health

Practical health

Presense

This is necessary to prevent state transition into various diseases.

The interaction of hygienic diagnostics and dispensarization should be carried out in 4 stages.

Stage 1 - study of the environmental situation, the conditions of life, lifestyle

Stage 2 - Medical Inspection

3 Stage - Wellness Events

4 Stage - Dynamic Dispensary Observation

A comprehensive assessment of the nature of the development and health status of a child requires the obligatory accounting for physical and neuropsychic development, the degree and harmony of the fullness of the functional state of its body.

The presence of methods for diagnosing pre -tological (donozological) states, a quantitative assessment of the depth and the degree of reversibility of these processes, can become the scientific basis of such preventive measures that will correspond to the tasks of primary and secondary prevention. Based on this, prevention becomes not aimed at preventing specific diseases, but to reduce the likelihood of their development as a whole. Allocate the following factors affecting the health of children and adolescents.

Factors for the health of the children's population

| | Social | |

| | Economic | |

| | Conditions | |

| Environment | Heredity | Physical |

| | | Education |

| Food | | |

| Conditions of life | Condition | Day of the day |

| | Health | |

| | Children's | |

| | Population | |

| | Indicators | |

| | Mortality | |

| | incidence | |

| | Disability | |

| | Phys. Development | |

| | | Training Conditions |

| | Medical and Sanitary | |

| | I help | |

It is necessary to pay attention to the role of such factors affecting the formation of health as biological (the age of the mother, the state of its health, the length of the body, the number of childbirth, the mass of the child at birth, the presence of deviations in the act - ---------- - and early postnatal periods, etc. 0 and social (apartment area, pillier income, parental education, public and family education, the day of the day, including sleep duration and outdoor stay).

2. Medical monitoring of the health of children.

One of the most important tasks of a pediatrician doctor is to control the formation and dynamics of the state of health

Control over the dynamics of the state of health is regulated by order of the Ministry of Health of the Russian Federation of 14. 03. 95 No. 60 "On approval of the instructions for conducting preventive inspections of children of preschool and school ages based on medical and economic standards"

Health monitoring is currently carried out on the basis of mass screening tests and is a new principle of organizing in-depth inspections of children and adolescents. It is carried out in several stages:

Stage 1 - survey of all children by screening program, which is carried out in the main medical sister of the children's institution; 7.

2 stage - examination of children made on screening tests, doctor of children's institution;

3 Stage - examination by narrow specialists Polyclinic children aimed at the preschool institution (school) for consultation.

This principle of the organization of the medical examination provides a significant increase in the role of medium honey. Personnel of the children's institution in monitoring the health of children, and also ensures the rational use of working hours of doctors and narrow specialists with differentiated monitoring of the health of children.

Screening program includes:

1. A questionnaire test - poll of parents or students using a special questionnaire. The survey is aimed at identifying anamnestic data and complaints characteristic of changes in the nervous, cardiovascular, digestive, urinary systems, as well as typical of nasopharynx and allergic diseases and states (Appendix 1).

In this questionnaire in the form of simple questions, the main "key" complaints arising from children and adolescents in the presence of deviations in the state of health on leading systems are grouped. When examining preschoolers and students 1-4 classes, the questionnaire fills parents, from grade 5 - students themselves.

The questions are aimed at identifying possible pathology from the nervous system - possible pathology from the cardiovascular system - from the nasopharynx side, - digestive organs, - kidneys, - allergies.

The results of the questionnaire are summarized by the nurse, which marks the sign (+) numbers of questions to which a positive answer is received. After that, the Children's Institution doctor analyzes the survey results and selects children who need survey, and after their inspection, the issue of the need to consult narrow specialists for additional surveys.

2. Individual assessment of physical development on regression scales.

3. Measurement of blood pressure (students of junior classes - taking into account age amendments to a standard cuff) to identify hypertensive and hypotonic states.

The objectification of blood pressure values \u200b\u200bin children is 8-12 years old is achieved only when using the "age" cuffs or additional calculations adjusting to the size of the shoulder circumference of each child, which closely correlates with a mass of the body. The values \u200b\u200bof the amendments, standardized on the basis of the individual assessment of the physical development of children, are shown in Table:

Amendments (in mm Hg. Art.) To the systolic * pressure numbers obtained when measuring with a standard cuff (for children of 8-12 years old with a different body weight)

Table 1

| years) | by | | |

|8 |+ 10 |+ 15 |+ 5 |

|9 |+ 10 |+ 15 |+ 5 |

|10 |+ 10 |+ 15 |0 |

|11 |+ 5 |+ 10 |0 |

|12 |+ 0 |+ 5 |0 |

|13** |0 |0 |0 |

Note: * Figures of diastolic pressure should be considered without amendments, since differences in the value of diastolic pressure when changing standard and age cuffs are insignificant.

** - in children of 13 years and older (regardless of body weight) true figurational pressure numbers when changing standard and age cuffs do not differ.

Blood pressure is measured by the generally accepted method - sitting, on the right hand, after a 10-minute rest, according to the Korotkov method. For greater accuracy, a 3-fold measurement is recommended with fixation of the latter measurement indicators.

Detection of disorders of the musculoskeletal system using a combined visual instrumental study.

Test to identify violations of posture. eight

This test examination is conducted by a children's institution doctor and includes a child's inspection with a response to 10 test card issues (Table 2).

table 2

Test card to identify posture violations

| 1. Explicit damage to the organ movement | yes no |

| Connected congenital vice, | |

| injury, illness | |

| 2. Head, neck rejected from medium | yes no |

| Lines: shoulders, blades, hips | |

| Installed asymmetrically | |

| Chest "shoemaker", | yes no |

| "Deformed" | |

| 4. Excessive decrease or | yes no |

| increase physiological curvature | |

| spine: cervical lordosis, | |

| Breast Kihosa, Lumbar Lordoza | |

| 5. Excessive lag of blades | yes no |

| 6. Excessive abdomen | yes no |

| Violation of the lower extremities axes | yes no |

| (O-shaped, x-shaped) | |

| 8. Inequality triangles waist | yes no |

| 9. Valgus's heel or | yes no |

| Both heels | |

| 10. Explicit deviation in gait | yes no |

The survey is carried out in the following order:

Inspection in the FAS. Position - hands along the body. The shape of the legs, the position of the head, neck, the symmetry of the shoulders, the equality of the waist triangles (triangle of the waist is the lumen of the triangular shape between the inner surface of the hand and the torso, from the top of the triangle at the level of the waist, in the norm, triangles should be the same in shape and equal in size) .

Inspection on the side. Position - hands along the body. The shape of the chest, abdomen, the speech of the blades, the form of the back is determined.

Inspection from the back. Position - hands along the body. The symmetry of the corners of the blades, the form of the spine, shape of the feet, the axis of heels (Valgus, Vius, Normal) are determined.

At the end of the examination, the child is invited to make several steps to identify possible disorders in the gait.

In the process of inspection, a test card is filled, according to which the revealed posture disorders is evaluated:

· Normal assessment - negative answers to all questions

· Some deviations that require the observation of the school and preschool pediatrician - positive answers to one or more questions from 3 to 7 numbers inclusive

· Significant posture violation - positive answers to 1, 2, 8, 9, 10 questions (one or more). Children assigned to this group are subject to the obligatory direction to the orthopedist.

Test to identify true scoliosis.

True scoliosis includes only those that are accompanied by a torsion, or by turning the spine relative to the axis, in which the spinner vertebral processes evaporate into one direction or another side from the middle strip, forming the convexity visible when the body is tilted.

The main reception to identify true scoliosis is considered to be inspected with the bending of the spine and the slope of the body forward: the slope of the body is carried out slowly, while the hands are free to hang down, the legs are straightened. In the presence of scoliosis, asymmetric ribrane is determined in the thoracic and muscular roller in the lumbar department.

For more accurate detection of caring, the verteons should be inspected in two positions: in front and rear.

When examining from behind (the child stands back to the doctor), tilting the body of the child from herself, you can reveal a torsion of spines in the breast-purpose spinal departments.

Test for detecting flatfoot - Plantography

Detection of premiecia using the test A. A. Malinovsky

This test is applied in preschoolers at the age of 6 years and students of 11 classes.

Typically, the examination of the visual acuity carried out on the special diagnostic tables of the Sivzian-groove, reveals mainly the existence of an already developed pathology of vision. Test A. A. Malinovsky allows you to identify children with predisposition to myopia.

Detection of premiecia using the test A. A. Malinovsky includes 2 research stages.

· Determination of visual acuity (according to the generally accepted method)

· Detection of children with premiecia among the contingent with normal urgency.

Survey method: After determining the usual method of visual acuity, lenza is brought to the eye with normal sharpness, the force of which corresponds to the average refraction of the eye for children of this age, and the acuity of sight is again determined (by the generally accepted way according to the alphabet table, the child sits on a chair at a distance of 5 m From the table (each eye is examined separately, when the shield is closed with another eye. For testing, the lenses are used + 1.0 d in children's frame, with a distance between optical

Rating results:

t Child, looking through the lens, reads the right 9-10 line of the table - Test deny

t Child, looking through the lens, can not correctly read the letters of 9-10 lines or in general to distinguish them - the test is positive (strengthening age refraction - pre-optical state)

Children with pre-reference are considered as a "risk group" in myopia, since they are 80 times more likely than the rest develops myopia. These children should be sent to an ophthalmologist for special observation and periodic control. The examination of the Malinovsky test holds a nurse of a children's institution. Children with a negative test of the Malinovsky study of visual acuity at school can be held 1 time in 3 years, i.e. in 4-7-10 classes. Test to identify violations of color vision (for schoolchildren).

Coloring violations plays a role in choosing a profession (driver, apparatchik, etc.), and having often hereditary character, more often detected in boys.

For the study of color view, special polychromatic tables of Rabkina are used. In these tables from the circles of different colors, but the same distinguished persons with normal color vision.

For use, only I-XIII polychromatic tables are used (the first series is the main one). The study is carried out with natural light (the surveyed sits back to the window, the researcher - face to the window). Tables are presented vertically from a distance of 1 m to 5-6 seconds. Each.

Evaluation of results: Incorrect difference of even individual tables - an anomaly of color vision. The schoolboy is sent for advice to the ophthalmologist.

Color view study is carried out in the 4th grade of the school on the eve of the vocational guidance selection.

Laboratory screening tests for the detection of screening proteinuria and glucose.

The protein and glucose in the urine are determined by the nurse of the children's institution with the help of special diagnostic jet strips, to change the color of which they judge the presence and even approximate concentration of them in the urine.

All children with traces of protein in the urine are sent for an additional examination to identify the causes of proteinuria, and with glucose traces in the urine for consultation to the endocrinologist.

Improving the quality and informativeness of medical examinations is also achieved by the preliminary holding of laboratory research to all children: the general analysis of blood and feces on the eggs of worms (no more than 2-3 weeks before the inspection), but today these recommendations are only wisp.

The program of medical examinations of schoolchildren includes a functional test of the cardiovascular system with a load to determine the degree of its training and a possible load in physical culture and sports. Children 8-10 years old with the form of load are offered 20 squats, 10-11 years 25 squats, boys 12-14 years old - 30 squats in 30 seconds.

Depending on the nature of the shifts after functional samples, the favorable and unfavorable reaction of the cardiovascular system is distinguished.

A favorable reaction is considered to be the increase in pulse in the range of 50-70% of the initial level, an increase in systolic pressure by 10-15 mm, a moderate increase in pulse pressure by 20-35 mm and the restoration of all indicators within 2-3 minutes.

An unfavorable reaction is considered significant (more than 70%) the increase in the pulse, a decrease in systolic and pulse pressure compared with the initial level, or a sharp increase in systolic pressure (by 25-40 mm or more) against the background of increasing diastolic, during a slow recovery period. Reducing the pulse rate and systolic pressure during the recovery period (2-3 minutes) below the source data is also considered as an unfavorable reaction.

3. Comprehensive assessment of the health of children and adolescents. Criteria and health groups.

A comprehensive assessment of the health status of children was introduced by order of the Ministry of Health of the Russian Federation No. 60 of January 19, 1983 "On the further improvement of outpatient polyclinic assistance to the children's population in cities", is given on the basis of accounting for the results of medical examination and current monitoring of the child, by analyzing the 4 main health criteria :

The presence or absence at the time of the examination of chronic diseases and the degree of their clinical manifestations;

The functional state of the main organs and systems: cardiovascular, respiratory, blood, nervous, etc. The resistance of the body, manifested by the number and duration of the diseases in the previous course of the medical examination year;

The level of physical and neuropsychic development and the degree of their harmony.

In accordance with the specified criteria, each individual is determined by the health group.

Table 3.

Distribution of health groups surveyed

| | | | Easy | age |

| | | deviations

| Long | Determinated (2 |

| | | (low | E sharp | Art.) | eleven

| | | | etc. | Esky |

Children I have a group of health are observed by a doctor during normal deadlines set for preventive medical examinations of healthy children.

Children II Health Groups ("Risk Group") are observed by a doctor in terms set for each child, in accordance with the degree of risk in relation to the formation of chronic pathology, the severity of functional relations and the degree of resistance.

Frequently ill children, children who have suffered acute pneumonia, Botkin's disease, etc. Although they belong to the II group of health, in the reconvaluation period, they are taken on the dispensary accounting by f. No. 30.

Children III, IV, V groups are taken on dispensary accounting by f. No. 30 and the procedure for their medical care is determined by special guidelines (M. 1968, 1974, Kharkov, 1982; Frunze, 1985).

According to the results of assessing the state of health, the level of physical development and physical fitness, the surveyed persons stand out in medical groups,. regulating their classes at the rate of physical education. The medical characteristics of these groups is provided in Table 4. When removing the medical group, the doctor must answer the following questions:

Could the examiner to fulfill the requirements imposed by training programs on physical education, or does it require restrictions and what?

Does the examined in the classroom exercise with the medical goal (corrective gymnastics, etc.) need it?

Can a surveyed study in sports sections, participate in training activities and competitions in which subjects under what conditions.

Table 4.

Groups for classes at the rate of physical education

| Naeameov | Allowed Events | Medical |

| Nie | | Group characteristics |

| Groups | | |

| Main | Program Classes | Persons without deviations in |

| | physical education in | physical development, |

| | full | health condition, a |

| | Roma Roms, GTO I, | Also Persons with |

| | GTO II Steps | Minor |

| | consistently. | Deviations are able |

| | Classes in one of | Health, but with |

| | Sports sections (general | sufficient physical |

| | physical training, | preparedness. |

| | Athletics | |

| | Gymnastics, etc.), | |

| | Participation in Competition for | |

| | one sport. | |

| Prepare | 1. Program classes | Persons having |

| Telny | Physical Education at | Minor deviations |

| | Conditions are more gradual | in physical development and |

| | passing them with deferred | health condition without |

| | Control | sufficient |

| | Tests and Norms of BGTO, GTO | Physical |

| | I steps for up to 1 | preparedness. |

| | year, passing the rules of the GTU II | |

| | Steps with special | |

| | Permissions of the doctor. | |

| | 2. Classes in the general section | |

| | physical training. | |

| Special | Persons on special | Persons having |

| Aya | Program or separate | Significant deviations in |

| | types of state | state of health |

| | programs, and term | permanent or |

| | preparation is lengthened, a | of a temporary nature, not |

| | Standards are reduced | Mumbling performance |

| | | regular program |

| | | Production work, |

| | | But being |

| | | Contraindication to |

| | | Traditional |

| | | State |

| | | Programs in General |

| | | Groups. |

To prohibit physical education classes, the doctor must in extreme cases when he doubts their benefits and success. Depending on the state of the child's health, the doctor after consultation with specialists appoints specific types of exercises, determines their duration and carries out systematic observation of the reactions and health of children. 13

Literature

1. Hygiene of children and adolescents ed. V. N. Kardatathenko - M. - Medicine - 1980 - s. 41-115

2. Guide to Laboratory Laboratory Hygiene Dip - Ed. V. N. Kardashenko - M., Medicine - 1983 - P. 7-51

Observation of the physical development of children

Weighing children up to one year in preschool institutions is carried out every 10 days, from 1 to 3 years - once a month.

These descriptive features are assessed by severity as "small", "medium", and "big".

	boys		girls		pulse	breath	hell
	weight	height	weight	height	pulse	breath	hell
1 year	11,5-13,8	82-87	11,7-13,5	80-87	120-125	35
2 year old	12-14	85-92	11,8-14,0	82-90	110-115
3 year	13,8-16	92-99	13,6-16	91-99	105-100	28
4 year	15,8-18,5	98-107	14,5-17,5	95-108	100-106
5 years	17,6-21,7	105-116	16,9-19,9	98-112	100
6 years	19,6-24,2	111-121	18,8-23,8	111-116	90-96	26
7 years	21,6-28,2	118-139	21,8-27,4	118-129	85-90
8 years					80-87
9 years					80-85
10 years					78-75	20
12 years					75-72
13 years					72-82
14 years					72-76	17

			Level of physical development
					Above medium average			Below the average
1	2		3		4 5			6		7
						Body mass
		18,7>		18,6-17,3		17,2-14,1	14,0-12,6		12,5<
				18,4-16,9		16,8-13,8	13.7-12,4		12,3<
		19,1>		19,0-17,8		17,4-14,7	14,6-13,1		13,2<
		18,7>		18,6-17,7		17,6-14,2	14,6-13,3		12,9<
		19,6>		19,5-18,3		18,2-15,3	14,1-13,0		13,8<
		18,9>		18,8-17,5		17,4-14,7	15,2-13,9		13,5<
				21,1-19,7		19,6-16,0	14,6-13,6		14,3<
		20,4>		20,3-18,3		18,2-15,7	15,9-14,4		14,1<
		22,9>		22,8-21,0		20,9-16,8	15,6-14,2		14,8<
		21,9>		21,8-20,2		20,1-16,6	16,7-14,9		14,9<
		23,9>		23,8-22,1		22,0-18,1	16,5-14,9		16,1<
		23,8>		23,7-21,8		21,7-17,6	18,0-16,2		15,5<
		25,0>		24,9-23,2		23,1-19,5	17,5-15,6		17,5<
		25,9>		25,8-23,5		23,4-18,6	19,4-17,6		16,1<
		26,7>		26,6-24,7		24,6-20,3	18,5-16,2		18,2<
		27,5>		27,4-24,9		24,8-19,7	19,6-17,6		17,5<

				Height of the body
















			Chest circle

Indicators of the development of children of preschool

Age

1. Methods of research and assessment of the health of children and adolescents

2. Methods of research and assessment of the physical development of children and adolescents

3. Hygienic assessment of the organization of physical education in children's institutions

4. Hygienic foundations of the educational process in children's institutions.

5. Diagnosis of child readiness for school education

6. Hygiene educational process in secondary school

Health is a criterion --------- Relationships of the children's body with the environment. It is formed under the influence of a complex complex of biological, environmental and social factors.

Full health

Practical health

Presense

This is necessary to prevent state transition into various diseases.

The interaction of hygienic diagnostics and dispensarization should be carried out in 4 stages.

Stage 1 - study of the environmental situation, the conditions of life, lifestyle

Stage 2 - Medical Inspection

3 Stage - Wellness Events

4 Stage - Dynamic Dispensary Observation

Factors for the health of the children's population

| | Social | |

| | Economic | |

| | Conditions | |

| Environment | Heredity | Physical |

| | | Education |

| Food | | |

| Conditions of life | Condition | Day of the day |

| | Health | |

| | Children's | |

| | Population | |

| | Indicators | |

| | Mortality | |

| | incidence | |

| | Disability | |

| | Phys. Development | |

| | | Training Conditions |

| | Medical and Sanitary | |

| | I help | |

2. Medical monitoring of the health of children.

One of the most important tasks of a pediatrician doctor is to control the formation and dynamics of the state of health

Stage 1 - survey of all children by screening program, which is carried out in the main medical sister of the children's institution; 7.

2 stage - examination of children made on screening tests, doctor of children's institution;

3 Stage - examination by narrow specialists Polyclinic children aimed at the preschool institution (school) for consultation.

Screening program includes:

The build fortress is also 100% of boys and 100% of girls 2-6 years old have a very weak physique. Such low values \u200b\u200bof the indicators are shown to the low development of children of preschool age, which can be caused by the action of numerous factors. In the future, continue further study of anthropometric parameters from schoolchildren 7-16 years old to establish the physical status of the school and ...

This adaptive norm is transmitted from generation to generation. Thus, the variability of the whole complex of mutually related signs is controlled. Consider this on the example of the physical development of children of preschool and junior school age, relating to various groups of the indigenous and old-timing population of the North of Russia. According to T.V. Chryry, kids kantov aged 3-7 years ...

Mastering engine skills that can navigate in the surrounding, actively overcome the emerging difficulties that manifests the desire for creative search. The theory of physical education of preschool children is continuously developing and enriched with new knowledge gained as a result of studies covering the diverse sides of the child's education. Research data, ...

Observation of the physical development of children

It is known that physical development along with other indicators of children is a significant indicator of the state of the health of children. The state of physical development depends on the innate features, as well as on environmental conditions, the organism is growing and formed in the coaster. To conduct examination of the physical development of children, in particular anthropometry, prepared medical workers should be allowed, since the technician and methods of anthropometric measurements require certain knowledge and practical skills.

The measurement of the children of the first year of life is carried out in the position lying horizontal growth. The child is placed on his back in such a way that the head is tightly touched by a painter to a lipstick of the register. The head is installed in a position in which the lower edge of the orphanage and the top edge of the ear goat are located in one vertical plane. The assistant fits the baby's head tightly. Legs should be straightened by a slight presses of the left hand on the baby's knees. The right hand under-water the movable bar of the growth is tightly to the heels, bending the feet to a straight corner. The distance between the stationary and sub-vitone plank will correspond to the growth of the child.

Growth measurement in children over a year is held in the standing position by Rostometer. The child becomes on the platform of the rodtomer with a vertical rack, in a natural, straightened position, touching the vertical rack heels, buttocks, an interco-daca region and a population, hands are omitted along the body, heels together, spokes apart. The head is set in a position in which the lower edge of the orphanage and the top edge of the ear goat on-go in one horizontal plane. The movable bar is applied to the head without pressing.

The determination of body weight in young children is carried out on scales with the maximum allowable load to 20 kg. Initially, the diaper is weighed. It is placed on the tray of the scales, so that the edges of the diaper do not breathe from the tray. The child is placed on a wide part of the tray head and a shoulder belt, legs on a narrow tray. If the child can be planted, it is planted on a wide part of the tray with buttocks, legs on a narrow part. It is possible to play a child on the scales and removes with them only when the scale of the scales is closed, standing is not on the side, but right on the side of the core-thoughts of the scales. Weight readings are counted on the side of the weights where there are notches or cutting (the lower girc need to be inserted only to the on the bottom, the score of the notches). After recording weight, the weights are put on zero. To determine the weight of the child, it is necessary to subtract the weight of the diaper from the testimony of the scales.

Weighing children up to one year in preschool institutions is carried out every 10 days, from 1 to 3 years - once a month.

The measurement of the busty circumference is made by a centimeter rubberized ribbon in a state of quiet respiration (pause, and older children when inhaling and exhale). The ribbon imparts is rear - at the corners of the blades, and in front - at the level of the bottom edge of the nipples.

In addition to anthropometric measurements, the muscle tone, tutor tours, the nature of grease, etc., is noted, etc. Determine the thickness of the subcutaneous layer should not be on a single site, but in various places (on the chest - between the nipple and sternum, on the stomach - at the level The navel, on the back - under the blades, on the limbs - on the outer surface of the thigh and shoulder, on the face - in the cheek area). Depending on the thickness of the subcutaneous layer, they talk about the normal, excess and insufficient deposition of fat. Attention is drawn to uniform (throughout the body) or uneven distribution of the subcutaneous layer.

The definition of a soft tissue turgora is carried out by squeezing with large and index fingers of the right hand of the skin and
all soft tissues on the inner surface of the hip and shoulder, with all this perceived the feeling of resilience or elbow, called the tour. If the tour is reduced, then the feeling of lethargy or decrees is determined.

These descriptive features are assessed by severity as "small", "medium", and "big".

The lag in physical development may be due to a number of reasons that need to identify a preschool doctor. The hereditary constitutional factor has a certain meaning. More often the cause of unsatisfactory physical development is chronic infections and inxica, primarily rheumatism, tonsilogenic cardiopathy, chronic pyelonephritis, hypothyroid nanism. On the launch can only be said if the growth rate is more than 10% lower than the standard.

age	boys

age		Level of physical development
		Tall	Above medium average	Below the average	low

				Body mass
	small ..l.

3 g.	mal..
6 months.


	mal..	21,2>
6 months.	vir..
	mal...

	mal...
6mis.
	mal...


6 months..

				Height of the body
	small ..

	small ..
6 months.
	small ..

	small ..
6 months.		1IZ\u003e
	small ..
		1I6\u003e
	small ..
6 months.					Ї02.<
	small ..
				.119-111
	small ..
6 months.
			Chest circle
	small ..

Indicators of the development of children of preschool

Age

1. Methods of research and assessment of the health of children and adolescents

2. Methods of research and assessment of the physical development of children and adolescents

3. Hygienic assessment of the organization of physical education in children's institutions

4. Hygienic foundations of the educational process in children's institutions.

5. Diagnosis of child readiness for school education

6. Hygiene educational process in secondary school

Health is a criterion --------- Relationships of the children's body with the environment. It is formed under the influence of a complex complex of biological, environmental and social factors.

Full health

Practical health

Presense

This is necessary to prevent state transition into various diseases.

The interaction of hygienic diagnostics and dispensarization should be carried out in 4 stages.

Stage 1 - study of the environmental situation, the conditions of life, lifestyle

Stage 2 - Medical Inspection

3 Stage - Wellness Events

4 Stage - Dynamic Dispensary Observation

Factors for the health of the children's population

| | Social | |

| | Economic | |

| | Conditions | |

| Environment | Heredity | Physical |

| | | Education |

| Food | | |

| Conditions of life | Condition | Day of the day |

| | Health | |

| | Children's | |

| | Population | |

| | Indicators | |

| | Mortality | |

| | incidence | |

| | Disability | |

| | Phys. Development | |

| | | Training Conditions |

| | Medical and Sanitary | |

| | I help | |

2. Medical monitoring of the health of children.

One of the most important tasks of a pediatrician doctor is to control the formation and dynamics of the state of health

Health monitoring today is carried out on the basis of mass screening tests and is a new principle of organizing in-depth inspections of children and adolescents. It is carried out in several stages:

Stage 1 - survey of all children by screening program, which is carried out in the main medical sister of the children's institution; 7.

2 stage - examination of children made on screening tests, doctor of children's institution;

3 Stage - examination by narrow specialists Polyclinic children aimed at the preschool institution (school) for consultation.

Screening program includes:

2. Individual assessment of physical development on regression scales.

3. Measurement of blood pressure (students of junior classes - taking into account age amendments to a standard cuff) to identify hypertensive and hypotonic states.

Amendments (in mm Hg. Art.) To the systolic * pressure numbers obtained when measuring with a standard cuff (for children of 8-12 years old with a different body weight)

Table 1

| years) | by | | |

|8 |+ 10 |+ 15 |+ 5 |

|9 |+ 10 |+ 15 |+ 5 |

|10 |+ 10 |+ 15 |0 |

|11 |+ 5 |+ 10 |0 |

|12 |+ 0 |+ 5 |0 |

|13** |0 |0 |0 |

Note: * Figures of diastolic pressure should be considered without amendments, since differences in the value of diastolic pressure when changing standard and age cuffs are insignificant.

** - in children of 13 years and older (regardless of body weight) true figurational pressure numbers when changing standard and age cuffs do not differ.

Detection of disorders of the musculoskeletal system using a combined visual instrumental study.

Test to identify violations of posture. eight

This test examination is conducted by a children's institution doctor and includes a child's inspection with a response to 10 test card issues (Table 2).

table 2

Test card to identify posture violations

| 1. Explicit damage to the organ movement | yes no |

| Connected congenital vice, | |

| injury, illness | |

| 2. Head, neck rejected from medium | yes no |

| Lines: shoulders, blades, hips | |

| Installed asymmetrically | |

| Chest "shoemaker", | yes no |

| "Deformed" | |

| 4. Excessive decrease or | yes no |

| increase physiological curvature | |

| spine: cervical lordosis, | |

| Breast Kihosa, Lumbar Lordoza | |

| 5. Excessive lag of blades | yes no |

| 6. Excessive abdomen | yes no |

| Violation of the lower extremities axes | yes no |

| (O-shaped, x-shaped) | |

| 8. Inequality triangles waist | yes no |

| 9. Valgus's heel or | yes no |

| Both heels | |

| 10. Explicit deviation in gait | yes no |

The survey is carried out in the following order:

Inspection on the side. Position - hands along the body. The shape of the chest, abdomen, the speech of the blades, the form of the back is determined.

At the end of the examination, the child is invited to make several steps to identify possible disorders in the gait.

In the process of inspection, a test card is filled, according to which the revealed posture disorders is evaluated:

· Normal assessment - negative answers to all questions

· Some deviations that require the observation of the school and preschool pediatrician - positive answers to one or more questions from 3 to 7 numbers inclusive

· Significant posture violation - positive answers to 1, 2, 8, 9, 10 questions (one or more). Children assigned to this group are subject to the obligatory direction to the orthopedist.

Test to identify true scoliosis.

The main reception to identify the true scoliosis is considered to be inspected with the bending of the spine and the slope of the body forward: the slope of the body is carried out slowly, with all this hands freely hang down, legs straightened. In the presence of scoliosis, asymmetric ribrane is determined in the thoracic and muscular roller in the lumbar department.