5. Indicators of physical development of children. Centile method for assessing physical development Given the observed variation in various indicators of a child's physical development, you need to know the so-called normal, or Gauss-Laplace distribution.

II. Features of physical development 1. A pronounced lag in physical development, which impedes the implementation of exercises and standards, provided by the curriculum; a sharp disproportion between the length of the limbs and the body. 2. All kinds of deformations of the upper

Methods for assessing the correct development of a premature baby and twins You can use the following two methods in order to check if your premature baby is lagging behind a full-term baby in development as it should normally, or

Methodology for the study of the physical development of children Anthropometric examination and determination of the degree of physical development according to its assessment tables (standards) is the responsibility of the paramedical worker and educator, and their interpretation is the responsibility

Appendix 2 Indicators of physical and neuropsychic development of children. Calendar of preventive vaccinations 1. Calendar of preventive vaccinations (from the order of the Ministry of Health of Russia dated 18.12.1997, No. 375) 2. Physical development of children Centile scales for the distribution of children by

Approximate norms of physical and psychomotor development of children in the first year of life Tatyana Ignatieva, Irina Nazirbekova Age: (from the first breath to 28 days) - newborn. Physical parameters: height 46–55 cm; weight 2600–4500 g. Psychomotor development: flexor posture.

Appendices 1 Results of the analysis of the physical development of seven-year-old children of Krasnoyarsk In the conditions of a deep demographic crisis, it is necessary to pay special attention to the upbringing of the younger generation. Physical development indicators are one of the main parameters

Normally, after physical exertion, the heart rate increases by 25-50% in relation to the initial value, and respiration - by 4-6 units. per minute.

In this case, the indicators should return to their original values ​​in 2-3 minutes.

Abnormalities are considered to be an increase in heart rate by more than 50% and a more significant increase in respiration rates.

The most common test for assessing physical performance is the step test (climbing a step or gymnastic bench up to 35 cm high). Children are offered two loads of increasing power - lifting on a bench with ascent frequencies 20 and 30 times per minute.

Duration of each load2 minutes and rest 3 minutes in between.

An increase in heart rate by 15-20% at the first load and by 45-60% at the second load in relation to the initial level corresponds to the norm.

Diagnostics of individual aspects of physical development is important for identifying the characteristics of a child's development, the selection of an individual strategy for working with him.

Endurance is the ability to resist fatigue in any activity. Endurance is determined by the functional stability of the nerve centers, the coordination of the functions of the motor apparatus and internal organs.

Endurance can be assessed by the result of continuous running at a uniform pace: for a distance of 100 m - for children 4 years old; 200 m - for children 5 years old; 300 m - for children 6 years old; 1000 m - for children 7 years old. The test is considered completed if the child has run the entire distance without stopping.

Quickness is the ability to perform motor actions in the shortest possible time, which is determined by the speed of reaction to a signal and the frequency of repetitive actions. Running 30 meters is suggested as a test exercise. The length of the treadmill should be 5-7 m longer than the length of the track. The finish line is drawn from the side with a short line, and behind it, at a distance of 5-7 m, a landmark (a flag on a stand, a cube) that is clearly visible from the start line is placed in order to avoid the child slowing down at the finish line. At the command “start, attention” the flag is raised, and at the command “march” the child strives to reach the finish line with maximum speed. After resting, you need to offer the child two more attempts. The best result out of three attempts is recorded in the protocol.

Strength is the ability to overcome external resistance, the ability to muscle tension. The manifestation of strength is provided primarily by the strength and concentration of the nervous processes that regulate the activity of the muscular apparatus. Arm strength is measured with a hand-held dynamometer, leg strength - with a dead-end dynamometer. Shoulder strength can be measured by the distance the child throws a 1 kg medicine ball with both hands, and the strength of the lower limbs is determined by the long jump from the spot. It should be noted that both the jump and the medicine ball throw require not only significant muscular effort, but also speed of movement. Therefore, these exercises are called speed-strength exercises. Medicine ball throwing weighing 1 kg is carried out in a way from behind the head with two hands. The child makes 2-3 throws; the best result is recorded.

More difficult tasks for the child are high and long jumps with a running start. These movements require a complex display of speed, strength and dexterity.

Agility can be assessed by the results of running at a distance of 10 m; it is defined as the difference in time during which the child runs this distance with a turn (5 + 5 m) and in a straight line. The child should be given two attempts, with a rest break in between. To increase the interest and effectiveness of actions, the task is best performed in a competitive environment.

Preschoolers 3-7 years old also perform with interest another, more difficult task, which is called "Obstacle Course". This task includes: running on a gymnastic bench (length 5 m); rolling the ball between objects (6 pcs.), laid out at a distance of 50 cm from each other (pins, stuffed balls, cubes, etc.); crawling under the arc (height 40 cm). Each child is given three attempts, the best result is counted.

Flexibility is a morphofunctional property of the musculoskeletal system, which determines the degree of mobility of its links. Flexibility characterizes the elasticity of muscles and ligaments. Flexibility is evaluated using the exercise - bending forward, standing on a gymnastic bench or other object with a height of at least 20-25 cm. To measure the depth of the inclination, a ruler or bar is attached in such a way that the zero mark corresponds to the level of the support plane. If the child does not reach the zero mark with his fingertips, then the result is determined with a minus sign. When performing the exercise, the legs at the knees should not bend

Ministry of Education of the Republic of Belarus

Francisk Skaryna Gomel State University

Department of Theory and Methods of Physical Culture

Course work

Physical development and functional state of preschool children

Gomel 2012

Coursework 37 pages, 2 tables, 8 annexes, 18 sources.

Key words: monitoring, diagnostics, physical development, functional state, method, research, assessment, anthropometry, standards, indices, correctional work, correction, posture, flat feet, weight, height, chest circumference. Research object: preschool children. Subject of research: diagnostics, correction of physical development and functional state of preschool children. Research methods: analysis of scientific and methodological literature. The purpose of the course work: to study the diagnosis of physical development and functional state of preschool children. Coursework objectives:

1. Expand the concept and meaning of diagnostics of physical development and functional state of preschool children.
2. Define and reveal research methods, methods for assessing the physical development of preschool children.
3. Consider research methods and methods for assessing the functional state of preschool children.
4. To characterize the correctional work with children with disabilities in physical development and to reveal programs for the correction of various deviations in physical development.

Conclusions: diagnostics of the physical development and functional state of preschool children is an integral part of monitoring work to protect the life and health of children in a preschool institution. Practical significance: these materials can be used for familiarization by students of the Faculty of Physical Education, heads of physical education, teachers and medical workers of preschool institutions.

Introduction

1.1 Allocation of functional responsibilities during diagnostics

2.1 Methods for the study of physical development

2.3 Methods for assessing the physical development of children

3.2 Research and assessment of the state of the respiratory system

4. Correctional work with children with disabilities

4.2 Body weight correction program

4.3 Short stature correction program

4.4 Chest circumference correction program

Conclusion

1. Diagnostics of physical development and functional state as part of monitoring to improve the health of preschoolers

Health is one of the main conditions for the full physical and mental development of a child. / 1 / The concept of "health" includes not only the absence of any diseases, but also the good functioning of various physiological systems, as well as the harmony of physical development. /5/

One can speak about the quality of preschool education only when health-preserving and health-strengthening components are present in it.

Preschool education is designed to create the most favorable conditions for the health and harmonious development of the child.

The best prevention in work is the timeliness of psychological and pedagogical monitoring of the organization of work to protect the life and health of children.

Psychological and pedagogical monitoring is a complex process that includes a system of interrelated specific types of activities of participants in the educational process, which perform various functions necessary for the operational tracking of the results of pedagogical influences and the environment of the institution on health, physical and mental development.

The purpose of psychological and pedagogical monitoring: timely correction of recreational and educational activities, environmental conditions to prevent possible adverse effects on the development of children.

Teachers, educational psychologists, medical workers build an individual picture of the psychophysical development of a child. /4/

These indicators are necessary for the educator to predict the "nearest zone" of health, physical and motor development of each of the children, and also in order to properly organize the process of physical and mental stress in motor-play and educational activities. The preschooler's body is just being formed, therefore it needs special careful handling. You cannot miss any deviations in development or underestimate the child's capabilities, since not only physical, but also general development largely depends on this. / 2 /

Educators and leaders of physical education of preschool institutions should take into account that rapid growth and development, maturation of morphological and functional structures determine the high plasticity of the child's body, which is very sensitive to both positive and negative environmental influences. Moreover, the influence of even weak stimuli that do not cause visible reactions does not always go unnoticed. They change the functional properties of body tissues, and against this background, a seemingly harmless environmental factor can become destructive in certain critical periods, lead to a longer and unfavorable course of acute diseases, that is, not only affect the child's health at the moment , but also to determine the course of its further development in the future.

The most important factor determining the effectiveness of the process of physical education of preschool children is diagnostics, which makes it possible to assess the initial physical state of the child in order to determine the nearest prospects for its optimization. Based on the analysis of the diagnostic results, it is planned to carry out physical culture and health-improving work in the kindergarten and monitor its effectiveness. / 3 /

Diagnostics is not an end in itself. It is inextricably linked with correction, the content of which is determined by the deviations from the norm identified in the process of diagnostics, determined by the physical development of the participants in the pedagogical process. The main purpose of pedagogical diagnostics is to create optimal conditions for the life and activity of each child on the basis of differentiation. An objectively compiled diagnostic card is a kind of individual program, or a plan for the individual development of a child.

The main directions of diagnostics:

-assessment of the health status of children;

-determination of the level of motor development;

assessment of physical development. / 2 /

1.1Distribution of functional responsibilities during diagnostics

The kindergarten doctor and specialists of a narrow profile invited from the polyclinic assess and predict the health of children, develop recommendations for educators. / 2 /

The presence or absence of diseases in a child is determined by medical specialists. The functional state of organs and systems is revealed by clinical methods using special tests, if necessary. / 3 /

The nurse evaluates the harmony of physical development, differentiates children into groups for correctional work.

The head of the kindergarten is the main organizer of the diagnostic work: she creates the conditions for its successful implementation, if necessary, takes a direct part, conducts final workshops in groups. Together with the deputy for the main activity, doctors and educators, he analyzes the results obtained, on this basis, coordinates the future in the work of the teaching staff and service personnel. / 2 /

1.2 Forms of control over physical development

A) Determination of the level of physical development:

-by external signs;

-by anthropometric indicators;

B) Dynamic monitoring of the state of health of children (performed by doctors).

C) Control over the sanitary and hygienic condition of the places of employment (gym, group room, sports ground).

D) Observation of a rational motor regime:

-the impact of forms of work on the child's body;

control over the implementation of hardening activities.

E) Sanitary and educational work among parents. /eight/

2. Diagnostics of the physical development of preschool children

Physical development is a complex of functional and morphological properties of an organism, which determines the stock of its physical strength. For children and adolescents, it should be expanded taking into account those biological processes that are most characteristic of the child's body, namely, its growth and formation.

The purpose of studying the physical development of children should be mainly to establish the correctness of these biological processes, so that, in the event that deviations of individual individuals are ascertained, measures can be taken to eliminate or reduce them with the help of appropriate environmental factors. / 6 /

Physical development is understood as a set of morphological and functional properties of an organism that characterize the processes of its growth and development. When studying physical development, not only the morphological and functional properties of the body are examined, but also the level of biological development of the child: the formation of teeth, motor skills, speech and growth processes. Diagnostics is used to assess the initial state of the child's body in order to determine the "closest zone" of his health, create conditions for building up the fundamental capabilities of systems and organs, developing vital motor skills and accordingly build a daily regimen and select hardening agents, ensure the optimal physical and mental stress in motor and educational activities. /eight/

The frequency of examination of children is determined by the pace of their physical development. Children of the first year of life are examined once a month, from 1 to 3 years - once every 3 months, from 3 to 7 years - at least once every six months. Depending on the medical indications, children who are weakened and lagging behind in physical development are examined more often. / 3 /

1.2 Methods for the study of physical development

The main methods for studying physical development are external examination (self-examination) and anthropometry. / 6 /

Anthropometry.

The main anthropometric indicators of physical development are body length, body weight, chest circumference and muscle strength. / 7 /

When carrying out anthropometric measurements, it is necessary to use only special standard instruments, strictly observe the official unified methodology. Measurements should be taken on an empty stomach or after a light breakfast. / 6 /

Height (body length) is one of the main indicators of a child's physical development. / 9 / Body length is the most stable indicator characterizing the state of plastic processes in the body. Body length in preschoolers is one of the criteria for the level of somatic maturity, and is also the basis for the correct assessment of body weight and chest circumference. / 7 /

Height is measured using a standard stadiometer in a standing position. The height rod is touched with 3 points: shoulder blades, buttocks, heels. The measurement is carried out in the morning, at least 2 times a year. The height of the body in the evening may be less due to the compression of the intervertebral discs and muscle relaxation due to fatigue by the end of the day. /nine/

Body weight reflects the degree of development of the bone and muscular systems, internal organs, subcutaneous fatty tissue. / 7 / Body weight is determined on a proven medical scale. / 6 / Measurement of body weight of children over 3 years old is performed while standing on a floor scale, on an empty stomach, after urination and bowel movement. The baby must be nude when weighed it in.

Measuring the circumference of the chest gives an indication of the development of the chest, chest and back muscles. The measurement of the circumference of the child's chest is performed using a measuring tape in a state of calm breathing, from 2 to 7 years old with outstretched arms with calm breathing. On the back, a measuring tape is applied at the lower corners of the shoulder blades, in front at the level of the nipples. /nine/

Measurement of muscle strength is carried out using dynamometers: wrist, backbone at the same time - in the morning. / 9 / The strength of the muscles of the hand is measured with a wrist dynamometer, the strength of the muscles of the extensors of the back - with a back dynamometer. / 6 / When measuring the strength of the muscles of the hand, the hand should be set aside (at shoulder level), the dynamometer is squeezed with maximum effort without jerking. Make 2 measurements with each hand, record the best result. /nine/

Anthropometric measurements complement the data of external examination, allowing you to more accurately determine the level of physical development.

Somatoscopy.

External examination (somatoscopy) assesses posture, condition of the musculoskeletal system. / 6 /

Posture is the usual posture of a person (his demeanor) in a standing and sitting position. It is usually assessed in a standing position. When determining the posture, the examinee should stand at ease, without straining the muscles. / 6 /

The ability and inability to properly hold your body affects not only the appearance of the child, but also the state of his internal organs, his health. Posture is formed as the child grows.

It is customary to call the correct posture the usual posture of a relaxed standing person, with slight natural bends of the spine: in the cervical and vertebral regions - forward, in the thoracic and sacral regions - backward. The best way to determine the posture is by placing the child in profile. In this position, natural physiological curves are clearly visible. Excessive or insufficient natural curvature of the spine indicates poor posture.

There are several types of posture: correct physiological and pathological (lordotic, kyphotic, stooped and straightened.).

With correct posture, the physiological curves of the spine are well pronounced, have a uniform, wavy appearance, the shoulder blades are parallel and symmetrical, the shoulders are deployed, the legs are straight. Correct posture has not only aesthetic, but also physiological significance - it contributes to the normal functioning of internal organs. / 10 /

The correct posture for preschoolers is considered to be when the head is slightly tilted forward, the shoulder girdle is slightly displaced anteriorly and does not protrude beyond the level of the chest (in profile). The shoulder blades protrude slightly, the line of the chest smoothly passes into the line of the abdomen, which protrudes by 1-2 cm, the physiological bends of the spine are poorly expressed, the angle of inclination of the pelvis is not great and is 22-25 ° . /3/

Posture disorders can be congenital or acquired, but in the vast majority there are acquired ones. /eleven/

The most characteristic external signs that predetermine the onset of posture disorders are:

a) increasing the tilt of the child's head forward;

b) the extension of the shoulder joints forward;

c) narrowing of the chest due to the extension of the arms forward;

d) increased stretching of the muscles of the posterior surface of the back due to the regular tilt of the head and upper body forward (especially when sitting);

e) the distance of the shoulder blades from the chest with a constant tilt of the head, which contributes to the formation of a round back;

f) constant, sufficiently long and incorrect standing with one leg extended forward or to the side, setting the leg with a wide toe to the side, moving on legs bent at the knee joints when walking and running. /5/

A slouching posture is characterized by a flattened chest, a significant increase in the cervical curvature of the spine, and a lowered head and shoulders. With lordotic posture, the cervical flexure is normal, and the lumbar exceeds physiological parameters. In this case, the upper part of the body is slightly turned back. Kyphotic posture is characterized by an increase in the depth of both the cervical and lumbar bends; the back is round, the shoulders are lowered, the head is tilted forward, the stomach is protruding. The asymmetry of the shoulder girdle (one shoulder is higher than the other) and lateral curvature of the spine are not uncommon.

The most serious disorder is scoliosis. / 10 / Scoliotic disease is not only a curvature of the spine, but also a general serious illness that involves all the most important functions of the body in the pathological process. /eleven/

Clinical symptoms of some types of posture disorders are given in Appendix A. / 11 /

The simplest and most accessible method for determining the presence or absence of posture disorders is the test card below. (Table 1)

Table 1

Signs of impairment Result Obvious damage to the organs of movement caused by congenital malformations, trauma, illness. The head, neck are deviated from the midline, the shoulders, shoulder blades, and the pelvis are not set symmetrically. Severe deformation of the chest - "shoemaker's chest", sunken "chicken" chest (changes in the diameter of the chest, sternum and xiphoid process sharply protrude forward). A pronounced increase or decrease in the physiological curvature of the spine. Strong lagging of the shoulder blades ("pterygoid" shoulder blades). Strong protrusion of the abdomen (more than 2 cm from the chest line). Violation of the axes of the lower extremities (O-shaped, X-shaped). Waist triangle inequality. Valgus position of the heels. Obvious deviations in gait (limping "duck") Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No

Test results are evaluated as follows:

1.Normal posture - negative responses;

2.A slight violation of posture - negative answers to one or more questions in points 3, 5, 6, 7 (corrective exercises);

.Severe postural disorder - positive answers to the questions of points 2, 4, 8, 9, 10 (consultation of an orthopedist is needed). / 3 /

Posture disorders can be associated with deformation of the bones of the lower limb and arches of the foot. Descent of the transverse or longitudinal arches of the foot is called flat feet. With flat feet, the foot touches the support surface with almost all points and the trace of the internal bend merges with the edges of the foot.

It is not difficult to identify flat feet. If there is no special plantographer, you can simply grease the foot with some coloring agent, then stand on a sheet of white paper so that you get a print. "Portraits" of a normal foot and a foot with flat feet will differ significantly.

Flat feet - deformity of the foot (a decrease in the height of its arch in combination with pronation of the heel and supination contracture of the forefoot). Depending on the reasons for the appearance of flat feet, a congenital flat foot is distinguished, rickets, paralytic, traumatic and static.

As a result of acquired flat feet, the medial edge of the foot descends, its ligamentous apparatus is pathologically stretched, and the position of the bones changes. The arch support muscles, which play the most important role in maintaining the arch of the foot, weaken and atrophy. / 3 /

2.2 Assessment of the physical development of preschool children

The assessment of physical development is carried out by the head nurse in the presence of the group educators according to generally accepted methods. It is important not only to collect anthropometric data, but also to analyze them: to determine the harmony (maturity of the morphological and functional capabilities of the organism at a certain period of its development and compliance with the requirements of the environment / 12 /) of physical development in terms of height and weight indicator (calculated using reference tables and indices), and also to establish deviations in physical development, which include:

-overweight or underweight,

Low growth,

underestimated chest circumference,

low overall physical development.

When assessing physical development, special attention should be paid to the posture and foot of the child, since violations in this area are currently the most frequent. / 2 /

3 Methods for assessing physical development

Assessment of physical development can be carried out using methods: anthropometric standards and indices.

Assessment of the physical development of children according to anthropometric standards.

Anthropometric standards are the average values ​​of signs of physical development obtained by static processing of a large number of measurements of a population of a homogeneous composition (by sex, age, etc.).

Evaluation by standards is made by comparing the estimated indicator with its arithmetic mean according to the tables in the group to which the researcher belongs. / 6 /

Each height group has two lines: one is marked with the Latin letter M, which means "media", that is, the arithmetic mean for each indicator, the other line - with the Greek letter s (sigma), meaning the standard deviation, which characterizes the magnitude of the fluctuations of the trait under study. The smaller the sigma, the more homogeneous the study group.

Physical development is considered to be average (typical) if its indicators coincide with the arithmetic mean or differ from it by ± 1.0 s ... with the results of assessing physical development from M ± 1 s up to M ± 2 s physical development, respectively, above or below average; from М ± 2 s up to M ± 3 s - high or low (depending on the + or - sign). / 6 /

To assess the level of physical development, the examination results are compared with the data presented in Appendix B. / 14 /

If growth lags behind by 20%, it is necessary to consult an endocrinologist, since they may have a general delay in physical development.

Excess body weight by 10% over the proper one is called obesity and requires correction. Children with underweight should be monitored by a pediatrician. / 7 /

Assessment of physical development by indices.

Physical development indices are indicators of the ratio of individual anthropometric characteristics expressed in mathematical formulas. Due to the simplicity of the definition and sufficient clarity, the index method was used very widely before. However, it is impossible to use only these indices when assessing physical development. Some of them may be useful at the present time, for a rough assessment of individual indicators of physical development. / 6 /

The proportionality of body development can be judged by determining the anthropometric coefficients (indices):

-according to the Erisman index, the proportionality of the development of the chest is calculated;

-according to the Pignet index, the proportionality of the length, body weight and chest circumference is determined. The lower the Pignet index, the stronger the physique; / 7 /

obesity index determines the ratio of weight and length;

the index of muscle development determines the proportionality of the ratio of weight and length of the body;

for the possibility of comparing the force with taking into account the weight, the relative value of the hand force is determined;

In the future, the mass-growth indices are calculated:

To assess the level of physical development, the examination results are compared with the data presented in Appendix C. / 14 /

3. Diagnostics of the functional state of preschool children

The degree of physical development allows, to some extent, to judge the functional, state of organs and, conversely, a violation of the functional ability of organs entails changes in physical development. / 7 /

1 Research and assessment of the functional state of the cardiovascular system

The study of the functional state of organs and systems involved in physical culture usually begins with the cardiovascular system. This is explained as follows. First, the level of performance of the muscular system depends on the functional state of the cardiovascular system, which, together with the respiratory and blood systems, provides nutrition to the working muscles. Secondly, the cardiovascular system, together with other organs and systems of the body, ensures the constancy of the internal environment of the body - homeostasis, without which the existence of the body in general is impossible. Thirdly, the cardiovascular system reacts most sensitively to all changes in both the external and internal environment.

The study of the cardiovascular system is of great importance for solving the question of the "dose" of physical activity for the muscles involved in physical culture.

Identifying possible pathological changes in the cardiovascular system is not an easy task. It requires high medical qualifications and the use of various instrumental research methods.

Physical culture classes cause certain positive changes both in morphology and in the function of the cardiovascular system, associated with its adaptation to great physical stress. This is due to the peculiarities of the reaction of the cardiovascular system to physical activity. By the nature of this reaction, one can get an idea of ​​the level of the functional state of the cardiovascular system. / 6 /

Changes in functional parameters are closely related to age-related anatomical changes in the parameters of the cardiovascular system in children, the main of which are heart rate (pulse), arterial and venous pressure, stroke and minute volumes, the amount of circulating blood, and blood flow velocity. /5/

To assess the functional state of the cardiovascular system and the body of preschoolers as a whole, it is necessary to determine the pulse rate. If there are no serious rhythm disturbances, there is a decrease in the pulse rate with age, it can be assumed that the motor regime does not exceed the child's functional capabilities. To assess the functional state of the child's body, along with the pulse rate, blood pressure measurements are carried out using the sound method of N. S. Korotkov. / 7 /

Blood pressure (BP) in children depends on age, gender, biological maturity and other indicators. / 5 / In this case, the systolic (SD) and diastolic (DD) pressure is determined.

Systolic pressure is the pressure that occurs in the arterial system at the time of left ventricular systole, diastolic pressure - during diastole, during the decay of the pulse wave. / 7 /

Measurement of blood pressure is a mandatory method for examining the cardiovascular system. /fourteen/

PD = SD - DD

Avg = 0.5 PD + DD

By the values ​​of the pulse and blood pressure, their derivatives can be calculated: the external work of the heart and the coefficient of endurance.

External work of the heart (VR) is an indicator recommended for assessing myocardial contractility:

VR = P (pulse) x SD (arb. Units)

The endurance coefficient (CV) reflects the functional state of the cardiovascular system, its readiness to perform long-term physical activity.

With an optimal motor mode, a tendency to a decrease in the numerical values ​​of P, SD, DD, VR, CV is revealed with an increase in PD. /fourteen/

In addition, in preschool children, the maximum blood pressure can be calculated using the formula

SD = 100 + H,

where H is the number of years, while fluctuations of ± 15 mm Hg are permissible. Art. (I.M. Vorontsov). / 7 /

The average value of indicators of the functional state of children is presented in Appendix D.

However, it is of great importance to study the parameters of the cardiovascular system, which characterize its function, that is, to assess changes in the heart and blood pressure after one or another dosage load and to determine the duration of the recovery period. Such a study is carried out using various functional tests. / 6 /

To study the functional state of the child's body, it is necessary to determine the body's response to physical activity. An increase in heart rate by 25-30% in deviation to the initial value, in respiratory rate by 4-6 per minute, an increase in diabetes mellitus within 15 mm Hg is considered normal. Art. with unchanged or reduced by 5-10 mm Hg. Art. DD. After 2-3 minutes, all indicators should reach their original values. / 7 /

When determining a medical group for physical education, as well as for admission to physical education after illness, it is necessary to carry out a functional test: Martine-Kushelevsky test (10-20 squats for 15-30 seconds).

Children are pre-taught this movement so that they squat rhythmically, deeply, with a straight back. Children 3-4 years old can hold the hand of an adult, who regulates their movements in depth and rhythm, 10 squats are recommended for them.

The test is carried out as follows: the child sits on a high chair at the children's table, he is put on a cuff to measure blood pressure, after 1-1.5 minutes. (when the reflex and excitement caused by the application of the cuff disappear) every 10 sec. determine the heart rate until 2-3 close indicators are obtained and take the average from them and write it down in the column "before the load". At the same time, the nature of the pulse is determined (even, arrhythmia, etc.).

After that, the blood pressure is measured. This data is also recorded as initial before the load. Then, without removing the cuff (the rubber tube is disconnected from the apparatus and fixed to the cuff), the child is offered to do squats. The child does squats under the clear account of an adult.

After the end of the dosed load, the child is immediately planted and during the first 10 seconds. determine the heart rate, then quickly measure the blood pressure and continue counting the heart rate for 10 - sec. interval until it returns to the original. Thereafter, the blood pressure is measured a second time. The frequency and nature of the measurement of respiration is visually monitored.

An example of recording the results of a functional test is presented in Table 2.

physical preschooler health respiratory

table 2

Seconds Heart rate Notes Before exercise After exercise 1 min 2 min 3 min 4 min Blood pressure

With a favorable reaction of the body to the load, the pulse increases by 25-50%, returns to its original values ​​after 3 minutes. The permissible reaction is an increase in the pulse rate up to 75%, a return to the initial one after 3-6 minutes, an increase in the maximum arterial pressure - by 30-40 mm Hg. Art., a decrease in the minimum - by 20 mm Hg. Art. and more. With an unfavorable reaction of the body, the pulse quickens by 100% or more, returns to the initial one after 7 minutes. /13/

2 Research and assessment of the functional state of the respiratory system

The functional usefulness of respiration is determined by the sufficient and timely satisfaction of the oxygen demand of the cells and tissues of the body and the removal of carbon dioxide formed during oxidation processes from them. / 6 /

The health of a person, his physical and mental activity, largely depends on the full function of breathing. / 3 /

To control the physical development of healthy children, the method of determining the vital capacity of the lungs (VC) is often used - the amount of air (ml) that can be exhaled by taking the deepest possible inhalation and then exhaling as deeply as possible. /15/

The vital capacity of the lungs (VC) is determined by maximum expiration into a spirometer or dry gas hours after maximum expiration. It allows you to indirectly estimate the size of the area of ​​the respiratory surface of the lungs, on which gas exchange occurs between the alveolar air and the blood of the capillaries of the lungs. In other words, the more VC, the larger the respiratory surface of the lungs. In addition, the more VC, the greater the depth of breathing can be and the easier it is to achieve an increase in ventilation volume.

Thus, VC determines the body's ability to adapt to physical activity, to a lack of oxygen in the inhaled air.

A decrease in the VC indicator always indicates any pathology. / 6 /

The level of VC is also determined by the size of the body and the degree of physical development.

Respiratory rate is determined by the number of movements of the chest or abdominal muscles per minute and depends on the body's physiological need for oxygen. In children, as a result of increased metabolism, the need for oxygen is slightly higher than in adults. Therefore, their respiration rate is higher. The older the child, the less frequent the respiratory rate. /eighteen/

Average values ​​of VC and respiratory rate are presented in Appendix D.

4. Correctional work with preschool children with disabilities in physical development

Correctional work is one of the most important areas of work in a preschool institution. It includes three main components: the activities of the educator in the process of conducting regime moments; special activities performed by the head of physical education and medical professionals; recommendations for parents. The data of the forecast of the nearest zone of physical development of each of the children indicate the directions of correctional work. In fact, this is an annual long-term plan for individual and differentiated work with children, it helps to determine the priority directions in work on physical education.

It is necessary to ensure the annual positive dynamics of the physical development of each child.

Correctional work is carried out differentially with a subgroup of children with homogeneous deviations, as well as individually.

Differentiated groups according to certain criteria can be created general garden (intergroup). In each case, special complexes of medical gymnastics are included in the daily routine, their implementation is assigned to certain persons. After exercise, water and other hardening procedures are useful. Corrective exercises are also envisaged in the complexes of physical education and morning exercises.

Special consultations for educators and parents are carried out by specialists from a physical dispensary, a doctor. / 17 /

4.1 Posture and foot correction program

Posture plays a significant role in shaping a child's health. With improper posture, the work of the heart and lungs becomes difficult, breathing becomes shallow, the vital capacity of the lungs decreases, and general well-being worsens. Incorrect posture can be the cause of inattention, low efficiency, nervous tension in the child. Therefore, it is extremely important to monitor the correct position of the baby's body in all activities.

Flat feet is one of the most serious orthopedic diseases, neglected cases of it entail profound health disorders. Flat feet - deformity of the foot, accompanied by a flattening of its arches, while walking and running are disturbed, and in the future other unpleasant symptoms appear: fatigue, pain in the legs, etc.

According to medical data, poor posture and flat feet are found in 40-50% of preschoolers. Since in the preschool age, the systems of the body's functions are actively formed, it is important to start the prevention of these disorders as early as possible. Children with such disabilities should be in the field of vision of the teacher during the entire time of their stay in kindergarten. Close contact with the physical education supervisor, healthcare providers and parents is essential. All measures provided for by the correction program must be performed without fail. Additional activities may be added to the proposed program (Appendix E). / 2 /

For children with deviations in posture, it is provided:

-optimal motor regime during the day;

-hard bed for sleeping;

the possibility of multiple (during the day) short-term rest for the spine (lying on the back, stomach);

the use of periodically repeating special physical exercises ("kitty", "rolling bun", "log", "snake");

short-term (1-10 seconds) hanging on the bar several times a day;

specially therapeutic gymnastics (2-3 times a week), massage;

walks and hardening.

2 Body weight correction program

Both overweight and deficiency have a negative impact on health. In overweight children, the normal activity of the cardiovascular system is disrupted, diabetes mellitus develops more often, increased fatigue is observed, and disorders of the musculoskeletal system appear. / 2 /

Obesity is an increase in body weight due to excessive deposition of adipose tissue. According to the WHO, 12-20% of children in the world are obese.

In the treatment and rehabilitation of obese patients, a set of methods is used, the most important of which are exercise and diet. When choosing physical exercises, determining the speed and intensity of their implementation, it should be borne in mind that endurance exercises (long-term moderate loads) contribute to the consumption of a large amount of carbohydrates, exits from the depot of neutral fats and their breakdown. It is advisable to use physical activity of medium intensity, which contributes to increased consumption of carbohydrates and activation of energy breakdown due to the breakdown of fats. Great importance in the classroom is given to cyclic exercises, in particular walking and running. The duration of the classes is 30-35 minutes. Movements are performed with a large amplitude, while large muscle groups are involved in the work, they use swings, circular movements in large joints, exercises for the trunk, exercises with objects.

For effective treatment, a positive psychological attitude is required, especially among family members and the child himself. Active emotional games will help to increase the motor regime. Taking into account the reserve capabilities of the cardiovascular system, it is necessary to gradually prepare the child's body for increasing physical activity during games, increase emotional tone, overall performance, improve the functional state of the cardiovascular and respiratory systems. To accomplish these tasks, it is necessary to use games of general physiological effects in therapeutic gymnastics classes, which have a training effect on the entire body, strengthen the respiratory muscles. Games with running alternating with walking are recommended. / 3 /

To prevent overweight, in consultation with the doctor, a set of therapeutic and prophylactic measures is being developed, including:

-a balanced diet with a slightly reduced calorie content and rich in vegetables and fruits;

-eating 4-6 times a day, which eliminates overeating;

the obligatory use of vegetable snacks - they satisfy the first hunger and do not affect the fullness;

thorough chewing of food (30-40 chewing movements) - in this case, food is better digested and less is required, which is especially important for those who are prone to overweight;

the use of special techniques that reduce appetite (eat candy before meals, drink a glass of juice);

optimal motor regimen, dosed taking into account the individual characteristics of health and physical development;

special medical purpose (if necessary).

In recent years, there has been a tendency for preschoolers to be underweight. These children are characterized by lethargy, fatigue and, as a rule, poor appetite. It is recommended for them:

-identify and try to eliminate the cause of poor appetite;

-provide a balanced diet; portion of food - strictly according to age, do not overestimate the volume, do not force feed; with a negative reflex to food, change the feeding environment; for dinner, give an easily digestible dish of vegetables, cottage cheese, fruits; do not give smoked meats; allow eating not at the table, but where the child wants;

to activate physical activity, to ensure a long stay in the air, good sleep, quiet games after physical exertion, water procedures, an individual regimen of the day, games and exercises. The body weight correction program is presented in Appendix G.

3 Short stature correction program

For children of short stature, jumping and running exercises, short-term hanging on the bar, high physical activity, additional fortification of food, juices, an increase in the caloric content of food are useful. The short stature correction program is presented in Appendix K.

4 Breast circumference correction program

The chest circumference must also meet age standards. The circumference of the chest to a certain extent reflects the state of the muscular corset and the functional capabilities of the respiratory system of the body. / 2 /

With a small chest circumference, physical exercises with the inclusion of breathing exercises are useful. / 17 /

List of sources used

1. Organization of preventive and recreational activities in institutions providing preschool education: Methodological recommendations // Praleska - 2004. - № 8 p.41-56
2. Shishkina V.A. Journal of monitoring of health, physical and motor development of preschoolers. - Mozyr: White Wind, 2005 .-- 36 p.
3. Physical rehabilitation and health strengthening of preschool children / ed. Narskina G.I. - Minsk: Polymya, 2002 .-- 176 p.
4. Methodical recommendations for the beginning of the 2005/2006 academic year // Praleska - 2005. - № 8 p. 3-12
5. Grokholsky G. G. Motor activity of preschool children: guidelines. - Minsk: IIP of the State Economic Plan of the Republic of Belarus, 1992 .-- 44 p.
6. Sports medicine / ed. Dembo A.G. - M: F and S, 1975 .-- 368 p.
7. Karmanova L.V., Shebeko V.N., Logvina T.Yu. Diagnostics of the physical development of preschoolers: guidelines. - Minsk: Main Computer Center of the State Statistics Committee of the Republic of Belarus, 1992 .-- 34 p.
8. Kozhukhova N. N., Ryzhkova L. A., Samodurova M. M. Physical education teacher in preschool institutions. - M .: Academy, 2002 .-- 320 p.
9. Popova N.M., Kharlamov E.V. Respiratory gymnastics for children. - M .: March, 2004.-160 p.
10. Margunova ON Prevention of flat feet and posture disorders in a preschool educational institution. - Voronezh: Teacher, 2005 .-- 109 p.
11. Bakovets Yu.V. Education of correct posture in preschool children. - Mozyr: White Wind, 2005 .-- 102 p.
12. Doroshkevich M.P., Nashkevich M.A., Muravyova D.M. Fundamentals of valeology and school hygiene. - M .: Vysheyshaya shkola, 2004 .-- 238 p.
13. Medical and pedagogical control over the organization of physical education of preschool children: Methodical recommendations / ed. Goluba V.S. - Minsk: RCGE MZ RB, 2000 .-- 164 p.
14. Lagvina T. Yu., Shestakova T. N. Karmanova L. V. Health passport of preschoolers: guidelines. - Minsk: - Minsktipproekt, 1992 .-- 32 p.
15. Usov I. N. Healthy child. - Minsk: Belarus, 1984 .-- 2007 p.
16. Makarenkova G.G. On pedagogical diagnostics in the system of preschool education of the Republic of Belarus. // Praleska - 2004. - № - 6 - p. 32-34
17. Shishkina V.A., Mashchenko M.V. What kind of physical education does a preschooler need? - Mozyr: White Wind, 2005 .-- 137 p.
18. Physiology and hygiene of children and adolescents. / ed. Kravtsova M.P. - Minsk: Vysheyshaya shkola, 1980. - 288 p.

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OBSERVATION OF THE PHYSICAL DEVELOPMENT OF CHILDREN

It is known that physical development, together with other indicators of children, is an essential indicator of the health status of children. The state of physical development depends on innate characteristics, as well as on the environmental conditions in which the organism grows and forms. Trained medical workers should be allowed to conduct an examination of the physical development of children, in particular anthropometry, since the technique and methods of anthropometric measurements require certain knowledge and practical skills.

Measurement of children in the first year of life is carried out in the supine position with a horizontal stadiometer. The child is placed on his back in such a way that the head firmly touches the top of the head to the crosswise bar of the stadiometer. The head is set in a position in which the lower edge of the orbit and the upper edge of the ear tragus are in the same vertical plane. The assistant fixes the child's head tightly. The legs should be straightened with light pressure with the left hand on the child's knees. With the right hand, they bring the movable bar of the stadiometer tightly to the heels, bending the feet to a right angle. The distance between the fixed and movable bar will correspond to the height of the child.

Measurement of growth in children over one year old is carried out in a standing position with a stadiometer. The child stands on the platform of the stadiometer with his back to the vertical stand, in a natural, erect position, touching the vertical stand with heels, buttocks, interscapular region and the back of the head, hands are lowered along the body, heels together, socks apart. The head is set in a position in which the lower edge of the orbit and the upper edge of the ear tragus are in the same horizontal plane. The movable bar is applied to the head without pressure.

Determination of body weight in young children is carried out on a scale with a maximum permissible load of up to 20 kg. The diaper is weighed first. It is placed on the weighing tray so that the edges of the diaper do not hang over the tray. The child is placed on the wide part of the tray with his head and shoulder girdle, legs on the narrow part of the tray. If the child can be seated, then he is seated on the wide part of the tray with his buttocks, legs on the narrow part. It is possible to place a child on the scales and to remove them from them only with the balance beam closed, standing not on the side, but directly from the side of the balance frame. Weight readings are counted from the side of the weight where there are notches or notches (the lower weight must be placed only in the notches available on the lower scale). After recording the weights, the weights are set to zero. To determine the weight of the child, subtract the weight of the diaper from the scale readings.

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

Measurement of the chest circumference is made with a centimeter rubberized tape in a state of calm breathing (pause, and older children when inhaling and exhaling). The tape is applied at the back - at the corners of the shoulder blades, and in front - at the level of the lower edge of the nipples.

In addition to anthropometric measurements, muscle tone, tissue turgor, the nature of fat deposition, etc., are noted. navel, on the back - under the shoulder blades, on the limbs - on the outer surface of the thigh and shoulder, on the face - in the cheeks). Depending on the thickness of the subcutaneous layer, one speaks of normal, excessive and insufficient fat deposition. Attention is drawn to the uniform (throughout the body) or uneven distribution of the subcutaneous fat layer.

Determination of soft tissue turgor is carried out by squeezing the skin with the thumb and forefinger of the right hand and
of all soft tissues on the inner surface of the thigh and shoulder, with all this, a feeling of resistance or elasticity is perceived, called turgor. If the turgor is reduced, then when squeezing, a feeling of lethargy or flabbiness is determined.

Muscle tone is determined using passive flexion
and extension of the upper and lower extremities. Muscle tone is judged by the degree of resistance that occurs during passive movements, as well as by the consistency of muscle tissue, determined by touch. In healthy children, muscle tone and mass in symmetrical places should be the same.

These descriptive traits are rated for their severity as "small", "medium", and "large".

An individual assessment of physical development is based on a comparison of his anthropometric data with regional standards developed by the method of regressive analysis. The use of normative or dental tables allows you to give a differentiated description of the physical, development of the child and highlight children who need constant monitoring and specialist advice.

Lagging in physical development can be due to a number of reasons that need to be identified by the doctor of a preschool institution. The hereditary and constitutional factor is of some importance. Chronic infections and intoxications, primarily rheumatism, tonsillogenic cardiopathy, chronic pyelonephritis, hypothyroid dwarfism, are more often the cause of unsatisfactory physical development. We can talk about nanism only if the growth rate is more than 10% below the standard.

A detailed examination of the child reveals the features of his skin, lymphatic system, and skeletal system. Scoliosis or a funnel chest may be present in preschool children. Timely detection of this pathology prevents the development of disability in the future. All children with suspected pathology of the musculoskeletal system should be referred for consultation to an orthopedist, corrective gymnastics is indicated.

CHILDREN'S DEVELOPMENT INDICATORS PRESCHOOL

AGE

1. Methods of research and assessment of the health status 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. Diagnostics of children's readiness to study at school

6. Hygiene of the educational process in a comprehensive school

According to the WHO (1990), the state of children's health is one of the most pressing problems in the world. Its importance is largely due to the progressive degradation of the environment. The child's body, which is in the process of development, is more susceptible to the influence of both favorable and unfavorable factors; it reacts more quickly and sharply to changes in the environment. When studying the influence of various factors, it is important to determine their complexes of influence, as well as to find out how, when they are combined, the influence of each factor is modified. The integral result of the impact of the environment on the child population is the level and quality of children's health. The pediatrician must be able to determine these two indicators, to determine the health status of the DIP.

Health is a criterion for --------- the relationship of the child'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 a dynamic balance 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 body's ability to function optimally, is characterized in this case not only by the absence of clinically pronounced symptoms of diseases, but also by the absence of their initial manifestations, states of pre-illness, and the so-called "minor pathology", often detected at the functional level, easily reversible changes, indicating a decrease in the overall resistance of the body to the effects of adverse environmental factors.

The indicators of health (morbidity, mortality, disability, etc.) revealed by the results of demographic studies are only the visible tip of the iceberg, the underwater part of which is made up of pre-pathological (prenosological) conditions reflecting the stages of movement from health to illness. The study of these conditions, as the basis for determining the "level" of a healthy child's health is the subject of hygienic diagnostics ("hygienic monitoring"), which studies the environment, health and the relationship between them. It is the health of the collective that acts in this case as a criterion for prenosological diagnostics, a “marker” of the negative impact of the environment on a person, a criterion for the effectiveness of all preventive work carried out by the bodies of the sanitary-epidemiological service.

In order to bring primary prevention closer to the main task - to increase the life expectancy of people, hygienic diagnostics, having 3 objects of study (health status, habitat, their relationship), is designed to identify the stages of the health scale

Full health

Practical health

Pre-illness

This is necessary to prevent the transition of states to various diseases.

The interaction of hygienic diagnostics and clinical examination should be carried out in 4 stages

Stage 1 - studying the ecological situation, living conditions, lifestyle

Stage 2 - medical examination

Stage 3 - wellness activities

Stage 4 - dynamic dispensary observation

A comprehensive assessment of the nature of the development and state of health of the child requires mandatory consideration of the physical and neuropsychic development, the degree and harmony of the usefulness of the functional state of his body.

The availability of diagnostic methods for pre-pathological (prenosological) conditions, a quantitative assessment of the depth and degree of reversibility of these processes, can become the scientific basis for such preventive measures that will correspond to the tasks of primary and secondary prevention. Based on this, prevention becomes aimed not at preventing specific diseases, but at reducing the likelihood of their development in general. There are the following factors affecting the health status of children and adolescents.

Factors shaping the health of the child population

| | Socially | |

| | economic | |

| | conditions | |

| Environment | Heredity | Physical |

| | | education |

| Food | | |

| Conditions of life | Condition | Regime of the day |

| | health | |

| | children's | |

| | population | |

| | Indicators | |

| | mortality | |

| | incidence | |

| | disability | |

| | physical development | |

| | | Conditions of training |

| | Medical and sanitary | |

| | I help | |

It is necessary to pay attention to the role of such factors influencing the formation of health as biological (mother's age, state of her health, body length, number of births, birth weight, presence of abnormalities in the act - ---------- - and early postnatal periods, etc. 0 and social (apartment area, per capita income, parental education, social and family upbringing of the child, daily regimen, including the duration of sleep and stay in the open air).

2. Medical control over the state of health of children.

One of the most important tasks of a pediatrician is to control the formation and dynamics of the health status of DIP.

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

Monitoring the state of health today is carried out on the basis of mass screening tests and represents a new principle for organizing in-depth examinations of children and adolescents. It is carried out in several stages:

Stage 1 - examination of all children according to a screening program, which is carried out mainly by a nurse of a children's institution; 7

Stage 2 - examination of children, performed according to screening tests, by a doctor of a children's institution;

Stage 3 - examination by narrow specialists of the polyclinic of children sent from a preschool institution (school) for consultation.

This principle of organizing a medical examination provides a significant increase in the role of average honey. the staff of the children's institution in monitoring the health of children, and also ensures the rational use of the working time of doctors and narrow specialists with a differentiated control over the health of children.

The screening program includes:

1. Questionnaire test - a survey 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 for diseases of the nasopharynx and allergic diseases and conditions (Appendix 1).

In this questionnaire, in the form of simple questions, the main “key” complaints that arise in children and adolescents in the presence of deviations in the state of health according to the leading systems are grouped. When examining preschoolers and students in grades 1-4, the questionnaire is filled out by parents, from grade 5 - by the students themselves.

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

The results of the questionnaire survey are summarized by the nurse, who marks the numbers of questions with a positive answer with a plus sign (+). After that, the doctor of the children's institution analyzes the results of the survey and selects the children in need of examination, and after their examination decides on the need to consult narrow specialists for additional examinations.

2. Individual assessment of physical development using regression scales.

3. Measurement of blood pressure (in junior schoolchildren - taking into account age corrections for a standard cuff) to identify hypertensive and hypotonic conditions.

Objectification of blood pressure values ​​in children aged 8-12 years is achieved only with the use of “age” cuffs or additional calculations, adjusted for the size of the shoulder circumference of each child, which is closely correlated with body weight. The values ​​of the corrections, standardized on the basis of an individual assessment of the physical development of children, are shown in the table:

Corrections (in mm Hg) to the numbers of systolic * pressure obtained when measuring with a standard cuff (for children 8-12 years old with different body weights)

Table 1

| Age (in | Body weight | | |

| years) | by | | |

| | relation to | | |

| | standard | | |

|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 corrections, since differences in the value of diastolic pressure when changing the standard and age cuffs are insignificant.

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

Blood pressure is measured in the generally accepted way - sitting, on the right hand, after a 10-minute rest, according to the Korotkov method. For greater accuracy, it is recommended to measure 3 times with fixation of the indicators of the last measurement.

Identification of disorders of the musculoskeletal system using a combined visual instrumental examination.

Test for detecting posture disorders. eight

This test examination is carried out by the doctor of the child care institution and includes an examination of the child with the answer to 10 questions of the test card (Table 2).

table 2

Posture Abnormalities Test Card

| 1. Obvious damage to the organs of movement | Yes No |

| associated with congenital malformations, | |

| injury, disease | | |

| 2. Head, neck deviated from the average | Yes No |

| lines: shoulders, shoulder blades, hips | |

| installed asymmetrically | |

| Chest of the "shoemaker", | Yes No |

| "Deformed" | |

| 4. Excessive reduction or | Yes No |

| increase in physiological curvature | |

| spine: cervical lordosis, | |

| thoracic kyphosis, lumbar lordosis | |

| 5. Excessive lagging of the shoulder blades | Yes No |

| 6. Excessive protrusion of the abdomen | Yes No |

| Violation of the axes of the lower extremities | Yes No |

| (O-shaped, X-shaped) | |

| 8. Waist Triangle Inequality | Yes No |

| 9. Valgus heel position or | Yes No |

| both heels | |

| 10. Obvious deviation in gait | Yes No |

The survey is carried out in the following order:

Full-face inspection. Position - arms 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 (the waist triangle is a triangular gap between the inner surface of the arms and the body, with the apex of the triangle at waist level, normally the triangles should be the same in shape and equal in size) ...

Side view. Position - arms along the body. The shape of the chest, abdomen, shoulder blades protrusion, and the shape of the back are determined.

Inspection from the back. Position - arms along the body. The symmetry of the angles of the shoulder blades, the shape of the spine, the shape of the legs, the axis of the heels (valgus, varus, normal) are determined.

At the end of the examination, the child is asked to take several steps to identify possible gait disturbances.

In the course of the examination, a test card is filled in, according to which an assessment of the identified posture disorders is given:

Normal rating - negative answers to all questions

Some deviations requiring supervision of a school-preschool pediatrician - positive answers to one or more questions from 3 to 7 numbers inclusive

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

Test for detecting true scoliosis.

True scoliosis includes only those that are accompanied by torsion, or rotation of the spine about the axis, in which the spinous processes of the vertebrae deviate to one side or the other from the middle strip, forming a bulge visible when the trunk is tilted.

The main technique for detecting true scoliosis is considered to be an examination with flexion of the spine and tilt of the body forward: the tilt of the body is carried out slowly, with all this, the arms hang freely down, the legs are straightened. In the presence of scoliosis, an asymmetric rib bulging in the thoracic region and a muscle ridge in the lumbar region are determined.

For a more accurate detection of the torsion of the vertebrae, the examination should be carried out in two positions: front and back.

When viewed from behind (the child stands with his back to the doctor), tilting the child's torso away from him, one can reveal the torsion of the spines in the thoracolumbar spine.

Flatfoot test - plantography

Detection of premyopia using A.A.Malinovsky's test

This test is used in preschoolers aged 6 years and students in grade 11.

Usually, the examination of visual acuity, carried out according to the special diagnostic tables of Sivtsev-Golovin, mainly reveals the presence of an already developed pathology of vision. A.A. Malinovsky's test allows you to identify children with a predisposition to myopia.

The detection of premyopia using the A.A.Malinovsky test includes 2 research stages.

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

· Identification of children with premyopia among the contingent with normal visual acuity.

Examination method: after determining the visual acuity in the usual way, a lens is brought to the child's eye with normal acuity, the strength of which corresponds to the average refraction of the eyes for children of this age, and the visual acuity is determined again (in the conventional way according to letter tables, the child sits on a chair at a distance of 5 m from the table (each eye is examined separately, with the other eye closed with a shield. For testing, use lenses + 1.0 D in a children's frame, with a distance between the optical

Evaluation of results:

t the child, looking through the lens, reads correctly 9-10 lines of the table - negative test

t the child, looking through the lens, cannot read the letters 9-10 lines correctly or even distinguish them at all - the test is positive (increased age-related refraction - pre-myopic state)

Children with premyopia are considered a “risk group” for myopia, as they are 80 times more likely to develop myopia than others. These children should be referred to an ophthalmologist for special observation and periodic monitoring. The examination with the Malinovsky test is carried out by a nurse of a children's institution. Children with a negative Malinovsky test can be tested for visual acuity at school once every 3 years, that is, in grades 4-7-10. Test for detecting color vision disorders (for schoolchildren).

Disorders of color perception play a role in choosing a profession (driver, apparatchik, etc.), and, being often hereditary, they are more often detected in boys.

For the study of color vision, special Rabkin's polychromatic tables are used. In these tables, faces with normal color vision are distinguished from circles of different colors, but the same.

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

Evaluation of the results: the incorrect distinction of even individual tables is an anomaly of color vision. The student is sent for a consultation with an ophthalmologist.

The study of color vision is carried out in the 4th grade of the school on the eve of the career guidance choice.

Laboratory screening tests for screening proteinuria and glucosuria.

Protein and glucose in urine are determined by a nurse of a children's institution using special diagnostic reactive strips, according to the color change of which they judge the presence and even the approximate concentration of them in the urine.

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

Improving the quality and information content of medical examinations is also achieved by preliminary conducting laboratory tests for all children: a general analysis of blood and feces for eggs of worms (no more than 2-3 weeks before the examination), but today these recommendations are only desirable.

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

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

A favorable reaction is considered to be an increase in heart rate within 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 restoration of all indicators within 2-3 minutes.

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

3. Comprehensive assessment of the health status of children and adolescents. Health criteria and 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 care for the children's population in cities", is given on the basis of taking into account the results of medical examination and current monitoring of the child, by analyzing 4 main criteria of health :

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

The functional state of the main organs and systems: cardiovascular, respiratory, circulatory, nervous, etc. resistance of the organism, manifested by the number and duration of diseases according to the appealability for the previous year by the time of the medical examination;

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

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

Table 3.

Distribution of the surveyed by health groups

| Group | Chronic | Functional | Resistance | Physical and |

| pa | pathology | state of the main | and reactivity | neuropsychic |

| | | systems and organs | organism | eskoe |

| | | | | development |

| 1 | None | No deviations. | Sharp | Good |

| | | Single caries | disease for | (normal), |

| | | teeth | preceded | harmonious |

| | | | th observation | physical |

| | | | period | development. |

| | | | absent | Nervous |

| | | | or leaked | esky status |

| | | | occasionally, | matches |

| | | | easy | age |

| 2 | Absent | Availability | Incidence | Normal |

| | | functional | frequent and | (1 tbsp.) |

| | | deviations

| long | worsened (2 |

| | | (lowered | e acute | Art.) | eleven

| | | hemoglobin, | subsequent |) or total |

| | | hypertensive and | lingering | delay |

| | | hypotonic | convalescent | (4st) |

| | | reactions, etc. | nym period - | physical. development |

| | | Dental caries - | lethargy, | |

| | | subcompensated | increased | normal |

| | | I form, anomaly | excitability, | or blurry |

| | | bite | sleep disturbance | pronounced |

| | | | and appetite, | lag |

| | | | subfebrile condition | neuropsychic |

| | | | etc. | eskogo |

| | | | | development. |

| 3 | Availability | Availability | Incidence | All Grades |

| | chronic | functional | - rare, | FR. |

| | pathology in | deviations in | mild to | Normal |

| | stage | pathological | character | or with blurred |

| | compensation, | modified system | flow | pronounced |

| | congenital | organ without | exacerbation | upholding |

| | developmental defects | clinical | main | neuropsychic |

| | organs and systems | manifestations, | chronic | eskoe |

| | | functional | diseases | development |

| | | deviations in others | without | normal

| | | organs and | expressed | or lagging behind |

| | | systems. Caries | deterioration | |

| | | teeth - | general | |

| | | decompensated | state and | |

| | | form. | well-being. | |

| | | | Rare |

| | | | intercurrent | |

| | | | e diseases | |

| 4 | Availability | Availability | Incidence | All Grades |

| | chronic | functional | - frequent | physical |

| | pathology in | deviations | exacerbation | development. |

| | stage | pathologically | main | neuropsychic |

| | subcompensation | changed | chronic | eskoe |

| | congenital | organ, system and | disease | development |

| | developmental defects | other organs and | rare and | normal |

| | organs and systems | systems | frequent acute | or lagging behind |

| | | | diseases with | |

| | | | violation | |

| | | | general | |

| | | | state and | |

| | | | Well-being |

| | | | after | |

| | | | exacerbation or | |

| | | | with a lingering | |

| | | | convalescent | |

| | | | nym period | |

| | | | after | |

| | | | intercurrently | |

| | | | th disease | |

| 5 | Presence of severe | Severe | Morbidity | All degrees

| | chronic | or congenital | - frequent | physical |

| | pathology in | functional | severe | development. |

| | stage | deviation | exacerbation | neuropsychic |

| | decompensation or | pathologically | main | eskoe |

| | severe | changed | chronic | development |

| | congenital | organ, system, | disease, | normal |

| | vice, | others. organs and | frequent acute | or lagging behind |

| | predetermining | systems | diseases | |

| | disability | | | |

| | individual | | | |

Children of the I health group are observed by a doctor at the usual times established for preventive medical examinations of healthy children.

Children of the II health group (“risk group”) are observed by a doctor at the time prescribed for each child, in accordance with the degree of risk in relation to the formation of chronic pathology in them, the severity of functional relationships and the degree of resistance.

Often sick children, children who have suffered acute pneumonia, Botkin's disease, etc., although they belong to the II group of health, during the period of convalescence are taken into dispensary registration according to f. No. 30.

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

According to the results of the assessment of the state of health, the level of physical development and physical fitness, the examined persons are allocated to medical groups. regulating the volume of their physical education course. The medical characteristics of these groups are given in Table 4. When removing a medical group, the doctor must answer the following questions:

Can the subject fulfill the requirements of the curriculum for physical education, or does he need restrictions and what?

Does the subject need physical exercises for therapeutic purposes (corrective gymnastics, etc.)?

Can the subject be engaged in sports sections, participate in training sessions and competitions, in what conditions and under what conditions.

Table 4

Groups for physical education courses

| Naymenova | Allowed events | Medical |

| nie | | characteristics of the group |

| groups | | |

| Main | Classes in the program | Persons without deviations in |

| | physical education in | physical development, | |

| | full | health status, and |

| | Submission of standards BGTO, TRP I, | also persons with |

| | TRP II stage | minor |

| | sequentially. | deviations in the state |

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

| | sports sections (general | sufficient physical |

| | physical fitness, | fitness. |

| | Athletics, | |

| | gymnastics, etc.), | |

| | participation in the competition | |

| | one sport. | |

| Prepare | 1. Classes under the program | Persons with |

| telny | physical education with | minor deviations |

| | condition of a more gradual | in physical development and |

| | passing them with a delay | health status without |

| | passing control | sufficient degree |

| | tests and standards BGTO, TRP | physical |

| | Stage I for up to 1 | readiness. |

| | year, delivery of the rules of the TRP II | |

| | steps with a special | |

| | doctor's permission. | |

| | 2. Classes in the general section | |

| | physical fitness. | |

| Special | Occupations by special | Persons with |

| th | program or individual | significant deviations in |

| | types of government | health status |

| | programs, and the term | permanent or |

| | preparation is lengthened, but | temporary, not |

| | standards are reduced | interfering with the implementation |

| | | regular program | |

| | | production work, |

| | | but are |

| | | contraindication to |

| | | classes on | |

| | | state |

| | | programs in general |

| | | groups. |

The doctor should prohibit physical education classes in extreme cases, when he doubts their benefits and success. Depending on the state of health of the child, the doctor, after consulting with specialists, prescribes specific types of exercises, determines their duration and systematically monitors the reactions and health of children. 13

Literature

1. Hygiene of children and adolescents, ed. V.N. Kardatenko - M. - Medicine - 1980 - p. 41-115

2. Guide to laboratory studies on hygiene DIP - ed. V.N.Kardashenko - M., Medicine - 1983 - S. 7-51

OBSERVATION OF THE PHYSICAL DEVELOPMENT OF CHILDREN

It is known that physical development, together with other indicators of children, is an essential indicator of the health status of children. The state of physical development depends on congenital characteristics, as well as on the environmental conditions in which the organism grows and forms. Trained medical personnel should be allowed to conduct a survey of the physical development of children, in particular anthropometry, since the technique and methods of anthropometric measurements require certain knowledge and practical skills.

Measurement of children in the first year of life is carried out in the supine position with a horizontal stadiometer. The child is placed on his back in such a way that the head firmly touches the top of the head to the transverse bar of the stadiometer. The head is set in a position in which the lower edge of the orbit and the upper edge of the ear tragus are in the same vertical plane. The assistant fixes the child's head tightly. The legs should be straightened with light pressure with the left hand on the child's knees. With the right hand, bring the movable bar of the stadiometer tightly to the heels, bending the feet to a right angle. The distance between the fixed and movable bar will correspond to the height of the child.

Measurement of growth in children over one year old is carried out in a standing position with a stadiometer. The child stands on the platform with his back to the vertical stand, in a natural, erect position, touching the vertical stand with heels, buttocks, interscapular region and the back of the head, hands are lowered along the body, heels together, toes apart. The head is set in a position in which the lower edge of the orbit and the upper edge of the ear tragus are in the same horizontal plane. The movable bar is applied to the head without pressure.

Determination of body weight in young children is carried out on a scale with a maximum permissible load of up to 20 kg. The diaper is weighed first. It is placed on the weighing tray so that the edges of the diaper do not hang over the tray. The child is placed on the wide part of the tray with his head and shoulder girdle, legs on the narrow part of the tray. If the child can be seated, then he is seated on the wide part of the tray with his buttocks, legs on the narrow part. It is possible to place a child on the scales and remove them from them only with the balance beam closed, not standing on the side, but directly from the side of the balance beam. Weight readings are counted from the side of the weight where there are notches or notches (the lower weight must be placed only in the notches available on the lower scale). After recording the weights, the weights are set to zero. To determine the weight of the child, subtract the weight of the diaper from the scale readings.

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

Measurement of the chest circumference is made with a centimeter rubberized tape in a state of calm breathing (pause, and older children when inhaling and exhaling). The tape is applied at the back - at the corners of the shoulder blades, and in front - at the level of the lower edge of the nipples.

In addition to anthropometric measurements, muscle tone, tissue turgor, the nature of fat deposition, etc., are noted. on the back - under the shoulder blades, on the limbs - on the outer surface of the thigh and shoulder, on the face - in the cheeks). Depending on the thickness of the subcutaneous fat layer, one speaks of normal, excessive and insufficient fat deposition. Attention is drawn to the uniform (throughout the body) or uneven distribution of the subcutaneous fat layer.

Determination of soft tissue turgor is carried out by squeezing the skin with the thumb and forefinger of the right hand and
all the soft tissues on the inner thigh and shoulder, while a feeling of resistance or elasticity is perceived, called turgor. If the turgor is reduced, then when squeezing, a feeling of lethargy or flabbiness is determined.

Muscle tone is determined using passive flexion
and extension of the upper and lower extremities. Muscle tone is judged by the degree of resistance that occurs during passive movements, as well as by the consistency of muscle tissue, determined by touch. In healthy children, muscle tone and mass in symmetrical places should be the same.

These descriptive traits are rated for their severity as "small", "medium", and "large".

An individual assessment of physical development is based on a comparison of his anthropometric data with regional standards developed by the method of regressive analysis. The use of normative or dental tables allows you to give a differentiated description of the physical, development of the child and highlight children who need constant monitoring and specialist advice.

Lagging in physical development can be due to a number of reasons that need to be identified by the doctor of a preschool institution. The hereditary and constitutional factor is of some importance. Most often, the cause of unsatisfactory physical development is chronic infections and intoxications, primarily rheumatism, tonsillogenic cardiopathy, chronic pyelonephritis, hypothyroid dwarfism. We can talk about nanism only if the growth rate is more than 10% below the standard.

A detailed examination of the child reveals the features of his skin, lymphatic system, and skeletal system. Scoliosis or a funnel chest may be present in preschool children. Timely detection of this pathology prevents the development of disability in the future. All children with suspected pathology of the musculoskeletal system should be referred for consultation to an orthopedist, corrective gymnastics is indicated.

CHILDREN'S DEVELOPMENT INDICATORS PRESCHOOL

AGE

1. Methods of research and assessment of the health status 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. Diagnostics of children's readiness to study at school

6. Hygiene of the educational process in a comprehensive school

According to the WHO (1990), the state of children's health is one of the most pressing problems in the world. Its importance is largely due to the progressive degradation of the environment. The child's body, which is in the process of development, is more susceptible to the influence of both favorable and unfavorable factors; it reacts more quickly and sharply to changes in the environment. When studying the influence of various factors, it is important to determine their complexes of influence, as well as to find out how, when they are combined, the influence of each factor is modified. The integral result of the impact of the environment on the child population is the level and quality of children's health. The pediatrician must be able to determine these two indicators, to determine the health status of the DIP.

Health is a criterion for --------- the relationship of the child'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 a dynamic balance 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 body's ability to function optimally, is characterized in this case not only by the absence of clinically pronounced symptoms of diseases, but also by the absence of their initial manifestations, states of pre-illness, and the so-called "minor pathology", often detected at the functional level, easily reversible changes, indicating a decrease in the overall resistance of the body to the effects of adverse environmental factors.

The indicators of health (morbidity, mortality, disability, etc.) revealed by the results of demographic studies are only the visible tip of the iceberg, the underwater part of which is made up of pre-pathological (prenosological) conditions reflecting the stages of movement from health to illness. The study of these conditions, as the basis for determining the "level" of a healthy child's health is the subject of hygienic diagnostics ("hygienic monitoring"), which studies the environment, health and the relationship between them. It is the health of the collective that acts in this case as a criterion for prenosological diagnostics, a “marker” of the negative impact of the environment on a person, a criterion for the effectiveness of all preventive work carried out by the bodies of the sanitary-epidemiological service.

In order to bring primary prevention closer to the main task - to increase the life expectancy of people, hygienic diagnostics, having 3 objects of study (health status, habitat, their relationship), is designed to identify the stages of the health scale

Full health

Practical health

Pre-illness

This is necessary to prevent the transition of states to various diseases.

The interaction of hygienic diagnostics and clinical examination should be carried out in 4 stages

Stage 1 - studying the ecological situation, living conditions, lifestyle

Stage 2 - medical examination

Stage 3 - wellness activities

Stage 4 - dynamic dispensary observation

A comprehensive assessment of the nature of the development and state of health of the child requires mandatory consideration of the physical and neuropsychic development, the degree and harmony of the usefulness of the functional state of his body.

The availability of diagnostic methods for pre-pathological (prenosological) conditions, a quantitative assessment of the depth and degree of reversibility of these processes, can become the scientific basis for such preventive measures that will correspond to the tasks of primary and secondary prevention. Based on this, prevention becomes aimed not at preventing specific diseases, but at reducing the likelihood of their development in general. There are the following factors affecting the health status of children and adolescents.

Factors shaping the health of the child population

| | Socially | |

| | economic | |

| | conditions | |

| Environment | Heredity | Physical |

| | | education |

| Food | | |

| Conditions of life | Condition | Regime of the day |

| | health | |

| | children's | |

| | population | |

| | Indicators | |

| | mortality | |

| | incidence | |

| | disability | |

| | physical development | |

| | | Conditions of training |

| | Medical and sanitary | |

| | I help | |

It is necessary to pay attention to the role of such factors influencing the formation of health as biological (mother's age, state of her health, body length, number of births, birth weight, presence of abnormalities in the act - ---------- - and early postnatal periods, etc. 0 and social (apartment area, per capita income, parental education, social and family upbringing of the child, daily regimen, including the duration of sleep and stay in the open air).

2. Medical control over the state of health of children.

One of the most important tasks of a pediatrician is to control the formation and dynamics of the health status of DIP.

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

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

Stage 1 - examination of all children according to a screening program, which is carried out mainly by a nurse of a children's institution; 7

Stage 2 - examination of children, performed according to screening tests, by a doctor of a children's institution;

Stage 3 - examination by narrow specialists of the polyclinic of children sent from a preschool institution (school) for consultation.

This principle of organizing a medical examination provides a significant increase in the role of average honey. the staff of the children's institution in monitoring the health of children, and also ensures the rational use of the working time of doctors and narrow specialists with a differentiated control over the health of children.

The screening program includes:

1. Questionnaire test - a survey 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 for diseases of the nasopharynx and allergic diseases and conditions (Appendix 1).

In this questionnaire, in the form of simple questions, the main “key” complaints that arise in children and adolescents in the presence of deviations in the state of health according to the leading systems are grouped. When examining preschoolers and students in grades 1-4, the questionnaire is filled out by parents, from grade 5 - by the students themselves.

Strong physique is also 100% of boys and 100% of girls 2-6 years old have a very weak physique. Such low values ​​of indicators indicate the low development of preschool children, which can be caused by the action of numerous factors. In the future, continue the further study of anthropometric parameters in schoolchildren of 7-16 years old to establish the physical status of the school and ...

This adaptive rate has been passed down from generation to generation. Thus, the variability of a whole complex of mutually related features is controlled. Let us consider this using the example of the physical development of preschool and primary school children belonging to various groups of the indigenous and old-time population of the North of Russia. According to T.V. Chiryatieva, children of the Khanty at the age of 3-7 years ...

Mastering motor skills, knowing how to navigate in the environment, actively overcome difficulties encountered, showing a desire for creative searches. The theory of physical education of preschool children is continuously developing and enriched with new knowledge obtained as a result of research covering the diverse aspects of child upbringing. Research data, ...