Patronage examination of children under one year old. Let's get acquainted! The first visit of the pediatrician to the child after discharge from the hospital

13.06.2019

The phenomenon in which a pediatrician or nurse comes to the house to examine a newborn baby is called patronage. Infant patronage is carried out during the first month of life. By this time, young parents have a lot of interesting questions. These questions relate to the general condition of the child, as well as caring for him.

The duties of the district pediatrician include clarification of incomprehensible points, as well as teaching parents the technique of feeding, bathing and swaddling the child. In addition, the local doctor is required to demonstrate the infant. An explanatory conversation with a young mother regarding the rules of nutrition during breastfeeding is an additional responsibility of the doctor.

Each medical visit is accompanied by a detailed examination of the newborn child for physical and neurological pathologies. During the examination, the district pediatrician probes the newborn's tummy, checks the physiological reflexes and assesses the condition of the umbilical wound.

Subject to the rules, the outreach nurse should be involved in childcare education. Her competence includes teaching massage and exercises with babies, as well as the technique of caring for the eyes, ears and nose of the baby. In addition, the nurse often gives advice on how to organize the diet of the newborn. The secret duty of a doctor is to assess the living conditions of a newborn child. The living conditions and the nature of the registration are taken into account.

Patronage frequency

The planned arrival of a medical specialist is mandatory in the near future after the mother and child are discharged from the hospital. If the baby has any physiological or psychological pathology, the doctor examines him on the day he arrives home from the maternity hospital. It is customary to highlight the following provisions:

Within 10 days from the date of discharge, the nurse or doctor will visit the child every day. They usually come together or separately;
The initial visit to the doctor is accompanied by an assessment of the baby's living conditions, as well as the solution of problems that arise in a young family;
The healthcare professional then collects information regarding the course of the pregnancy. Important points are the presence of toxicosis, as well as the severity of the course of the birth process. All the information received is entered into an exchange medical card, which is issued to a young mother from the moment she is discharged from the hospital;
The next item is to collect the pedigree of the baby. In this case, the health status of dad and mom, grandparents, as well as other close relatives is assessed.

After the pedigree history has been collected, the doctor proceeds to examine the child. At this stage, the shape of the head, the color of the skin, the location of the auricles, the shape of the chest, the appearance of the genitals, the position of the upper and lower extremities, the reaction of the pupils to light, as well as the structure of the soft and hard palate are assessed.

The final stage of the patronage visit is the examination of the mammary glands of the young mother. Based on the information received, the medical specialist makes recommendations to the parent on the care of the mammary glands and newborn baby.

Each of the subsequent visits to the pediatrician is accompanied by sequential actions, supported by a discussion of topical issues.

The last visit of a healthcare professional is scheduled individually by the parents. This happens on the eve of an independent visit to the children's clinic. The frequency of preventive examinations of newborns under 1 year old is 1 time in 30 days. This day is called a baby day. If the parents suspect a deterioration in the general condition of the newborn child, they need to independently consult a medical institution for advice without waiting for the next visit of the visiting doctor.

Here you have crossed the threshold of your house, carrying in your arms a precious bundle with a newborn baby. But discharge from the hospital is only the beginning of a new stage in your life, in which you have to take care of and care for your child. And then a lot of questions arise: how to bathe the baby, how often to feed it, why does it cry, is it normal, what flinches in a dream, what to do if the breast hurts from the arrival of milk ... Don't panic! The nurse is already in a hurry to help you, because there is such a thing as nursing a newborn.

Tasks and goals of patronage

The term patronage is of French origin, and literally means "patronage".

Newborn patronage is a special program, the purpose of which is to monitor an infant in the first month of life at home. Visits and examinations are carried out by the local pediatrician or the nurse of the local clinic, to whom the child will be assigned. The program is absolutely free and is provided to all newborns, regardless of social status, registration or lack of insurance.

The main tasks of patronage are as follows:

Establishing contact and trusting relationships with the family.
Help the young mother to cope with the practical and psychological problems of caring for a child and establishing lactation.
Assessment of the baby's health status, the degree of its development, as well as identifying possible risk factors for the occurrence of hereditary diseases.

How does the patronage system work in practice? When the baby is discharged from the hospital, information about him is immediately transferred to the district clinic for registration. The same information is transmitted to the antenatal clinic, where the mother was observed throughout the pregnancy - from there they will also call and inquire about the state of the mother's health.

During patronage, the doctor will listen and examine the baby

The primary care of a newborn, as a rule, occurs in the first 2 days, a maximum of 3 days after arrival from the hospital. If in the maternity ward it was considered that the child may have complications, he is the first in the family, the birth was premature or, conversely, late, the nurse visits the family directly on the day of discharge.

According to the rules of patronage, a doctor or nurse is obliged to visit the baby every day for the first 10 days of his life. However, in practice, this is not always possible due to the increased birth rate, on the one hand, and the reduction in the number of medical workers, on the other. Therefore, an individual visit schedule is usually drawn up based on the child's health condition. After clarifying the basic issues of caring for the baby, the baby is visited once a week until he reaches 1 month.

The doctor who will continue to guide the baby comes home for the examination, however, as an exception (weekend or holiday, vacation time), the doctor on duty makes a visit.

First visit: childcare

The initial visit includes three stages:

Inspection of the infant's living conditions, collection of data on family members.
Collecting anamnesis of pregnancy and childbirth.
Inspection of the baby.

"Who lives in the little house?"

The medical staff entering the home of a newborn is friendly. The pediatrician will congratulate the family on the birth of the baby and meet the mother and father of the child. It turns out how many people live in a given living space and what kind of relationship they are with the baby; are there any pets in the family?

During the primary care of a newborn, it is checked in what conditions the child will live: whether he has a sleeping place, a stroller, a bath, a changing table, whether the bed is away from drafts and direct sunlight.

The temperature and humidity in the room are taken into account, the mother is given recommendations on how to ventilate the room and carry out wet cleaning. The linen is viewed, as well as the conditions for its storage. The nurse will also look into the first aid kit for the newborn. If something is missing, she will definitely tell you what needs to be purchased.

The doctor will help to put together a first aid kit for a newborn

Information is collected about the closest relatives (mom, dad, grandmothers, grandfathers, brothers and sisters), their chronic diseases. This is done with the aim of drawing up the pedigree of the baby and identifying the risk of developing hereditary diseases.

Birth and prenatal history

The initial visit also includes a review of documentation on the management of pregnancy and childbirth. The doctor will find out if there were any complications during the gestation of the child, whether the mother had to lie in preservation. If so, with what diagnosis. No less important are the data on the birth itself: how it proceeded, whether there was hypoxia or asphyxia, how the baby was assessed on the Apgar scale.

Baby examination

Then the doctor proceeds directly to the most important stage, examining the child from head to toe. He pays attention to the color of the skin, the symmetry of the paired organs (eyes, ears), shoulders, examines the pharynx, fontanelles, assesses the shape of the head.

The touching doctor will teach you the swaddling technique

With the help of a phonendoscope, auscultation or listening to the heart and lungs is carried out. The tummy, genitals are palpated, reflexes inherent in this age are checked. The doctor assesses the muscle tone, whether there are any changes in the direction of its increase or decrease. Much attention is paid to the condition of the navel, since the overall health of the baby will depend on its correct processing.

Mom should not be shy about asking everything that interests her in relation to caring for a newborn. If necessary, the nurse will show you how to handle the navel, how to carry out a daily toilet (clean the nose, ears), how to bathe, wash, cut nails, swaddle, apply to the chest, etc. If desired, you will be shown simple elements of gymnastics and massage.

At the end of the first visit, the mother is told under what conditions and symptoms an ambulance should be called immediately and how to behave in such situations. Usually mom is left with a contact phone number so that if she has any questions, she can contact the doctor and consult.

First visit: caring for the mother

It is equally important to pay attention to the mother herself, especially if motherhood is a completely new role for her. The nurse learns about her physical and mental well-being, gives advice on how to organize the day's rest.

Breastfeeding comes with a variety of challenges. Therefore, be sure to examine the mother's breast, whether there are seals indicating the development of lactostasis. The doctor can show you how to develop the mammary glands to avoid stagnation, express correctly if necessary. The mother will be taught how to properly latch the baby to the breast.

The specialist will tell you how to properly attach the baby to the breast

Continuing the topic of the formation of lactation, the doctor will talk about an enhanced drinking regime that increases the arrival of milk, and about personal hygiene (you need to change your bra every day, do not forget to wash your hands after going outside, going to the toilet and before feeding your baby). Together, you can choose a feeding regime: on demand or by the hour, as well as balance the mother's nutrition.

Further patronage

When your baby is one month old, you will most likely be invited by phone to the first outpatient appointment in order to undergo further examination. In pediatric practice, there are special days for admitting children under one year old - babies.

For example, if it's a baby's day on Thursday, healthy children are brought (or rather, brought) to the clinic, so the probability of catching an infection is minimal. On a baby's day, other narrow specialists also work, so there is an opportunity for a comprehensive examination. Vaccination rooms are open for babies on the same days.

The visit starts with the pediatrician. The cards of the smallest patients on "their day" are, as a rule, not in the registry, but right in the office of the district doctor. The baby will be undressed, his skin and navel will be examined, and he will be probed for any umbilical hernias. Weighing procedures, measuring height, as well as the circumference of the head and chest are mandatory. These indicators allow you to see how well the baby is developing. Weight gain is used to judge whether he has enough milk or needs supplementation. The baby visits the pediatrician every month, until he reaches 1 year.

If your baby is 1 month old, it means it's time to have scheduled checkups. During the first year there will be 4 of them, and the baby will get acquainted with different specialists. Below is a table that represents a sample of visiting doctors at certain milestones in life.

Doctors	1 month	3 months	6 months	12 months
Pediatrician	+	+	+	+
Ophthalmologist	+	+	-	+
Neurologist	+	+	+	+
Orthopedist	+	+	-	+
Surgeon	+	-	-	+
ENT	+	-	-	+
Dentist	-	-	-	+

Medical examination of narrow specialists

Neurologist

A visit to a neurologist is very important, since it is he who monitors the psychomotor development of the baby. The doctor assesses the extinction of congenital reflexes, the muscle tone of the baby, the formation of healthy motor functions.

The neurologist monitors the timely emergence of basic skills (holding the head, how many months the baby began to roll over, sit down, get up, etc.) Asks about the manipulation of the baby with toys. further examination.

Orthopedist

Examination of children by an orthopedist is especially important in the first months of life in order to exclude hip dysplasia. This disease can be successfully treated if it was diagnosed on time. Otherwise, the wasted time works against the child, and complications are possible for life. Therefore, the screening program for the examination of newborns includes ultrasound of the hip joints.

It is extremely important to visit each doctor in a timely manner so as not to miss the development of pathology

Closer to the year, when the baby learns to take the first steps, the role of the orthopedist is to determine possible varus and hallux valgus deformities of the foot and limbs. The doctor monitors the formation of the correct gait, posture, gives recommendations on the purchase of children's shoes.

Ophthalmologist

Vision in babies is checked with special devices, the fundus is examined, pathologies such as strabismus and astigmatism are excluded. The nasolacrimal canals are examined for their patency.

Surgeon

Examination by a surgeon helps to identify the following pathologies in time:

inguinal and umbilical hernia;
hemangiomas on the skin;
cryptochism (a condition in boys where the testicles do not descend into the scrotum);
physiological and pathological phimosis in boys.

ENT

During the first month of life, audioscreening is done to detect hearing defects. If there is a suspicion of hearing loss, the child is referred to the audiological center for a more detailed examination.

Dentist

With the appearance of the first teeth, it is necessary to see the dentist. Despite the fact that the teeth are milky, it is very important for their correct eruption and growth, as well as the formation of a correct bite.

In addition to passing the doctors, during the first month, blood, urine and feces tests are taken, which can also tell a lot about the health of the baby.

At 1 year old, the child undergoes a full routine medical examination, and he is no longer considered a baby. After a year, visits to the pediatrician will become much less frequent, mostly they will be associated with routine vaccinations or due to illness. But, as before, doctors will be happy to provide qualified medical care to your baby.

From the maternity hospital where the baby was born, information about his discharge will be transferred to the children's district clinic, where the baby will be attached to the actual address of residence. The senior nurse of the children's polyclinic, having received information about the discharge of the baby from the hospital, on the same day enters the data in the newborn register; she fills in the developmental history of the newborn, inserts prenatal care inserts into it, transfers the developmental history to the registry or directly to the district nurse.

The first patronage of a newborn should be performed no later than 1-2 days after discharge from the hospital; For premature babies discharged with symptoms of perinatal and congenital pathology, the nurse and the local doctor should visit on the day of discharge. If this day falls on weekends or holidays, such children are visited by the pediatrician on duty.

The goals of patronage

The general goal of patronages is to create a child rehabilitation program.

Specific goals:

Assess the child's health;

Assess the state of health of the mother;

Assess the socio-economic conditions of the family;

Develop a mother's education program to meet the child's vital needs.

Umbilical wound treatment

It is enough to treat the umbilical wound once a day, after an evening swim. Do not strive to do this at every opportunity: this way you will too often rip off the crusts formed on the wound, which will not speed up, but only complicate and delay healing.

You will need:

cotton buds,
ALCOHOLIC SOLUTION OF BRILLIANT GREEN ("brilliant green") or CHLORPHILLIPT,
clean pipette,
3% HYDROGEN PEROXIDE SOLUTION.
Step by step:
Wiping (more precisely, wetting) the baby's skin after bathing, dry well the navel area as well.
Soak a cotton swab in an antiseptic solution and lubricate the wound with it.
If there is a lot of discharge and crusts in the wound (usually this happens in the first days of a baby's life), they can be removed with a 3% HYDROGEN PEROXIDE SOLUTION.
Pipette the HYDROGEN PEROXIDE SOLUTION.
Release the solution into the umbilical wound. When it comes into contact with biological media, it will begin to foam and carry crusts and discharge to the surface.
Dry the wound with a dry cotton swab or cotton swab.
Use another stick to lubricate the wound with an antiseptic solution.
Currently, in most large obstetric institutions, the umbilical cord is surgically removed on the 2nd day of the baby's life. Usually, with this approach, there is no need to use hydrogen peroxide, since the healing process is usually smooth.
Bathing
Schedule of visits
What makes up newborn patronage?
Its official program includes as many as 10 doctor and nurse visits. But parents can change it in the way that suits them and the child.
- 1,3,10,14 day - visit to the pediatrician
- 2,4,11,15,21,28th day - visits of the patronage nurse
- By the end of the first month of life, the baby will have time to get stronger and the mother will be able to go with him to the clinic herself.

Newborn patronage

It is very important that a little person who has just been born is surrounded by care and love. It is equally important that qualified specialists monitor its correct development. Our center offers patronage of newborns in Moscow conducted by experienced midwives.

What is newborn care?

Everyone knows that data about a newborn is transferred from the maternity hospital to the children's clinic at the place of residence. The next day after discharge, the young mother and baby are visited by a local pediatrician, whose task is to clarify the child's health and give recommendations to parents. Also, the pediatrician and nurse visit the baby for some time, first daily and then once a week.

However, not all young parents are satisfied with the quality of free patronage. Our center offers newborn nursing on a paid basis. Depending on your wishes, you can choose one of three options for postpartum consultations:

Program	Description	Price
Obstetric patronage	It is recommended after early discharge from the hospital to control the woman's recovery, prevent possible mistakes and problems, as well as for the calmness and confidence of the woman and her family members.	RUB 7,000
Children's patronage	Help in the first days of life with a new family member: walking, bathing, gymnastics, grooming, etc., as well as solving issues that arise during the first year of life: complementary feeding, problems with breastfeeding, weaning, etc.	RUB 6,000
Sling consultant	Assistance in choosing a sling, advice on winding methods, solving problems that arise.	RUB 1,500

An experienced doctor will listen carefully to you, examine the skin and mucous membranes, assess breathing, reflexes and sucking activity, examine and process the umbilical wound. Also, the pediatrician examines the baby's head, evaluates its shape, the condition of the fontanelles. The eyes of the child, the genitals, the symmetry of the folds on the legs are also subject to mandatory examination.

In our clinic, this is an attentive, benevolent attitude, high professionalism of doctors, an individual approach to each child.

Who needs postpartum care?

A postnatal visit to mother and child is absolutely essential for all families. If the baby is uncomfortable, often cries, spits up or suffers from constipation, it is necessary to inform the doctor about this so that he can adjust the mother's diet or prescribe special medications. In addition, a doctor who comes to visit a baby provides invaluable assistance to a woman who has just given birth. Typically, mom can get the following recommendations:

Teaching the techniques of "maternal massage" for babies under three months old.
Examination of the mammary glands and training in proper breastfeeding.
Selection of preventive measures against mastitis and lactostasis.
Help in answering burning questions about how to dress a baby, how to pick it up correctly, whether it is necessary to swaddle a baby, when to start walking, and many others.

SURVEILLANCE OF NEWBORNS IN THE PEDIATRIC AREA

A healthy newborn is a child born from a practically healthy mother who did not have complications during pregnancy and childbirth, with an assessment on the Angar scale of 8-10 points, having a body weight of 3 to 4.5 kg, with a mass-growth coefficient of 60-80, with a normally proceeding period of adaptation, with a maximum loss of initial body weight of no more than 6-8%, being breastfed and discharged from the maternity hospital for 5-6 days.

Newborns conditionally include children of the first month of life (up to 28 days).

The following clinical groups of newborns are distinguished.

Full-term babies born at a gestational age of 38-40 weeks,
with a body weight of 2501 g and more, an increase of 47 cm and more, morphologically and
functionally appropriate for gestational age.

Premature babies born at a gestational age of less than
38 weeks, weighing less than 2500 g, height less than 47 cm.
They can be mature, immature, with intrauterine hypotrophy.

■ Classification of the degree of prematurity by gestational
age at birth is given below.

♦ I degree - 35-37 weeks of pregnancy.

♦ II degree - 32-34 weeks of pregnancy.

♦ III degree - 29-31 weeks of pregnancy.

♦ IV degree - less than 29 weeks of gestation.

■ There is still a classification of premature babies in
depending on body weight.

♦ Body weight from 2500 to 2001 g - I degree prematurity.

♦ Body weight from 2000 to 1501 g - prematurity II degree.

♦ Body weight from 1500 to 1001 g - III degree prematurity.

♦ Body weight from 1000 to 500 g - IV degree prematurity.

Immature children - inappropriate gestation maturity
age. They can be full-term or premature.

Post-term babies - those born at a gestational age of more than
42 weeks and showing signs of postmaturity.

Children with intrauterine malnutrition are children who have mass-growing
the product indicator is below normal (norm 60-80) or there are signs for
intrauterine development support.

■ The forms of intrauterine growth retardation are given below.

♦ Hypotrophic form: predominantly defi
citation of body weight in relation to length.

♦ Hypoplastic: relatively proportional
decrease in all indicators of physical development.

♦ Dystrophic (dysplastic) form: pronounced
imbalances, impaired physique, trophic races
construction against the background of a significant decrease not only in weight
body, but also body length and head circumference.

■ The following degrees of severity of intrauterine growth retardation are distinguished.

♦ Mild: 2 sigma reduction in body weight compared to burrows
the minimum body weight of the corresponding gestational
age with normal or moderately reduced length
not, the size of the head does not go beyond M - 2 sigma.

♦ Average, decrease in body weight and length by 2 or more sigma in
compared with the normal values of these indicators with
appropriate gestational age. 75% of these children
note a similar decrease in head circumference.

♦ Severe: a significant decrease in all parameters of physical
of whom development and especially body length (3 or more sigma)

Small children born at term - children weighing less than 2500 g, anatomically and functionally mature in accordance with gestational age, with a height proportional to body weight.

After the newborn is discharged from the maternity hospital, the child is transferred under observation to the children's clinic. Information about the discharge of children is received by the children's clinic every day. These data are recorded in the register of newborns and transferred to the district pediatricians on the same day.

Medical and nursing patronage for a newborn is carried out regardless of the mother's registration. Preventive work with this age group of children consists in conducting primary medical and nursing patronage in the first 3 days after discharge from the maternity hospital, if the newborn is healthy, and obligatory on the first day if he has deviations in his health state or unfavorable living conditions.

PRIMARY NURSING CARTRIDGE

Primary nursing care is carried out according to a specific scheme.

The local pediatrician should clarify and evaluate the social, genealogical and biological history, using information from interviews with the mother, antenatal care and data from the exchange card of the newborn.

Particular attention is paid to feeding the newborn.

Evaluates the mother's skills and knowledge about breastfeeding
to identify difficulties and problems with feeding.

The mother's breasts are examined.

How to position and attach the baby to the breast.

Feed the child on demand (up to 8-12 times a day) without nighttime
breaks.

Give the newborn no food other than breastfeeding.
milk.

Do not use nipples or pacifiers.

During an objective examination of a newborn, attention is paid to a number of signs

General condition, cry, sucking activity.

The condition of the skin, mucous membranes, the presence of edema, pasty
ty, cyanosis, "transitional states", reactions to vaccine administration
BCG.

Physique, nutrition.

Posture, muscle tone, physical activity.

Skeletal system: the shape of the skull, sutures, fontanelles, dysembri stigma
ogenesis, clavicle, congenital dislocation of the hip

Respiratory system: type, frequency, breathing pattern, chest shape
noise cells, percussion, auscultation of the respiratory system.

CCC: heart boundaries, sonority of tones, noises, visible pulsation,
Heart rate.

Condition of the abdomen: examination of the umbilical ring and umbilical wound, op
Determination of the size of the liver, spleen, examination of the genitals. Find out
They improve the frequency and nature of the stool.

The anthropometric data of the newborn are compared with the indicators of the physical development of children of a given age, and the physical development is assessed.

There are a number of features of the neurological examination of newborns that are characteristic only of this age period. First, all reflexes are checked in the supine position, then in the state of vertical suspension with the legs down, and last of all in the prone position. Pay attention to the position of the head, trunk, extremities, to the severity of spontaneous movements of the arms and legs Determine the child's posture, the shape of the skull, its size, the state of the cranial sutures, the size and condition of fontanelles, the presence of cephalohematoma, a birth tumor, as well as hemorrhages in the scalp , face, sclera of eyes.

For newborns, physiological, mild hypertonicity of the flexor muscles of the extremities is characteristic, the legs are slightly divorced at the hips, the hands are clenched into fists. The muscle tone of the extensor muscles of the head and neck is slightly increased; therefore, newborns normally have a slight tendency to throw the head back. Lying on its back, the newborn independently turns its head to the sides. In the prone position, he sometimes raises his head for 1-2 s.

In the first week of life, the following features are noted.

The child squints and worries in bright light, shudders when
loud sound (bell, pop), eyeballs float to the side
loud sound.

Possibly a slight convergent strabismus.

Inhibition prevails over arousal.

When waking up and hungry, the child screams, and appears on his face
a grimace of displeasure.

The sleep is calm, the child wakes up if wet.

At the breast of the mother, well-fed and disguised, the child falls asleep.

All unconditioned reflexes are symmetrical; from tendon reflex
owls are most permanent knee.

It is good to evoke physiological reflexes: Babkina,
Robinson, Moreau, plantar, suspension reflexes, support, vol
ripping, automatic walking, Perez, Talent, sucking, swallowing.
By the 10th day, the child, laid on his stomach, tries to raise his head,
lingers on the mother's face.

The presence of a pronounced tremor of the hands, nystagmus, a symptom of the "setting sun", seizures, stiff neck, paresis, paralysis indicate functional or organic damage to the nervous system of the newborn.

As a result of assessing the state of health, they determine the health group, the risk group and draw up a plan for medical examination for the first month of life. The plan should include the moments of the regimen, care, education, feeding and hardening of the child, and if indicated - restorative, preventive and therapeutic measures. Measures are also provided to prevent hypogalactia in the mother.

The data of the primary medical and nursing patronage is entered into the history of the child's development (form No. 112 / y).

During subsequent examinations, the adaptation of the newborn to the new conditions of life, the state of his health, the dynamics of body weight, behavior and neuropsychic development are assessed, the observance of the rules of care, feeding and the implementation of the prescribed measures are monitored.

REPEATED DOCTOR'S CARTRIDGE

The district pediatrician conducts repeated medical patronage of a healthy newborn on 14-21 days of the child's life, and at the age of 1 month, the mother and child are invited to a preventive appointment at the clinic. As a rule, the doctor visits children of II-V health groups more often:

Children of the II health group are examined by the pediatrician on the first day of the
le discharge from the maternity hospital, on the 10th, 14th and 21st days of life, and in the cart
1 month old mother and child are invited to a preventive appointment at
clinic.

Children of the III health group are visited on the first day after discharge
ki from the maternity hospital, then every 5 days for the first month
life, then according to the underlying disease.

Children of IV-V health groups must be examined in the first
24 hours after discharge from the neonatal pathology department, then
2 times a week during the first month of life and then, respectively
the underlying disease.

A patronage nurse in the first year of life visits the child 20-25 times: in the first month on the first day after discharge, then 2 times a week, during the 2nd and 3rd months - 3 times a month, during the 4th , 5th and 6th months - 2 times a month and in the 2nd half of the year - 1 time per month. If a purulent-inflammatory disease is suspected, the nurse examines the newborn every day for 10 days.

5 During the first month of life, medical care for children is provided by a pediatrician and specialists of the children's polyclinic only at home.

By the end of the neonatal period, the district pediatrician draws up a plan of medical examination for the first year of the child's life, depending on the health group and risk groups. The plan provides for the following activities.

Prophylactic vaccinations.

Examinations by specialists (dispensary observation is possible).

Additional examinations (blood tests, urine tests, if indicated
niyam biochemical, radiological and instrumental studies
daniya, etc.).

Preventive (prevention of anemia, rickets), correcting
and health-improving activities.

When providing medical care to a sick newborn at home, a local pediatrician and a nurse observe him daily until he fully recovers. According to the testimony of the child at home, all the necessary laboratory tests are carried out, they are called for con-

consultations of narrow-profile specialists. In case of difficulties in diagnosis or differential diagnosis, the local pediatrician identified in a newborn pathology is obliged to invite the head of the department or a more highly qualified specialist. A doctor has no right to leave a child with an unclear diagnosis at home without medical assistance or consultation.

ORGANIZATION OF NEWBORN CARE AT HOME

It is very important for a healthy newborn to create an optimal individual regimen. The alternation of sleep and wakefulness with timely feeding of the child contributes to the normal functioning of all functional systems of the body.

When feeding a newborn, it is recommended to use the free feeding technique, in which the child receives food 8-10 times a day, including at night. With this practice of feeding a newborn, the mother forms a quick and sufficient production of breast milk, the child's behavior becomes calmer, his need for nutrients is fully satisfied, which ensures high-quality and full-fledged physical and neuropsychic development. With free feeding, a newborn, as a rule, does not need additional administration of fluid (except in special cases, for example, in the hot season, with profuse regurgitation, during illness, etc.). Usually at home, by the end of the neonatal period, when the mother has sufficient lactation, and the child is able to suck out the required amount of milk for each feeding, he develops an individual feeding regimen (6 or 7 times a day, usually without a night break).

It is advisable to prescribe probiotics for children who are late applied to the breast, or who are on early mixed and artificial feeding, for 3-4 weeks.

By the time the newborn is discharged from the maternity hospital, it is necessary to prepare the room where he will be and the items for his care. Before leaving the room, a general wet disinfectant cleaning should be carried out.

The bed should be placed in the brightest and warmest place in the room, but not near the radiator or in a draft. Constant stay of a child in a stroller is undesirable. In order for the upper half of the newborn's body to be slightly raised (by about 30 °), slightly raise the head end of the mattress (a flat pillow or folded blanket is placed under it).

The air temperature in the room where the newborn is located should be within 22 "C, and for a premature or a child with hypotrophy - 23-24 ° C. The room should be ventilated every 3 hours for 10-20 minutes at any time of the year. should be covered with a net to reduce the air flow rate.

The following items should be prepared in advance for the newborn.

Bathtub, wash bowl and wash basin
niya baby, water jug.

3 thermometers: to measure the temperature of the body, air and water.

Rubber cans: for a cleansing enema and for cleaning
nasal passages from mucus and crusts.

Gas outlet tube.

2 pots: for boiling teats and for boiling bottles.

3-5 bottles with divisions (in case of artificial feeding
niya).

Glass jars with lids for sterile cotton wool, nipple, lo
gum.

Container for collecting dirty laundry.

For the daily care of a newborn and his toilet, the following are necessary.

Baby cream or boiled and then strained sunflower
new oil.

5% potassium permanganate solution.

Baby soap.

Scissors, pipettes (for nose and eyes).

4-6 baby sheets.

3 duvet covers.

2 thin and 1 warm blanket.

20 thin square nappies with an area of 1 m 2.

10 flannel nappies.

25-30 diapers 65 cm long and 60 cm wide made of gauze or
worn out cotton fabric.

10-12 undershirts, including 6-8 cotton and 4-6 flannel
out.

2-3 caps or scarves.

The diapers are of the appropriate size.

The daily toilet of the newborn should be carried out.

The toilet of the eyes is carried out by rubbing the eye slits with separate
each eye with sterile cotton swabs moistened with cool
boiled water. If necessary, use a solution of fu-

racillin (1: 5000). It is necessary to wipe the eye slits from the outer edge of the eye to the inner one. If indicated, after the toilet, a 20% solution of albucide, 0.25% solution of chloramphenicol is instilled into the eyes. With persistent preservation of purulent discharge from the eyes, it is recommended to consult the child with an ophthalmologist, to do a bacteriological examination.

Toilet of the nose is carried out in the morning and during the day as needed.
availability. The nasal passages are cleaned with cotton filaments (for
use a separate flagellum for each nasal passage), moistened
sterile vegetable oil. If you have dry crusts, you can
use saline or breast milk (if you are missing
purulent discharge). When rhinitis occurs (congestion
nasal discharge, profuse serous discharge) should be followed before each feeding
eat, and, if necessary, and more often, suck mucus from the nasal passages
a small rubber can, the tip of which is lubricated
sterile vegetable oil. After suction into the nasal passages
instill 0.01% nasivin solution, furacillin-adrenaline drops
whether they use antiviral ointments. In the presence of a purulent discharge
examination by an otolaryngologist, bacteriological examination
giving.

The toilet of the umbilical wound is carried out with 70% ethyl alcohol, and then
5% potassium permanganate solution or 2% brilliant solution
green. In the presence of fresh or dried umbilical discharge
wound, it is preliminarily removed with a 2-3% solution of pere
kisi of hydrogen. In cases of hemorrhagic crusts or bleeding
to treat the wound, a solution of epinephrine hydrochloride is used.

Treatment of the oral mucosa in a newborn
Benka is necessary when thrush appears. Processing is carried out 2%
a solution of soda (1 teaspoon of soda in 200 ml of boiled water) or
antifungal drugs. The oral cavity is treated with pe
before each feeding with a gauze pad. Effective
the effectiveness of the treatment of thrush in a child depends on the quality of the treatment of ma
terin nipple before breastfeeding. With steadfastly preserving
Xia thrush and a history of the mother or child's therapy of an
tibacterial drugs, it is necessary to examine the child for dysbacteriological
riosis.

The toilet of the external auditory canals is rarely produced: they are
are eaten with dry cotton filaments.

Newborns and babies' nails should be trimmed. It is more convenient to use scissors with rounded jaws or nail clippers.

Skin care for a newborn includes a morning toilet, washing after a bowel movement, and a hygienic bath. In the morning after sleep, the mother wipes all the baby's skin folds with a napkin soaked in boiled water, and after drying them with a soft diaper, lubricates with sterile vegetable oil or baby cream. Currently, there is a large selection of these products on the market. It is undesirable to use baby powders, since they roll into balls with the baby's skin discharge and cause microtraumatization of the newborn's skin, which can cause diaper rash and pustular rashes.

The baby's linen must be clean. It can be washed only with baby soap or special powders for baby clothes, and then be sure to iron it on both sides.

Kupa r baby follows after the umbilical cord has fallen off daily. Bathing is carried out in boiled water with a temperature of 36.5-37 ° C, and children aged 6-12 months - with a temperature of 36-36.5 ° C. Two or three times a week, when bathing, use baby soap. On other days, the child is bathed without soap, using a flannel or terry mitten. It is better to bathe your baby before the last feeding. The duration of bathing should be 5-10 minutes. The face and head are washed last. After bathing, the child is poured from a jug with water at a temperature of 36 ° C. Then the skin is thoroughly dried with a soft sheet or diaper. Skin folds (behind the ears, on the neck, in the axillary and groin areas) are lubricated with baby cream or oil. If the parents are inexperienced, then at the first bathing, a nurse must be present, who does this bathing. After bathing, the mother feeds the baby and puts her to bed.

In case of violation of the sanitary and hygienic conditions of care in a newborn, it is possible to develop prickly heat - a small-point reddish rash, localized in places of natural folds on the skin of the trunk and extremities. The appearance of prickly heat is associated with insufficient or improper care of the child, with overheating. Miliaria usually disappears after the elimination of these factors. As a remedy, you can recommend baths with decoctions of a string, celandine, oak bark, chamomile, St. John's wort. A decoction of herbs is prepared at the rate of 15 g of dry matter per bath.

In a newborn, if the conditions of care are violated, diaper rash may appear. Most often they are localized in the buttocks, inner thighs, in natural folds and behind the ears. There are 3 degrees of diaper rash.

I degree: moderate redness of the skin without a visible violation of its integrity.

II degree: bright hyperemia of the skin with large erosions.

III degree, bright hyperemia of the skin, oozing as a result of drainage
running erosion.

Diaper rash II and III degrees can become infected.

Treatment of diaper rash consists in proper sanitary and hygienic care for the newborn: thorough washing of the child after the act of defecation, followed by drying the skin with a soft diaper or sheets and treating the folds with oil or baby cream, drapolen ointment, 1% brilliant green solution. It is advisable to carry out a hygienic bath with the addition of decoctions of medicinal herbs 2 times a day (morning and evening). The diapers must be ironed thoroughly on both sides. With diaper rash II and III degrees, you can use open swaddling and local UV-irradiation of the affected skin. The local doctor should pay attention to the mother's diet, excluding obligate allergens from it, and prescribe antihistamines to the child. If an allergic genesis of diaper rash is suspected, the drugs of choice are chloropyramine, hifenadine, clemastine in doses appropriate for age. Antihistamines can also be used as ointments.

When prickly heat or diaper rash is infected, you can prescribe ointments with antibacterial agents, which can be combined with medicinal baths from a decoction of herbs. In such cases, the child should be examined for dysbiosis.

HARDENING EVENTS

A newborn is recommended to be indoors without a cap. It is necessary to swaddle the baby while sleeping or feeding in order to limit his general physical activity. During wakefulness, the child should be in a shirt, romper or panties. Exposing the feet is a good means of hardening from the neonatal period. If the feet are cold and the baby begins to sneeze, you can cover the lower body with a blanket, but do not swaddle the baby.

In the absence of contraindications, walks in the warm season can be started immediately after discharge from the maternity hospital, avoiding exposure to direct sunlight on the child. The duration of the walk at first should be 15-20 minutes, and then it is gradually brought to 1.5-2 hours. On windy, rainy, and very hot days (over 30 ° C), it is better for a child to sleep indoors with open windows or on the veranda. In winter, walks with a newborn should be started at home with an open window or window. To stay in the fresh air in a cool time, the child should be taught gradually, starting with

the duration of the walk is equal to 15-20 minutes. You can take it out for a walk at a temperature not lower than minus 10 ° С. The child's face should not be covered, but should be dressed according to the weather.

For proper physical development, it is necessary from the age of 2 weeks to lay the newborn on his stomach before feeding for 2-3 minutes with a gradual increase in this time to 10 minutes. First, the child is laid out on his stomach 1-2 times, then 3-4 times a day.

An indicator of the effectiveness of dispensary observation of a newborn in the pediatric area is its normal physical and neuropsychic development in the absence of diseases.

The results of the observation of the newborn and the assessment of his condition are recorded by the doctor in the history of development (form No. 112 / y).