Patronage examination of children under one year old. Why do you need a newborn baby to be patronized by medical workers? What advice do young parents get from a doctor and nurse? Algorithm and scheme of the procedure

03.08.2019

After the newborn is discharged from the maternity hospital, the information is sent by phone to the children's clinic, where the mother's name, address and date of birth are recorded in the newborn's visit log. During the first three days after discharge from the maternity hospital, the district doctor and nurse perform the first patronage of the newborn. Children with risk factors, congenital anomalies and diseases, premature or post-term, as well as the first child in the family, should be examined on the first day after discharge from the maternity hospital.

How is the first patronage of a newborn?

The history includes the collection of social, biological and genealogical information. The exchange card contains

information about pregnancy and childbirth,
the condition of the child at birth (assessed on the Apgar scale),
basic parameters of physical development (body weight, body length, head and chest circumference),
health group
and the risk group.

An objective examination dj during the first patronage of a newborn is carried out according to the systems: skin, posture, head, chest, abdomen, genitals, limbs, nervous and mental development. Parents are instructed on child care, feeding and upbringing.

The crib should be placed in a bright place in the room, but not in a draft. The newborn is placed on its side in the crib, without a pillow.

Bathing is done every day in a special baby bath, which is not used for washing diapers or baby clothes. Bathing duration - 10 min. It is good to add decoctions of herbs (string, chamomile) to the water. The baby should be gradually immersed in water, wrapped in a diaper, so as not to cause anxiety.

Morning toilet - every morning after the first feeding of the child, wash with a cotton swab moistened with warm boiled water, eyes - from the outer corner to the inner, each eye with a separate swab. The nose is cleaned with cotton wool soaked in vaseline oil.

Swaddling is an important point of care when a newborn is first patronized. Loose and wide swaddling is recommended. For free swaddling, the child is put on a jersey with sewn-on sleeves. The legs are laid in a diaper.

At the first patronage of a newborn, it is necessary to tell the mother about the conditions requiring urgent medical attention, and inform where to go for help in case of diseases.

How does the second patronage of a newborn take place?

It is carried out on the 14th day of the child's life, the second patronage of the newborn. Its purpose is

repeated examination of the newborn for organs and systems to establish the state of health,
monitoring the implementation of recommendations,
answers to the mother's questions in connection with the problems that have arisen,
briefing.

Basic examinations of the newborn during the second patronage

When collecting anamnesis, it is necessary to find out the questions

feeding,
daily routine,
behavior of the newborn.

An objective examination is carried out in stages. With the second patronage of a newborn, it is necessary to assess how the child is gaining weight. If there are regurgitation, then it should be explained to the mother that children under 1 year old have a physiological insufficiency in the work of the sphincter apparatus of the gastrointestinal tract.

If air is swallowed while feeding, the baby should be held upright for 10 minutes after feeding. If the regurgitation is persistent, constant, there is vomiting in a fountain, the child does not gain weight well, then he must be examined in a hospital.

From the age of two weeks, children may experience cramping abdominal pain (colic), which is due to the adaptation of the gastrointestinal tract to new living conditions. This is manifested by the child's sudden anxiety.

The mother is obliged to report such symptoms to the local doctor, who assesses whether these changes are functional abnormalities or are caused by organic pathology.

Massage, gymnastics for a newborn and their place in the instruction during the second patronage

The mother is instructed on the importance of massage and gymnastics for the newborn. Massage and gymnastics are connected to hardening and health-improving activities.

The first exercise: the baby lies on its back, the mother lets him grab her thumbs with her hands, then spreads the newborn's arms to the sides and brings them together, crossing them on her chest. Exercise helps relax the muscles in your chest and shoulder girdle.

The second exercise: the child lies on his back, the mother raises his arms above his head and lowers him through the sides down. The exercise relaxes the muscles of the shoulder girdle and upper limbs.

The third exercise: the child lies on his back, the mother takes him by the shins and gently bends his knees to the stomach, then extends his legs. Exercise relaxes the muscles in the legs, helps the child to free the intestines from gases.

The fourth exercise: the baby lies on his stomach, the mother props the baby's feet with her hands, this makes the baby straighten his legs and crawl forward (reflex crawling). Exercise helps develop muscles in the legs, arms and back.

For the upbringing and development of visual concentration of the newborn, toys are hung over the bed at a distance of 40-50 cm from the face.

How is the third newborn patronage going?

It is held on the 21st day of the child's life, the third newborn patronage. Its goals:

monitoring in dynamics the state of health and conditions of development of the newborn, feeding,
carrying out sanitary and educational work,
treatment of identified developmental abnormalities.

Main examinations during the third patronage

When examining a newborn, it is necessary to pay attention to his behavior, health, reaction to the environment. In dynamics, the indicators of body weight, height, head circumference, chest, condition of the large fontanel are assessed.

On the oral mucosa, there may be thrush with defects in child care. A newborn in the third week of life can already fix his gaze, react with positive emotions to an affectionate appeal to him.

The skin is normally elastic, velvety, pink, clean. In the presence of pustules, treatment at home is necessary with a satisfactory condition of the child and the possibility of good care.

In a state of moderate severity or an unfavorable sanitary and cultural level in the family, the district doctor gives a referral for examination and treatment in a hospital.

The navel area by the 21st day of the child's life should be epithelialized. With purulent discharge from the umbilical wound, hyperemia around the navel, the child should be sent to a hospital.

To determine the condition of the newborn, the doctor re-

evaluates unconditioned physiological reflexes (Babkina, sucking, grasping, automatic gait, crawling),
conducts percussion and auscultation of the lungs,
hearts,
palpation of the abdomen.

Objectives of the instruction in the third newborn patronage

In a conversation with the mother, the doctor clarifies the nature of the child's physiological functions, gives recommendations on feeding and caring for the newborn, and answers questions that arose in her during the third week of the child's life.

During the third patronage to the newborn, you should tell the mother about rickets in children and prepare her for the need to prevent this disease, inform about the importance of ultraviolet rays, vitamin D for the vital activity of the body and write a prescription for purchasing an oil solution of vitamin D in a prophylactic dose of 450 IU / days

It is necessary to talk about deficiency anemia in children, the importance of breastfeeding and the prevention of anemia. The doctor discusses with the mother the issues of hardening the child's body and strengthening its resistance, introduces the method of teaching swimming.

At the end of the conversation, the district doctor invites the mother and the child to an appointment at the outpatient clinic for the baby one month old, informs the work schedule of the district doctor and specialists, and informs about the day of a healthy child.

Patronage is the observation of a small patient at home. The term comes from the French language and literally means "patronage". The very etymology of the word indicates the goals of medical practice: to provide the baby with the necessary conditions for harmonious mental and physical development, as well as to identify and prevent possible violations in time.

The visits of friendly and experienced professionals are also beneficial for a young mother. The pediatrician will tell you how to organize the child's regimen, give recommendations on the choice of care cosmetics, check the sanitary conditions of the room and answer all your questions.

The medical center offers three types of comprehensive Healthy Baby programs: maximum, optimum and standard.

Several specialists will monitor the child's health at once:

endocrinologist;
surgeon;
orthopedist;

In addition to regular check-ups, each of the proposed types of programs includes all the tests necessary for the baby. The procedures are carried out in one place: at the address Moscow, North-Eastern Administrative District, metro Otradnoe, Bibirevo, Vladykino. The center has its own laboratory equipment, which eliminates waiting in queues, which means stress for the parents and the baby.

Specialists of the “Human Health” medical center will help to carry out a comprehensive examination of the baby.

Leave your phone number.
The center administrator will call you back.

Make an appointment

Programs for children

from 54 360 rubles / year

Goals and objectives of patronage of children of the first year of life

The importance of regular patronage examinations explains the wide range of tasks. The specialist observing the baby should:

collect a medical history of the newborn;
prevent and timely diagnose the risk of possible developmental disorders;
to carry out preventive measures against common childhood diseases: rickets, anemia, malnutrition, infectious diseases.
to assess the compliance of the child's neuropsychological development with age norms (for children of the first year of life, this is the ability to concentrate and hold their gaze on moving and stationary objects, to raise and hold the head in a prone position);
provide assistance to young parents: advise the mother about the optimal feeding regime, hygiene procedures, if necessary, help to establish breastfeeding;
give recommendations on how to prepare for.

Based on the examination data, the pediatrician determines the child's health group and prescribes the necessary procedures.

Observation schedule

According to current legislation, a district pediatrician or nurse is required to visit every newborn during the first 10 days of life. Then the frequency of visits is gradually reduced:

newborns up to 1 month old are examined once a week;
an infant up to six months of age should be visited by a doctor 2 times a month;
from 6 months to one year, patronage examinations are carried out once a month.

Alas, in practice, the regime of visits to a doctor from a district polyclinic is far from always possible: due to an increase in the birth rate, physicians do not physically have time to go to all attached families.

Parents often have to wait for a long time for a specialist. The well-staffed staff of professionals and the own equipment of the children's medical center "Human Health" guarantee: a small patient will receive the necessary assistance just in time. The schedule of visits to doctors and the test procedure is drawn up in advance. In addition, unscheduled visits by a pediatrician must be included in the patronage program for children under one year old.

How is the initial examination going?

During the first patronage, the baby is examined at home by a pediatrician and a nurse. The doctor examines the condition of the umbilical wound, carefully checks the cleanliness of the skin and mucous membranes, monitors the speed of reflexes and palpates the abdomen. Also, doctors check the baby's living conditions: the cleanliness of the room, the availability of medicines and clothing necessary for the baby. The first visit should take place within 1-3 days after discharge. Employees of the state polyclinic are obliged to visit the child and young parents, regardless of the presence of a residence permit and a compulsory medical insurance policy.

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.

LECTURE No. 3. The neonatal period. Newborn patronage

1. The first patronage of the newborn

Anamnesis is collected to identify and clarify risk factors, an objective examination of the child, instructing the mother and drawing up a document (f. No. 112).

The history includes the collection of social, biological and genealogical information. The parameters of the social history are: the completeness of the family and the psychological climate in it, housing and living conditions, material security, the level of sanitary and hygienic conditions for caring for a child and an apartment, lifestyle. The biological history covers the features of the antenatal period, the state of health of the mother and child, the genealogical history - the state of health of parents and relatives (at least 3 generations). The mother hands over to the doctor the exchange card received upon discharge from the maternity hospital. It contains information about pregnancy and childbirth, the state of the child at birth (assessed on the Apgar scale), the main parameters of physical development (body weight, body length, head and chest circumference), health group and risk group.

Objective examination

Objective examination is carried out by systems. Congenital malformations, symptoms of intrauterine infection and purulent-septic diseases, birth trauma should not go unnoticed.

The newborn's skin should be pink, clean and velvety. Changes in the color of the skin (cyanosis, icterus, an earthy gray tint and pallor) require a special examination. Prickly heat and diaper rash indicate defects in care. The turgor and elasticity of the skin matter. With abscesses on the skin, purulent discharge from the umbilical wound or hyperemia around the navel, it is necessary to send the child to a hospital for examination and treatment.

The pose of a newborn can be physiological or pathological (posture "frog", "cop dog"). In physiological posture, the tone of the flexors of the arms and legs prevails ("embryonic" posture). Forced position indicates pathology.

The head of a newborn is rounded. Sometimes it may have a cephalohematoma (subperiosteal hemorrhage as a result of birth trauma). The size of the large fontanelle ranges from 1 to 3 cm in medians. The small fontanelle is closed in most newborns. Bulging of the fontanelle above the level of the bones of the skull, a suffering expression on the face indicate an increase in intracranial pressure (with hydrocephalus, meningitis, cerebral hemorrhage). Such a child should be monitored by a neurologist.

When examining the eyes, the pupils should be symmetrical, with a lively reaction to light. Nystagmus, a symptom of the "setting sun" usually indicates a severe pathology of the central nervous system and the need to consult a neurologist. Underdeveloped and low-lying auricles can be combined with congenital malformations of internal organs and deafness. When examining the pharynx, attention is paid to the soft and hard palate to reveal a hidden cleft and arched configuration. The frenum of the tongue can be shortened, and if this leads to a violation of the sucking act, its surgical correction is necessary.

The rib cage is actively involved in the act of breathing, it is symmetrical. Pay attention to the frequency and nature of breathing, percussion and auscultation data when examining the lungs and heart. It should be remembered that congenital heart defects rank first among other congenital malformations. Their first manifestation may be a harsh murmur, found during au-scultation for the first time in the neonatal period. When auscultation of wheezing in the lungs, the child should be examined in a hospital. It should be remembered that percussion data in a newborn are more reliable than auscultation data, since due to the thin chest, breathing is well conducted from one half of the chest to the other, which makes it difficult to fix the weakened breathing.

The abdomen is palpated counterclockwise. The edge of the liver can normally be 1–2 cm below the costal arch. When palpating pathological formations, the child should be sent for ultrasound of the abdominal organs.

The genitals should be shaped according to the sex and age of the child.

Extremities. Legs bent at the hip joints at an angle of 90 ° can be retracted until they fully touch the table surface. With a congenital dislocation of the hip, a dull click will be heard. The paralysis of Erb-Duchenne and Dejerine-Klumpke indicate a birth traumatic injury to the brachial plexus.

The nervous system and mental development are assessed when observing a child and communicating with him - according to activity, gaze, and the severity of unconditioned reflexes. Reflexes of the greatest diagnostic value are: sucking, searching, grasping, crawling, protective, support and automatic walking, Babkin's reflex. Tendon reflexes, their symmetry, muscle tone are determined.

Briefing

Parents' instruction concerns issues of childcare, feeding and upbringing.

Care recommendations. Cleanliness is important to the health of a newborn. The crib should be placed in a bright place in the room, but not in a draft. The newborn is placed on its side in the crib, without a pillow. The air temperature is maintained at 20–22 ° C.

Bathing is done every day in a special baby bath, which is not used for washing diapers or baby clothes. Bathing duration - 10 minutes.

You can bathe your child in the morning or in the evening. The best time is in the evening, before the last feed, as this improves the baby's nighttime sleep. Before bathing in the first 2 weeks, the bath must be scalded with boiling water. The newborn should be bathed in boiled water until the umbilical wound has healed. The water temperature is 37–38 ° C. Water is poured into the tub to cover the bottom. It is good to add decoctions of herbs (string, chamomile) to the water. The baby should be gradually immersed in water, wrapped in a diaper, so as not to cause anxiety. They support the child's head with one hand, and wash it with the other.

It is convenient to use an individual soft sponge for washing. The soap is used 2 times a week, only for children. After bathing, the child is laid face down on the palm, clasping the chest, and rinsed with water from a jug. Then you should dry the baby's skin with a towel, while making blotting movements. It is especially important that the skin folds are dry.

They are treated with baby cream, dusting powder or boiled sunflower oil. Each mother chooses the products for the child's skin care herself. The area of the umbilical wound is treated with brilliant green solution or 5% potassium permanganate solution, or 5% iodine solution.

Swaddling is an important part of caring for a newborn. Loose and wide swaddling is recommended. For free swaddling, the child is put on a jersey with sewn-on sleeves. The legs are laid in a diaper. The rib cage remains free, making breathing easier and preventing lung disease. For wide swaddling, an additional diaper is placed between the thighs, so that the thighs remain in a dilated state, which contributes to the reduction of the femoral head into the acetabulum, and in congenital hip dislocation is a conservative treatment.

Outdoor walks should be started immediately after leaving the maternity hospital. For the first time, the duration of the walk is 5 minutes at a temperature not lower than -10 ° C. In order to adapt to the environment, the duration of walks is increased gradually, adding 5 minutes daily. Walking is contraindicated in case of a child's illness. They should be renewed after recovery, gradually increasing in duration.

Correct feeding of a newborn ensures its timely harmonious development and forms immunity. Latching the baby to the breast immediately after birth stimulates lactopoiesis. It is necessary to explain to the mother the advantages of breastfeeding and to recommend breastfeeding at the request of the child during the period of lactation. With breastfeeding, a very important emotional contact is established between the mother and the child, which favorably affects the psycho-emotional state of the mother and the formation of the child's personality. It is necessary to alternate feeding with each mammary gland. To determine the amount of milk eaten by a child, control weighing is used.

Before feeding, the mother should put on a scarf, wash her hands with soap and water, and strain one drop of milk. Most often, difficulties in breastfeeding are caused by the irregular shape of the nipples, their cracks. To improve the shape, you should gently pull the nipples for 2-3 minutes 3-4 times a day. For the treatment of cracks, 1–5% synthomycin liniment, 0.2% furacilin ointment, and calendula ointment can be used. After using these products, the breasts should be thoroughly washed with warm water and baby soap before feeding the baby.

Sometimes breastfeeding is contraindicated. This may be due to the condition of the mother or child. Contraindications to breastfeeding on the part of the mother include renal, heart failure, malignant tumors, severe blood diseases, severe infectious diseases (such as tuberculosis, meningitis, diphtheria, tetanus, etc.).

The child is not applied to the breast in case of severe intracranial birth trauma, respiratory, heart failure, deep prematurity with the absence of sucking and swallowing reflexes, hemolytic disease of the newborn (if high titer antibodies are found in the mother's milk), hereditary metabolic disorders (phenylketone-ria, galactosemia and etc.). All these conditions are absolute contraindications. Mastitis in the mother is a relative contraindication. With a serous nature of the inflammation, feeding from a healthy breast is allowed. With purulent mastitis, breastfeeding stops completely.

Sometimes there is a decrease or cessation of lactation in the mother. Hypogalactia can be primary and secondary. Primary hypogalactia is caused by neurohormonal disorders, therefore, hormones are prescribed for the development of lactation: lactin 70-100 units. intramuscularly 1-2 times a day for 5-6 days; oxytocin 1.5–2 units. (0.3-0.4 ml) intramuscularly 2-3 times a day daily for 3 days, pituitrin 2.5 units. (0.5 ml) 1-2 times a day intramuscularly for 5-6 days. Secondary hypogalactia is more common. Its occurrence is facilitated by insufficient sleep, malnutrition, violation of the rules of breastfeeding, taking medications (antibiotics, diuretics, barbiturates, furazolidone, etc.). Treatment of secondary hypogalactia consists in eliminating its causes. To stimulate lactopoiesis, vitamins are prescribed (A, B 12 , B6 C, PP), apilak (0.01 g 3 times a day under the tongue for 10-15 days), dry brewer's yeast (1-2 g 3 times a day inside for 10-15 days), use phytotherapeutic agents ( hawthorn, lemon balm, strawberry leaves, oregano herb, dill). If it is impossible to restore lactation, then it is necessary to provide the child with donor breast milk. Collecting points for breast milk have been created in dairy kitchens. The donor woman must be healthy and clean.

In the absence of human milk, its substitutes can be prescribed - mixtures adapted to human milk. Unadapted simple mixtures have now lost their meaning.

Upbringing. From the very beginning, mutual understanding is established between the parents and the child with the help of specific signals, a unique form of relationship is formed - attachment. A newborn child has the ability to withstand the adverse effects of a new environment and to selectively respond to certain stimuli. The mental structure of the personality of a newborn, individual characteristics of temperament are visible from the first days of life ("difficult child", "easy child"). The variability of the child's behavior is due to changes in his forming consciousness. Breastfeeding plays an important role in the upbringing of a small person. A breastfed baby feels protected, needed, wanted. In conditions of positive mental contact, children grow up more obedient.

From the first days of life, the baby needs the correct daily regimen (alternation in time of the basic physiological needs: sleep, wakefulness, nutrition, walks, hygienic and tempering measures). This contributes to the formation of a certain rhythm of life. Children develop a reflex for a while, a dynamic stereotype of behavior is formed, biological rhythms are established, which provides him with a calm and quick fall asleep, good appetite, active behavior during wakefulness. Children living according to a set rhythm do not need additional reassurance (motion sickness, carrying on their hands, using a dummy).

In the future, such a child easily gets used to the daily routine. This teaches him to be organized and makes life easier for him and his parents. The correct daily routine should not be imposing. A child can be taught better and faster if you adapt to the level of his mental development, individual biological rhythm, taking into account the physical condition and individual mental characteristics. Deviations from the regime by 30 minutes or, in extreme cases, by 1 hour are allowed.

The leading factor in the regime is feeding the child. Feeding on demand is carried out during the adaptation period in order to establish the optimal feeding regime for the mother and child. The subsequent transition to feeding according to the regimen should be gradual. The criterion for a correctly chosen regimen is the child's health, primarily the functions of the central nervous system. In conditions of impaired adaptation, the child becomes capricious, whiny and irritable.

In accordance with the feeding regime, other regimes are formed: sleep and wakefulness, walks, hardening and hygienic measures.

At the first patronage of a newborn, it is necessary to tell the mother about the conditions requiring urgent medical attention, and inform where to go for help in case of diseases.

Document execution

Information about the content of the first newborn patronage is recorded in the history of the child's development (form No. 112) under the heading "First newborn patronage". The recording is made according to the following scheme: history, physical examination data, diagnosis indicating the health group and risk group, recommendations for care, feeding and upbringing. If the child belongs to the II-V health groups, then recommendations for rehabilitation should be given in accordance with the risk group or nosological form of the disease.

2. Second patronage of the newborn

The second patronage of the newborn is carried out on the 14th day of the child's life. Its purpose is a repeated examination of the newborn in organs and systems to establish the state of health, monitoring the implementation of recommendations, answering questions from the mother in connection with the problems that have arisen, instructing.

When collecting an anamnesis, it is necessary to find out the issues of feeding, the daily routine, the behavior of the newborn.

Objective examination

An objective examination is carried out in stages. It should be treated no less carefully than during the first patronage, since a pathology that did not appear earlier can be detected at this age.

It is necessary to evaluate how the child is gaining weight. If there are regurgitation, then it should be explained to the mother that children under 1 year old have a physiological insufficiency in the work of the sphincter apparatus of the gastrointestinal tract. If air is swallowed while feeding, the baby should be held upright for 10 minutes after feeding. If the regurgitation is persistent, constant, there is vomiting in a fountain, the child does not gain weight well, then he must be examined in a hospital.

The mother is obliged to report such symptoms to the local doctor, who assesses whether these changes are functional abnormalities or are caused by organic pathology.

Briefing

The mother should be reminded of the importance of massage and gymnastics for the newborn. Massage and gymnastics are connected to hardening and health-improving activities.

The main massage techniques are stroking, rubbing, kneading, tapping, vibration. In the initial stages, massage should be light; of all the techniques, stroking is mainly used, since it helps to relax the muscles. During the massage, the baby's mass grows faster. A lethargic child becomes more lively and active, an excitable one falls asleep faster, his sleep becomes deeper and longer.

Massage is carried out with clean, warm, dry hands. They start with the face: the forehead is stroked from the center outward with the thumbs of the right and left hands. The cheeks are massaged from nose to ear and from the center of the upper lip to the ear, then from the chin to the ear. Limb massage is carried out from the distal end to the proximal from the outside and inside. When massaging the back, stroking movements are carried out with the palms from top to bottom and the back of the hand from bottom to top. When massaging the chest, the ends of the fingers are moved along the intercostal spaces from the sternum to the sides, without pressing on the ribs. Massage the abdomen clockwise, it is necessary to spare the liver area and not touch the genitals. The feet and palms are massaged last.

If during the procedure the child is capricious and crying, you need to interrupt it and calm the baby. Carrying out the massage from 2–3 weeks of age should be alternated with laying the baby on the stomach to strengthen the muscles of the back, abdomen and limbs. Spreading is done for 2-3 minutes before feeding.

Using special exercises during the neonatal period will help the baby to control his body. Since hypertonicity of the flexor muscles predominates in the newborn, it is necessary to help them relax. Movements should be performed slowly, rhythmically and smoothly. Gymnastics is carried out during wakefulness, when the child is in a good mood. The exercises are done while playing with the baby, while the mother should smile, talk to him affectionately or hum a song.

For the upbringing and development of visual concentration of the newborn, toys are suspended over the bed at a distance of 40–50 cm from the face.

The first toys after discharge from the maternity hospital can be 2-3 large brightly colored balls, suspended above the bed in turn every 2-3 days. This contributes to the development of the visual analyzer and creates a joyful mood in the child.

Patronage data are documented in the history of the child's development (f. No. 112) under the heading “Second patronage for a newborn”.

3. Third patronage of the newborn

The third newborn patronage is carried out on the 21st day of the child's life. Its goals are to monitor the dynamics of the health and developmental conditions of the newborn, feeding, conduct sanitary and educational work, and treat the identified developmental deviations.

Objective examination

On the oral mucosa, there may be thrush with defects in child care. A newborn in the third week of life can already fix his gaze, react with positive emotions to an affectionate appeal to him.

The skin is normally elastic, velvety, pink, clean. In the presence of pustules, treatment at home is necessary with a satisfactory condition of the child and the possibility of good care.

In a state of moderate severity or an unfavorable sanitary-cultural level in the family, the district doctor gives a referral for examination and treatment in a hospital.

The navel area should be epithelized by the 21st day of the child's life. With purulent discharge from the umbilical wound, hyperemia around the navel, the child should be sent to a hospital.

To determine the state of the newborn, the doctor re-evaluates the unconditioned physiological reflexes (Babkina, sucking, grasping, automatic gait, crawling), conducts percussion and auscultation of the lungs, heart, palpation of the abdomen.

Briefing

Then the doctor clarifies in a conversation with the mother the nature of the child's physiological functions, gives recommendations on feeding and caring for the newborn, and answers questions that arose in her during the third week of the child's life.

During the third patronage, you should tell your mother about rickets in children and prepare her for the need to prevent this disease, inform about the importance of ultraviolet rays, vitamin D for the vital activity of the body and write a prescription for purchasing an oil solution of vitamin D at a pharmacy in a prophylactic dose of 450 IU / day.

The data obtained are recorded in the history of the child's development (f. No. 112) under the heading "Third patronage for a newborn."

By the end of the neonatal period, the local doctor should make a forecast of the child's health for the first year of life. Some children of risk groups can be removed from dispensary observation and from the second month they can be observed in the same way as healthy children. In the presence of deviations in the state of health and development of the child, it is necessary to conduct an in-depth examination with the involvement of specialists, to correct the tactics of health-improving measures.

4. Features of observation and rehabilitation of premature and post-term newborns

All premature and premature newborns are at risk. They require increased attention from the district doctor: the first patronage to them is carried out the next day after discharge from the maternity hospital or hospital (departments of the I and II stages of nursing), since they need special care due to their weakening.

When collecting anamnesis, it is necessary, if possible, to establish the etiological factors that led to the birth of a premature or post-term baby, since the volume of rehabilitation measures depends on this.

With an objective examination, one should remember about the functional characteristics of premature babies. On the part of the nervous system, depression syndrome, a weak cry, a decrease in muscle tone, physiological reflexes, and imperfect thermoregulation are characteristic.

When assessing the state of the respiratory system, the lability of the respiratory rate (35–80 per 1 min), uneven breathing depth, weakened breathing during auscultation over the area of atelectasis, and apnea attacks can be detected. Heart rate is also variable and can vary between 140-180 beats per minute.

Vascular dystonia is noted. Immaturity of the respiratory and circulatory organs leads to an insufficient supply of oxygen to the child's body, as a result of which his condition worsens even more.

Nursing premature babies is extremely challenging. To preserve their vital activity, it is necessary to create special conditions for care and feeding.

The air temperature in the apartment should be in the range of 24-26 ° C (as premature babies quickly cool down), the baby should be swaddled quickly in pre-warmed diapers. Cooling of a premature baby can occur with prolonged lying in wet diapers. After bathing, the child is wrapped in a heated towel. Coldness of the nose is a symptom of hypothermia. Due to imperfect thermoregulation, overheating of a premature baby can easily occur. Then beads of sweat appear on the forehead and at the root of the nose.

Feeding premature babies presents significant difficulties. Due to the small capacity of the stomach, frequent feeding in small portions is recommended for such children. For a premature baby, breastfeeding is especially important, since the secretion of its own digestive enzymes is not enough. Breastfeeding compensates for the low level of humoral immunity of the premature baby and nonspecific protective factors. The risk of developing anemia in prematurity with breastfeeding is lower. For their artificial feeding, adapted formulas can be used.

Given the immaturity of the nervous system, a premature baby should create a protective regime, protect it from strong external stimuli: loud music, screams, bright light. You should talk more and take in your arms a premature baby, which contributes to his mental development. Sensory stimulation plays a huge role in neurological and physical maturation. However, it is necessary to remember about the rapid fatigue of premature babies.

For the prevention of respiratory diseases, given the tendency of such children to stagnation, the position of the premature baby in the crib should be changed more often.

It is necessary to pick up the child slowly, since due to vascular dystonia, when the position of the child's body changes, a violation of the blood supply to the brain can easily develop.

All premature babies are examined by a neurologist, otolaryngologist, ophthalmologist in the first month of life. If violations of the central nervous system, musculoskeletal system, hearing, visual impairment are detected, premature babies are under the supervision of a specialist of the appropriate profile.

Nursing a premature baby after discharge from the hospital is carried out in accordance with an individual rehabilitation program, which depends on the identification of risk factors for the development of pathology. Premature newborns belong to the II health group. Strict adherence to medical recommendations and close contact with the family are required. Most often, premature babies are characterized by a lag in physical and neuropsychic development, neurological diseases leading to disability (cerebral palsy, hydrocephalus, epilepsy, deafness); long-term consequences are mental and personality defects. Unfavorable outcomes (disability and death) in some cases are caused by the low socioeconomic status of the family, a lack of attention to the child, and improper upbringing.

Morbidity and mortality among post-term infants is also significantly higher than in term infants. They often have asphyxia, birth trauma of the central nervous system, aspiration syndrome, pyoderma, acute respiratory diseases, mental retardation, a tendency to overweight, viscerovegetative disorders (hyperexcitability, regurgitation, constipation, dyskinesia of the gastrointestinal tract).

The rehabilitation program, like in premature babies, is compiled on an individual basis in accordance with the identified risk factors.

Given the tendency of post-term newborns to be overweight, it is recommended to increase the number of feedings (7 instead of 6), but to reduce the one-time amount of food in the first months of life. With pronounced dryness of the skin, its peeling, hygienic baths have a good effect, softening and nourishing the skin. To do this, add rye or wheat bran, potato starch (50-100 g per 10 liters of water) to the water. For dry skin, baby soap can be used no more than 2 times a week. In connection with the dysfunction of the nervous system, a protective mode is prescribed. They give recommendations for the development of motor skills and education, taking into account the physiological characteristics of preterm and post-term newborns.

PATRONAGE(French patronage patronage) is a form of organized preventive work carried out at home by certain medical and preventive institutions (antenatal clinics, clinics, dispensaries, outpatient clinics, feldsher-obstetric centers, etc.).

P. is most widespread in maternity and childhood protection institutions (see). Its purpose is to protect the health of pregnant women, mothers and children. P. of a certain category of mentally ill provides for their aftercare in a family, production and labor collective (collective farm) under constant supervision to lay down. institutions, and P. inf. patients and convalescents - prevention of relapses, complications and spread inf. illness.

P. in specialized dispensaries (oncological, tuberculosis, narcological, etc.) aims to monitor the patients' compliance with the recommended regimen.

A special form of P. is the provision of medical and social assistance to lonely and elderly patients, invalids of war and labor; it is carried out by the Red Cross and Red Crescent Societies (see Union of the Red Cross and Red Crescent Societies of the USSR).

History

In pre-revolutionary Russia, P. for children was first organized at children's consultations in Moscow, St. Petersburg, Kiev and some other large cities, but it could not have a significant effect on improving the health of children, since the network of children's consultations was insignificant (see. Consultation). P. for pregnant women in the USSR on a limited basis first began to be carried out in the 20s. After the publication by the People's Commissariat of Health of the USSR in 1933, "Instructions on the work of consultations for women", it became an indispensable element of the work of antenatal clinics.

Monitoring inf. patients and contacts were carried out in the distant past. It had the character of a superficial medical examination and was part of primitive anti-epidemic measures. A deeper content in this concept was invested during the period of widespread national measures to combat inf. diseases in the USSR in 1917-1935. Since the 50s, it has become mandatory to observe convalescents after the transferred inf. diseases. However P.'s role inf. patients gradually decreased and by the beginning of the 70s, it was replaced by dispensary observation of inf. patients and convalescents, which is carried out by offices of infectious diseases (see) polyclinics. In the early 20s. in the USSR, together with the creation of a network of anti-tuberculosis dispensaries (see. Dispensary) P.'s system of tuberculosis patients was developed.

P. of the mentally ill first appeared in the 16th century. in the city of Geele (Belgium) and in the second half of the 19th century. in the form of colonies of family charity spread to almost all countries of Western Europe. In Russia P. of the mentally ill was first organized by H. N. Bazhenov in 1886 in the Ryazan psychiatric hospital ("at the gates of the hospital"); it consisted in the resettlement of patients in the localities close to the psychiatric hospital, which ensured the provision of regular medical assistance to them and the possibility, if necessary, of timely placement back to the hospital. However, it did not last long and was soon closed under pressure from conservative members of the Zemstvo Council. In 1892 H. N. Bazhenov again creates P. in the village of Semenov near Moscow. In 1893 P. of mentally ill people was organized in Yekaterinoslavskaya, in 1898 - in Nizhny Novgorod (in Balakhna - on the initiative of P.P. Kashchenko) and in Voronezh provinces and received universal recognition not only as a means of unloading psychiatric patients -ts, but also as a measure that has a certain therapeutic value for patients, a long stay in psychiatric hospitals leads to the development of the so-called. hospital dementia.

During the First World War, and then the Civil War, P. mentally ill almost everywhere ceased to exist. It was later restored in a number of places. In 1954, the main organizational forms of P. and the duties of psychiatric (neuropsychiatric) institutions and families or collective farms in relation to patronized patients were regulated, the amount of remuneration for patronage of mentally ill patients was established.

With the development of Soviet health care, the creation of a powerful base, lay down. - prof. institutions especially wide development was acquired by P. of pregnant women, mothers and children. In cities, workers' settlements P. of pregnant women, mothers, and children is carried out by children's and antenatal clinics and clinics, and in rural areas - by central district, district and district hospitals, outpatient clinics, and medical and obstetric posts. It is carried out by doctors, paramedics, nurses, midwives (at paramedics and midwives, as a rule, by one person - a paramedic or midwife) Ch. arr. on a local basis.

More perfect organizational forms are also developed for P. of the mentally ill, to-ry it is carried out by neuropsychiatric dispensaries (out-of-hospital P.) and psychiatric (neuropsychiatric) b-tsami (hospital P.). The nurses of the Red Cross and Red Crescent Society are assigned to the nursing of lonely and elderly patients, invalids of war and labor.

P. in socialist countries is organized according to a similar principle. In the capitalist countries P. is carried out in limited sizes, has mainly a dignity. - skylight, character, the state honey is carried out. service or charitable and private capitalist organizations (insurance companies).

Patronage of pregnant women

Patronage of pregnant women aims to ensure a favorable course of pregnancy, childbirth and the birth of a healthy child. It contributes to the observance of the rules of personal hygiene by a pregnant woman, improvement of a dignity. - gigabyte. conditions in everyday life, health and preventive measures in the family. P. is part of the dispensary method of observation (see Clinical examination), is carried out as planned, and in case of complications during pregnancy, it is also carried out outside the plan. Patronage work is performed by district midwives of antenatal clinics, outpatient clinics, rural medical stations, feldsher-obstetric points, nurses of children's clinics under the guidance and supervision of a doctor.

The midwife spends the first visit to a pregnant woman at home at the beginning of pregnancy, while she finds out the working and living conditions of the pregnant woman, gives advice on improving the gig. the situation at home, based on specific conditions, ascertains the health of others and family relationships, conducts conversations about personal hygiene, work and rest, rational nutrition, explains Soviet legislation on the protection of women's rights and health (if necessary, the midwife turns to the lawyer of the antenatal clinic , to-ry provides practical assistance in solving issues of concern to a woman). The midwife enters all the advice and recommendations into the visiting nurse's work at home notebook (patronage sheet) for subsequent verification of their implementation. During repeated visits, the midwife measures the blood pressure of the pregnant woman, listens to the fetal heartbeat, determines its position, gives advice on wearing a bandage, on preparing the mammary glands for feeding the baby, etc. HELL, wrong position of the fetus, etc.) she invites the pregnant woman to the antenatal clinic or informs the doctor about it, to-ry decides the question of the possibility of treating the pregnant woman at home or the need for her hospitalization. In the latter case, the midwife monitors the timeliness of the woman's admission to the hospital and continues active monitoring after she is discharged home. The success of patronage work largely depends on the ability to establish and maintain optimal psychological, ethical and business contact with a pregnant woman.

Patronage visits are also carried out in cases where a pregnant woman, for whatever reason, does not attend a consultation in order to check her health (a pregnant woman should attend a consultation in the first half of pregnancy once a month, from the 21st week - once every 3 week; from the 32nd week - once every 2 weeks, from the 37th week until the end of pregnancy - every week), as well as if a woman misses classes on physiopsycho-preventive preparation for childbirth in consultation. The midwife finds out the reason for the absence and appoints another day of class. In some cases (the distance to the antenatal clinic, large families), the midwife conducts individual lessons at home, paying special attention to the need to educate the pregnant woman with positive emotions and confidence in a favorable completion of labor for her and the child. It is advisable to invite husbands to classes in preparation for childbirth, where they can familiarize themselves with the physiology of pregnancy and childbirth and the importance of physiopsycho-professional training for a favorable course of pregnancy and childbirth. P. is of particular importance in rural areas, where the midwife not only visits pregnant women, but also actively identifies them.

In P.'s process, the district midwife conducts a dignity. The district nurse of the children's polyclinic visits the expectant mother at home after receiving information about pregnancy from the antenatal clinic and at the end of pregnancy. The pediatrician conducts prenatal P, only among pregnant women with an unfavorable course of pregnancy or with a burdened obstetric history. A postpartum woman who did not attend a consultation after 2-3 weeks. after childbirth, also subject to P.

Patronage of children

Patronage of children - systematic, continuous, active monitoring of the development of young children (up to 3 years old) and for weakened children, regardless of age. It is carried out by pediatricians and district nurses, starting with prenatal P. The patronage nurse of the pediatric section of the children's polyclinic must carry out prenatal P. within 10 days after receiving information about the pregnant woman from the antenatal clinic. The second time a nurse visits the expectant mother at home at 32 weeks. pregnancy. She checks how the family is prepared for the birth of a child, whether there is everything necessary for the care and upbringing of an infant, conducts a conversation about the characteristics of the behavior and development of a newborn. After discharge from the maternity hospital, the pediatrician and nurse of the children's clinic visit the newborn in the first 2-3 days. If the first child is born in the family, it is advisable to do this on the first day. Thereafter, the district nurse visits the child at home in 1-2 days during the first week and weekly during the first month after birth. The local pediatrician visits the child at home 3-4 times during the first month of a child's life. Particular attention is paid to the activity of sucking, the state of the umbilical wound, skin, mucous membranes, etc. Great help to the district pediatrician at the first visit to the child is provided by a detailed history of the child's development (see), compiled in the maternity hospital.

It is desirable that the primary P. was carried out by a pediatrician together with a nurse, the edges processes the umbilical wound of the newborn (if necessary), performs other doctor's prescriptions, receives instructions for monitoring the child in the future. They explain to mothers the rules of breastfeeding, newborn toilet, swaddling, bathing, give recommendations regarding the regimen, caring for the newborn, starting walks, etc. The pediatrician, on the basis of examining the child, evaluates the function, the state of his organs and systems, especially the nervous system, identifies existing developmental anomalies. All the data obtained is recorded in the history of the child's development. The district nurse records her work in a notebook for work at home - a patronage sheet. On subsequent visits, the nurse notes on the patronage certificate the mother's adherence to the advice and makes new suggestions and recommendations. The local pediatrician will periodically check the nurse's notes and follow up on the mother's recommendations.

Twins, premature babies, children born with a large body weight, with intracranial trauma, as well as mothers suffering from pathology of pregnancy and childbirth are at risk and should be under the special supervision of a doctor.

Children of the first and second year of life are observed according to the active P. system. At the age of 1 month. the child must be examined at the children's clinic on a day specially designated for admission of young children. In the future, healthy children are observed by a district pediatrician and a visiting nurse 1 time per month up to 1 year of age. During these visits, the dynamics of body weight, height, chest circumference, head, and the formation of the child's neuropsychic development are monitored. Taking into account the data obtained and the child's condition, the pediatrician gives recommendations on feeding, organizing the daily regimen, hardening, physical education, preventing rickets, etc. In the history of the child's development, records are made about preventive vaccinations carried out, infectious and other diseases.

Under the age of 3 months. children should be examined by a surgeon in order to identify congenital diseases, Ch. arr. dysplasia of the hip joint.

At the end of the first year of life, the pediatrician draws up an epicrisis, in which he assesses the state of health of the child, his physical and neuropsychic development, reflects the nature of feeding, data on past diseases, information about the specific prevention of rickets, massage and gymnastics , outlines a plan of observation, and if necessary, and recovery in the second year of life.

A district pediatrician and a visiting nurse observe a child of the second year of life once a quarter with anthropometric measurements. Once a year, the child is examined by a zhgomatologist for preventive purposes. A child is tested once a year for blood, urine, and feces for eggs of worms. The pediatrician gives a detailed opinion on the state of health of the child at the age of two years, assesses his physical and neuropsychic development.

In the third year of a child's life, a pediatrician examines him as a preventive measure once every 6 months, at the same time anthropometric measurements are taken. The patronage nurse observes the child once a quarter. Once a year, the child is examined by an ophthalmologist and a dentist, in addition, he is tested for blood, urine, and feces. The main attention in the second and third year of a child's life is paid to the organization of the regime, the holding of tempering activities, gymnastics in accordance with age, rational nutrition.

At the end of the third year of the child's life, the doctor sums up the results: assesses the state of health, the dynamics of his physical and neuropsychic development during this period, draws up a plan for recovery and treatment (according to indications).

Patronage of tuberculosis patients

The peculiarity of P. of patients with tuberculosis is the carrying out of preventive, therapeutic and educational work in the foci of tuberculosis infection, not only at home, but also at factories, in institutions and children's groups. P. is carried out by the nursing staff of the anti-tuberculosis dispensary on a regular basis for a long time due to the fact that a patient with tuberculosis is considered infectious for 2 years after the termination of his bacillus excretion. Work in the outbreak is carried out according to a plan drawn up by a doctor, depending on the degree of danger of the outbreak, entered in the district nurse's card (patronage card). P.'s main goal - improvement of the hearth - is achieved as the implementation of the general gigabyte. measures (washing and disinfection of objects surrounding the patient, solutions of chloramine and bleach, keeping the premises clean, airing them regularly), and instilling in the patient the rules of personal hygiene, correct behavior at home, at work, on the street. The importance of P. is in monitoring the implementation of the doctor's prescriptions regarding the regimen and treatment and the implementation of prescribed therapeutic measures, as well as in teaching the patient's family members the rules of precaution and prevention, especially those caring for a severe bacillary patient. Much work in the order of P. is carried out on the observation and systematic examination of family members who are constantly in contact with the patient, especially children. Immediately after revealing an open form of tuberculosis in a patient, family members are registered at the anti-tuberculosis dispensary, their examination data, information on anti-tuberculosis vaccinations given to children are entered into the patronage card. An important element of P. is carrying out a dignity. - skylight, work with the patient and members of his family.

P. at the workplace provides for the registration and treatment of tuberculosis patients working at the enterprise, regular preventive examinations of persons, especially those in direct contact with tuberculosis patients. In the order of P., they also protect the interests of the patient at work, decide on his employment, monitor the observance of instructions, according to which they are not allowed to work in food and communal enterprises, children's preschool, school and other institutions, patients with tuberculosis with active bacilli laziness.

Patronage of the mentally ill

The patronage of the mentally ill is intended for the sick, to-Crimea further stay in closed lay down. institutions are not shown, but due to mental inconsistency, they cannot fully integrate into ordinary life. P.'s goal is follow-up care of the mentally ill in out-of-hospital conditions.

In connection with the emergence of neuroleptic drugs and the intensive development of the social rehabilitation direction in psychiatry (see. Rehabilitation) P., especially in rural areas, attach great importance as an organizational form of out-of-hospital psychiatric care, providing the most favorable opportunities for involving patients in various work processes in conditions healthy environment. P. is organized at neuropsychiatric and psychiatric institutions and can be carried out in the patient's family, in other people's families by individuals and production and labor collectives (collective farms).

The choice of collective farms and families, in to-rye patients can be placed, their referral to P. and removal from P. is made by the patronage commission, consisting of Ch. a doctor of a neuropsychiatric or psychiatric institution, a doctor acting as the head of P., and an attending physician.

The contracting parties conclude a patronage agreement (agreement), providing for mutual obligations of a neuropsychiatric or psychiatric institution and patronage persons or a collective farm in relation to patients placed in P.

Restless patients, dangerous to themselves and others, prone to vagrancy, or weak, unkempt patients, as well as those suffering from severe somatic diseases or infectious diseases (tuberculosis, syphilis, etc.) are not subject to placement on P. It is forbidden to transfer to P. of patients undergoing compulsory treatment.

Monitoring of patients patronized in families, their treatment and maintenance is carried out by regular visits (at least once every 3 months) at home by district psychiatrists and psychoneurol nurses, dispensaries, dispensary departments and offices. In rural areas, where sometimes significant groups of patients are placed on collective farm P., special medical personnel are allocated to monitor them, to implement measures for social and labor readaptation by a psychiatric institution, as a rule, a psychiatric hospital.

The patient is on P. until his mental state changes; if the condition worsens, he is transferred to the appropriate stationary to lay down. institution, and if improved, it can be removed from P.

Bibliography: Belova A. P. Organization of medical care for children in a large city, JI., 1978; Boytsova OS Organization of outpatient polyclinic care for children, M., 1978; Grebesheva II Organization of medical and preventive care for children, M., 1977; Doroshenko KG, JI e x-te r AM and P ya n y x AM Office of infectious diseases and anti-epidemic work at the medical site, Tomsk, 1976; E p e N to about in V. A. Medical worker and patient, p. 60, Chisinau, 1976; Guidelines for the work of a doctor in the office of infectious diseases, comp. A. F. Podlevsky, JI., 1971; Novgorodtsev G.A., D e m-chenkov.a G. 3. and Polonsky M. JI. Clinical examination of the population in the USSR, p. 100, etc., M., 1979; Practical obstetrics, ed. Ya.P. Solsky, p. 15, Kiev, 1976; Reformed H. N. Family charity of the mentally ill in Russia and abroad, St. Petersburg, 1907; Serebryakova 3. N. Organization of psychiatric patronage and prospects of its development in the USSR, M., 1965, bibliogr .; Handbook of Obstetrics and Gynecology, ed. JI. S. Persianinov and I. V. Ilyin, p. 8, M., 1978.

I. V. Shatkin; V.P.Bisyarina (ped.), G. S. Klochkova (phthiz.), V. V. Kochemasova (ac.), 3. N. Serebryakova (psychiatrist).

How is the first patronage of a newborn?

How does the second patronage of a newborn take place?

How is the third newborn patronage going?

Goals and objectives of patronage of children of the first year of life

Observation schedule

How is the initial examination going?

Popular questions:

What is newborn care?

Who needs postpartum care?

History

Patronage of pregnant women

Patronage of children

Patronage of tuberculosis patients

Patronage of the mentally ill