For expectant mother 

Features of prophylactic medical examination of children. Features of children's medical examination. What groups of dispensary observation of children exist

For any parent, the health of the child is the most important thing. How to prevent diseases? How to prevent and prevent them? How to make your baby grow up healthy? To do this, you need to regularly undergo medical examination.

Prophylactic examinations are at the heart of the clinical examination, because, as you know, it is easier to prevent than to cure. Any preventive examination allows you to identify the disease at the very initial stage, when it has not even manifested itself.

Clinical examination is provided for by a special "Program of state guarantees for the provision of free medical care to the population." But, as a rule, parents do not know anything about how, when and at what age a child should visit a particular specialist. And, unfortunately, not every polyclinic has competent pediatricians who clearly know the instructions and strive to follow them. Many do not tell parents about the importance of clinical examination for the healthy development of their children and do not indicate the timing of its implementation. Today we want to tell you in detail about the children's medical examination.

Up to 1 year

The first year of a baby's life is a period of active neuropsychic development. Children also need preventive examinations so that this development proceeds without pathology.

Any preventive examination allows you to identify the disease at the very initial stage, when it has not even manifested itself
  • At 4 months, the child is examined by a pediatrician.
  • At 4, 5 months, the baby is given a second vaccination against whooping cough, diphtheria, tetanus and poliomyelitis.
  • At 5 months, the child is examined by a pediatrician.
  • At 6 months after being examined by a pediatrician, the child is given the last vaccination against whooping cough, tetanus, diphtheria and poliomyelitis, as well as hepatitis B.
  • At 7.8 months, the baby must again visit the pediatrician for a routine examination.
  • At 9 months old she joins the pediatrician. He not only examines the erupted teeth, but also gives recommendations on how to properly care for teeth, monitor the occlusion and prevent dental diseases.
  • At 10 and 11 months, a pediatrician monitors the health and development of the baby.
  • At 12 months, an orthopedist, surgeon and neurologist are connected to the pediatrician. They evaluate what the baby could not achieve in the first year of his life, and give parents recommendations for his further development. Blood, stool, and urine tests are again needed. Preventive vaccinations are given against diseases such as measles, rubella and mumps. The Mantoux reaction is carried out.

From 1 to 2 years

If your baby is healthy, then in the second year of life, the pediatrician examines him not monthly, but once every 3 months. It's enough.

At 1.5 years old, the child's teeth should be examined by a dentist. Also required are blood, urine and feces. At the same age, revaccination against whooping cough, tetanus and diphtheria is carried out. And after a couple of weeks - against polio.

3 years

Many mothers at this time are just coming out of maternity leave and sending their children. Before this, the child must undergo a full examination and examination by the specialists of the polyclinic. The same examination is repeated at age 6, one year before the child enters school.

7 years

10 years

This age is considered prepubertal, that is, the period before puberty. That is why, in addition to the already familiar specialists, endocrinologists and pediatric gynecologists are involved in the examination.

12 years

As a rule, puberty begins at this age. This is a kind of restructuring of the body, which affects not only the reproductive system, but also all organs and tissues of the child. Therefore, during this period it is so important that he received a full examination and advice from all specialists, including a pediatric gynecologist (for girls) and a pediatric urologist (for boys).

14 years old

The same examination is carried out as at 12 years old.

15 years

In addition to a preventive examination, a teenager is undergoing fluorography for the first time.

16 and 17 years old

Conducting preventive examinations of all specialists, taking tests and transferring to an adult clinic.


Clinical examination- the method of active dynamic observation of healthy persons, united by common physiological characteristics or working conditions; patients suffering from chronic diseases, most often resulting in temporary disability, disability, mortality, or have had some acute illness; persons with risk factors.

This method is aimed at preventing diseases, actively detecting them in the early stages and timely implementation of medical and recreational activities. Clinical examination of the population has now changed from the method of work of individual institutions into the system of work of all medical and preventive institutions in the country. Each of them, in accordance with the profile of their work, carries out prophylactic medical examination of various groups of the population and certain contingents of patients.
The main purpose of the prophylactic examination consists in preserving and strengthening the health of children, increasing life expectancy through systematic monitoring of their health, studying and improving their everyday life, a wide range of socio-economic, sanitary and hygienic, preventive and therapeutic measures.
Methods for conducting clinical examination of healthy and sick people are basically the same.

Clinical examination of healthy should ensure proper physical development, improve health, identify and eliminate risk factors for the occurrence of various diseases through a wide range of public and individual social and medical events.

Clinical examination of patients should actively identify and treat the initial forms of diseases, study and eliminate the causes that contribute to their occurrence, prevent the exacerbation of the process and its progression on the basis of constant dynamic monitoring and the implementation of therapeutic and recreational and rehabilitation measures.

The main tasks of the prophylactic medical examination of the population are:

1. determination of the state of health of each individual by an annual examination and assessment of health, taking into account age, gender and professional characteristics;

2. differentiated active dynamic monitoring of healthy people; persons with risk factors and patients; a gradual shift from individual surveillance to family surveillance;

3. identification and elimination of the causes of disease; assistance in eliminating bad habits and ensuring a healthy lifestyle;

4. timely implementation of medical and recreational activities;

5. improving the quality and efficiency of medical care to the population through interconnection and continuity in the work of all types of institutions, the wide participation of doctors of various specialties, the introduction of new organizational forms, further technical support and the use of computers.

Stages of medical examination:

First step. Planning of work on medical examination of the population: conducting a population census at the site, selecting a list of persons subject to active dynamic observation in a medical institution, determining the order of invitations for medical examinations and an individual examination program.

Second phase. Inspection on appealability and during preventive examinations. Carrying out medical and diagnostic measures, assessing the state of health, determining the health group.

Stage three. An active invitation to receive patients under dispensary supervision, conduct medical and health-improving and rehabilitation measures. Assessment of the quality of medical examination.

For health reasons, all examined residents are divided into three groups of dispensary observation.

The main method of prevention in pediatrics is clinical examination of healthy children. By 1997, pediatricians were observing children from birth to 15 years of age, and currently up to 18 years of age. During the prophylactic examination, a comprehensive health assessment is carried out with the definition of a health group. Accordingly, the volume and nature of health-improving and therapeutic measures for children with identified pathology or a tendency to it is determined. In modern conditions, clinical examination is the main form of work for children's clinics.

Clinical examination is carried out both by age and depending on the diseases, the child has.

The following contingents of the child population are subject to dispensary observation by the district pediatrician:

- All children in the neonatal period;

- Children of the 1st year of life;

- Children from risk groups;

- Children over 1 years of age who do not attend preschool institutions;

- Children with chronic diseases. Clinical examination of the child population includes the following activities:

1) regular medical examinations with a specified volume of laboratory and instrumental studies;

2) determination and assessment of the state of health in order to identify children with risk factors;

3) additional examination of sick children who need it, using all modern diagnostic methods;

4) identification of diseases in the early stages, followed by a complex of necessary therapeutic and recreational measures and dynamic monitoring of the state of health of children.

The district pediatrician is responsible for carrying out all stages of the clinical examination of the child population in his area and monitors its implementation. For each child subject to dispensary observation, a "control card of the dispensary observation "(form No. 030 / y)... Along with performing signaling functions (monitoring dispensary visits), this map also reflects data on the health status of children of various ages. These data help the doctor in carrying out dispensary observation, adherence to the terms of examination, urgent medical and recreational activities. The control card should be, first of all, an operational document in the work of a doctor.


In our country, a clinical examination of the entire child population is being carried out. The peculiarity of the prophylactic medical examination of children is that the struggle for the health of the child practically begins before his birth (prenatal care of a pregnant woman).
Further observation of children is carried out in accordance with age groups in preschool, school and other children's groups (boarding schools, special kindergartens and schools, etc.).
The Soviet system of health care and education has developed special regimes for the upbringing and recuperation of children, aimed at the formation of a healthy generation of Soviet people.
Children of the first month of life are examined at least 3 times by a nurse and 2 times by a doctor (more often at home). This allows you to identify signs of congenital pathology, malformations and developmental anomalies, consult a specialist and begin to correct defects and anomalies according to indications.
Children of the first year of life are examined monthly by a local pediatrician. Children are received in a healthy child's room, specially equipped with visual forms of agitation, allowing the mother to learn the rules of hygiene, feeding, hardening, etc. In the first year of life, the child is given many preventive vaccinations.
By the end of the first year, the child had already erupted teeth, the formation of which took place in the antenatal period. There is convincing evidence that children born to mothers with extragenital diseases (rheumatism, tuberculosis, hypertension, nephropathy, etc.) or who have suffered toxicosis during pregnancy, children born prematurely, who have had purulent-septic diseases during neonatal period who received antibiotics, etc., have an increased risk of developing defects of hard dental tissues in the form of hypoplasia and aplasia. Diagnosis of these defects and developmental anomalies is possible by the end of the first year of life.
Timely measures taken make it possible to prevent the development of caries in places of malformed tissues, and then its complications.
At the end of the first year of life, an epicrisis is written in the history of the child's development with the involvement of data obtained during laboratory research and examination of the child by other specialists.
In the child's individual card (form No. 112) in the first epicrisis there must be a record of the dentist about the number of erupted teeth, their position and the state of hard tissues. Parents should be given advice on the individual care of the child's oral cavity, the timing of visiting the dentist for the prevention of dental diseases. If a pathology is detected, the child should be taken for treatment and dispensary observation by a dentist, it is necessary to approve a plan of complex therapy and the use of prophylactic means with the pediatrician (see "Dispensary examination of children at the dentist aged from birth to four years old"). Order No. 770 of August 20, 1986 provides for annual examinations of the child by the dentist.
Children aged three years and older are examined once a year, in the month the child is born. At the same time, mandatory laboratory tests of blood, urine, and feces are provided. The participation of a dentist in examining children of these ages is described in the chapter "Clinical examination of preschool children".
Children of the fifth year of life are examined by a pediatrician once a year. In addition to the pediatrician, the child must be examined by other specialists: otorhinolaryngologist, ophthalmologist, dentist,
orthopedic surgeon, speech therapist and neuropsychiatrist. The child is preparing to go to school. Dentist examination, if it is performed for the first time, up to 70% of children in this period are belated. Such examinations allow only to identify and before the child enters school to treat the most severe form of dental caries: complicated forms, remove decayed teeth, and some correction of deviations in the development of the jaws.
Based on the examination of the child, all pediatricians, including pediatric dentists, make entries in the child's individual development chart and formulate recommendations.
At school, every year an in-depth examination of children is carried out by a school doctor with the participation of specialists.
During these examinations, anthropometry, spirometry, dynamometry, measurement of blood pressure, determination of visual acuity and hearing are performed, according to clinical indications - functional tests of the cardiovascular system, as well as the necessary laboratory and instrumental studies. The sequence of the examination is such that it provides for an examination first by specialist doctors, and finally by a school doctor. The school doctor determines the level of physical development of students and the health group.
The participation of dentists in conducting preventive examinations is necessary. Often, dentists believe that at the same time it is necessary to carry out the sanitation of the oral cavity, but this is wrong. The task of professional examinations is to identify pathology and determine the level of physical development of schoolchildren. According to the recommendations of the Institute of Hygiene of Children and Adolescents, with a comprehensive assessment, it is turned off along with body length, annual weight gain, ossification of the hand, the development of secondary sexual characteristics, the number of erupted permanent teeth [Stromskaya EP et al., 1974].
Proceeding from the above, the participation of a dentist in professional examinations should provide for filling out paragraph 10 of the child's individual card (form No. 26) in the following sequence: the number of erupted permanent teeth, the presence of caries and the degree of its activity (I, II, III degree), the state of the bite, in the presence of anomalies of bite, active causes and risk factors in their progressive development should be indicated, the condition of the periodontium and the hygienic index should be assessed.
It is these data that form the basis for determining the physical development of the child and the health group.
Children with dental caries in the III degree of activity are classified by the pediatrician in the third health group, and children with a formed malocclusion, causing a violation of biting and chewing food, in the second health group.
Since the prevalence of dental diseases in children is high, the amount of work on the rehabilitation of the oral cavity is large, the dentist may not participate in examinations, but enter his data in form No. 26 as the special examination and sanitation of the oral cavity is carried out in the dental office.
A child with a referral from a pediatrician or other pediatric specialist, the dentist must thoroughly examine, carry out treatment and write down a detailed dental diagnosis in the dispensary observation card, indicate the activity of the process development, formulate an individual program of therapeutic and preventive measures, the frequency of repeated examinations, etc. Pediatrician contact with a dentist, when observing children weighed down with a common pathology, should be carried out in the manner of double differentiated control.

Preschool institutions- kindergartens, day nurseries, kindergartens - state institutions for the protection of infancy and childhood of an open type, of a therapeutic and prophylactic, recreational and educational nature for children aged 1.5 to 7 years.

Approximate standards for the number of children:

In the nursery 180-200 children

There are 600 children in the desk garden

In schools - 2000 per 1 pediatrician

Clinical examination:

Healthy children (medical examination at the prescribed time)

Infant age (up to 1 year):

early neonatal 1 month - the first three days after discharge 2 times a month

late neonatal

postneonatal once a month.

From 1 to 3 years old - early childhood

In the second year - 1 time in half a month

On 3rd-1 every six months

3-7 years old-preschool 1 time per year

special emphasis at 6 years old, ml school age (prepubertal)

up to 15 years old - puberty

15-18 years old - adolescent

Clinical examination of preschool children:

Children under 1 year old are examined by a pediatrician monthly. At 1 month, a neurologist's examination, audiometry, ultrasound of the hip joints is required.

At the age of 1, in addition to a pediatrician, children are examined by a surgeon, orthopedist, neuropathologist, otolaryngologist, ophthalmologist, dentist, speech therapist.

For young children (up to 3 years old), preventive examinations by a pediatrician are carried out:

1 time per quarter - for children aged 1 to 2 years;

1 time in 6 months - for children aged 2 to 3 years.

With the preparation of milestone epicrises in 1 year 6 months; at 2 y. 6 months and dispensary epicrisis once a year (2, 3, 4, 5 years).

At the age of 2, in addition to the pediatrician, children are examined by an otolaryngologist, ophthalmologist, neuropathologist, and dentist.

At the age of 3 - surgeon, orthopedist, otolaryngologist, ophthalmologist, neuropathologist, dentist, speech therapist.

Information about preventive examinations at the prescribed time is entered in the form 026 / y-2000, sections 6.1; 6.2; 6.3.

According to the order of the Ministry of Health and the Ministry of Defense of the Russian Federation No. 186/272 dated June 30, 1992, the decreed

terms of examination of preschool children (from 3 to 7 years):

At 3 years old, before entering the preschool educational institution

At 5-6 years old, one year before entering school

At 6-7 years old, in the year of entering school (spring-summer).

With the obligatory examination of all specialists (pediatrician, surgeon, orthopedist, otolaryngologist, neuropathologist, ophthalmologist, dentist). Speech therapist, psychiatrist, psychologist - according to indications.

The main institution for preschool children (from 2 to 7 years old) is the nursery-kindergarten (currently, in some cases, the nursery and the kindergarten exist separately).

The children's polyclinic is responsible for treatment and prophylactic work; compliance with the sanitary and hygienic regime in the preschool children's institutions of the district. Before entering the nursery-kindergarten, children undergo a comprehensive examination. Only healthy children are admitted to the nursery-kindergarten. For children with physical and mental developmental defects, for patients with chronic diseases, specialized day nurseries are organized. The child is in the nursery from 10 to 14 hours a day. For children whose parents work night and evening shifts, for children of single and large mothers, round-the-clock five-day nurseries are organized, from which parents take their children only on weekends.

The doctor and the nurse conduct systematic observation of the physical and neuropsychic development of children, the vaccinations, the implementation of the sanitary and hygienic regime. Children from 1 to 3 years old are systematically examined once every 3 months and once a year - a preventive examination , deworming, oral cavity sanitation. The results of the observation of the child and the data of the examinations are entered into the individual card of the child.

The doctor and nurse of preschool institutions devote a special place to the fight against infectious diseases. Every child who comes from home is carefully examined by a nurse every day upon admission to a child care facility, and in case of suspicion of an infectious disease, he is placed in an isolation ward.

Registration of visits by children to institutions is carried out daily by a nurse or a nurse-educator. An analysis of the physical development of children, morbidity, mortality and terms of use by children of each place in the year is carried out annually (planned employment - 300 days).

Medical workers of preschool institutions systematically inform educators and the children's polyclinic about the physical and neuropsychic development of children.

Preschool institutions:

Nursery - 120-180 children, kindergarten - 600 children for one pediatrician,

1. Preschool institutions of general type

2. Center for preschool education

3. Complex of preschool education

4. Educational complex

5. Preschool with first grades

6. Small preschool institutions

7. Preschool combined with staff housing

8. Family kindergarten

9. Walking groups

10. Round-the-clock duty group of short-term supervision.