Organization of medical care for children. Features of the organization of medical care for children. Providing qualified and specialized medical care in the clinic and at home

The share of the child population reaches 14%. Children are persons aged 0 to 14 years inclusive (14 years, 11 months, 29 days). This is a priority direction in the organization of medical services. help. Infant mortality is mortality under 1 year per 100 births. The incidence in children is 2 times higher than in adults. Although infant mortality is decreasing, its share in overall mortality remains high. Russia ranks 52–54 in the World in terms of infant mortality. Its share in total mortality is 205.

Causes of infant mortality:

acute indigestion

pneumonia

diseases of the upper respiratory tract

acute childhood infections

The main cause of infant mortality is unfavorable conditions for feeding and caring for infants. The death of a child should be considered as an emergency for health care facilities. One of the main tasks of bodies and institutions of medical and preventive care for children is to reduce infant mortality.

The main child health institutions are:

multidisciplinary children's hospitals

children's clinics

children's departments of adult clinics

children's departments of multidisciplinary hospitals for adults

specialized children's hospitals and institutions

children's home

preschool institutions

orphanages

In cities, the main institutions are city clinics. In the village, a midwife at the primary care center is responsible for providing medical care to children, in the local hospital with 35 beds there is a pediatrician, in the central district hospital there is a polyclinic department for children and a children's department in the hospital and a district pediatrician. All assistance to children in the region is headed by the Regional Hospital.

Previously, there were children's consultations (up to 3 years old) and children's clinics, i.e. micro- and macropediatrician. Now the principle of a single pediatrician is in effect.

Based on capacity, children's clinics are divided into 5 categories:

1 – 800 visits per day, 2 – 700, 3 – 500, 4 – 300, 5 – 150.

City Children's Clinic

It works on a territorial-precinct principle (800 children per site). The main load is children under 1 year old (50-60 children). Recently, pediatricians, obstetrician-gynecologists and therapists have been working in one obstetric-therapeutic-pediatric area (1 obstetrician-gynecologist, 3 therapists, 2 pediatricians).

Children's clinics are staffed in such a way that they consist of local pediatricians with visiting nurses at 1.5 rates. Doctors of all narrow specialties: 0.3 positions per 1000 children, 0.45 positions per 1000 children.

Structure of the children's clinic:

healthy child department

specialized care department (specialists, physiotherapy, laboratory).

preschool - school department

clinical examination

The children's clinic has:

filter with box

local pediatricians' offices

vaccination and treatment room

specialist doctors' offices

rooms for hygienic and physical development of girls

x-ray room

physiotherapy room

physical therapy room

laboratory

wardrobe

registry

dairy kitchen

breast milk collection point

first aid rooms

Features of the children's clinic that are related to its tasks:

Serving healthy children: healthy children come through the main entrance. There is a filter where they examine the child and decide whether to let him through or not. If an infection is suspected, the child is placed in a box where he is examined by a doctor.

The main method in serving children is the clinical examination method.

Child health protection includes 3 periods:

Antenatal fetal care (contact between an obstetrician-gynecologist and a pediatrician)

Dynamic observation of newborns. The visiting nurse takes part: upon discharge from the maternity hospital, she must register the child. No later than 3 days later, the doctor must examine the child, especially children who belong to the risk group - whose mothers have toxicosis of pregnancy, etc. Healthy children are examined by a doctor at least 3 times a month, and the sister visits the child at least 6 times a month. If the child has abnormalities or diseases, the doctor examines him 4 times. During the year, every 3,6,9,12 months, the doctor writes milestone reports.

Dynamic observation from one year to 7 years. At 2 years old, the doctor examines him 4 times a year. At 3 years old, 2 times a year. In subsequent years - once a year.

All children are divided into 3 groups based on health status:

healthy

with a risk of pathology

Objectives of the healthy child’s office:

promotion of a healthy lifestyle

teaching parents how to raise a healthy child

health education for children

disease prevention

The need to pay attention to proper balanced nutrition takes a lot of attention. Children up to 4 months old should receive breast milk, for which purpose a breast milk collection room is organized in the clinic.

All sick children are cared for at home. This is the basis of anti-epidemic work. A lot of effort is devoted to medical examination of schoolchildren (patients with tuberculosis, helminthic infestation, and those in need of sanitation of the oral cavity and pharynx are identified). Special preschool and school departments are created in children's clinics. They include pediatricians and nurses who work in nurseries, kindergartens and schools. There are the following staffing standards for children's institutions: 1 doctor per 2000 schoolchildren, 1 nurse per 600–800 schoolchildren; 1 doctor per 400 – 600 children per child. kindergartens, 1 nurse per 100 children per day. gardens If there are 6 – 9 doctors, then the position of head is allocated. department.

The main tasks of the preschool - school department:

examination of all children who enter and stay in this institution

honey. control over sanitary and hygienic conditions

control over the implementation of daily routines, nutrition, hardening

honey. monitoring health status, conducting routine medical examinations, identifying patients

san - enlightenment. Job

summer health activities

analysis of institutions' activities

To raise children over 3 years old, the education system has a network of orphanages. For organizing medical help in them is answered by honey. institution. There must be a doctor in the orphanage, and if there is none, there must be a medical doctor. services are provided to the nearest children's clinic.

MINISTRY OF HEALTH
RUSSIAN FEDERATION

DECISION OF THE COLLEGE

Organization of medical care for children
adolescence in modern conditions

Having heard and discussed the report of the head of the Department of Medical Problems of Maternity and Childhood A.A. Korsunsky on the organization of medical care for adolescent children, the board notes that negative trends in the health of adolescents have caused an increase in the number of socially maladjusted children, a decrease in the suitability of young men for military service, an increase the proportion of people who have restrictions on receiving vocational education and employment due to health reasons. The decline in the personnel, intellectual, and defense potential of the state can currently be regarded as threatening the national security of Russia.

The health of modern adolescents is characterized by an increase in chronic pathology, which affects 70% of the teenage population, an increase in the number of disabled children due to the age group of 10-14 years and 15 years, a high mortality rate (the mortality rate in the group of people 10-17 years old in 1999 was 213 .4 per 100 thousand people).

Among adolescents, due to the special specifics of adolescence, the number of socially determined and socially significant diseases is increasing.

Adolescents are much more likely than children to experience mental disorders, metabolic disorders, diseases of the endocrine system, diseases of the nervous system and sensory organs, the circulatory system, and urination. The frequency of drug addiction and substance abuse among 15-17 year olds was 86.7 per 100 thousand people, which is 40 times more than among children under 15 years of age. 733.5 per 100 thousand adolescents aged 15-17 years are on preventive registration in connection with the use of psychoactive substances (including alcohol) (under 15 years - 28.2 per 100 thousand).

The prevalence of gynecological pathology among girls is increasing, the frequency of which currently exceeds 130 per 1000. Delayed puberty is detected in more than 30% of boys and girls.

In recent years, the incidence of complications associated with pregnancy, childbirth and the postpartum period has increased by 25% in girls 10-14 years old and by 33.6% in girls 17 years old.

Rapid puberty and early onset of sexual activity have led to the emergence of the phenomenon of “teenage motherhood,” which negatively affects both the health of newborns and the health of young mothers.

The number of children with mental health disorders and borderline mental states is increasing, often forming the social insufficiency of adolescents. Of the adolescents declared unfit for military service in peacetime, more than 40% are persons with mental disorders.

The health status of adolescents and its specific characteristics do not allow them to fully perform their social and biological functions - vocational training, work, military service, reproductive function and the associated reproduction of future generations.

Currently, about 70% of adolescents have health restrictions to obtain a profession. Among modern young men, the level of fitness for military service does not exceed 60%.

At the same time, when organizing medical care for adolescents, both the current features of the health status of this age category and the entire complex of factors influencing the formation of health at the adolescent stage of development, as well as the very system of organizing and providing medical care to them, were not sufficiently taken into account.

In order to create a system of continuous medical monitoring of adolescents, in 1999 the Ministry of Health of the Russian Federation decided to reform the system of providing medical care to adolescents. Order of the Ministry of Health of Russia dated 05.05.99 N 154 “On improving medical care for adolescent children” suspended the transfer of medical supervision of children upon reaching 15 years of age to outpatient clinics of the general medical network.

After the order was put into effect, a system of continuous monitoring of the health of children at all stages of their development was organized in 64 constituent entities of the Russian Federation. The volume of preventive work has increased, the coverage of adolescents with preventive examinations has increased, the number of people placed under dispensary observation with a newly diagnosed diagnosis has increased, and the coverage of adolescents with planned medical care has increased.

In 30% of the territories, departments (offices) of medical and social assistance have been created on the basis of outpatient clinics, which allow solving issues of education in the field of health, social adaptation and legal protection of adolescents.

In a number of territories, modern institutions have been created to work with adolescents - youth CDCs, child and adolescent health centers, adolescent reproductive health centers, psychological and career guidance centers, etc.

In most territories, children's clinics have established departments for organizing medical care for adolescents in educational institutions.

The pediatric service has begun work on medical support for preparing young men for military service. Identification of deviations in health status at the pre-conscription stage made it possible to reduce the return of young men from the Armed Forces.

Currently, the joint Central Military Medical Commission of the Ministry of Defense of the Russian Federation is studying the possibility of conducting a medical examination of young men during initial military registration in children's clinics (Ivanovo region).

Taking into account the medical and social problems of adolescents related to reproductive health and sexual activity, measures are being taken to protect the reproductive health of adolescents.

To help institutions and specialists providing medical care to adolescents, various educational and methodological manuals, recommendations, and information letters on protecting the health of teenage girls and boys have been published.

As a result of the work carried out in recent years, positive trends have emerged in the reproductive health of adolescents. The number of abortions over the past 1995-1999 in the age group of girls under 14 years old decreased by 39.6%, and in the age group 15-19 years old - by 32.0%. Over the same period, the number of criminal abortions among 14-year-olds decreased by 63.3%, in the group of 15-19 years old - by 33.0%, respectively.

One of the most important areas of preventive work among children and adolescents is vaccine prevention of infectious diseases. The new vaccination calendar provides for the possibility of vaccination against rubella, incl. teenage girls.

The strategic directions of the maternal and child health service involve the development of hospital-substituting forms of medical care for children. The introduction of hospital-replacing technologies into the work of pediatric treatment and preventive institutions will increase the volume of medical care for adolescents.

Rehabilitation assistance for adolescents is provided in the rehabilitation treatment departments of children's clinics. It should be noted as a positive moment the transition to hospitalization of disabled children and children suffering from chronic pathologies in children's hospitals.

In a number of territories, shifts were organized at the Mother and Child sanatorium for teenagers and parents and special shifts for teenagers at children's health camps.

The Ministry of Health of the Russian Federation is forming a regulatory framework for providing medical care to children and adolescents.

By a joint order of the Ministry of Health of Russia and the Russian Academy of Medical Sciences, the Center for Medical and Social Problems of Adolescent Children of the Ministry of Health of Russia was created on the basis of the Scientific Center for Children's Health of the Russian Academy of Medical Sciences.

Statistical accounting and reporting documentation on the health status of children has been improved.

The indications for sending children to educational institutions with an advanced level of education have been revised.

Together with the Ministry of Defense of the Russian Federation, guidelines have been developed “Organization and conduct of medical examinations, examinations of citizens during initial military registration and medical and health measures among them.”

Medical indications for choosing a profession have been prepared, taking into account health conditions.

Additions have been developed to the unified program for advanced training of pediatricians and a curriculum for the specialization of adolescent therapists in pediatrics, and additions have been made to test tasks in the specialty "Pediatrics".

At the same time, an analysis of materials from 79 constituent entities of the Russian Federation and the results of inspections of a number of territories of the Russian Federation shows that there are certain difficulties and unresolved issues in carrying out this work.

In a number of constituent entities of the Russian Federation, the formation of a modern system of medical care for adolescents is slowly progressing.

Hospital-substituting forms of medical care for children are not being developed sufficiently. Thus, with an increase in 1999 in the number of day hospitals of all types, including hospitals at home, to 300 (1997 - 224) and the number of beds in them to 4625 (1997 - 3532), they account for only 2% (1997 - 1.5%) to the total number of children's beds.

Due to the lack of trained personnel, work on creating medical and social care departments in children's clinics has not begun in most territories.

To date, no work has been carried out on medical care for adolescents in primary and secondary vocational education institutions.

Insufficient attention is paid in children's clinics to the medical care of young men in preparation for military service.

The system for protecting the reproductive and mental health of adolescents requires improvement.

It is necessary to continue work on the formation of a regulatory framework for the activities of children's outpatient clinics.

In connection with the above and with the aim of further improving medical care for adolescents, colleagues

1. Department of medical problems of motherhood and childhood (Korsunsky A.A.):

1.1. Prepare a draft order “On improving medical care for children and adolescents in primary and secondary vocational education institutions.”

Deadline - December 31, 2001.

1.3. In accordance with the approved plan, complete a joint experiment with the Ministry of Defense of the Russian Federation on medical examination of young men during initial military registration in children's clinics.

Deadline - 03/01/2002.

1.4. To develop a model of information support for children's clinics on the problems of protecting the reproductive health of adolescents.

Deadline - December 31, 2001.

2. The Department of Medical Problems of Maternity and Childhood (Korsunsky A.A.), the Department of Scientific Research Medical Institutions (Tkachenko S.B.) to organize on the basis of the Moscow Research Institute of Pediatrics and Pediatric Surgery of the Ministry of Health of Russia an Organizational and Methodological Center for Medical Problems of Training Young Men for military service.

Deadline - 05/01/2001.

3. The Department of Medical Problems of Maternity and Childhood (Korsunsky A.A.), the Department of Scientific Research Medical Institutions (Tkachenko S.B.), the Scientific Center for Children's Health of the Russian Academy of Medical Sciences (Baranov A.A.) (as agreed) to develop modern science-based technologies improving the health of children and adolescents in educational institutions.

Deadline - 03/01/2002.

4. Department of educational medical institutions and personnel policy (Volodin N.N.):

4.1. Ensure control over the inclusion in the educational programs of pediatric faculties, pediatric departments of medical universities and departments of advanced training of pediatricians of the necessary additions and changes, taking into account the specifics of adolescence.

Duration - within a year.

4.2. Develop a program for training clinical psychologists and social work specialists for children's outpatient clinics.

Deadline - December 31, 2001.

5.1. Take measures to complete the work on creating a system for organizing medical care for adolescents in children's outpatient clinics.

Deadline - December 31, 2001.

5.2. Ensure the organization of medical and social care departments in children's outpatient clinics.

Deadline - 02/01/2002.

5.3. Organize permanent seminars for pediatricians on physiology, pathology, organization of medical care for adolescents, including medical support for the preparation of young men for military service.

Duration - within a year.

5.4. Organize rehabilitation assistance for children under 17 years of age (inclusive) with chronic pathologies and people with disabilities in local sanatoriums and medical rehabilitation centers.

Deadline - 01/01/2002.

6. The heads of medical educational and research institutions should strengthen organizational and methodological assistance to children's outpatient clinics of the constituent entities of the Russian Federation in providing medical care to adolescents.

Duration - within a year.

7. Entrust control over the implementation of the board’s decision to Deputy Minister O.V. Sharapova.

Chairman of the Board
Yu.L. Shevchenko

Secretary of the Board
A.V.Veremeenko

The text of the document is verified according to:
"Official documents in education",
N 35, December 2001

Provides outpatient care to the children's population children's clinic, which can be independent or be part of a united children's hospital as a structural unit. In the attachment area, the children's clinic provides treatment and preventive care to children from birth to 14 years inclusive (14 years 11 months 29 days). Medical care is provided in the clinic, at home, in preschool institutions and schools. 75-85% of children begin and complete treatment in a children's clinic.

The work of the children's clinic is built in accordance with the general principles of treatment and preventive care (the local principle of service and the dispensary method of work). In the pediatric area - no more than 700-800 children from birth to 14 years inclusive. Despite the significant increase in the volume of specialized care in the children's clinic (surgeon, orthopedic traumatologist, otolaryngologist, psychoneurologist, ophthalmologist, allergist, etc.), the leading figure remains the local pediatrician. More than 60% of all visits are made to the local pediatrician.

All sick children should receive medical care only at home, therefore only healthy children or those with chronic diseases without exacerbation go directly to the children's clinic. More than 90% of all child home visits are made by the local pediatrician.

The tasks of a local pediatrician, in addition to providing medical care, include preventive work with healthy children and those with chronic pathology and in need of dispensary observation. The local pediatrician must know the features of the development and formation of the child’s health, the conditions for raising a healthy child, issues of preventing the occurrence and unfavorable course of diseases, especially at an early age, the role and significance of the family’s conditions and lifestyle. Essentially, a good local pediatrician is a children's family doctor.

The local pediatrician is obliged to maintain constant contact with obstetric and gynecological institutions and ensure continuity in monitoring children, especially in the presence of risk factors. Preventive work in a children's clinic with healthy children includes preventive examinations by a local pediatrician, when parents are given recommendations on nutrition, child care, physical education, hardening, examinations by specialist doctors, laboratory diagnostic examinations and preventive vaccinations.

Comprehensive medical examinations make it possible to identify diseases in the early stages, provide timely treatment and, accordingly, prevent the development of a chronic process.

Particular attention should be paid to frequently (4 illnesses per year or more) and long-term (more than 40 days per year) sick children, since these children are more likely to develop various chronic diseases.

Children of the 3rd, 4th and 5th health groups who have a chronic disease of various stages of compensation are under the dispensary supervision of a pediatrician and specialists.

Preventive work with both healthy and sick children includes sanitary and educational work, hygienic education, the effectiveness of which is largely determined by clarity and persuasiveness. Health education conversations are carried out both during an appointment at the clinic, and during home visits, and in special classes. Healthy child rooms play a major role in health education work, where parents are taught the basic rules of raising a healthy child and the basics of a healthy lifestyle are promoted.

Based on the results of comprehensive medical examinations, the health group of each child is determined.

The work of a doctor under the “single pediatrician” system was introduced in our country in 1952-1953. A child from birth to 14 years inclusive is observed by a local pediatrician in a children's clinic. Until 1953, children of the first 3 years of life were observed by a micropediatrician working in a children's clinic, and children over 3 years of age were observed by a macropediatrician in a children's clinic. The introduction of the “single pediatrician” system made it possible to introduce dynamic monitoring of the health status of children (up to 14 years of age inclusive), but increased the number of contacts of young children with older children, which, naturally, contributed to the increase in morbidity. In this regard, a number of fundamental features have appeared in the work of the children's clinic.

Firstly, only healthy children or those suffering from a chronic disease and who do not pose a danger in terms of the spread of infection should visit the children's clinic. Sick children should receive medical care at home until they recover.

Secondly, when visiting a children's clinic, all children must go through a filter, where, as a rule, the most experienced nurse is on duty. Based on a survey about the child’s health status and the reasons for visiting the clinic, examination of his skin and pharynx, and, if necessary, thermometry, she decides on the possibility of the child visiting the clinic. If necessary, the child is sent to the box, where he is examined by the doctor on duty.

Thirdly, it is advisable to take children in the first years of life, who are most susceptible to various diseases, on certain days of the week.

The children's clinic has a school and preschool department, the staffing of which is established at the rate of 1 pediatrician per 180-200 toddlers, per 600 preschool children, per 2000 school-age children, per 200 children in sanatorium nurseries, nurseries and kindergartens, 300 children studying in auxiliary schools; 1 nurse per 100 children in nurseries

kindergartens, for 700 children studying in schools, for 50 children studying in sanatorium kindergartens, for 300 children studying in auxiliary schools.

The workplaces of these employees are located in the relevant institutions where medical supervision of children is organized, and in the children's clinic itself there is an office of the head of the preschool institution.

An important principle of the children's clinic is to provide medical care to children with acute illnesses at home. While visiting a sick child at home, the pediatrician makes a preliminary diagnosis of the disease, determines the severity of the child’s condition, and decides on the possibility of treatment at home or in a hospital setting.

When organizing a hospital at home, the clinic provides the patient with free medicines, and, if necessary, organizes a nurse’s post or visits by a nurse several times a day; the doctor visits the child as indicated, but at least once a day until recovery.

A large amount of medical care at home is provided by an emergency physician. As a rule, he has to deal with a rather severe pathology, since calls are received due to a sudden illness (hyperthermia, abdominal pain, vomiting, injuries, poisoning, etc.). In some cases, sick children require hospitalization.

Recently, the specialty “family doctor” has been developing - a general practitioner who monitors the health of all family members, children and adults.

Children's hospitals distinguished by profile (multidisciplinary and specialized), by organizational system (integrated and unintegrated), by volume of activity (various bed capacity). The children's hospital includes specialized departments (pediatric, surgical, infectious diseases), and those, in turn, have departments by age up to 3 years and by gender among children over 3 years old. In addition, the hospital has a laboratory diagnostic service and a pathology department.

The emergency department in children's hospitals consists of reception and examination boxes, the number of which must be at least 3% of the total number of hospital beds. In addition, when accepting children, it is necessary to have information from the sanitary and epidemiological department (sanitary and epidemiological center) about the availability

or lack of contact with patients with infectious diseases and from the pediatrician about past childhood infections. This allows you to correctly decide the issue of hospitalization of the child. In order to limit the spread of nosocomial infection, it is advisable to provide wards with 1-2 beds for children under 1 year old, and for older children with no more than 4 beds.

No less attention in children's hospitals should be paid to nutrition; first of all, special attention is paid to the nutrition of children in the first years of life. The daily routine should correspond to the age of the child.

Educational and pedagogical work with sick children is an integral part of the treatment and preventive activities of the hospital and is aimed at creating a treatment and protective regime. Mothers should be involved in child care and hospitalization of children, primarily during the first 2-3 years of life, together with their mothers, should be more widely practiced.

In the process of healthcare reform, there is a reduction in the number of beds not only for adults, but also in children's hospitals, especially in infectious diseases. At the same time, there is a slight increase in the number of specialized beds.

A special place in raising a healthy child belongs to the system of public education and medical care in preschool institutions and schools.

All institutions of public education for children of preschool and school age are divided depending on the age, health status of the children and the social status of the family.

A typical institution for the education of preschool children is a nursery-kindergarten preschool institution.

There are open-type institutions (nurseries, kindergartens and schools), where children spend part of the day, and closed-type institutions (children's homes, orphanages and boarding schools), where children spend a relatively long time (or permanently) without their parents. Closed institutions are intended for the upbringing and education of orphans, children of single mothers, abandoned children, as well as children whose parents have been deprived of parental rights.

A pediatrician providing medical care to children in such institutions must:

Examine all newly admitted children and recommend a set of medical and pedagogical measures aimed at speedy adaptation;

Conduct laboratory diagnostic examinations of children;

Carry out constant medical monitoring of health status, physical and neuropsychic development;

Ensure preventive vaccinations;

Organize comprehensive examinations by medical specialists;

Take an active part in the distribution of children into groups and classes in accordance with anatomical, physiological and neuropsychic characteristics;

Carry out a set of preventive measures to prevent the introduction and spread of infectious diseases.

Among the measures to reduce the incidence of children, it is necessary to pay great attention to the prevention of difficult adaptation to a preschool institution.

An equally important role in reducing the incidence of children belongs to individual work with frequently ill children, as well as with children with chronic diseases.

Medical care for women and children living in rural areas, like the entire population, it turns out in stages.

At the 1st stage (rural medical district), mainly preventive, anti-epidemic and, to a small extent, therapeutic care for children is provided. Mostly children with mild forms of the disease are hospitalized in the rural district hospital; in severe cases, care is provided in the central district hospital, since low-power rural district hospitals are not sufficiently equipped with pediatricians and children are often provided with care by a general practitioner.

Paramedic and midwife stations provide outpatient care mainly for pregnant women and children in the first years of life. These institutions employ a paramedic or visiting nurse.

The main stage of providing medical care to children throughout the region is the central district hospital (2nd stage). The work of the hospital is led by a district pediatrician, and in large districts the position of deputy chief physician for childhood and obstetrics has been introduced.

There is still a fairly high proportion of children in need of treatment in somatic, general surgical, and infectious diseases departments, but referred for treatment to regional children's and general hospitals.

In accordance with the recommendations of experts, it is advisable to concentrate about 70% of the total bed capacity for children in central regional hospitals, about 10% in the local hospital, and the remaining 20% of beds should be provided for hospitalization of children in the regional center.

Pediatricians and obstetricians of the regional center, in addition to providing highly qualified specialized medical care, are entrusted with the functions of supervisors of rural areas in carrying out organizational, methodological, treatment and advisory work.

One of the important but still far from resolved problems remains the organization of medical care. teenagers Recently, the provision of outpatient care has been entrusted to children's clinics, and therefore to pediatricians. Before this, adolescent clinics operated at clinics for adults (they were preserved at a number of clinics).

As noted in the national project “Health”, in the first stages the main attention and organizational measures are aimed at radically improving the most widespread - primary health care. However, inpatient medical care has not been forgotten. The emphasis here is on improving its quality by improving its organization, strengthening its specialized types, especially the intensive introduction of high medical (i.e. complex, expensive) technologies, and the creation of modern diagnostic and treatment centers throughout our country. It is planned to build at least 15 such centers in the coming years, to modernize the outdated material, technical and resource base of hospitals. It is also expected that there will be a consistent significant increase in wages for employees of hospital institutions so that in a short number of years their financial situation will not lag behind that of local therapists, pediatricians, and emergency medical workers.

In the national project “Health”, much attention is paid to the protection of motherhood and infancy - pediatric and obstetric-gynecological care. Mass screening of newborns will be achieved to improve diagnosis and especially

identification of hereditary diseases, which will affect the reduction of disability in children. Work has begun to provide inpatient obstetric facilities with modern diagnostic and treatment equipment; The construction of 20 perinatal centers is planned. Already in 2006, almost 5 thousand local therapists and pediatricians, 1,500 general practitioners (family doctor) are being trained under modern programs; in 2007 this number will increase by more than 1 thousand specialists. Federal budget funds for providing medical care to women during pregnancy and childbirth are significantly increasing (10.5 billion rubles in 2006 and 14.5 billion rubles in 2007). Birth certificates are being introduced. For each such certificate in the case of a favorable birth, the antenatal clinic receives 2 thousand rubles, and the maternity hospital - 5 thousand rubles. This will not only affect the quality of medical care and the overall increase in the birth rate, but also the wages of medical workers in these institutions. In 2007, the size of certificates will increase and 2 thousand rubles will be allocated. children's clinic for dispensary observation of each child.

Maternity certificates are also issued to women themselves - from the 30th week of pregnancy. The cost of a birth certificate in a antenatal clinic will increase to 3 thousand rubles, in maternity hospitals - up to 7 thousand rubles. Special benefits are also being introduced - 1.5 thousand rubles. for the first child and 3 thousand rubles. - for the second or 40% of salary. A material certificate at birth has been introduced - for a mortgage, a child’s education or for the funded part of a pension. The certificate can be used when the child reaches 3 years of age.

One of the most important issues of modern pediatrics in our country is children's health, which is based on general principles of organizing treatment and preventive care: accessibility, freeness, locality of medical care, use dispensary observation, sequence of outpatient and inpatient care, stages of medical care.

The precinct principle is based on dividing the territory of settlements on a site in such a way that in one area no more than 800 children lived under the age of 15 years, of which up to 100 children are 1 year of age. Medical care for children provided by the local pediatrician and a nurse.

Stages and sequence of medical support is the provision of medical care to children in a certain order. First, the child is examined by a local doctor with the involvement (if necessary, consultations) of specialists of a narrow profile. For further examination and treatment, the child is sent to a district or city hospital, then to a regional hospital. If necessary, medical care can be provided at maternal and child health centers and research institutes. The last stage of assistance to children is rehabilitation and health institutions (sanatoriums and resorts).

In our country, a powerful network of children's treatment and preventive institutions has been created to provide medical care. In all regional centers and large cities, children receive general and specialized care in multidisciplinary children's hospitals. The composition of these medical institutions includes cardiological, pulmonary, gastroenterological, nephrological and other departments, as well as the intensive care and resuscitation department, the neonatal pathology department, the department for nursing premature babies, and the like.

2.Principles of organizing medical and preventive care for children.

Leading institution in providing medical and preventive care to children is a children's clinic. The clinic operates on a local basis. The work of the doctor and nurse at the site includes continuous dynamic monitoring of children, starting from birth, providing medical care to children with acute and chronic diseases, medical examination of children from risk groups, children who have suffered acute diseases, and children with chronic pathology.

Pediatricians carry out preventive and anti-epidemic measures aimed at ensuring proper physical and neuropsychic child development, to reduce morbidity and mortality, prepare and conduct vaccinations. In addition, an important aspect of the work of a pediatrician and nurse is sanitary education and legal protection of children.

Effective preventive measures on site begin even before the baby is born. The district nurse provides prenatal care to the pregnant woman within 10 days after receiving notification of the pregnant woman from the antenatal clinic. She conducts a conversation about the importance of a woman’s daily routine and nutrition for the development of the fetus and the birth process. For the second time, the nurse visits the expectant mother at the 32nd week of pregnancy in order to determine the family’s preparedness for the birth of a child, the availability of what is necessary to care for the newborn, and talks about the characteristics of its behavior, feeding and development. A pediatrician visits a pregnant woman at the end of pregnancy only if necessary.

The organization of child care is of great importance in reducing morbidity and child mortality after discharge from the maternity ward. First patronage newborn baby The pediatrician and nurse carry out the examination within the first 3 days after receiving the notification. The purpose of the first visit is to determine the child’s health status and assess his physical and neuropsychic development. Particular attention should be paid to the child’s behavior (excitement or lethargy), sucking activity, skin condition (pallor, jaundice, cyanosis, rash, induration) and umbilical ring. After a thorough examination of the child, they assess her condition, specify her health group, outline health-improving measures, and draw up a plan for further monitoring of the child. Also, during the first visit, it is necessary to familiarize the mother with the rules of feeding, bathing and caring for a newborn, breast care, and pumping techniques. breast milk. During the 1st month, the pediatrician must examine the newborn three times, and a child at risk - at least 4 times. During repeated visits to the newborn child, the local pediatrician and the nurse make sure that the child is developing correctly. Particular attention should be paid to these children: premature babies, twins, bottle-fed children, children who have suffered asphyxia, birth trauma; patients with rickets, malnutrition, anemia, diathesis, children who often suffer from acute respiratory diseases. These children belong to a high-risk group and are subject to clinical examination together with specialists (neurologist, ophthalmologist, surgeon, otolaryngologist, etc.). According to an individual schedule.

At the clinic, a “Child’s Individual Development Card” is issued for the child, which is maintained until the age of 15. It notes the dates of visits, the child’s age, the dynamics of physical and mental development, feeding characteristics, care disorders, and data on the disease.

Further observation of healthy children of the 1st year of life is carried out monthly by a local pediatrician and a nurse in the clinic. The doctor evaluates the child’s physical and neuropsychic development, the state of various functional systems of the child’s body. Prescribes measures to prevent the most common diseases (rickets, anemia, etc.). The pediatrician examines healthy children from 1 to 2 years old once a quarter, from 2 to 3 years old - once every 6 months.

In the future, planned regular medical examinations are carried out in clinics. Based on examination data, anthropometric indicators and laboratory tests, the doctor determines the health group for each child, since the volume of necessary treatment, preventive and rehabilitation measures depends on this. The distribution of children into health groups is as follows. The first group includes children who do not have deviations in the functional state of the main organs and systems. Acute diseases are rare and have a mild course. The physical development of children corresponds to their age. The second group includes children with functional changes in one organ or system, as well as children of the 1st year of life with a burdened obstetric history (preeclampsia, complicated labor, multiple pregnancies, etc.), prematurity without pronounced signs of immaturity, unfavorable course of early pregnancy. neonatal period. These children often suffer from acute illnesses, and the recovery process is protracted. Basically, they have normal physical development, but minor deviations in the form of deficiency or excess body weight are possible. Possible delay in neuropsychic development. The third group includes children with chronic diseases or congenital anomalies of the development of organs and systems in the compensation stage. Existing functional and pathological changes in the main organs and systems, but without clinical manifestations. Children rarely suffer from intercurrent diseases, but their course is complicated by a mild exacerbation of the underlying chronic disease. The physical and neuropsychic development of these children corresponds to their age; there may be deficiency or excess body weight and short stature. Children of the fourth group have chronic diseases or developmental defects in the subcompensation stage, functional disorders of one or more pathologically altered organs or systems. With intercurrent diseases, an exacerbation of the underlying chronic disease occurs with a disturbance in the general condition and well-being or with a protracted period of recovery. Children may lag behind in neuropsychic and physical development. The fifth group includes children with chronic diseases or congenital malformations in the stage of decompensation, which leads to the child’s disability. Existing congenital functional disorders of pathologically altered organs or systems. Frequent exacerbations of the underlying chronic disease are observed.

The local pediatrician sets the timing of preventive vaccinations and immunobiological tests in accordance with the latest instructions. It is important to correctly select children for preventive vaccinations. Before vaccinations, the pediatrician must carefully collect anamnesis and examine the child and, if necessary, prepare the child for vaccination. Medical examination of older children– this is dynamic observation and organization of therapeutic and recreational activities among children with identified pathology. The doctor enters all data on the identified pathology in the “Dispensary Observation Control Card”, outlines in it the scope and nature of the necessary measures aimed at preventing relapses of diseases, and records the number of examinations during the year.

At the pediatric site Much attention is paid to sanitary education work, which includes individual and group conversations about raising a healthy, harmoniously developed child, systematic sanitary and hygienic education of parents and other family members, and promotion of a healthy lifestyle.

In the medical care of the children's population, hospitals occupy an important place, where sick children receive highly qualified medical care. A children's hospital may have general and specialized departments, taking into account the specifics of local conditions, morbidity characteristics, and the age composition of children. When organizing children's hospitals, it is taken into account that the vast majority of acute pathologies in children are of an infectious nature. Taking this into account, the need to create conditions for maximum separation of children has been proven, which is achieved by organizing a box or drinking box system of departments and applying the principle of one-time occupancy of wards.

In any department, the child is under the supervision of a resident physician, whose job is to collect anamnesis, conduct a clinical examination and instrumental examination, establish a diagnosis, treat the child, and determine a plan of rehabilitation measures. If necessary, specialized specialists and employees of scientific institutions are involved in examining the child.

Each child is assigned an individual regimen, taking into account the severity of the pathology, the child’s age, changes in his behavior, and the number of feedings. All this is recorded in the “Inpatient History”, which is drawn up upon the child’s admission to the hospital. Referral of children for inpatient treatment can be planned (by referral from local pediatricians) or emergency (by self-referral or referral by emergency or emergency medical services).

Compliance with the regime necessary for the child and fulfillment of prescriptions is possible only in the case of clearly coordinated work of the medical staff of the department. All necessary data on the course of the disease, changes in the child’s condition, and the implementation of doctor’s orders are reported by the nurse; her work must be well thought out, clearly regulated and coordinated with the actions of other employees in order to ensure maximum continuous monitoring of sick children.

The main functional responsibilities of a ward nurse are to carry out doctor’s orders, toilet sick children, measure body temperature, feed children, monitor their leisure time and sleep, organize walks, and assist doctors during their rounds. During the round, the nurse receives clear instructions from the doctor about changing the prescriptions and regimen for each sick child.

The nurse pays special attention to strict adherence to the sanitary and anti-epidemic regime in the department and monitors the work of junior medical staff. She places patients in wards according to the type of disease, age and gender, monitors the cyclical filling of the wards and compliance with the daily routine. Seriously ill children require special attention. Another nurse monitors the breathing, pulse, condition of the mouth, eyes, and skin of such children, comfortably places them in, turns them over, picks them up, records any changes in their condition, changes diapers and underwear. If the condition of a seriously ill child worsens, she must immediately call a doctor and provide emergency medical care before he arrives.

The nurse monitors the correct organization of nutrition for sick children, which must correspond to the age, nature of the disease, and individual tastes of the child. Even minor disturbances in feeding can cause deterioration in health.

With older children, they carry out educational work, and in some hospitals where children stay for a long time, educational work, which is included in the therapeutic and protective regime and significantly affects the emotional tone of the child, accelerating the recovery process.

One of the most important issues of modern pediatrics in our country is the protection of children’s health, which is based on the general principles of organizing treatment and preventive care: accessibility, freeness, locality of medical care, the use of dispensary observation, the sequence of outpatient and inpatient care, phasing of medical care.

The basis of the precinct principle is the division of the territory of settlements in the area in such a way that no more than 800 children under the age of 15 years live in one area, of which up to 100 children are in their 1st year of life. Medical care for children is provided by a local pediatrician and a nurse.

The phasing and sequence of medical care is the provision of medical care to children in a certain order. First, the child is examined by a local doctor with the involvement (if necessary, consultations) of specialists of a narrow profile. For further examination and treatment, the child is sent to a district or city hospital, then to a regional hospital. If necessary, medical care can be provided at maternal and child health centers and research institutes. The last stage of assistance to children is rehabilitation and health institutions (sanatoriums and resorts).

In our country, a powerful network of children's treatment and preventive institutions has been created to provide medical care. In all regional centers and large cities, children receive general and specialized care in multidisciplinary children's hospitals. These medical institutions include cardiology, pulmonology, gastroenterology, nephrology and other departments, as well as an intensive care and resuscitation department, a neonatal pathology department, a department for nursing premature babies, and the like.

The leading institution in providing medical and preventive care to children is the children's clinic. The clinic operates on a local basis. The work of the doctor and nurse at the site includes continuous dynamic monitoring of children, starting from birth, providing medical care to children with acute and chronic diseases, medical examination of children at risk, children who have suffered acute diseases, and children with chronic pathology.

Pediatricians carry out preventive and anti-epidemic measures aimed at ensuring the correct physical and neuropsychic development of children, reducing morbidity and mortality, preparing and administering vaccinations. In addition, an important aspect of the work of a pediatrician and nurse is health education work and legal protection of children.

Effective preventative measures in the area begin even before the birth of the child. The district nurse provides prenatal care to the pregnant woman within 10 days after receiving notification of the pregnant woman from the antenatal clinic. She conducts a conversation about the importance of a woman’s daily routine and nutrition for the development of the fetus and the birth process. Suddenly, a nurse visits an expectant mother in the 32nd week of pregnancy in order to determine the family’s preparedness for the birth of a child, the availability of what is necessary to care for the newborn, and talks about the peculiarities of its behavior, feeding and development. A pediatrician visits a pregnant woman at the end of pregnancy only if necessary.

Of great importance in reducing morbidity and child mortality is the organization of care for the child after discharge from the maternity ward. The first visit to a newborn child is carried out by a pediatrician and a nurse within the first 3 days after receiving the notification. The purpose of the first visit is to determine the state of health, assess its physical and neuropsychic development. Particular attention should be paid to the child’s behavior (excitement or lethargy), sucking activity, skin condition (pallor, jaundice, cyanosis, rash, induration) and umbilical ring. After a thorough examination of the child, they assess her condition, specify her health group, outline health-improving measures, and draw up a plan for further monitoring of the child. Also, during the first visit, it is necessary to familiarize the mother with the rules of feeding, bathing and caring for the newborn, breast care, and the technique of expressing breast milk. During the 1st month, the pediatrician must examine the newborn three times, and a child at risk - at least 4 times. During repeated visits to the newborn child, the local pediatrician and the nurse make sure that the child is developing correctly.

Particular attention should be paid to the following children: premature babies, twins; children who are bottle-fed; children who have suffered asphyxia, birth trauma; patients with rickets, malnutrition, anemia, diathesis for children who often suffer from acute respiratory diseases. These children belong to a high-risk group and undergo a clinical examination together with specialists (neurologist, ophthalmologist, surgeon, otolaryngologist, etc.) according to an individual schedule.

At the clinic, a “Child’s Individual Development Card” is issued for the child, which is maintained until the age of 15. It notes the number of visits, the age of the child, the dynamics of physical and mental development, feeding characteristics, care disorders, and data on the disease.

Further observation of healthy children of the 1st year of life is carried out monthly by a local pediatrician and a nurse in the clinic. The doctor evaluates the physical and neuropsychic development of the child, the state of various functional systems of the child’s body. Prescribes measures to prevent the most common diseases (rickets, anemia, etc.). The pediatrician examines healthy children from 1 to 2 years old once a quarter, from 2 to 3 years old - once every 6 months.

In the future, planned regular medical examinations are carried out in clinics. Based on examination data, anthropometric indicators and laboratory tests, the doctor determines the health group for each child, since the volume of necessary treatment, preventive and rehabilitation measures depends on this. The distribution of children into health groups is as follows. The first group includes children who do not have deviations in the functional state of the main organs and systems. Acute diseases occur rarely and are mild. The physical development of children corresponds to their age. The second group includes children with functional changes in one organ or system, as well as children of the 1st year of life with a burdened obstetric history (preeclampsia, complicated labor, multiple pregnancies, etc.), prematurity without pronounced signs of immaturity, unfavorable during the early neonatal period. These children often suffer from acute illnesses, and the recovery process is protracted. Basically, they have normal physical development, but minor deviations in the form of deficiency or excess body weight are possible. Possible delay in neuropsychic development. The third group includes children with chronic diseases or congenital anomalies of the development of organs and systems in the compensation stage. Existing functional and pathological changes in the main organs and systems, but without clinical manifestations. Children rarely suffer from intercurrent diseases, but their course is complicated by a mild exacerbation of the underlying chronic disease. The physical and neuropsychic development of these children corresponds to their age; there may be deficiency or excess body weight and short stature. Children of the fourth group have chronic diseases or developmental defects in the subcompensation stage, functional disorders of one or more pathologically altered organs or systems. During intercurrent illnesses, an exacerbation of the underlying chronic disease occurs with a disturbance in the general condition and well-being or with a protracted period of recovery. Children may lag behind in neuropsychic and physical development. The fifth group includes children with chronic diseases or congenital malformations in the stage of decompensation, which leads to disability of the child. Existing congenital functional disorders of pathologically altered organs or systems. Frequent exacerbations of the underlying chronic disease are observed.

Clinical examination of older children is a dynamic observation and organization of therapeutic and recreational activities among children with identified pathology. The doctor enters all data about the detected pathology in the “Dispensary Observation Control Card”, outlines in it the scope and nature of the necessary measures aimed at preventing relapses of diseases, and records the number of examinations during the year.

In the pediatric department, much attention is paid to sanitary and educational work, which includes individual and group conversations about raising a healthy, harmoniously developed child, systematic sanitary and hygienic education of parents and other family members, and promotion of a healthy lifestyle.

The main functional responsibilities of a ward nurse are to carry out doctor’s orders, toilet sick children, measure body temperature, feed children, monitor their leisure time and sleep, organize walks, and assist doctors during rounds. During the round, the nurse receives clear instructions from the doctor about changing the prescriptions and regimen for each sick child.

The nurse pays special attention to strict adherence to the sanitary and anti-epidemic regime in the department and monitors the work of junior medical staff. She places patients in wards according to the type of disease, age and gender, monitors the cyclical filling of the wards and compliance with the daily routine. Seriously ill children require special attention. Another nurse monitors the breathing, pulse, condition of the mouth, eyes, and skin of such children, comfortably places them in, turns them over, takes them in his arms, records any changes in their condition, changes diapers and underwear. If the condition of a seriously ill child worsens, she must immediately call a doctor and provide emergency medical care before he arrives.

With older children, educational work is carried out, and in some hospitals where children stay for a long time, educational work is carried out, which is included in the therapeutic and protective regime and significantly affects the emotional tone of the child, accelerating the recovery process.

Thus, in Ukraine, a whole system of diversified medical and preventive institutions has been created, with the goal of not only saving the child’s life, but also ensuring its normal harmonious development and potential quality of life for the future.