Health groups in children: comprehensive health assessment

A comprehensive assessment of the health status of children is conducted from the age of 3.

The system of comprehensive health assessment is based on four basic criteria:

1. presence or absence of functional disorders and / or chronic diseases (taking into account the clinical variant and the phase of the course of the pathological process);
2. the level of the functional state of the body's basic systems;
3. the degree of the body's resistance to adverse external influences;
4. the level of development achieved and the degree of its harmony.

The main method of obtaining characteristics that allow a comprehensive assessment of the state of health is a preventive medical examination.

A comprehensive assessment of the health status of each child or adolescent with the formalization of the result in the form of a definition of the health group occurs with the mandatory consideration of all the above criteria.

[1], [2], [3]

Major groups of children's health

Depending on the health status of children can be attributed to the following groups:

• 1 st group of health - healthy children with normal physical and mental development, without anatomical defects, functional and morphofunctional abnormalities;
• 2 nd group of health - children who do not have chronic diseases, but there are some functional and morphofunctional disorders, convalescents, especially those suffering from serious and moderate infectious diseases; children with a general delay in physical development without endocrine pathology (low growth, lag in the level of biological development), children with a body mass deficit (less than M-1σ) or overweight (more than M + 2σ). Also included in this group are children who are often and / or permanently ill with acute respiratory diseases; children with physical disabilities, the consequences of injuries or surgeries with safely corresponding functions;
• The third group of health - children suffering from chronic diseases in the stage of clinical remission, with rare exacerbations, preserved or compensated functionality, in the absence of complications of the underlying disease. So this group includes children with physical disabilities, the consequences of injuries and operations, provided that the corresponding functions are compensated, and the degree of compensation should not restrict the child's learning or work, including adolescence;
• 4-th group of health - children suffering from chronic diseases in active stage and stage of unstable clinical remission with frequent exacerbations, with preserved or compensated functional capabilities or incomplete compensation of functional capabilities, with chronic diseases in remission, but limited functionality, complications of the main disease, the underlying disease requires maintenance therapy. Also in this group include children with physical disabilities, the consequences of injuries of operations with incomplete compensation of the corresponding functions, which to a certain extent limits the possibility of training or child labor;
• 5-th group of health - children suffering from severe chronic diseases, with rare clinical remissions, frequent exacerbations, continuously recurrent course, with pronounced decompensation of the body's functional capabilities, the presence of complications of the underlying disease requiring constant therapy; disabled children; children with physical disabilities, the consequences of injuries and operations with a pronounced violation of compensation for the respective functions and a significant restriction on the possibility of training or work.

The assignment of a sick child or adolescent to the 2-, 3-, 4- or 5-th groups of health is performed by the doctor taking into account all the criteria and attributes given. The specialist doctor, on the basis of the analysis of the data contained in the history of the child's development, the medical chart of the child for educational institutions, the results of his own examination, and instrumental and laboratory studies, issues (in his specialty) an accurate clinical diagnosis indicating the underlying disease (functional disorder), his stage, variant of the course, the degree of preservation of functions, the presence of complications, concomitant diseases, or the conclusion "healthy."

A comprehensive assessment of the child's health based on the conclusions of specialists and the results of his own examination is provided by the pediatrician, who leads the work of the medical team conducting the preventive examination.

Children with the first time suspected diseases or functional impairments (and also with suspicion of the changed nature of the course of the disease, the level of functionality, (the appearance of complications) based on the results of preventive medical examination do not give a comprehensive assessment of the state of health. After receiving the results of the examination, they make a precise diagnosis and give a comprehensive assessment of the state of health.

All children, regardless of the health group, undergo a screening test every year, which results in the need for further pediatric examination.

Children, referred to the 1 st group of health, undergo preventive medical examinations in full in terms determined by the current regulatory and methodological documents.

Monitoring of the health status of children referred to the 2nd group of health is performed by a pediatrician with preventive medical examinations and annually.

Children, referred to the 3-4th group of health, undergo preventive medical examinations at appropriate age periods. In addition, the monitoring of their health status and evaluation of the effectiveness of treatment and rehabilitation measures are carried out on the basis of the results of dispensary observation.

The results of a comprehensive assessment of the health status as a screening can play a role in solving the applied problems of maintaining the health of children - referring to certain groups for physical physical education, sports selection, solving expert questions regarding their professional choice, military service, etc.

A comprehensive assessment of the health status of children under 3 years of age occurs in accordance with the USSR Order No. 60 of 19.01.1983 and the additions of 2002-2003. In doing so, consider:

• features of ontogeny (data of genealogical, biological.
• social anamnesis);
• physical development;
• neuropsychic development;
• level of resistance;
• functional state of the organism;
• The absence or absence of chronic diseases or the birth defects of development.

Genealogical method - the collection of pedigrees, i.e. Tracing of trait or illness in the family, in the family, indicating the type of kinship between the members of the family tree.

For a screening quantitative assessment of the burden of the genealogy, an indicator called the burden index of the hereditary anamnesis (Jor) is used, which can be calculated by the formula Jor = the total number of sick relatives (about the diseases of which there is information, including the proband) / total number of relatives information, including the proband).

Criteria for evaluation:

• 0-0.2 - the burden of genealogy is low;
• 0.3-0.5 - moderate burdens;
• 0.6-0.8 - heaviness expressed;
• about 0,9 and above - weighed high.

Children with severe and high burden belong to the risk group for predisposition to certain diseases.

Biological history includes information about the development of the child in different periods of ontogeny.

• Antenatal period (separately during the 1 st and 2 nd half of pregnancy):
  • toxicosis of the 1st and 2nd half of pregnancy;
  • risk of miscarriage;
  • extragenital diseases in the mother;
  • o professional harm from parents;
  • negative Rh-belonging of the mother with increasing titer of antibodies;
  • surgical interventions;
  • viral diseases during pregnancy;
  • visiting a mother's mother on psycho-prophylaxis of childbirth.
• Intratinal and early neonatal periods (first week of life):
  • the nature of the course of labor (long anhydrous period, rapid delivery);
  • benefit in childbirth;
  • operative delivery (caesarean section, etc.);
  • an Apgar score;
  • cry of the child;
  • diagnosis at birth and discharge from the maternity hospital;
  • the period of application to the breast and the nature of lactation in the mother;
  • the vaccination period for BCG;
  • time of falling of the umbilical cord;
  • the state of the child at discharge from the maternity hospital;
  • the mother's condition at discharge from the maternity hospital.
• Late neonatal period:
  • birth injury;
  • asphyxia;
  • prematurity;
  • hemolytic disease of the newborn;
  • acute infectious and non-infectious diseases;
  • late transfer to artificial feeding;
  • boundary conditions and their duration.
• Postnatal period:
  • repeated acute infectious diseases; the presence of rickets;
  • presence of anemia;
  • eating disorders of tissues in the form of dystrophy (hypotrophy or paratrophy);
  • the presence of diathesis.

Information about the biological history of the district pediatrician receives from the extracts of the maternity hospital and other medical institutions, interviews with parents.

In the presence of one or more risk factors in each of the five listed periods of ontogeny, one should speak of a high burden of the biological anamnesis. The presence of risk factors in 3-4 periods indicates a pronounced aggravation (a group of high risk for a biological anamnesis); in two periods - a moderate burden (risk group for a biological anamnesis); in one period - about low burden (group of attention on the biological anamnesis). If the risk factors are absent in all periods of the child's development, then the biologic history is considered unimpaired.

The degree of disadvantage in the periods of intrauterine development of the child can be indirectly judged by the level of its stigmatization. Stigma of disembryogenesis includes small anomalies in the development of connective tissue (MAP), which do not lead to organic or functional disorders of a particular organ. Normally, the number of stigmas is 5-7. Exceeding the threshold of stigmatization should be regarded as a risk factor of not yet manifested pathology.

Social anamnesis:

• the completeness of the family;
• age of parents;
• education and the profession of parents;
• psychological microclimate in the family, including in relation to the child;
• the presence or absence of harmful habits and antisocial behavior in the family;
• living conditions;
• financial security of the family;
• sanitary and hygienic conditions of child upbringing.

These parameters can be used to identify socially disadvantaged families and children of social risk groups.

In the form 112 / y in the case of a successful history should be written briefly "Social anamnesis is safe." In the case of a dysfunctional anamnesis, it is necessary to indicate parameters that have a negative characteristic. An unsuccessful social anamnesis negatively affects the neuropsychological development of the child, in the future it can lead to an incorrect formation of the person's personality.