Health groups in children: a comprehensive assessment of health status

A comprehensive assessment of children's health is carried out starting from the age of 3.

The comprehensive health assessment system is based on four criteria:

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

The main method for 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 teenager with the formalization of the result in the form of determining a health group occurs with mandatory consideration of all the listed criteria.

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Main health groups of children

Depending on the health status of children, they can be classified into the following groups:

• 1st health group - healthy children with normal physical and mental development, no anatomical defects, functional and morphofunctional deviations;
• Health group 2 — children who do not have chronic diseases, but have some functional and morphofunctional disorders, convalescents, especially those who have suffered severe and moderate infectious diseases; children with general delayed physical development without endocrine pathology (low growth, lag in the level of biological development), children with body weight deficit (weight less than M-1σ) or excess body weight (weight more than M+2σ). This group also includes children who often and/or suffer from acute respiratory diseases for a long time; children with physical disabilities, consequences of injuries or operations with the preservation of the corresponding functions;
• Health group 3 - children suffering from chronic diseases in the stage of clinical remission, with rare exacerbations, preserved or compensated functional capabilities, in the absence of complications of the underlying disease. Thus, this group includes children with physical disabilities, consequences of injuries and operations, subject to compensation of the corresponding functions, and the degree of compensation should not limit the child's ability to study or work, including adolescence;
• Health group 4 - children suffering from chronic diseases in the active stage and the stage of unstable clinical remission with frequent exacerbations, with preserved or compensated functional capabilities or incomplete compensation of functional capabilities, with chronic diseases in the remission stage, but limited functional capabilities, complications of the underlying disease are possible, the underlying disease requires supportive therapy. This group also includes children with physical disabilities, consequences of injuries and operations with incomplete compensation of the corresponding functions, which to a certain extent limits the child's ability to study or work;
• Health group 5 - children suffering from severe chronic diseases, with rare clinical remissions, frequent exacerbations, continuously relapsing course, with pronounced decompensation of the functional capabilities of the body, the presence of complications of the underlying disease requiring constant therapy; disabled children; children with physical disabilities, consequences of injuries and operations with pronounced impairment of compensation of the corresponding functions and significant limitation of the ability to study or work.

The assignment of a sick child or teenager to the 2nd, 3rd, 4th or 5th health groups is carried out by a doctor taking into account all the given criteria and signs. A specialist doctor, based on the analysis of data contained in the child's development history, the child's medical record for educational institutions, the results of his own examination, as well as instrumental and laboratory studies, makes (in his specialty) an accurate clinical diagnosis indicating the underlying disease (functional disorder), its stage, course, degree of preservation of functions, presence of complications, concomitant diseases or the conclusion "healthy".

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

Children with diseases or functional disorders suspected for the first time at the time of examination (as well as with a suspected change in the nature of the course of the disease, the level of functional capabilities, (the emergence of complications) based on the results of a preventive medical examination are not given a comprehensive assessment of their health. In such cases, a full diagnostic examination is necessary. After receiving the examination results, a more accurate diagnosis is made and a comprehensive assessment of their health is given.

All children, regardless of health group, undergo an annual screening test, the results of which determine the need for further pediatric examination.

Children assigned to the 1st health group undergo preventive medical examinations in full within the timeframes specified by current regulatory and methodological documents.

The health status of children assigned to the 2nd health group is monitored by a pediatrician during preventive medical examinations and annually.

Children assigned to health groups 3-4 undergo preventive medical examinations at the appropriate age periods. In addition, monitoring of their health status and assessment of the effectiveness of treatment and rehabilitation measures is carried out based on the results of dispensary observation.

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

A comprehensive assessment of the health status of children under 3 years of age is carried out in accordance with the order of the Ministry of Health of the USSR No. 60 of 19.01.1983 and amendments of 2002-2003. In this case, the following is taken into account:

• features of ontogenesis (genealogical, biological data.
• social history);
• physical development;
• neuropsychic development;
• resistance level;
• functional state of the body;
• the presence or absence of chronic diseases or congenital defects.

The genealogical method is the collection of family trees, i.e. tracing a trait or disease in a family, in a lineage, indicating the type of kinship between members of the family tree.

For screening quantitative assessment of the burden of the genealogical history, an indicator called the burden index of the hereditary history (Jor) is used, which can be calculated using the formula Jor = total number of sick relatives (about whose diseases there is information, including the proband) / total number of relatives (about whose health status there is information, including the proband).

Evaluation criteria:

• 0-0.2 - the burden of the genealogical history is low;
• 0.3-0.5 - moderate burden;
• 0.6-0.8 - severe burden;
• 0.9 and above - high burden.

Children with severe and high burden are at risk for predisposition to certain diseases.

The biological anamnesis includes information about the child’s development during various periods of ontogenesis.

• Antenatal period (separate course of the 1st and 2nd half of pregnancy):
  • toxicosis of the 1st and 2nd half of pregnancy;
  • threat of miscarriage;
  • extragenital diseases in the mother;
  • about professional hazards in parents;
  • negative Rh factor of the mother with an increase in antibody titer;
  • surgical interventions;
  • viral diseases during pregnancy;
  • a woman's visit to a school for mothers on psychoprophylaxis of childbirth.
• Intranatal and early neonatal periods (first week of life):
  • the nature of the course of labor (long anhydrous period, rapid labor);
  • maternity allowance;
  • operative delivery (caesarean section, etc.);
  • Apgar score;
  • child's cry;
  • diagnosis at birth and discharge from the maternity hospital;
  • the period of attachment to the breast and the nature of lactation in the mother;
  • BCG vaccination period;
  • time of cord separation;
  • the child's condition upon discharge from the maternity hospital;
  • the mother's condition upon discharge from the maternity hospital.
• Late neonatal period:
  • birth trauma;
  • asphyxia;
  • prematurity;
  • hemolytic disease of the newborn;
  • acute infectious and non-infectious diseases;
  • late transfer to artificial feeding;
  • borderline states and their duration.
• Postnatal period:
  • repeated acute infectious diseases; presence of rickets;
  • presence of anemia;
  • tissue nutrition disorders in the form of dystrophy (hypotrophy or paratrophy);
  • presence of diathesis.

The local pediatrician obtains information about the biological anamnesis from records from the maternity hospital and other medical institutions, and from conversations with parents.

If one or more risk factors are present in each of the five listed periods of ontogenesis, we should talk about a high burden of biological history. The presence of risk factors in periods 3-4 indicates a pronounced burden (high-risk group according to biological history); in two periods - a moderate burden (risk group according to biological history); in one period - a low burden (attention group according to biological history). If risk factors are absent in all periods of the child's development, then the biological history is considered unburdened.

The degree of unfavorable conditions during the periods of intrauterine development of a child can be indirectly judged by the level of its stigmatization. Stigmas of dysembryogenesis include minor anomalies of connective tissue development (MAD) that do not lead to organic or functional disorders of a certain organ. Normally, the number of stigmas is 5-7. Exceeding the threshold of stigmatization should be considered as a risk factor for pathology that has not yet manifested itself.

Social history:

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

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

In form 112/u, in case of a favorable anamnesis, it is necessary to write briefly "Social anamnesis is favorable". In case of an unfavorable anamnesis, it is necessary to indicate the parameters that have a negative characteristic. An unfavorable social anamnesis has a negative effect on the neuropsychic development of the child, and in the future it can lead to the incorrect formation of the person's personality.