Health status is determined by growth and development. Growth and development are changes in anatomical and morphological parameters, i.e. body length and weight, proportions of individual parts of the body, transverse and volumetric dimensions, changes in physiological systems, tissues and organs - i.e. functional direction in the age aspect. Growth and development are interconnected and dependent on each other; from the environment; social hygiene; school; food hygiene; work and rest; physical education and sports. Periods of increased growth are followed by periods of increased development, differentiation of tissues and systems, and vice versa. This is the so-called heterochrony - the different timing of two phases of a single process, the harmony of which depends on external and internal factors.

Hygienic aspects of the health of children and adolescents begin with preventive medicine at the stage of planning and conception, gestation and childbirth, with a whole range of measures to protect motherhood and childhood. These are antenatal clinics, maternity hospitals, social protection - prenatal and post-maternity leave, transfer to safe and easy work, incentives and rewards for early registration in antenatal clinic, for childbirth. Genetic counseling, observations, monitoring of intrauterine development, preventive recommendations on a woman’s lifestyle, her nutrition, movement, and rest. In the mother’s body, the third circle of blood circulation of the embryo and fetus is formed; first of all, everything good and bad goes to them, the priority of the new life.

Modern hygienic aspects of the growth and development of children and adolescents must begin with the term valeology. Valeo - hello from the birth of a new life. All diseases of children's feet enter adulthood. The level and quality of health depends on many well-controlled factors, both genetically determined and external forces of nature, lifestyle and the help of preventive medicine. The entire interconnected complex of physical, mental and moral health is formed and nurtured not only by the surrounding biological and social world, but also by the person himself.

Health is the highest good. Scientific and technological progress reduces the share of physical labor and increases its intensity, intellectual and mental stress, and reduces physical activity. Three pillars of physical, mental and moral health - nutrition, movement, protection. Food is increasingly becoming refined, high in calories, poor or devoid of biologically active substances. A lack of sleep protection gives rise to neurotic and asthenoneurotic conditions. Motor hunger increases deformations of the musculoskeletal system.

Health- the integral indicator is formed from the following components: somatic, physical, emotional, personal, moral, mental, spiritual, mental, social.

To assess the health of children and adolescents, it is necessary to use at least four criteria, namely: 1) the presence or absence of chronic diseases at the time of examination; 2) the level of achieved physical and neuropsychic development and the degree of its harmony; 3) level of functioning of the main systems of the body; 4) the degree of resistance of the body to adverse effects.

From a hygienic point of view, the assessment of health status based on the combination of all four signs deserves the greatest attention.

The methodology for comprehensive assessment and distribution of children and adolescents into health groups meets these goals.

In accordance with the proposed scheme, children and adolescents, depending on the totality of health indicators, are divided into five groups.

First group - These are persons who do not have chronic diseases, who were rarely ill during the observation period, and who have normal, age-appropriate physical and neuropsychic development (health, without deviations).

Second group- it consists of children and adolescents who do not suffer from chronic diseases, but have functional and morphological abnormalities, are often ill - 4 times a year or more - or a long-term illness - more than 25 days (healthy, with functional abnormalities and reduced resistance).

Third group- unites people with chronic diseases or congenital pathologies in a state of compensation, with rare and not severe exacerbations of a chronic disease, without a pronounced impairment of general well-being (patients in a state of compensation).

Fourth group- persons with chronic diseases, congenital malformations in a state of subcompensation, with disturbances in general condition and well-being after an exacerbation, with a protracted period of convalescence after acute intercurrent diseases (patients in a state of subcompensation).

Fifth group- includes persons with severe illnesses in a state of decompensation, with significantly reduced functional capabilities (patients in a state of decompensation). As a rule, such patients do not attend general child and adolescent institutions and are not covered by mass examinations.

Children and adolescents classified as different groups health, require a differentiated approach when developing a set of treatment and preventive measures. For persons included in the first health group, educational, labor and sports activities are organized without any restrictions in accordance with existing programs of the educational process. A pediatrician or therapist at a teenager’s office conducts a preventive examination at regular (scheduled) times. Medical appointments consist of ordinary general health measures that have a training effect on the body.

Children and adolescents who are part of the second health group (sometimes called the risk group) require closer attention from doctors. The fact is that this contingent needs a complex of health-improving measures, the timely implementation of which is most effective in preventing the development of chronic pathology in childhood and adolescence. Of particular importance are hygienic recommendations for increasing the body’s resistance by nonspecific means: optimal physical activity, hardening with natural factors, a rational daily routine, additional fortification of food.

Children and adolescents assigned to the third, fourth and fifth health groups are under clinical observation by doctors of various specialties in accordance with existing methodological recommendations for medical examination of the child population.

Patients receive the necessary therapeutic and preventive care, due to the presence of one or another form of pathology and a decrease in compensation. In children's and adolescent institutions, a gentle daily routine is created for them, the duration of rest and night sleep is extended, the volume and intensity of physical activity is limited, etc. If necessary, patients with chronic diseases or those with birth defects developmental children are sent to special children's and adolescent institutions, where, taking into account the characteristics of the pathology, treatment and education are purposefully carried out.

The Republic of Belarus is implementing a targeted program to preserve the health of students.

The “Somatic Health” program is held under the motto of primary hygienic prevention “I know how not to get sick.” The main areas of activity in this program are: systematic medical examinations of children (September, May) with the distribution of children into medical groups to organize the correct distribution of physical activity on the body. Four medical groups have been identified for physical education: basic, preparatory, special medical group and therapeutic physical education. At the same time, a series of lectures is held for parents and students, educators, and teachers.

The “Physical Health” program sets as its main task the diagnosis of the physical condition of children, their physical development and health.

Health criteria:

for the mental - I want, I desire;

for the physical and somatic - I can;

for the moral - I must.

Signs of health:

motivation of behavior;

growth and development indicators;

resistance to damaging factors;

specific and nonspecific resistance;

functional state and reserve capabilities of the body;

level of moral and volitional qualities;

presence or level of disease, developmental defects.

Monitoring the health status is carried out by health care organizations. Children's clinics and adolescent clinics conduct in-depth medical examinations with the involvement of various specialists.

Modern principles of differentiation by health make it possible to conduct a comprehensive individual and collective assessment of the health of children and adolescents, screening tests, social and hygienic monitoring, and identify risk factors and consequences of the Chernobyl accident.

The concept of health of children and adolescents should be understood as a state of complete socio-biological and mental well-being, harmonious, age-appropriate physical development, a normal level of functioning of all organs and systems of the body and the absence of diseases.

Children, depending on their health status, can be classified into the following health groups.

Group I – healthy children with normal age-appropriate physical and neuropsychic development, without functional and morpho-functional abnormalities.

Group II - children who do not suffer from chronic diseases, but have functional or morpho-functional abnormalities, convalescents, with a general delay in physical development without endocrine pathology, as well as children with a low level of immune resistance of the body - often (4 times or more per year) or for a long time (more than 25 calendar days for one disease) sick.

Group III – children suffering from chronic diseases in the stage of remission (compensation).

Group IV – children suffering from chronic diseases in the subcompensation stage.

Group V – children suffering from chronic diseases in the stage of decompensation, disabled children.

1) characteristics of the health of the child population, obtaining statistical snapshots of health indicators and the number of relevant health groups;

2) comparative comparison groups of children in various groups, educational institutions, different territories, in time;

3) assessing the effectiveness of preventive and therapeutic work in children's medical institutions based on the transition of children from one health group to another;

4) identifying and comparing the effect of risk factors affecting the health of children and adolescents;

5) determining the need for specialized services and personnel.

The main groups of statistical indicators used to characterize the public health of children and adolescents are the following:

1) medical and demographic criteria;

2) physical development;

3) distribution of children by health groups;

4) morbidity;

5) data on disability.

Physical development is an integral indicator (index) of the sanitary and hygienic well-being of the child population. There are 3 groups of main factors that determine the direction and degree of physical development:

1) endogenous factors (heredity, intrauterine influences, prematurity, congenital defects, etc.);

2) natural and climatic factors of the habitat (climate, terrain, as well as atmospheric pollution, etc.);

3) socio-economic and socio-hygienic factors.

Healthy child. Comprehensive assessment children's health status

The main indicator of the effectiveness of measures to protect children's health is the level of health of each child. Health is not only the absence of diseases and injuries, but also harmonious physical and neuropsychic development, normal functioning of all organs and systems, absence of diseases, sufficient ability to adapt to unusual conditions environment, resistance to adverse influences.

The child’s health status is examined using basic criteria, which are determined during each preventive examination of the decreed age groups. The following features are taken into account: 1. Deviations in the ante-, intra-, early postnatal periods.2. Level and harmony of physical and neuropsychic development.3. Functional state of the main organs and systems.4. Resistance and reactivity of the body.5. The presence or absence of chronic (including congenital) pathology.

Assessment of physical development is an important prognostic indicator of a person’s health status. This assessment allows us to identify groups that are at risk, and this in turn plays an important role in the diagnosis and prevention of various diseases. A low level of physical development is often considered main reason diseases. In turn, chronic diseases cause deterioration in physical development. Physical development is a natural process of gradual formation and change in the forms and functions of the body. On the other hand, this is the degree of maturation at each stage of life.

There are three phases of the process of physical development: - Increasing its level (up to 25l) - Relative stabilization (up to 60l) - Gradual decrease in a person’s physical capabilities.

Physical development is influenced by three groups of factors: biological (heredity), climatic and geographical (climatic and meteorological conditions in different climatic and geographical zones), social (conditions material life, labor and educational activities, content of physical education). But it is a mistake to consider the characteristics of physical development only by linear and weight indicators. Its adequate assessment requires taking into account the results of testing the functional capabilities of the body. In each class, three groups of students can be distinguished: acceleraters (children whose biological age is ahead of their passport age), mediants (children whose biological age corresponds to their passport age) and retordants (children whose passport age is ahead of their biological age). This fact must be taken into account when determining the physical development of children and when selecting and dosing physical exercise(in accelerators there is an increased incidence).

Level of functioning of the main body systems. The level of functioning of the main body systems is a criterion that characterizes the health of children and adolescents from the standpoint of the morphological and functional maturity of the body, taking into account age-related characteristics. Some children may exhibit functional impairment in the absence of disease. The reasons for such deviations are very diverse: fast pace growth in certain age periods (6-7 years old; 11-13 years old (girls) and 13-15 years old (boys)), which leads to a discrepancy in the structure and functions of organs; unfavorable family and living conditions; excessive mental and physical activity etc.. When assessing functional state Much attention is paid to determining the functional state of the cardiovascular system, respiratory and nervous systems. Sleep, appetite, mood, emotional state, communication with other children, learning characteristics educational material etc..

Assessment of the functional state of body systems is carried out using clinical methods, as well as using functional tests (Martine, Stange-Gen, Letunov, PWC170 tests). The determination of the group for physical education is carried out based on the data of an in-depth medical examination.

IN high school Children and adolescents are usually divided into three physical education groups. The main group of physical education includes children and adolescents who do not have any deviations in health or have minor deviations and sufficient physical fitness. Classes on physical culture are carried out according to the curriculum of the subject in full, and the passing of control standards is carried out with differentiated assessment. TO preparatory group include children and adolescents who have health problems and are sufficiently physically prepared, as well as convalescent children. Physical education classes are conducted according to curriculum with mandatory adherence to the principles of gradualism and continuity. TO special group include children and adolescents with significant deviations in their health status, temporary or permanent. Physical education classes are conducted according to specially developed differentiated programs and exercise therapy programs.

level of physical fitness A significant level of correlation was found between indicators of somatic health of children and adolescents with the results of motor tests characterizing strength (hands and deadlift), speed, general endurance and speed-strength capabilities). This fact can be used to improve the level of health of children by influencing individual components of physical fitness through physical education.

the degree of resistance of the body to adverse factors. The degree of body resistance is determined by the number and duration of acute diseases suffered by the child (or exacerbations of chronic ones) per year. Acute respiratory viral diseases (ARVI) are most common among preschool and younger children school age. Acute childhood infections (chicken pox, rubella, mumps, measles, etc.), acute gastrointestinal diseases, and allergic reactions occupy a significant share in the structure of childhood morbidity. According to statistics, the most common diseases among children are respiratory diseases (up to 50%) and systematic acute respiratory viral infections (90%), which indicates a decrease in the body’s resistance to unfavorable environmental factors. Based on the number of acute illnesses suffered per year, children are divided into three groups: 1 - those who have never been sick; 2 - those who were ill occasionally (1-3 times during the year); 3 - those who were sick often (4 times or more). The absence of acute diseases during the year or their episodic nature indicates good resistance of the child’s body

the presence or absence of chronic diseases. According to the Ministry of Health, about 90% of school-age children have health problems. Over the past 5 years, there has been a 41% increase in children belonging to a special medical group

A comprehensive health assessment allows you to form groups that unite children with the same health status, taking into account all of the above indicators. Group I - healthy children with normal indicators of the functional development of all systems, who rarely get sick (up to 3 times a year) with normal physical and neuropsychic development, and do not have significant abnormalities in their medical history. Group II - risk group: subgroup A - children with risk factors according to biological and social history; subgroup B - children with functional deviations, with initial changes in physical and neuropsychic development, often get sick, but do not have chronic diseases. Groups III, IV and V - children with chronic diseases: Group III - compensation state: rare exacerbations of chronic diseases, rare acute diseases, normal level of body functions; Group IV - state of subcompensation: frequent (3-4 times a year) exacerbations of chronic diseases, frequent acute diseases (4 times a year or more), deterioration in the functional state of various body systems; Group V - state of decompensation: significant functional deviations (pathological changes in the body; frequent severe exacerbations of chronic diseases, frequent acute diseases, the level of physical and neuropsychic development corresponds to age or lags behind it).

The distribution of children by health groups makes it possible to identify persons with risk factors for the development of pathological changes, children with initial forms diseases and functional abnormalities and develop a set of measures to protect and strengthen their health and prevent chronic diseases.

A comprehensive assessment of the child's health is carried out during the initial visit after the child is discharged from the hospital to get an idea of ​​​​the initial level of health. In the future, the health status of children of the 1st and 2nd years of life is assessed quarterly, children of the 3rd year - at the end of each six months. With several diagnoses, the health group is determined according to the main diseases. During the process of monitoring a child, the health group may change depending on the dynamics of the level of health.

First of all, this concerns children and adolescents belonging to the second health group: children - convalescents; children who are often sick for a long time; children with general delay and disharmony of physical development both due to excess body weight and its deficiency without endocrine pathology; children with poor posture, flat feet; children with functional changes in the cardiovascular system; myopia, caries, hypertrophy of the palatine tonsils II degree, allergic reactions, enlargement thyroid gland I and II degrees, asthenic syndrome, etc.

Children of health group I should be observed at the usual times established for preventive examinations of healthy children. Preventive, educational and general health measures are carried out for them. Children of health group II deserve closer attention from pediatricians, because preventive and therapeutic measures can contribute to the transition of children of this group to group I. Children in this group are observed and rehabilitated according to an individual plan, which is drawn up according to the degree of risk of developing chronic pathology, the severity of functional abnormalities and the degree of resistance. Children of groups III, IV and V are under the supervision of pediatricians and specialists in accordance with " Methodological recommendations for medical examination of the child population" and should receive the necessary treatment depending on the presence of a particular pathology.

Features of examining children of different ages When examining a child, it is necessary to remember three mandatory conditions: - Find contact with the child and his parents; - Provide optimal lighting and temperature conditions; - Provide a comfortable position for the doctor and his individual protection from possible infection

FEATURES OF THE NEWBORN PERIOD Early neonatal period - lasts from ligation of the umbilical cord to 7 days (168 hours). This is the most crucial period for a child’s adaptation. At this time, pulmonary breathing appears and the pulmonary circulation begins to function. This period is characterized by transitional states (physiological jaundice, sexual crisis, uric acid infarction, physiological catarrh of the skin, etc.). Diseases in newborns may occur due to disturbances in intrauterine development. During this period, developmental anomalies, fetopathy, hereditary diseases, hemolytic disease, asphyxia, birth injuries, aspiration, and infection of the child are identified. In the first day of life, purulent-septic diseases, bacterial lesions of the intestines and respiratory tract occur. In the early neonatal period, aseptic conditions must be provided to protect the child from infection and optimal temperature conditions.

Late neonatal period (lasts from 8 to 28 days of life). During this period, the newborn is at home. Particular attention is paid to feeding the child, the nature of the mother's lactation, and the child's weight is monitored. The most important criteria for a child’s well-being are the dynamics of body weight and the state of neuropsychic development. During this period, analyzers and coordination of movements intensively develop, conditioned reflexes appear, and emotional and tactile contact with the mother arises.

INFANCY PERIOD (lasts from 29 days of life to 1 year). During this period, the child’s adaptation is completed, the mother breastfeeds the child, intense physical, neuropsychic, motor and intellectual development child. Problems of rational nutrition, introduction of timely correction, and complementary feeding arise. Functional immaturity of the digestive system leads to frequent intestinal diseases of various etiologies. Metabolic disorders appear, rickets and anemia occur in children. Against the background of the anatomical and physiological characteristics of the respiratory organs in infants bronchiolitis and pneumonia often occur. During this age period they are used various means and hardening methods (massage, gymnastics, water procedures). Preventive vaccinations are carried out in infancy.

The main method of prevention in pediatrics is medical examination of healthy children. By 1997, pediatricians were seeing children from birth to 15 years of age, and now up to 18 years of age. During the clinical examination, a comprehensive health assessment is carried out to determine the health group. Accordingly, the volume and nature of health-improving and therapeutic measures for children with a certain pathology or a tendency to it are determined. IN modern conditions Clinical examination is the main form of work of children's clinics. Clinical examination is carried out both according to age and depending on the diseases that the child has.

The following contingents of the child population are subject to dispensary observation by a local pediatrician: - All children in the neonatal period; - Children 1 year of life; - Children from risk groups; - Children over 1 year of age who do not attend preschool institutions; - Children with chronic diseases

Clinical examination of children 1 year of age The task of preventive examinations of children 1 year of life is to organize an appropriate regimen and rational feeding - prevention of rickets, anemia, infectious diseases, identification and treatment of congenital pathologies. In the first year of life, a healthy child should be examined by a pediatrician 14 times, including in a clinic - 12 times with a mandatory examination by an orthopedist, ophthalmologist, neurologist and other specialists. The district nurse visits the child at home once a month. Medical monitoring of the child’s development is carried out taking into account individual characteristics at different periods of 1 year of life. For children of the first 3 months it is important: discharge from the maternity hospital, adaptation to new living conditions, the beginning of the first walks, prevention of rickets, prevention and treatment of hypogalactia, organization of rational feeding, prevention of malnutrition.

Medical examination of children 1 year of age from 3 to 6 months special attention for preventive vaccinations, introduction of nutritional correction and complementary feeding. At the age of 6 to 9 months, it is necessary to prevent respiratory tract infections, intestinal diseases and injuries. The period from 9 to 12 months coincides with weaning, expanding the diet, and vaccination. The local pediatrician records his observations of the child in stage-by-stage epicrises (3, 6 and 9 months). At the end of 1 year after a clinical examination, anthropometric measurements, laboratory tests ( general analysis blood and urine), analysis preventive vaccinations and illnesses suffered during the year, draws up an epicrisis with an assessment of physical, neuropsychic development and a plan for further observation and improvement of the child in the next period.

Clinical examination of the child population includes the following activities: 1) regular medical examinations with carrying out the established volume of laboratory and instrumental studies; 2) determination and assessment of health status in order to identify children with risk factors; 3) additional examination of sick children who need it, using all modern methods diagnostics; 4) identification of diseases in the early stages, followed by a set of necessary therapeutic and health measures and dynamic monitoring of the health status of children.

The local pediatrician is responsible for carrying out all stages of medical examination of the child population in his area and monitors its implementation. A bachelor's nurse helps him with this task. For each child who is subject to dispensary observation, a “Dispensary observation control card” is created (form No. 030/у). Along with performing signaling functions (monitoring dispensary visits), this card also reflects data on the health status of children of different age groups. These data help the doctor in carrying out clinical observation, meeting the deadlines for the examination, and urgent medical and health measures. The control chart should be, first of all, an operational document in the doctor’s work.

Thank you for your attention!