Child Health Problems - Park's Textbook of PSM

Main Child Health Problems (as enumerated by Park)

1. Low Birth Weight

• Discussed separately in detail in the maternal/perinatal chapter.
• About 80% of newborn mortality occurs in babies who are of low birth weight.

2. Malnutrition

• Major health and nutrition problem in India; affects weaklings and children in the first years of life.
• 45% of children who died before age 5 had malnutrition as an underlying factor.
• Globally (2018): >21.9% of under-5 children were stunted; 7.3% had wasting.
• India (NFHS): 35.7% children under 5 are underweight; 7.5% have moderate-to-severe wasting; 38.4% have moderate-to-severe stunting.
• Leads to stunted growth, poor physical/mental development, and increased susceptibility to infections.

• Deficiency of essential vitamins and minerals (Vitamin A, calcium, iodine, iron, zinc).
• About 2 billion people globally affected.
• Nutritional anaemia - affects all age groups including pre-school and school children; reduces resistance to fatigue; has a profound effect on psychological and physical behaviour.
• Vitamin A deficiency / Nutritional blindness - most common cause of preventable childhood blindness worldwide; xerophthalmia most frequent in children aged 6 months to 6 years; ~20% children at increased risk of death from common infections; ~2% blinded or with serious sight impairment.
• Iodine deficiency - at least 30,000 babies stillborn each year; over 120,000 born mentally retarded, physically stunted, deaf-mute or paralysed due to iodine deficiency.

3. Infectious and Parasitic Diseases

• Diarrhoea
• Respiratory infections (ARI)
• Measles
• Pertussis
• Polio
• Neonatal tetanus
• Tuberculosis
• Diphtheria

• A child may be affected several times in a year; incidence increases with malnutrition.
• Of ~4 million deaths/year from ARI in the developing world, a quarter are linked to malnutrition.
• 2017 global under-5 mortality: ~8% due to diarrhoeal diseases, ~12% due to ARI, ~2% measles, ~5% malaria.
• Intestinal parasites (ascariasis, hookworm, giardiasis, amoebiasis) are common due to poor environmental sanitation and lack of potable water.

4. Accidents and Poisoning

• In the developed world, accidents and poisoning have become a relatively more important child health problem.
• In developing countries: burns, trauma from home accidents, and increasingly traffic accidents.
• Children and young adolescents are particularly vulnerable to domestic accidents including:
  • Falls
  • Burns
  • Poisoning
  • Drowning

5. Behavioural Problems

• Behavioural disturbances are a notable child health problem increasingly recognized in most countries.
• Children abandoned by their families present severe social and health problems.
• Over 60,000 children are abandoned each year in India.

6. Other Factors Affecting the Health of Children

• Malnourished
• Under 18 years (too young) or over 35 (too old)
• Last child born less than 2 years ago (too close)
• More than 4 births (too many)
• Deprived of basic pregnancy care

• Family size, relationships, and stability all influence child health.
• Number of episodes of infectious diarrhoea increases with family size.
• Prevalence of malnutrition increases in families with more than 4 children.

• Poverty, illiteracy (especially mothers' illiteracy), and sickness create a vicious circle.
• Under-privileged children are smaller, lighter, and less advanced in psychomotor and intellectual performance.

• After the first week of life, environmental factors are major determinants of infant/childhood morbidity and mortality.
• Insufficient safe water, inadequate disposal of human excreta, abundance of insects/disease vectors.
• Environmental stimulation also influences child development - speech, personality, intellectual potential.

• Community and social support measures: creches, day care facilities, and organized health care systems.

Health Problems of the School Child (separate enumeration by Park)

1. Malnutrition
2. Infectious diseases
3. Intestinal parasites
4. Diseases of skin, eye and ear
5. Dental caries

Summary mnemonic for main child health problems (LIBAB): Low birth weight | Infections & parasitosis | Behavioural problems | Accidents & poisoning | Bad nutrition (malnutrition)