HYGIENE OF CHILDREN

PHYSICAL DEVELOPMENT AS IMPORTANT A CRITERION OF ESTIMATION OF THE STATE OF CHILDREN AND ADOLESCENT HEALTH. HYGIENIC ESTIMATION OF ORGANIZATION AN EDUCATIONAL-EDUCATE PROCESS IN PRESCHOOL ESTABLISHMENTS AND AT SCHOOL.

THE ASCERTAINMENT OF A 6-YEAR-OLD CHILD READINESS FOR SCHOOL STUDIES

 

Health of the adult human depends on its health in children’s and adolescents’ age. In particular, the average duration is longed during this century and depends on the decreasing of the children’s death and illness. According to the children’s illness we can speaking about nation’s health.

In biological respects children’s age is characterized by weak adaptation of organism to the changeable optimal state of the environment (early children’s age). With the age adaptation’s possibility is increased.

As a result of biological changes of the children’s age hygienic conditions must be changed in separate periods of children’s organism development. Hygiene of the children’s age is so different like a children’s age. Hygienic norms are differentiating according to the age. So, the hygiene of the children and adolescent is the part of the hygiene that shows the methods of health organism making. According to it the hygiene of children and adolescent is named as hygiene of the education.

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Objects of the children’s and adolescents’ hygiene:

1. Dynamical (in development process) studying of the environment’s factors’ influence, including the education and studying, to the children’s and adolescents’ health.

2. Making of the scientific grounded hygienic norms and measures that further to stronger the health and better mental and physical development. In this case the hygiene has both influence: a) growth organism of child in education process with improvement adaptation possibility (steel in the wide understanding) and b) environment that is around child, in direction of it adaptation according to age changes.                       

The factors influence on development of the child’s organism.

During all children’s and adolescent age organism growths and develops every time, and passes from one stage to other. Child’s development process is made at the influence of conditional and unconditional actions of the external and internal environment. The main factors that are determining development of organism are original anatomo-physiological properties, external environment, child’s activity and education. And by the way the last one has the main role.

 The most fall effect has the constant influence on the adaptation to the changeable conditions of the environment, so the adequate pass from one stage to other. Such result may be received at the process of education with taking into account the origin and anatomo-physiologic properties of child’s organism and are given environment’s condition that these properties are demanded.

Main stages of the child’s organism development and its hygienic guaranteeing (securing, ensuring).

Work periodisation of the children’s age is grounded on the M.P.Gundobin’s and M.P.Krasnogorsky’s proposition. Here are taking into the account the main conformity of child’s organism development and properties of the education of the children and adolescent.

According to this sketch there are such age periods: 1) intrauterine, 2) neonate (0-10days), 3) infants (10days-1year), 4) kindergarten, 5) preschool (early, medial, older), 6) school (early, medial, older).

During the infant age the adaptation of the nervous system is increased and the sleep is increased too. It gives the possibility to making of the conditional reflexes, in particular the reflex of quick sleeping at the “fresh air”.

At the influence of the rational education in the child’s organism the protective function and function of adaptation to different external influences and changable conditions of the environment are developed.

The main hygienic measures that are necessary in this period are:

  Rational regime of child and long-lasting staying at the fresh air

  Guaranteeing by the rational closes, furniture and apparatus

 Systematic physical exercises

  Massage

  Steel

Systematic control by the infants’ physical development – necessary condition of their rational education.

TRAINING INSTRUCTION

on complex assessment of children’s and adolescents’ health

 

Assessment of health state is the most important role of a physician, who works with children and adolescents. It’s main importance lies in the fact, that the formation of physical and psychological human health, organism’s resistance to influence of unfavourable environmetnal factors and social contitions takes place in childhood.

The following criteria of complex assessment of the children and adolescents health state are used nowadays in everday practice of sanitary doctors, doctors of general education establishments, pediatricians, general practitioners and family doctors:

     Presence or absence of chronical diseases during examination;

     Functional state of main systems of organism;

     Level of organism resistance to unfavourable influence of environemntal factors;

     Current level of nervous and psychological, and physical development, its harmonicity.

According to listed above criteria, allocation scheme of children and adolescents by health groups was elaborated. There are 5 health groups:

First health group includes healthy children and adolescents with harmonious development and development level of organism functional systems corresponding to the age.

Second health group includes healthy children and adolescents who have functional and some morphological deviations, low resistance to acute and chroonic diseases, they are ill frequently during long period of time.

Third health group includes children and adolescents suffering from chronic diseases in compensation stage, with normal fucntional resources of organism.

Fourth health group includes children and adolescents suffering from chronic diseases in subcompensation stage with lowered funcional resources of organism.

Fifth health group includes children and adolescents suffering from chronic diseases in decompensation stage with significantelly lowered funcional resources of organism.

morbidity rate

years old

Fig. 38.1 Changes of morbidity rate of children and adolescents depending on age (morbidity rate per 1000 population of corresponding age)

 

Change of morbidity rate (see fig. 38.1) and its structure (table 1) depending on age has to be taken into account during the complex assessment of health state of children and adolescents.

Table 1

Patterns of rank distribution of diseases in different age groups

 

Rank place

Age group, years old

0–3

3–6

7–14

15–17

I

Diseases of respiratory organs

Diseases of respiratory organs

Diseases of respiratory organs

Diseases of respiratory organs

II

Diseases of nervous system and sense organs

Diseases of nervous system and sense organs

Diseases of nervous system and sense organs

Diseases of nervous system and sense organs

III

Diseases of gastrointestinal tract

Diseases of skin and subcutaneous fat layer

Diseases of gastrointestinal tract

Diseases of gastrointestinal tract

IV

Diseases of endocrine system

Diseases of blood and hemopoietic organs

Diseases of endocrine system

Diseases of endocrine system

V

Diseases of skin and subcutaneous fat layer

Infectious and parasitic diseases

Diseases of musculoskeletal system

Diseases of musculoskeletal system

Allocation of children by health groups allows to reveal people who have risk factors concerning development of pathological deviations, children with initial forms of diseases and functional deviations, and, based on received results to work out complex measures for protection and strengthening of children’s health, prevention of chronic diseases appearance.

First of all these measures must be directed on children, belonging to the second health group (children-reconvalexscents, children who are ill frequently during long period of time, with general delay and dysharmonicity of physical development due to being overweight or underweight without endocrine pathology, with bending disorders, flat feet, with functional deviations of cardiovascular system, myopia, carries, II stage hypertrophy of palatine tonsils, allergic reactions, thyriod gland enlargement of I and II stages, asthenic syndrom etc.).

Following data may be used for assessment of organism resistance: morbidity rate with temporal disability and exacerbation of chronic diseases during previous and current years, incides of nonspecific resistance (X-chromatine and geretochromatne content in the cheek mucous membrane epithelium, glicogen content in neutriphils, activity of alkaline and acid phosphotase in neutrophils, dehydrogenas in limphocytes, lysozyme and lactatedehydrohynase in saliva, level of skin bactericidal action etc.).

Assessment of functional state of organism is carried out using clinical methods and special functional tests (orthostatic sign, Martine-Kushelevskiy test), Letuvov test, step-test (ÐWÑ170) etc.).

There are favourable (sanitary, health-improving) and unfavourable (or risk factors) factors which form health and significantly influence processes of development of growing organism.

Sanitary (health-improving) factors are the follwoing:

     rational regime of daily activity;

     adequate and balanced nutrition;

     correspondence of environment to hygienic standards;

     optimal motor activity;

     tempering;

     healthy lifestyle and following of the everyday hygienic rules.

Unfavourable (risk factors) are the following:

     disturbances in day regime, educational process;

     disadvantages in organization of nutrition;

     breaches of hygienic requirements to game, educational, extracurricular and labour activity;

     insufficient or excess motor activity;

     unfavourable psychological climate in family and collective;

TRAINING instruction

on assessment of physical developent of children and adolescents

Physical development of children and adolescents is assessed based on somatoscopic (ànthroposcopic), somatometric (anthropometric) and physiometric indices with their further interpretation using method of sigmal deviations, regression scales, complex or centile methods.

There are following somatoscopic indices: condition of skin and mucous membranes, degree of fat diposity, characteristics of musculoskeletal system (bearing, form of chest, sceleton, legs and feet), also signs of sexual development (pilosis/hair distribution on armpit and pubis, mammary glands development for girls, hair distribution on face, development of larynx thyroid cartilage, voice mutation for boys) (see fig. 38.3, 38.4 and 38.5).

 

Fig. 1 Main types of bearing

(àlordotic; b – kyphotic; c correct; d – stooping; eerect)

                                                                                                                                                   (1)                                               (2)

Fig. 2 Method of measurement of normal spinal curvatures (1)

and main types of scoliosis (2)

(1–4 – length of spinal column; 2 – cervical bending; 3 – lateral bending;

àthorax right-side; btotal lift-side; cS–shaped)

Fig. 3 Forms of lower extremities

(ànormal; b – X–shaped; cÎ-shaped)

                                                   

Main somatometric incides are the following: body length and weight, thorax circumference and other (circumferences of head, shoulder, hip etc.), and they are determined using special anthrpometric points (see fig. 4).

Fig. 4 Special anthropometric points

à –lateral view: 1-  apical; 2 -  glabella; 3 -  occipital; 4 -  upper thorax; 5 -  styloid; 6 -  terminal; 7 -  calcaneal;b – frontal view: 1 -  apical; 2 - parietal; 3 - glabella; 4 - chin; 5 - upper thorax; 6 - middle thorax; 7 -  shoulder; 8 -  radial; 9 - styloid; 10 -  finger; 11-  upper crus; 12 - lower crus; 13 -  trochanteric; 14 – pubic.

There are such physiometric indices as muscle strength of hands, lung vital capacity, torso strength etc.

Wooden auxanometer is used for determination of body length in standing and sitting positions. Wooden auxanometer is 2 meters high pole which is fixed on 70 x 45 cm frame with folding bench at 40 cm height used for length determination in sitting position. Two columns of centimeter points are marked on the pole. Results are read according to the first column from the frame, according to the second column – from the folding bench. Movable muff with horizontal plane is fixed on the pole. This muff is lowered until it touches the parietal bone of examined person.

The examined person has to stand still, leaning with his/her back to the pole, hold heels together and toes separately and touch the stick in three points – heels, buttocks and interscapular region during examination of body length in standing position. The head of examined person must be in such position that the line connecting lower border of eye-hole and upper border of ear tragus is parallel to floor.

Medical scale is used for the body weight measurement.

Thorax circumference is measured with tape-line when patient is maximally calm, takes a forced inspiration and expiration (tape line has to pass along lower border of mammillary ring for boys and along four rib for girls at the front, and along the lower border of scapulas with arms put down - behind).

Water or pneumatic spirometer is used for determination of lung vital capacity, hand dynamometerfor determination of muscle strength of hands, torso dynamometer – for determination of torso strength. Maximum result is registered during examination in any case.

The assessment of physical development is carried out comparing individual data and regional standards of physical development (average standard values for each age and sex group which reflect level of physical development of chlidren and adolescents living in same conditions).

Assessment of physical development using method of sigmal deviations

Method of sigmal deviations with image of physical profile is used to assess the physical development comparing each individual index with weight-average arithmetical value for this index at certain age. This allows to find out this index’s actual deviation from standard values.

Then the sigmal deviation (σ) is found by division of actual value by the value of mean square deviation. This information reveals the sigma value which may vary, this value for each child may differ from average special for certain age and sex group values.

Deviations from –1σ to +1σ mean average development of this index, from –1.1σ to –2σdevelopment is below average, from –2.1σ  and belowlow, from +1.1σ to +2σ above average, from +2.1σ  and highhigh.

To draw a profile of physical development the following procedure has to be done: horizontal lines corresponding to the number of indices for further assessment are drawn and the value of received sigmal deviation is pointed on each line, then these points are connected with straight line (see fig. 5).

                            -     -      -        Ì       +1σ     +2σ    +3σ       

Body length

 

 

 

 

 

Body weight

 

 

 

 

 

Chest circumference

 

 

 

 

 

 

Fig. 5 Profile of physical development

Method of sigmal deviations allows to determine the level of each separate index of physical development and its proportionality based on the profile data. If values of deviations correspond to one sigma - the physical development is proportional, if the values of deviations are two and more sigmas – the physical development is disproportional.

The conclusion about physical development of a child has to be the following while using method of sigmal deviations: Physical development of Petrenko ²., 10years old, is average (below average, low, above average, high) accroding to the body length, average (below average, low, avobe average, high) according to the body weight, average (below average, low, avobe average, high) according to the ches girth, proportional (disproportional)”.

Example: it is necessary to assess the physical development of 10-year-old boy Petrenko with 129 cm body length, 37 kg body weight and 61 cm chest girth.

During self-training task the data about this pupil (surname, sex, age, health state) are drawn into the protocol, then according to the example (table 2) the column “Pupil” is filled with data of examined pupil concerning body length, body weight and chest girth.

Table 2

Data of individual assessment of physical development

Indices of physical development

Pupil

Standard

Difference between actual and standard values

Value of sigmal deviation

Assessment

Ì

s

Body length, cm

129

137.3

5.6

– 8.3

– 1.48 s

Below average

Body weight, kg

24

33.4

6.0

– 9.4

– 1.56 s

Below average

Chest girth, cm

61

67.5

4.8

– 6.5

– 1.35 s

Below average

After that, using the table 3, the sex and age of examined pupil are found, coresponding standard values of separate indices (body length and weight, chest girth) of physical development: average arithmetical weighted value (Ì) and mean square deviation (s) and drawn into the table 2 (see columnStandard”).

After that, the difference between actual and standard values is calculated for each index. In our example, body length of 10 years old boy is 129 cm, standard value of this index (Ì) is 137.3 cm, difference between them is 129 – 137.3 = –8.3 cm.

Received difference is divided by s (in our example it’s value is 5.6 cm) and sigmal deviation is found: –8.3 : 5.6 = –1.48s. And, at last, the assessment of physical development according to each index is substantiated based on value and indication of sigmal deviation.

In our example, taking into account that sigmal deviation is –1.48s, physical develpment of a boy according to the body length is under average.

Using mentioned above sequence, data of physical development according to other indices are analyzed.

Based on received results the conclusion is substantiated. In our example the conclusion is following: Physical development of 10 years old Petrenko I. According to the body length and weight, chest girth is below average, proportional.

There are such main disadvantages of this method of physical development assessment as indices are assessed separately and level of their correlation is not taken into account. At the same time certain values of body weight and chest girth correspond to certain body length of an organism, and physical development has to be proportional. This disadvantage can be removed using method of physical development assessment by regerssion scales, complex and centile methods.

Assessment of physical development using regression scales

Usage of method of assessment of physical development using regression scales allows to overcome the main disadvantage of method of sigmal deviationsseparate character during assessment of each somatometric index. In this case tables for assessment include correlation between height, body weight and chest girth. This correlation allows to give more substantiative assessment of physical development taking into account interconnected indices.

First stage of the physical development assessment using regression scales tables includes search of group (developmnt is average, below average, above average, high, low) to which the child body length is attributed.

Then the body weight and chest girth indices corresponding to actual height are compared with actual indices of examined people. For this, it is necessary to subtract standard value of examined index from value of actual development of this index and the received result is divided by sigma-regression (σR) for each examined index.

Physical development may be:

          harmonic, if determined individual indices of body weight and chest girth circumference have values ̱1σR;

          disharmonic, if determined individual indices of body weight and chest girth have values from Ì-1.1σR to Ì-2σR or from Ì+1.1R to Ì+2σR due to increased fat deposity;

          sharply disharmonic, if determined individual indices of body weight and chest girth have values from Ì-2.1σR and low or from Ì+2.1σR and high due to increased adipopexis.

If the method of regression scales is used for the physical development assessment the conclusion has to be the following: Physical development of 10 years old Petrenko I. is average (above average, high, below average, low) according to the body length, harmonic (disharmonic, sharply disharmonic) according to the body weight and chest girth.

Fuethermore, this type of examination can determine one from four groups of physical dvelopment for this child: normal physical developmentif body weight is from Ì–1σR to Ì+2σR; body weight deficiencyif body weight is lower than Ì–1.1σR; body weight excessif body weight is more than Ì+2.1σR; low heightif body length if lower than Ì–2σ.

 

Assessment of physical development using complex method

 

Complex method of the physical develoment assessment includes both peculiarities of morphological and functional state of the organism and correspondence of the organism biological development to his chronological age (table 4).

Table 4

 

Assessment criteria of physical development of children and adolescents

(using complex method)

 

At first, biological age of a child has to be determined based on the body length and annual body length increase, number of permanent teeth, secondary signs of sexual development, time of ossification of hand bones and compared with chronological age. Depending on the received data the biological age may be corresponding to the chronological age, ahead of or behind the chronological age.

Next stage of the complex method is assessment of morphological and functional state of the organism according to regression scales, age and sex standards of the functional indices development. Physical development may be:

          harmonic, if determined body weight and chest girth values are ̱1σR or from ̱1.1σR and functional indices have deviations from –1σ  and more;

          disharmonic, if determined body weight and chest girth values are from Ì-1.1σR to Ì-2σR or from Ì+1.1σR to Ì+2σR due to body weight deficiency or increased adipopexis and functional indices are from –1.1s to –2s;

          sharply disharmonic, if determined body weight and chest girth values are from Ì-2.1σR and low or from Ì+2.1σR and more due to body weight deficiency or increased fat deposity and functional indices are from –2.1s and lower.

If complex method is used for assessment of physical development the conclusion has to be the following: Physical development of 10 years old Petrenko I. is average (above average, high, below average,low), harmonic (disharmonic, sharply disharmonic), biological age corresponds to chronological age (ahead of chronological age, behind ones)”.

Level of biological development is determined based on correlation between its main signs and age and sex standards (tables 5 and 6) while using complex method of the physical development assessment.

 

Level of physical development according to the body length may be determined using regression scales or method of sigmal deviations.

As in a previous case there are five criteria of physical development according to the height: high, avobe average, average, below average, low.

Regression coefficient (Ry/õ) reveals the value by which value of body weight (kg) or chest girth (cm) changes while body length increases or decreases by standard measurement unit (cm). Sigma-regression (sR) allows to determine the value of the individual body weight and thorax girth deviation from standard data of body length.

Assessment tables (regression scales according to height) are drawn using regression coefficient and sigma-regression. These tables allow to determine harmonicity of the organism development according to morphological indices. Comparing actual values of body weight and chest girth with their standard values for certain age and sex it is possible to identify level of the physical development harmonicity.

Difference between actual and standard values of the physical development index is divided by sigma-regression and the value of sigmal deviation is received, which allows to determine the level of harmonicity of the schoolchild’s physical development.

Assessment criteria of the organism physical development using regression scales are presented above. If a child has deviation of body weight from standard values more than ±3sR he/she should bee sent to the doctor-endocrinologist for further advice.

Method of standard sigmal deviations is used for assessment of functional indices by complex method.

Example: it is necessary to assess the physical development of 11-year-old girl with 148 cm body length, 37 kg body weight, 71 cm chest girth, 8 cm annual body length increase, she also has 20 permanent teeth and secondary signs of sexual development are the following: Ìà1. Ð1. Àõ1. The doctor’s actions during physical development assessment include such steps.

First of all, the doctor has to compare data of examined girls with standards of biological development for 11 years old girls to determine level of biological development (table 5).

The values of examined girl must be the following: body length – 142.8±7.1 cm, annual body length increase – 6-8 cm, 21±3 permanent teeth, secondary signs of sexual development – Ìà1. Ð0.1. Àõ0.1 according to the standards of biological development for 11 years old girls. In our example, indices of this girl’s biological development correspond to standard values. It means that level of biological development corresponds to chronological age.

Then assessment tables according to regression scales (table 8) are used for assessment of physical development. According to the table data this girl’s height corresponds to average, her physical development according to the body length is average. Next stepusing values of sigma-regression to find values of body weight and chest girth which this girl must have according to her height. According to the regression scales tables data body weight has to be 40.4 kg, sigma regression (sR)5.37 cm for 11 years old and 148cm height girls. Difference between actual and standard values is 37 – 40.4 = –3.4; value of the sigma regression deviation is –3.4 : 5.37= –0.63sR. These data reveal that this girl has harmonic development according to the body weight comparing to the height.

Correspondence of chest girth to body length of this girl is calculated in the same way. Chest girth has to be 70.7 kg, sigma-regression (sR)4.92 cm for 11 yeas old girls with 148 cm. Difference between actual and standard values is 71 – 70.7 = 0.3; value of sigma-regerssion deviation is 0.3 : 4.92= 0.06sR. This means that physical development of this girls is harmonic according to the chest girth comparing to her height.

If physical development is disharmonic or sharply disharmonic it is necessary to point the cause of revealed morphological and functional disorders (due to being overweight or underweight, small chest girth) and substantiate recommendations concerning physical development correction (increasing or decreasing of the food intake energy content, usage of other food products, implementation of active physical training, sport etc.).

 

Assessment of physical development using centile method

 

Centile method, opposed to traditional ones allows to assess physical development signs varying according to the normal distibution law. Centile method is effective non-parametric instrument to describe their distribution briefly which may have right-sided or left-sided asymmetry.

Essence of centile method means comparing of actual value of each separate index of the physical development to sorted series. These sorted series include 100 interval ranges of examined index. Probabilities of an index belonging to each of these intervals are equal, but sizes of those centile intervals are unequal in absolute units.

For determination of physical development level 7 fixed centiles are used: 3rd, 10th, 25th, 50th, 75th, 90th and 97th and corresponding 8 centile intervals:

          1st interval (below 3%) – very low indices;

          2nd interval (from 3% to 10%) – low indices;

          3rd interval (from 10% to 25%) – reduced indices;

          4th and 5th intervals (from 25% to 50% and from 50% to 75% correspondently) – average indices;

          6th interval (from 75% to 90%) – increased indices;

          7th interval (from 90% to 97%) – high indices;

          8th interval (above 97%) – very high indices.

Individual assessment of morphologicl and functional indices is carried out using single-measured assessment scales which include double-amplitude peaks (maximum and minimum values), centile tendency (median of sorted series) and 8 centile intervals. Such approach allows to determine both separate characteristics of the somatometric signs development and level of physical development harmonicity taking into account the fact, that 4th and 5th centiles of nomorgam correspond to harmonic physical development, 3rd and 6thdisharmonic, 1st, 2nd, 7th and 8thsharply disharmonic due to being overweight or underweight.

 

TRaiNING INSTRUCTION

on hygienic assessment of health state and physical development among organized children collectives

 

Comparative assessment of physical development level in different organized collectives or the same collective during study in modern school is carried out based on the determination of difference of main health state indices and physical development values using methods of mean arithmetic values comparison, algebraic number distribution and square deviation comparison, and correlation method.

While using method of mean arithmetic values comparison only indices of health state and physical development of similar age and sex groups have to be compared. First of all it is necessary to establish difference between mean values of comparative groups by using Student's test (t) calculation according to the following formula:

t =  ;

where: Ì1 and Ì2 - mean arithmetic-weighted values of comparative groups;

  m1 and m2 - errors of mean arithmetic-weighted values.

Assessment of Students test (t) includes the following parameters: if t value exceeds 3, than differences of mean values are valid (p<0.05), if t value does not exceed 3 - differences between mean values are invalid (p>0.05).

Example: deep medical examination was carried out among 10 years old schoolchildren in towns B. and K. Following physical development indices were revealed during this examination:

     in town Â.: average body length of boys is 156.00±0.72 cm, average body weight – 44.40±0.38 kg.

     in town Ê.: average body length of boys is 151.00±0.58 cm, average body weight – 43.20±0.73 kg.

Assessment of validity of differences between schoolchildren’s body length and weight in mentioned above towns is carrying out by following way:

For body length:                   t =  =  = 5.6;

For body weight:                  t =  =  = 1.3.

10-year-old schoolchildren in town Ê. are significantly shorter than schoolchildren in town Â. Additional research is necessary to identify main causes of this phenomenon.

While using method of algebraic number distribution, at first physical development of each child of organized collective is assessed and the assessment group is determined for each child. After that, the percentage of children in each group is calculated.

Validity of differences is calculated according to the following formula:

t =  ;

where: Ð1 - number of children (%) in first comparative collective;

Ð2 - number of children (%) in second comparative collective;

m1 - error of Ð1;

m2 - error of Ð2.

Error of percentage of children is calculated according to the following formula:

m1 =  ;

where: m1 - error of Ð1;

Ð1 - number of children (%) in first comparative collective.

Method of square deviation comparison is used for assessment of health state and physical development homogeneity according to the certain index. If standard deviation (s) value is higher, double-amplitude peaks of examined indices is also higher and, as a result, higher is the degree of their variability and heterogeneity.

Correlation method allows to discover the certain correlation between characteristics of health state and physical development by calculation of correlation coefficient (r). If value of r equals to 0 the correlation between examined indices is absent. On the contrary, if value of r equals to 1, correlation between indices is very strong, absolute, functional. If values of r are from 0 to 0.3, correlation is weak; if values of are from 0.3 to 0.5, correlation is moderate, if values of r are from 0.5 to 0.7, correlation is strong, if values of r are from 0.7 to 1.0, correlation is very strong. If value r is positive, correlation is direct (if one examined index increases - another one also increases), if value of r is negative, correlation is reverse (if one examined index increases another one decreases).

Preschool age includes fourth – sixth years of the life.

Protective-physiologic function and adaptation to the changed conditions of the environment are developed in this age period more intensive. But it is important to protect child from the external infections, invasions and other unpleasant influences in this age. Properties of the preschool age cause the necessarity to spreading quantity of hygienic measures, which have the stymulised, trending-steeling, but not only protective character. Movement games, especially with ball, natural movement and special physical exercises, partly such from them that are helped to development of muscles tone, exercises in sitting position, general and special measures to steel the organism against the cold are belong to these measures.

School age, as a rule, is the period of the education. They are different four stages of the school age: younger – to 10-12 years, middle or adolescent – to 14-15 years, earth youth and sexual puberty.

Together with hygienic protective measures on children of younger school age against different environment factors great meaning to stronger their health have continuous of the rational trending and steel of the organism in everyday life (regime of the day, rational nutrition, active kind of living), and special measures (rational physical exercises, games, sport, steel against the cold and other). Increasing the role of the hygienic education that plays integral part of the school studying.  

Middle and older school age is from the prepubertal state to the puberty. That is why somebody united these periods into one.

Practice of the medical observing shows that normalization of the mode of life and work furthers to caring the life and increasing of the adolescents’ ability to work.

Hygienic education of children is actual in all periods of the childhood. Questions of the hygiene are part of the biology, zoology, anatomy, physiology, physical training, chemistry, physics etc.

Sanitary-hygienic education of schoolchildren and fighting with the pathology further to increasing of pupils studying, chouse of the profession, ability to the work, decreasing of the illnesses in adult age.

The physical development of the child is complex of the morpho-functional properties of the organism, that case its stature and formation, and stock of its physical strength and ability to the work.        

Stature and development of the child are not only increasing of the sizes and weight of the body. It is complete complex of depth quality changes that are shows not only in morphological changes but in progressive development of its functional abilities. Modern practice of the dynamic stock of the children’s and adolescents’ health includes the examination of the physical development as a necessary element of the examination.

Systemic stock of health’s state and physical development of children and adolescent have the various meaning.

As a result of statistic analysis of data about health’s state and physical development of children forming adequate indexes that are used by the doctors to marking individual physical development of children and adolescents (so named “standarts”). Studying of these indexes gives the possibility to orientation in the changes of physical state of children’s population and roles of different factors that are cased these changes. Analysis of dynamic examining of the physical development of children gives the possibility to formation the main rules of growth and development of children.

Main conformity with the low of physical development of the children and adolescent:

Main conformity with the low of physical development of the children and adolescent:

As shows the knowledge of medical monitoring to the children’s and adolescents’ development here are:

a)          those who have staying of growth between common observing. This may be observe in the period of sexual development, or may be increasing of it;

b)          those who have staying in some indexes, especial attention is necessary to children who have increased indexes;

c)           those who have discordance, or unproportional body structure; for example, sexual period, when the extremites are long and trunk is short;

d)          those who fall behind in age necessarity in motor and static functions, have defect of the speach, carriage, deformations of the chest, of the vertebral colon, of the pelvis, of the  knee joins, flat-foot, defects of the teeth system, sings of the hypovitaminosis, decreased quantity of erythrosites and decreased hemoglobin in the blood, discordance in the pulse and arterial pressure, other early deviation in physical development course.

Determined measures may be show as such complex: active (despansering) observing of the children and adolescents.  All measures must content al main sides of the studying hygiene of the children and adolescents: rational nutrition, rational regime of the day, successive studying of the carriage, treatment physical exercises, taking of the property hygiene, systematic stomatologic control and sanation of the mouth.

Comprehensive development is connection between the physical and mental work. Organization of the health psychical area is based on the age properties of physical and nervous-psychical development.

What measures are used to the physical studying of the children and adolescents?

The main measures are:

1)          rational changes through the day different kinds of the work,

2)          physical exercises as: a) different exercises that are made every day with the aim of development and prophylactic of the motor apparatus, b) motor games and walks, c) gymnastic – active and passive (massage), d) sport and tourism, e) dosed physical work,

3)          using of the natural powers (light, air, water) and synthetic springs of the radiation,

4)          Rational nutrition.

5)          Favorable hygienic conditions of surrounding, accordingly clothes, furniture, and accommodation too.

6)          Inuring habits of personal hygiene.             

If systematic physical training and tampering is combined with rational regime of day effect will be more expressed. Rational regime is such proportion between rest and any varieties of activity when harmonious correlation between excitement and braking processes of cortex permit most optimal developing of organism. Possible to divide three type of regime of the day: which spare, which exhaust, and so-called stimulating. By first type of regime, the organism percept few irritators, which are monotonous and little amplitude. Children undeveloped physically and psychologically, appear elevated morbidity (so called `hospitality` of children). By severe regime the organism accept a lot of irritators with high amplitude, and diverse. Naturally if such regime is constantly repeated it cause over-extension of central nervous system. Gradually central nervous system will exhaust and produce delay of developing.

Main elements of regime of the day for children and teenager are:    1) Sleeping;2) Food; 3) Fresh air; 4) Hygiene of body and special tampering procedures; 5) Diversity of physical activity;6) Contact with children and teenagers, adults; 7) Different varieties of studying, working practice, esthetic upbringing. 8) Participation in socially useful working, aid to family; 9)Activity for satisfaction of individual interesting;

Hygienic demands for each of main elements of the regime are different, accordingly to different age groups.

In age before school rational regime includes suitable sleeping and unsleeping duration, duty of it accordingly to rhythm of eating, organization different care program for children, fresh air walking, games, and amusements.

For age before school, rational regime in upbringing institutions gradually alters. Essential difference, in comparison with older age before school, is :  more long fresh air walking, gymnastic classes, moving games, music. Gradually intelligent activity stays more difficult and longer (calculation, mother tongue).

On the basis of investigation of reaction schoolboys on the different combinations of the main elements of regime, was recommended by hygienists such scheme, essential positions are: duration of sleeping stay more short later, from 9 years, as result of refusing from sleeping in day (it is 1-1.5 hours every day); gradually sleeping in night stay more  short too. Long fresh air walking shorten too, but  in older school age period fresh air walking must be not less then 2-2.5 hours every day,  in  weekend –half of day.

Studying – organized and planned process of mastering certain knowledge, abilities and habits. Main elements of studying have place in all age periods of upbringing but are different: sense, volume, features, methods, forms of organizations and conditions of studying on different degrees of child’s development.

 On special classes, yet in before school age, elements of studying have place in moving games. It is studying games, in a day regime in crèche, child’s home they take relatively short time. Studying in before school age, get a planned feature , carry out in every day special classes by certain program –moving games, sculpture classes, constructing from paper or cardboard, music classes. Gradually elements of game disappeared, children’s efforts increase.

Hygienic demands of school age and before school age, must provide  as surrounding, so regime of the day.

Considered, in junior before school age lesson must continue not over 15 minutes on the beginning of period and not over 20 in the end , for middle before school age lesson must continue not over 25 minutes for senior  before school age lesson must continue not over 25-30 minutes.

For senior before school age are planned two lessons with interruption between them 10-15 minutes. Here first must be lesson from calculation or mother tongue, second –drawing, sculpture, music, gymnastic. Regime of the lessons for senior before school age, must be gradually approximated to day regime of first form.

Hygienic demands to the regime of school day include such aspects of school upbringing: schedule of the day, rational organization of time after lesson, rational integration of physical and mental activity, organization of  home working preparing.

Systematic investigation of different authors by usage of direct and mediocre physiologic, psychological, pedagogical methods showed typical dynamic of mental activity of schoolchild during  common school day.

Visible decreasing of the ability for the work in schoolchild of junior school age appear after 1.5 hour of lesson, in schoolchild of  middle and senior school age appear after 2-3 hours of lesson. Pupils of senior school age, feel on the six lesson changes of capacity of the work and physiologic functions, which show weakness of excitements in brain cortex.

Concerning optimal duration of the lesson was proofed on the practice -45 minutes. In a school for children with psychological, neurological or rheumatic diseases optimal duration of the lesson 40 minutes.  As a measure, which promote and safe capacity of the work, is important organization and structure of lesson, especially in junior forms, volume and features of home work. The special investigation shows that maximal capacity of the work coincide  with  such days as Wednesday, Tuesday ;minimal capacity of the work coincide with Saturday. Concerned  oscillation of capacity of the work during  the day, peak  coincide with 2 and 3 lesson, minimum coincide with 5 and especially 6 lesson. First lesson, obviously,  is period of accustoming for studying. So, subjects which need more intelligent efforts and are not obvious, for example mathematics, foreign languages more effective teach on second and third lessons.

Investigation of different authors proofs that physical working for schoolchild is variety of active rest. It improves quality and speed of simple psychical and according verbal reactions. Special investigation express that lesson of hand working, in school working classes and lesson of physical training improve capacity of the work not only after that lessons, but after this school day. Most effective when schedule includes such lesson in Monday, Thursday, Friday; on the third lesson in junior forms; on the forth lesson in senior forms.

Evaluation of exams and investigation proof that main factors, which cause functional disturbances of pupil’s organism in exams period and before exams (changes to worse in appetite, sleeping; disturbances of equilibration between excitement and braking in cortex, loose of weight), are: regime of day is not optimal; decrease of duration active rest and sleeping; irregular eating and walking on the fresh air. Especially influence has bad emotions. The  main hygienic demands for exams are: decrease numerous of them as possible, children with psychological, neurological or rheumatic diseases must be liberated from some exams; it is for schoolchild  don’t  loose rational day regime; and at last   exams must be provided  in tranquil psychical environment.

Working training, in favor hygienic conditions, in combination    with mental activity increase the brain tone and develops muscular system: improves differentiating in moving analysator; coordination of hands; increase the maximal muscular effort; endurance to static muscular effort.

The changes of  activity during  the lesson, make limited ability of active rest of children, especially for posture of the body. Interruptions between lessons, during pupils make personal doings by their  willing, as showed investigations are necessary and very effective type of rest.

The main conditions, which promote hygienic effectiveness of interruptions between lessons are:

1.          Moving activity during interruption between lessons;

2.          Being pupils on fresh air during interruption, fresh air favor and promote quality of air surrounding and microclimate in class rooms and corridors of school buildings, because improve  through-ventilation of school accommodations.

3.          Removing over activity  of pupils during interruption, for example games such as football, basketball. In  this case  period of accustomation  to studying  will increase on beginning of the next lesson.

4.          Using third or  forth interruption for organization warm eating for pupils .

5.          Optimal duration of interruption.

Observation for effectiveness of interruption show, that duration of interruption don’t must  be less then 10-15 minutes.

Sunday ,free day from studying,  must use for being on the fresh air, with moving, for excursion  in suburban , sport training, personal doings.

Main means for fighting with over-extensions pupils from home work, which cause  disturbances of sleeping, shorten time of fresh air being, are:

1.          Rational week-schedule which suggest certain volume and features of home work from separate subjects.

2.          Perfection of organization and methods of teaching  for separate themes of subjects, such as perception of material on the lesson, by teacher correction,  take the main part in studying  process.

3.          Systematic check from tutor and  school doctor for volume of home work.

During preparing of home work, through each 40-50 minutes ought to do  10-minutes  interruptions, for active moving on the fresh air or in accommodation with opened windows. 

Situation of studying institutions  for teenagers and children is caused by rational combination of such two principles:

1.          Supplying of studying institutions  for teenagers and children for optimal microclimate, fresh air, high level of social and sanitary facilities, far from city noises too.

2.          Territorial  access  for service stuff accordingly to profile  of service.

Radius  for service must be for crèche 0.5 km,  for school 1/2-3/4 km(pupils of junior  forms) and 1-1.5  for pupils of  middle and senior  forms);and 2-3 km in village –accordingly to  low  density of population.

Ground plot of studying institutions  for teenagers and children- the base for  sanitary benefits. They must be entire structure, be defended not only from  fabric or street noises, but from contamination of air and soil too. Sonority of noise must not be over then 40 decibels. For additional defense of studying institutions  for children from noise and dust, it must be situated  in center of area  on 20-30 m. and, at any rate,  not less then 15 m. from red line of building.

TECHNIQUE of ANTHOPOMETRICAL MEASUREMENTS

       Somatometrical  attributes. Growth standing and sitting measure with the help wooden restorer or metal anthropometry (fig. 20). Wooden restorer represents the rack in height up to 2 m with divisions on 0,5 sm, it is good on a strong platform. On the rack moves Mehta with plantlet. For definition of growth sitting there is on a restorer platform folding bench.

      Measurement of growth standing. Surveyed stands directly, hands on seams, socks separately. Thus it concerns the rack restorer, buttocks and interscapular area. The head should be in such position that the line which has been mentally carried out from the top edge of an ear up to the bottom edge of an eye-socket, was horizontal.

      Measurement of growth sitting. Surveyed sits on a bench rostomer, concerning its rack interscapular area and buttocks. Position of a head such, as at measurement of growth standing. Legs are bent in knee joints under a right angle. A foot lean about a floor or a support. Hands lay along hips.

   Growth standing or sitting can be measured also metal antropometr which consists of four empty tubes. Being are inserted one into another, they form a bar in length of 2 m with millimetric divisions. On the end of the top tube motionlessly muphta with a metal ruler, the second mupht with incisura through which divisions are visible, freely may move on a bar antropometr. The ruler is inserted into this mupht by the oblique end up.

At measurement of growth antropometr a position surveyed same, as at measurement of growth with the rostomer. Surveyed becomes a back to wall, antropometr establish vertically ahead it, and a ruler antropometr lower on apical point of a head. With the help metal antropometr it is possible to determine the sizes of a trunk, top and

The bottom finit enesses etc. For exact measurement use anthopometrical points; for example, at measurement of length of the top finitenesses use humeral and manual points. The mistake at measurement should not exceed 0,5 see.

Definition of body weight.

 For weighing use medical weights. To the top part there are two rods with divisions. Divisions into the bottom rod correspond to tens kgs (10, 20.), on top divisions through everyone are designated 50.  Balance before weighing should be verified. Weighing make on an empty stomach, without clothes and footwear. Surveyed becomes on middle of a platform of weights.

  Measurement of circles. For measurement of circles (heads, a chest cell), a shoulder, a hip, a shin…) - use a steel roulette or a usual centimetric tape. A circle of a chest cage measure in a condition of rest, the maximal breath and the maximal exhalation. A tape I put behind on the bottom corners scapulaes at the lifted hands. Then hands omit, and a tape, sliding off, lie under corners scapules. At men and the tape should pass children in front on overnipped territory a mug, at women on IV edge. In time, a deep breath and an exhalation the tape should follow without a delay movement of a chest cage.

Somatoscopic attributes. At survey (somatoscopia) pay attention to a condition of integuments and mucous membranes (color, cleanliness, and humidity), a degree feeting, a condition of the impellent device (skeleton, the form of a chest cage, a backbone, the form of legs and stops).

Feetling-development hypodermic fatty layer - objectively determine measurement of thickness fatty on a stomach (at a umbilical level on 5-6 Sm sideways from it and under scapula). Measured small tolstostnim compasses thickness divide half-and-half. Average count feetling at thickness fatty from 1 up to 2 sm, is lower - at thickness fatty less than 1 sm, is above the average at thickness more than 2 see.

        Skeleton. Distinguish three types of skeleton: thin, muscular and intermediate between them. Thin it is characterized by narrow shoulders and a chest cage, the small sizes of brushes of hands and a foot; thickset wide shoulders and a chest cage, in the big sizes of brushes of hands and a foot.

        Forms of a chest cage. Distinguish the cylindrical, conic, flat and mixed chest cage. A chest cage of the cylindrical form at

Examining in front and sideways looks in regular intervals advanced in the top and bottom departments, underthoracical the corner shaped forms and on size comes nearer to 90 °. The chest cage of the conic form has more

Bottom department wide and acting forward in comparison with top. Underthoracical corner big, more than 90 °. The flat chest cage usually has lengthened form; underthoracical  corner is narrowed and, it less than 90 °. At younger age frequently there are mixed forms of a chest cage. May to be combined rachitic and it is rare forms.

            Backbone. Distinguish normal, lordical, kiphotical. The normal backbone in sagital planes has the 5-shaped form. Cervical and lumbar curvature is insignificant, inverted forward, chest camber is inverted back. For lordical small cervical curvature and sharply expressed lumbar is characteristic. At kiphotical backbone all three lines are expressed sharply.

             The right and left-hand scolioses of a different degree concern to deformations but. At a scoliosis of the first degree feebly marked asymmetry of shoulders, scapulaes is marked. Defect has no proof character at a pressure of muscles is corrected. The second degree is characterized by a steady curvature of a backbone to the right or to the left, presence muscular kompensational platens. At the third degree are marked deep the curvatures accompanying with deformation of a chest cage. Beginning changes of a backbone can be found out the following simple way: will carry out with known pressing by a finger on tops awned vertebras - on a formed red strip judge deviations in a bend of a backbone.

The form of legs.

Distinguish normal, Õ-shaped and 0-shaped forms of legs. At definition of the form of legs surveyed puts together, socks divided. At the correct form of a leg adjoin in the field of knee joints, at the 0-shaped form knee joints do not adjoin, at Õ-sharped -îne knee joint comes for another.

      The form stops. Distinguish to stop normal, and flat. For revealing ïëîñêîñòîïèÿ investigate prints stops (plantographia). With a solution ìåòèëåíîâîãî dark blue with the help of a wadded tampon moisten to stop and put the child on the clean sheet of a paper unwrapped on a floor - on it there are dark blue prints. For wetting stop also it is possible to use 10 % a solution halfchlorical iron, the paper at it is moistened 10 % with a solution of tannin in spirit.

The analysis of a print stops.

 On the received print (fig. 21) stops will carry out(spend) a tangent to the most acting points of internal edge(territory). From Middle of a tangent restore a perpendicular up to external edge stops. Then calculate percentage of length of that part of a perpendicular which has passed through a print (à), to all length (á).

If the isthmus makes up to 50 % from length of a perpendicular, - stop normal, 50-60 % -flatted, over 60 % - flat.

Estimation of a degree of puberty.

 Degree of puberty of girls estimate on hairing axillary hollows (Ah) and pubis (Ð), to development dairy glandula (Ìà), time of occurrence of the first menstruation and establishments menstrual cycle.

   At boys take into account hairing  axillary hollows and pubis, a mutation of a voice (V), hairing  persons (Ð) and development of an adam's apple (Ü). The degree of development of an attribute is defined on following system:

Hairing axillary hollows (Ah)

Àõo - hairing  is absent;

Àõ1 - individual hair;

Àõ2-The rare hair located on small central

 Site of an axillary hollow;