Medicine

HYGIENE OF CHILDREN AND ADOLESCENTS

HYGIENE OF CHILDREN AND ADOLESCENTS.CONFORMITIES TO THE LAW OF GROWTH AND DEVELOPMENT OF CHILD'S ORGANISM.HYGIENE OF LABOUR, PHYSICAL, PSYCHOPHYSIOLOGICAL STUDIES AND EDUCATION OF CHILDREN AND ADOLESCENTS.

HYGIENICAL BASES OF PLANNING AND EQUIPMENT OF PRESCHOOL AND SCHOOLS ESTABLISHMENTS, METHOD OF THEIR HYGIENICAL ESTIMATION.

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.

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.

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.

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).

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

Types of Play

Motor/Physical Play

     Motor play provides critical opportunities for children to develop both individual gross and fine muscle strength and an overall integration of muscles, nerves, and brain functions. Recent research has confirmed the critical link between stimulating activity and brain development. Young children must have ample opportunities to develop physically, and motor play instills this disposition toward physical activity in young children.

Social Play

     A variety of opportunities for children to engage in social play are the best mechanisms for progressing through the different social stages. By interacting with others in play settings, children learn social rules such as, give and take, reciprocity, cooperation, and sharing. Through a range of interactions with children at different social stages, children also learn to use moral reasoning to develop a mature sense of values. To be prepared to function effectively in the adult world, children need to participate in lots of social

Constructive Play

     Constructive play is when children manipulate their environment to create things. This type of play occurs when children build towers and cities with blocks, play in the sand, construct contraptions on the woodworking bench, and draw murals with chalk on the sidewalk. Constructive play allows children to experiment with objects; find out combinations that work and don't work; and learn basic knowledge about stacking, building, drawing, making music and constructing. It also gives children a sense of accomplishment and empowers them with control of their environment. Children who are comfortable manipulating objects and materials also become good at manipulating words, ideas and concepts.

Fantasy Play

     Children learn to abstract, to try out new roles and possible situations, and to experiment with language and emotions with fantasy play. In addition, children develop flexible thinking; learn to create beyond the here and now; stretch their imaginations, use new words and word combinations in a risk-free environment, and use numbers and words to express ideas, concepts, dreams, and histories. In an ever-more technological society, lots of practice with all forms of abstraction - time, place, amount, symbols, words, and ideas - is essential.

Games With Rules

     Developmentally, most children progress from an egocentric view of the world to an understanding of the importance of social contracts and rules. Part of this development occurs as they learn that games like Follow the Leader, Red Rover, Simon Says, baseball and soccer cannot function without everyone adhering to the same set of rules. The "games with rules" concept teaches children a critically important concept - the game of life has rules (laws) that we all must follow to function productively.

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 namedstandarts”). 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.

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.

 

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.

        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, Х-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 Х-sharped -оne knee joint comes for another.

      The form stops. Distinguish to stop normal, and flat. For revealing investigate prints stops (plantographia). With a solution метиленового 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 (а), to all length (б).

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 (Р), to development dairy glandula (Ма), 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 (Р) and development of an adam's apple (Ь). The degree of development of an attribute is defined on following system:

Hairing axillary hollows (Ah)

Ахo - hairing  is absent;

Ах1 - individual hair;

Ах2-The rare hair located on small central

 Site of an axillary hollow;

Ах3 - the rich direct hair located on all surface

Axillary hollow;

Ах4 - rich twisted hair.

Pubical hairing (Р)

Р0- hairing is absent;

Р1 - individual hair;

Р2 - the smooth hair located on the central pubis site;

Р3 The rich direct hair in regular intervals located on a pubis surface with a precise horizontal line;

Р4 - the rich, twisted hair in regular intervals located on all

Surfaces of hips and in a direction to umbilica (man's hairing type).

Development dairy glandula(Ма)

Ма0 - dummies above overnipped a circle it is not lifted, dairy,

Some iron does not give out;

Ма1 - dummies it is lifted above overnipped a circle, dairy iron does not give out;

Ма2 - dummies and overnipped the circle acts as a cone,

dairy iron it is a little bit raised;

Ма3 - dummies and overnipped  a circle keep the form of a cone, iron it is lifted on the big space;

Ма4 - dummies rises above overnipped a circle, dairy iron it is generated.

Person’s hairing (F)

F0- hair is absent;

F1 - beginning hairing above a upper lip;

F2 -  hairing bove top  their occurrence in the field of a chin

F3- hairing distribution above a upper lip and in area chin with the tendency to merge of the specified zones, the beginning

Growth of whiskers;

F4 - clear merge of hairing  zones above a upper lip and

Areas of a chin with the tendency to submaxillary hairing

The areas, the expressed growth of whiskers.

Development of a thyroid cartilage of a throat - adam's apple (L)

L0 - absence of attributes of growth of a thyroid cartilage of a throat,

L1 - small  thyroid cartilage of a throat;

L2 - distinct extraposit.

Mutations of a voice (V)

V - a children's voice;

V - a voices mutation;

V - a man's timbre of a voice.

Physiometrical attributes. Vital capacity easy measure with the help of the water spirometer consisting from external and internal  cylinders. On a forward wall of the internal cylinder divisions on which it is counted amounts of inhaled air (in milliliters) are put. On a cover of the cylinder there is an aperture with a rubber fuse. It open, when the internal cylinder should be lowered on a necessary bottom. Below there is a crane connecting to the internal cylinder on which put on a rubber tube with a glass mouthpiece on the end. Before work the water level should be on "0". Surveyed makes the maximal breath, having detained breath, densely. Clasps a mouth a mouthpiece and exhales in a tube all air, having excluded an exhalation through a nose. It is made 2-3 measurements, write down the greatest parameter.

Muscular force of hands determines a manual dynamometer.

Surveyed maximum tries to compress a spring of a dynamometer at the hand extended and allocated aside. Take into account the maximal result in kgs. For the following measurement an arrow returns in zero position.

Stand-force determines with the dynamometer help (fig. 22, б). Surveyed fixes dynamometer by legs, bends down and trying it is unbent maximum, pulls hands the handle of the device which should be at a level of knees. Take into account the maximal result.

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

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

To somatometric index belong length and weight of body, circumference of thorax and head, shoulder, thigh, etc. To phisiometric - muscle force of arms, legs.

To somatoscopic index belong state of skin and mucous covers, state of fat tissue, state of bone tissue (shape of chest, cord, legs and feet).

Processing of antropometric factors

Result of research is brought to the table. In column 1 in decreasing or increasing order are brought values of growth, weight of the body and volume of the thorax, which is met in given group and it is marked by letter 'а'.

In another column ('p') we can put the number of the accidents with 1 value of sign. In third column ('m') we write the middle meaning which is defined by multiplying a and p and dividing on number of sign ('n'). In column 4 we calculate declination of each of variant from the middle (M) and mark in column 5 - each deflection is taken to the square (d2) and multiplied to the frequency of variant (p) and divided on number of accident (n) and mark the middle square:

δ =Σ d2 x p/n.

The way of dividing d/δ one can find the sigmal decline, which shows the number of sigma on which deflect the factors of child’s research from the middle sign. The profile of physical development of child is estimated by means of sigmal meanings.

Hygienic demands to current sanitary-epidemiological school state. Hygienic demands for each of main elements of the regime are different, accordingly to different age groups.

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.

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.

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 homework. 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.

1. Medical criteria:

1.1.        The level of biological developmenmt.

The most accurate characteristics of the biological age is the stage of skeleton differentiation (skeleton age). However, the usage of that method is restricted because of the danger of excessive roentgenologic examinations. That’s why the biological age is determined by the measuring of body length (with the help of sigmatic deviations method), yearly body length surpluses, the substitution of deciduous teeth with permanent ones.

1.2.        Health condition assessment.

The most basic criteria for health condition assessment are as follows:

a) level of the functional condition of main organism’s systems;

b) chronic diseases presence or absence at the moment of examination ;

c) degree of organism resistibility to unfavorable actions;

d) level of development achievement and its harmony degree.

2.      Psychophysiological criteria.

Psychophysiological examination of children is performed for revealing the lag in the development of indispensable school functions: motor, analytic and synthetic functions of cerebral cortex (Kern-Iraseque’s test and articulative-vertibular tests (articulation quality)).

2.1.        Kern-Iraseque’s test. This is an oriented test of “school maturity”; it is performed with one child or a group of children (10-15 children.) The test contains three tasks: a picture of a human being (a man), copying a short phrase of three words (“he ate soup”), copying a group of dots.

The first task is accompanied with following instructions: “here please draw any man how you can”. There are no other further explanations for this task. For the fulfilment of other two tasks the reverse side of the paper sheet is used which is beforehand divided in half with a horizontal line.

The second task presumes the copying of a short phrase of a type “he ate soup” from a special card. The vertical dimension of letters on the card should be 1 sm and the first capital letter – 1,5sm high. The second task is accompanied with the following task: “Please have a look, there is something written here. You can’t write so far, so please try to copy this; please have a good look how this is written and please copy that in the upper part of the sheet (show where”.

The third task of the oriented test of school maturity presumes the copying by a child of a dots group which is drawn on a specific card with 1sm distance between the dots along vertical and horizontal lines; the diameter of each dot should be 2mm, and with a pentagon formed by dots with an acute angle directed down. The following instruction is added: “There are dots drawn here. Try to draw the similar ones in the bottom part of the sheet (show where)”.

Copying a dots group (fig.3).

1 point – the accurate depicting of the origin. Dots are drawn, not circles. The figure symmetry is preserved both along horizontal and vertical lines. Any diminution of the figure is accepted, but the enlargement may be acceptable if it is not more than half as large as the origin.

2 points – some not important violation of the symmetry: one dot may be behind the margins of columns or lines. The depicting of circles instead of dots is acceptable.

3 points – The dots group hardly resemble the origin. The eventual violation of the whole figure symmetry is possible. The view of a pentagon is preserved, it is directed with its top up or down.

4 points – The dots are drawn all together, their grouping may resemble any geometrical figure. The dimensions and quantity of dots do not matter. Other pictures, as e.g. lines, are not acceptable.

5 points – scrawls.