First Time Consultation by Pediatrics or General Medicine

It is the set of activities through which the pediatrician or general practitioner, duly trained in growth and development, assesses the state of health and biological, psychological and social risk factors, to detect early circumstances or pathologies that can alter their growth and development.

The following actions are carried out within the consultation:

  • Preparation of medical records

The medical history includes: complete identification data; family composition and functionality; people in charge of child care; housing conditions; family pathologies; pregnancy and childbirth conditions, newborn data; feeding (breastfeeding, complementary, current feeding); review of the vaccination status according to the current scheme; review of results of paraclinical examinations (screening for hypothyroidism, hemoclassification, serologies of the mother, the child and others); growth assessment (weight, height and head circumference until three years of age); assessment of psychomotor development (abbreviated scale of development up to five years and proof of cognitive development in the elderly); complete physical exam; diagnosis of genetic, environmental and psychosocial risks,

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  • Diligenciamiento of the card of infantile health

Diligenciamiento of the card of control of Infantile health, explanation of the same and delivery to parents or guardians.

  • Assignment of the next control

It will be done in all cases, even when the child is referred to another level of care. Special situations are excepted (Numeral 11), in which the child will continue to be treated in another institution.

  • Assignment of appointment for education activity in childcare

Parents or guardians are informed of the importance of this activity and are assigned the appointment for it.

  • Referrals

If necessary, the corresponding referrals are filled out.

  • Activity log

Filling out the corresponding registration forms.

10.1.5.2 Control consultation by pediatrics, general medicine or nursing

Individual or collective pre-consultation and post-consultation processes can be included, in which part of the actions to be carried out by one of the members of the health team are advanced. It includes the following actions:

  • Diligenciamiento of the clinical history

The vaccination card is reviewed, questions about diseases, feeding, stimulation, child care, compliance with recommendations given in previous controls are examined, paraclinical examinations are reviewed, a complete physical examination is done, assessment of physical growth (weight gain, height and head circumference up to 3 years of age and recording them in the growth curves), assessment of psychomotor development (application of abbreviated scale of the development or the cognitive development test in the age of 5 years), diagnosis of the condition of health and nutritional status, diagnosis of risks found, recommendations and referrals

  • Diligenciamiento of the card of infantile health

The information corresponding to that query is filled out in the card.

  • Assignment of the next control

The date and time of the next control of a healthy child is assigned to every child, so that it has been sent to a specialized assessment.

  • Assignment of appointment for education activity in childcare

Parents or guardians are informed of the importance of this activity and are assigned the appointment.

  • Referrals

If necessary, the corresponding referrals are filled out. If the nurse finds any alteration in the physical examination of the child, it must be assessed by pediatrics or general medicine.

  • Activity log

Filling out the corresponding registration forms.

10.1.6 Education activities in childcare

Although the cost effectiveness of these actions has not been demonstrated, they are strongly recommended (level of evidence 2 grade of recommendation A) (28). They are made by the members of the health team, according to availability and topics to be discussed. It develops from the first level of care, with groups of parents or caregivers of children of the same age. Its frequency is:

  • Parents and caregivers of children from 0 – 3 months
    • Parents and caregivers of children from 3 to 6 months
    • Parents and caregivers of children from 6 to 9 months
    • Parents and caregivers of children from 9 to 12 months.

Its characteristics are as follows:

  • Responsible health agent: this activity can be carried out by any health agent that is part of the promotion and prevention teams, after training in it. The responsibility for the fulfillment of the action is at the head of the promotion and prevention programs, that is, EPS, ARS and regional and local health organizations.
    • Number of participants: a maximum of twenty parents or guardians participate.
    • Duration time: one hour.
    • Contents: the contents must be adjusted to the needs and cultural characteristics of each community. Several of the following issues must be addressed: characteristics of the age group, adequate food, timely stimulation, good treatment, humanized upbringing, prevention and management of diseases and more frequent age problems
    • Methodology: a participatory methodology is used. The workshop methodology is recommended, following the guidelines presented in Annexes 1 and 2 for health promotion and parenting workshops, respectively
    • Registration: it is recorded in the history of each attending child and in the children’s health card and the corresponding activity record is completed. The responsibility for the fulfillment of the action is at the head of the promotion and prevention programs, that is, EPS, ARS and regional and local health organizations.

10.1.7 Breastfeeding counseling

It is carried out by members of the health team that have received the respective training. It is done by demand or by referral. It can be an individual or collective activity (29).

  • Collective activity: offered to the entire community. It is done in groups of maximum twenty mothers with a duration of one hour. Breastfeeding education is done, attendees’ concerns are resolved. It is recorded in the history of each child and in the children’s health card. The corresponding activity record is completed • Individual consultation: it is done on demand or by referral of any of the child’s consultants. It is attended as a priority consultation. It is recorded in the history of each child and in the children’s health card. The corresponding activity record is completed.

The responsibility for the fulfillment of the action is at the head of the promotion and prevention programs, that is, EPS, ARS and regional and local health organizations.

The comprehensive assessment of the newborn is performed by the pediatrician or general practitioner, according to the levels of care. It must be done at the time of birth or in the first days of life, by the professional attending the child.

10.1.8 Supplementation with iron

It is prescribed by the professional who controls the child.

Iron supplementation will be given to all children at a dose of 2 mg / kg / day of elemental iron for thirty days every six months, from six months of age to 5 years of age (B1) (30, 31 , 32, 33, 34).

10.1.9 Active search

It is done when a newborn enrolled child does not attend the first control, when a child under one year does not attend the assigned control or when the community detects a child under one year of age who is not attending controls. It can be done by phone and, in case of no response or no phone, a home visit must be made. The activity must be recorded in the child’s history and, in the case of the home visit, in the children’s health card. In the event that the child is not taken to health checks, despite the home visit, the situation is reported to the protection system (National Family Welfare System).

This search is at the forefront of promotion and prevention programs, ie EPS, ARS and regional and local health organizations. It is done by the nursing assistant or the health promoter.

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