COMMUNITY HEALTH NURSING (LEC)

MAYOLYN MANINGDING - SEMI-FINALS

Nimuan, Zara Wyn R. BSN - 2G PPT-BASED

○ 5. Prevention and management of infection

MATERNAL, NEWBORN, AND CHILD HEALTH
○ 6. Counseling on STI/HIV/AIDS, nutrition, personal
NUTRITION
hygiene, and the consequences of abortion
THE CURRENT MATERNAL AND CHILD HEALTH AND ○ 7. Adolescent health services
NUTRITION SITUATION ○ 8. Provision of oral health services
● Pregnancy and childbirth still pose a great risk to Filipino ● Pre-Natal Package
women of reproductive age Maternal mortality rate is still ○ 1. Prenatal visits (at least 4 through pregnancy) and
high:162 per 100,000 live births (NSO, 2006) Prenatal assessment
● Complications include hypertension, post-partum ○ 2. Micronutrient Supplementation
hemorrhage, severe infections, and other medical ○ 3. Tetanus toxoid immunization
problems arising ○ 4. Promotion of exclusive breastfeeding, newborn
● Poor birth spacing, maternal malnutrition, unsafe abortions screening, and infant immunization
and presence of concurrent infections ○ 5. Counseling on healthy lifestyle
● Neonatal deaths within the first week of life are often due ○ 6. Early detection and management of complications
to asphyxia, prematurity, severe infections, congenital of pregnancy
anomalies, newborn tetanus, and other causes ○ 7. Prevention and management of other conditions
● More than 59% of births take place at home, with more where indicated: hypertension, anemia, diabetes,
than 25% of the births attended by traditional birth tuberculosis, malaria, schistosomiasis, STI/HIV/AIDS
attendants or hilots (DOH-NEC, 2008). ○ 8. Birth planning and promotion of facility-based
● This contributes to the three delays that lead to maternal delivery
and neonatal deaths:
○ Delay in identification of complications; HOME-BASED MOTHER’S RECORD (HBMR)
○ Delay in referral; and ● HBMR is a simplified record of history of present and past
○ Delay in the management of complications pregnancies, and measures of the TBA, BHW, or health
● The likelihood of maternal and neonatal death increases professional
with identified risk factors, namely (DOH, 2008): ● HBMR has been concluded to:
○ Having mistimed, unplanned, unwanted and ○ – Provides a means of promoting continuity of care
unsupported pregnancy; through a woman’s reproductive life;
○ Not securing adequate care during the pregnancy; ○ – Promotes early recognition of women who are at
○ Delivering without skilled birth attendance, i.e., risk of developing conditions
attendance by skilled midwives, nurses, or ○ – Encourages self-care where appropriate and referral
physicians, and not having access to emergency suited to the needs of the woman;
obstetric and neonatal care; and ○ – Supports initiation of appropriate care
○ Not having proper postpartum and postnatal care for ○ – Serves as a useful record of care and health
the mother and the newborn. information and source of health statistics; and
○ – Guides the health workers in providing for the health
THE CURRENT MATERNAL AND CHILD HEALTH AND educational needs of the client
NUTRITION (MNCHN) STRATEGY
● In its response to the maternal and child health situation, POSTPARTUM PACKAGE
the DOH takes into consideration the interrelatedness of ● Post-partum visits: within 72 hours and on the 7th day
○ a) direct threats to the life of mothers and children that postpartum check
necessitate immediate health care and risk ● Micronutrient supplementation
management ● Counseling on nutrition, child care, family planning, and
○ b) underlying socioeconomic conditions that hinder other available services
the provision and utilization of maternal, newborn, and
child health and nutrition (MNCHN) core package of
services NEWBORN (FIRST WEEK OF LIFE) CARE PACKAGE
● The following are the four key strategies of MNCHN: ● Interventions within the first 90 minutes
○ 1. Ensuring universal access to and utilization of an ○ – Immediate and thorough drying
MNCHN Core Package of services and interventions ○ – Skin to skin contact between mother and newborn
○ 2. Establishment of a service delivery network at all ○ – Cord clamping 1 to 3 minutes after birth
levels of care to provide the package of services and ○ – Early initiation of breastfeeding means
interventions; breastfeeding within an hour after birth
○ 3. Organized use of instruments for health systems ○ – Non-separation of baby from the mother, also known
development to bring all localities to create and as rooming-in
sustain their service delivery networks ● Essential newborn care after 90 minutes to 6 hours
○ 4. Rapid build-up of institutional capacities of DOH ○ – Vitamin K prophylaxis;
and PhilHealth, being the lead national agencies that ○ – Hepatitis B and BCG vaccination;
will provide support to local planning and development ○ – Examination of the baby for birth injuries,
● The MNCHN strategy aims for: malformations, or defects; and
○ – Every pregnancy to be wanted, planned and ○ – Additional care for a small baby (a baby with a birth
supported; weight <2,500 Gms) or twin.
○ – Every pregnancy to be adequately managed ● Care prior to discharge: after the first 90 minutes
throughout its course; ○ – Support for unrestricted, per demand breastfeeding,
○ – Every delivery to be facility-based and managed by day and night;
skilled birth attendants/skilled health professionals; ○ – Ensuring warmth of the baby.
○ – Every mother and newborn pair to secure proper ○ – Washing and bathing (hygiene);
post-partum and newborn care with smooth transitions ○ – Monitoring for danger signs and resuscitation, if
to the women’s health care package for the mother necessary
and child survival package for the newborn ○ – Newborn screening (blood spot) and newborn
hearing screening (if available)
○ – Discharge Teachings
THE MNCHN CORE PACKAGE OF SERVICES
● Pre-Pregnancy Package
○ 1. Nutrition CHILD CARE PACKAGE
■ Nutritional counseling; ● Immunization
■ Promotion and Provision of micronutrient ● Nutrition
supplements: ● Exclusive breastfeeding up to 6 months;
○ 2. Promotion of healthy lifestyle ● Sustained breastfeeding up to 24 months with
○ 3. Advice on family planning and provision of family complementary feeding; and
planning services ● Micronutrient supplementation
○ 4. Prevention and management of lifestyle-related ● Integrated management of childhood illnesses
diseases ● Injury prevention
● Oral health
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● Insecticide-treated nets for mothers and children in PHILIPPINE FAMILY PLANNING PROGRAM (PFPP)
malaria endemic areas ● National Family Planning Policy (A.O. 50-A, s. 2001)
asserts that family planning as a health intervention shall
MNCHN SERVICE DELIVERY NETWORK be made available to all men and women of reproductive
● MNCHN network can be a province or city-wide network of age (15 to 44 years old)
public and private health care facilities and providers ● FP is a means to prevent high-risk pregnancies brought
capable of giving MNCHN services, including basic and about by the following conditions:
comprehensive emergency obstetric and essential ○ 1. Being too young (less than 18 years old) or too old
newborn care (over 34 years old);
● Includes the communication and transportation system ○ 2. Having had too many (4 or more) pregnancies;
supporting this network ○ 3. Having closely spaced (too close) pregnancies
(less than 36 months); and
○ 4. Being too ill or unhealthy/too sickly or having an
3 LEVELS OF CARE IN THE MNCHN SERVICE existing disease or disorder like iron deficiency
DELIVERY NETWORK anemia (DOH, 2001).
● Community level service providers or the community ● A.O. 132, s. 2004: DOH Natural Family Planning (NFP)
health team (CHT) for primary health care services Program
and functions: ○ – recognition of modern NFP methods
○ a) navigation ● A.O. 2012-0009: National strategy towards reducing
○ b) basic service delivery unmet need for modern family planning as a means to
● Basic Emergency Obstetric and Newborn Care achieving MDGs
(BEmONC)-capable facility performing ○ – emphasized the implementation of the FP program
○ 6 obstetric functions: integrated and synchronized with other public health
■ a) Parenteral administration of oxytocin in the programs such as the MNCH and Garantisadong
third stage of labor; Pambata in the broader context of the Kalusugan
■ b) Parenteral administration of loading dose of Pangkalahatan Execution Plan
anticonvulsants;
■ c) Parenteral administration of initial dose of
antibiotics; FOUR PILLARS OF THE PFPP
■ d) Performance of assisted deliveries (imminent
breech delivery); RESPONSIBLE PARENTHOOD
■ e) Removal of retained products of conception; ● Will and ability to respond to the needs and aspirations of
and the family.
■ f) Manual removal of retained placenta
○ Emergency Newborn Interventions RESPECT FOR LIFE
■ g) Newborn resuscitation; ● The 1987 Constitution protects the life of the unborn from
■ h) Treatment of neonatal sepsis/infection; and the moment of conception
■ i) Oxygen support ● Prevent abortions, thereby saving lives of both women and
○ Provision of blood transfusion children
● Comprehensive Emergency Obstetric and Newborn
Care (CEmONC)-capable facility BIRTH SPACING
○ perform the six signal obstetric functions for BEmONC ● Proper spacing of 3 to 5 years from a recent pregnancy
○ provide caesarean delivery services
○ blood banking and transfusion services INFORMED CHOICE
○ other highly specialized obstetric interventions ● Couples and individuals are fully informed on the different
○ providing neonatal emergency interventions for modern FP methods
BEmONC
○ management of low birth weight or preterm newborn CLIENT COUNSELING AND ASSESSMENT
and other specialized newborn services ● Family planning counseling is a client-centered,
○ – In an area with a population of at least 500,000, face-to-face, interactive communication process between
WHO recommends 1 CEmONC-capable facility the health service provider and the client that helps the
latter to make free and informed choices regarding his/her
REPRODUCTIVE HEALTH PROGRAM fertility intention or plan
● Reproductive health (RH) is a state of complete physical, ● Essential content of the nurse-client interaction regarding
mental and social well-being, and not merely the absence the chosen method (DOH, 2006b):
of disease or infirmity, in all matters relating to the ○ 1. Effectiveness;
reproductive system and to its functions and processes ○ 2. Advantages and disadvantages;
● Based on the right of access to appropriate health care ○ 3. Possible side effects, complications, and signs that
services require an immediate visit to the health facility;
● RH Care refers to the constellation of methods, ○ 4. How to use the chosen method; and
techniques, and services that contribute to reproductive ○ 5. Prevention of sexually transmitted infections; and
health and well-being by preventing and solving ○ 6. When to return to the health facility.
reproductive health problems
● Basis: Magna Carta of Women (R.A. 9710), which was BENEFITS OF FAMILY PLANNING
enacted in 2009 and R.A. 10354, also known as the ● Benefits to mothers
Responsible Parenthood and Reproductive Health Act of ○ – Enables her to regain her health after delivery
2012 ○ – Gives enough time and opportunity to love and
provide attention to her husband and children
10 ELEMENTS OF RH CARE ○ – Gives more time for her family and own personal
● Family planning; advancement
● Maternal and child health and nutrition (MCHN); ○ – When suffering from an illness, gives enough time
● Prevention and control of reproductive tract infections for treatment and recovery
(RTIs), sexually transmitted infections (STIs) and human ● Benefits to children
immunodeficiency virus/acquired immune deficiency ○ – Healthy mothers produce healthy children
syndrome (HIV/AIDS); ○ – Will get all the attention, security, love, and care
● Adolescent reproductive health (ARH); they deserve
● Prevention and management of abortions and its ● Benefits to fathers
complications (PMAC); ○ – Lightens the burden and responsibility in supporting
● Prevention and management of breast and reproductive his family
tract cancers and other gynecological conditions; ○ – Enables him to give his children their basic needs
● Education and counseling on sexuality and sexual health; (food, shelter, education, and better future)
● Men's reproductive health (MRH) and involvement; ○ – Gives him time for his family and own personal
● Prevention and management of violence against women advancement
and children; ○ – When suffering from an illness, gives enough time
● Prevention and treatment of infertility and sexual for treatment and recovery
dysfunction.

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 NATURAL FAMILY PLANNING ○ red blood cells break down when the body is exposed
● Lactational amenorrhea method (LAM) to certain drugs, foods, severe stress, or severe
○ – based on the natural effect of breastfeeding on the infection
mother’s fertility ● Maple syrup urine disease
● Fertility awareness-based (FAB) methods ○ Inability to break down the amino acids leucine,
○ – methods involve recognition of physiologic markers isoleucine, and valine; urine of affected persons
(within menstrual cycle) indicating a woman’s fertility smells like maple syrup
○ a) Billings’ Ovulation Method (BOM)
○ b) Basal Body Temperature (BBT) NBS PROCEDURE
○ c) Sympto-thermal Method ● Law provides that NBS be done after 24 hours of life, but
○ d) Standard Days Method (SDM) not later than three (3) days from complete delivery of the
○ e) Two-day Method newborn
● Disadvantage of FAB Methods ● Specimen for NBS is obtained through a heel prick
○ – Except for SDM, the couple need training and time ○ – A few drops of blood are taken from the baby's heel,
to use the method effectively blotted on a special absorbent filter card and then sent
○ – Except for SDM, methods require consistent and to a Newborn Screening Center (NSC)
accurate record-keeping ○ – Sample for NBS may be obtained by a physician,
○ – methods require a high level of diligence and nurse, medical technologist or trained midwife
motivation by the couple ○ – Normal (negative) NBS Results are available by 7 -
○ – require periods of abstinence from intercourse, 14 working days from the time samples are received
which may be difficult for some couples at the NSC
○ – They offer no protection against STIs/HIV/AIDS
NEWBORN HEARING SCREENING
ARTIFICIAL FAMILY PLANNING METHODS ● R.A. 9709: Universal Newborn Hearing Screening and
● Combined oral contraceptives (COCs), Intervention Act of 2009
○ – preparations that contain hormones– estrogen and ○ – Universal Newborn Hearing Screening Program
progesterone – to suppress ovulation (UNHSP) for the early detection of congenital hearing
● Depo-MedroxyProgesterone Acetate (DMPA), loss and referral for early intervention for infants
○ – Depo-Provera, is a Progestin-only preparation ○ – Establishment of Newborn Hearing Screening
injected intramuscularly every 3 months Reference Center at the National Institutes of Health
● An intrauterine device (IUD) ○ – On any healthcare practitioner who delivers, or
○ – a small plastic or metal device; releases copper or a assists in the delivery of a baby in the Philippines the
hormone obligation to inform the parents or legal guardian of
● Barrier methods the newborn of the availability, nature and benefits of
○ – involve the use of devices that mechanically or hearing loss screening among newborns or infants
chemically prevent fertilization. Barrier devices include three (3) months old and below
male condoms, diaphragm, cervical cap, and
spermicides
● Permanent Methods EXPANDED PROGRAM ON IMMUNIZATION (EPI)
○ a) Vasectomy ● EPI was established in 1976 to ensure that infants/children
■ surgical procedure where the vas deferens is and mothers have access to routinely recommended
tied and cut or blocked through a small opening infant/childhood vaccines
on the scrotal skin. ● Reducing the morbidity and mortality among children
○ b) Bilateral tubal ligation (BTL) against the most common vaccine-preventable diseases
■ involves cutting or blocking the two fallopian ● Supporting Legislation:
tubes; prevents conception by blocking the ○ – R.A. 10152, also known as Mandatory Infants and
passage of the ovum through the fallopian tube Children Health Immunization Act of 2011
● Each method has its own advantages and disadvantages ○ – R.A. 7846 provided for compulsory immunization
● Every method entails a risk and success is not guaranteed against hepatitis B for infants and children below 8
years old
● Specific Goals of EPI
NEWBORN SCREENING ○ 1. To immunize all infants/children against the most
● A simple procedure to find out if a baby has a congenital common vaccine-preventable diseases.
metabolic disorder even before clinical signs and ○ 2. To sustain the polio-free status of the Philippines.
symptoms are present ○ 3. To eliminate measles infection. Presidential
● Metabolic disorders may lead to mental retardation or Proclamation No. 4, s. 1998 launched the Philippine
even death if left untreated Measles Elimination Campaign (Office of the
● NBS is important because most babies with metabolic President, 1998).
disorders look "normal" at birth ○ 4. To eliminate maternal and neonatal tetanus.
Presidential Proclamation No. 1066, s. 1997 declared
NEWBORN SCREENING IN THE PHILIPPINES a national neonatal tetanus elimination campaign
● R.A. 9288: Newborn Screening Act of 2004 starting 1997 (Office of the President, 1997).
○ – prior to delivery, any health practitioner who ○ 5. To control diphtheria, pertussis, hepatitis B and
delivers, or assists in the delivery, of a newborn in the German measles.
Philippines has the obligation to inform the parents or ○ 6. To prevent extra pulmonary tuberculosis among
legal guardian of the newborn of the availability, children.
nature and benefits of newborn screening
○ – establishment of the Newborn Screening Reference
Center (NSRC), IMMUNIZATION SCHEDULE
■ responsible for the national testing database and
case registries, training, technical assistance ANTIGEN AGE DOSE ROUTE SITE
and continuing education for laboratory staff in
all Newborn Screening Centers BCG At birth 0.5 ml Intradermal Right deltoid
region (arm)

DISORDERS TESTED FOR NBS HEPA B At 0.5 ml Intramuscular Anterolateral

● Congenital hypothyroidism borth thigh muscle
○ inability to produce enough thyroid hormone
DPT-HEP B- HIB 6wks, 0.74 ml Intramuscular Anterolateral
● Congenital adrenal hyperplasia (PENTAVALENT) 10wks, thigh muscle
○ inability of the adrenal gland to secrete cortisol or 14wks
aldosterone
● Galactosemia OPV 6wks, 2 drops Oral Mouth
○ unable to metabolize galactose and the person is 10wks,
14wks
unable to tolerate any form of milk – human or animal
● Phenylketonuria
ANTI-MEASLES 9-11 0.5 ml Subcutaneous Outer part of
○ inability to properly break down an amino acid called VACCINE (AMV months upper arm
phenylalanine 1)
● Glucose-6-phosphate-dehydrogenase (G6PD) deficiency

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MEASLES-MUM 12-15 0.5 ml Subcutaneous Outer part of previous exposure to
PS-RUBELLA months upper arm tuberculosis.
VACCINE No management is
(AMV2) needed.

ROTAVIRUS 6wks, 1.5 ml Oral Mouth Deep abscess at Refer to the physician for
10wks vaccination site; almost incision and drainage.
invariably due to
subcutaneous or deeper
injection.
EPI VACCINES

VACCINE CONTENTS FORM Indolent ulceration: an Treat with INH powder.

ulcer which persists after
12 weeks from
BCG (BACILLUS Live, attenuated bacteria Freeze-dried, reconstituted
vaccination date.
CALMETTE-GUE with a special diluent
RIN)
Glandular enlargement: If suppuration occurs,
enlargement of lymph treat it as deep abscess.
HEPA B RNA-recombinant, using Cloudy, liquid, in an
glands draining
Hepatitis B surface auto-disable injection
the injection site.
antigen (HBsAg) syringe if available

HEPA B Local soreness at the No treatment is necessary.

DPT-HEP B- HIB Diphtheria toxoid, Liquid, in an auto-disable
injection site.
(PENTAVALENT) inactivated pertussis injection syringe
bacteria, tetanus toxoid,
recombinant DNA DPT-HEP B- HIB Fever that usually lasts Advise mother to give
surface antigen, and (PENTAVALENT) for only 1 day. Fever antipyretic.
synthetic conjugate of beyond 24 hours is
Haemophilus influenzae not due to the vaccine
B bacilli but to other causes.

OPV Live, attenuated virus Clear, pinkish liquid Local soreness at the Reassure mother that
(trivalent) injection site. soreness will
disappear after 3 to 4
days.
ANTI-MEASLES Live, attenuated virus Freeze-dried, reconstituted
VACCINE (AMV with a special diluent
1) Abscess after a week or Incision and drainage may
more usually indicates be necessary.
that the injection
MEASLES-MUM Live, attenuated viruses Freeze-dried, reconstituted
was not deep enough or
PS-RUBELLA with a special diluent
the needle was not
VACCINE
sterile.
(AMV2)

Convulsions: although Proper management of

ROTAVIRUS Live, attenuated virus Clear, colorless liquid, in a
very rare, may occur in convulsions;
container with an oral
children older than The pertussis vaccine
applicator
3 months; caused by should not be given
pertussis vaccine. anymore.
TETANUS Weakened toxin Clear, colorless liquid
TOXOID
OPV None

TARGET SETTING AND VACCINE REQUIREMENT ANTI-MEASLES Fever 5 to 7 days after Reassure the mother and
● Vaccine requirement is calculated based on target VACCINE (AMV vaccination in some instruct her to give
population size. 1) children. Sometimes, antipyretic to the child.
● The nurse uses the following formulas to estimate target There is a mild rash.
population size:
MEASLES-MUM Local soreness, fever, Reassure the mother and
○ – Estimated number of infants = total population x PS-RUBELLA irritability, and malaise in instruct her to give
2.7%; VACCINE some children. antipyretic to the child.
○ – Estimated number of 12-59 month-old children = (AMV2)
total population x 10.8%; and
○ – Estimated number of pregnant women = total ROTAVIRUS Some children develop Reassure the mother and
mild vomiting and instruct her to give
population x 3.5%. diarrhea, fever and antipyretic and Oresol to
irritability the child.
MAINTAINING THE POTENCY OF EPI VACCINES
● To be potent, vaccines must be properly stored, handled TETANUS Local soreness at the Apply cold compress at the
TOXOID injection site. site. No other treatment is
and transported needed
● 1. Maintain the Cold Chain
○ – The cold chain is a system for ensuring the potency
of a vaccine from the time of manufacture to the time CONTRAINDICATION TO IMMUNIZATION
it is given to an eligible client ● In general, there are no contraindications to immunization
○ – In RHU, PHN is the Cold Chain Officer of a sick child if the child is well enough to go home
● 2. Observe the first expiry-first out (FEFO) policy ● Absolute contraindications – DO NOT GIVE:
● 3. Comply with recommended duration of storage and ○ – Pentavalent vaccine/DPT to
transport ■ children over 5 years of age (DOH, 2003a);
● 4. Take note if the vaccine container has a vaccine vial ■ a child with recurrent convulsions or another
monitor (VVM) and act accordingly. active neurological disease of the central
○ – The VVM is a round disc of heat-sensitive material nervous system (WHO, 2005a);
placed on a vaccine vial to register cumulative heat ○ – Pentavalent vaccine 2 or 3/DPT 2 or DPT 3 to a
exposure child who has had convulsions or shock within 3 days
● 5. Abide by the open-vial policy of the DOH of the most recent dose (WHO, 2005a);
● 6. Reconstitute freeze-dried vaccines ONLY with the ○ – Rotavirus vaccine when the child has a history of
diluents supplied with them hypersensitivity to a previous dose of the vaccine,
● 7. Discard reconstituted freeze-dried vaccines six hours intussusceptions or intestinal malformation, or acute
after reconstitution or at the end of the immunization gastroenteritis (DOH, 2012b); and
session, whichever comes sooner ○ – BCG to a child who has signs and symptoms of
● 8. Protect BCG and Rotavirus vaccine from sunlight AIDS or other immune deficiency conditions or who
are immunosuppressed (DOH, 2003a).
SIDE EFFECTS AND ADVERSE REACTIONS OF
IMMUNIZATION
EPI RECORDING AND REPORTING
VACCINE SIDE EFFECTS MANAGEMENT ● Accomplished using the Field Health Service Information
System (FHSIS)
BCG (BACILLUS Koch’s phenomenon: an No management is ● 1. Fully immunized children (FIC)
CALMETTE-GUE acute inflammatory needed. ○ a) BCG
RIN) reaction within 2 to
4 days after vaccination; ○ b) 3 doses of OPV
usually indicates ○ c) 3 doses of DPT
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 ○ d) hepatitis B vaccine or 3 doses of Pentavalent ● 2. Exclusive breastfeeding for the first six months, which is
vaccine possible, except for a few medical conditions
○ e) one dose of anti-measles vaccine before reaching ● 3. Extended breastfeeding up to two years and beyond,
one year of age which is recommended even if the infant’s consumption of
● 2. Completely immunized children breast milk declines as complementary foods are given;
○ completed their immunization schedule at the age of ● 4. Appropriate complementary feeding with the use of
12 to 23 months locally available and culturally acceptable foods;
● 3. Child protected at birth (CPAB) ● 5. Micronutrient supplementation;
○ is a term used to describe a child whose mother has ● 6. Universal salt iodization
received ● 7. Food fortification
○ a) 2 doses of tetanus toxoid during this pregnancy,
provided that the second dose was given at least a PROMOTING BREASTFEED
month prior to delivery, OR ● To promote the practice of breastfeeding, providing
○ b) at least 3 doses of tetanus toxoid anytime prior to mothers and families with adequate, accurate and timely
pregnancy with this child information and opportunities for developing necessary
skills for good breastfeeding practices is essential.
INFANT YOUNG CHILD FEEDING (IYCF): ● The nurse then makes a health education plan based on
THE PHILIPPINE SITUATION the mother’s needs
● Optimal infant and young child feeding practices rank ○ – Benefits of Breastfeeding
among the most effective interventions to improve child ○ – Techniques of Breastfeeding
health
● Administrative Order 2005-0014: National Policies on COMPLEMENTARY FEEDING PRACTICES
Infant and Young Child Feeding ● Complementary feeding becomes necessary to fill the
● Supporting Legislation energy and nutrient gap from the age of 6 months
○ – Executive Order No. 51: Milk Code ● Complementary foods should be:
○ – Executive Order No. 382: National Food Fortification ○ – Timely –introduced when the need for energy and
Day nutrients exceeds what can be provided
○ – R.A. 7600: Rooming-In And Breast-Feeding Act ○ – Adequate – provide sufficient energy, protein and
○ – R.A. 8172: ASIN (Act for Salt Iodization Nationwide) micronutrients to meet a growing child’s nutritional
Law needs;
○ – R.A. 8976: Philippine Food Fortification Act ○ – Safe – foods are hygienically stored and prepared,
○ – R.A. 10028: Expanded Breastfeeding Promotion Act and fed with clean hands using clean utensils and not
○ – A.O. 36, s2010 : Expanded Garantisadong Pambata bottles and artificial nipples;
(GP) ○ – Properly fed – foods are given consistent with a
child’s signals of appetite and satiety, and that meal
NUTRITIONAL ASSESSMENT OF THE INFANT AND frequency and feeding method – actively encouraging
YOUNG CHILD the child, even during illness, to consume sufficient
● Nutritional assessment begins with history taking, food using fingers, spoon or self-feeding – are suitable
describing feeding practices: for age
○ – Exclusive breastfeeding –infant receives breast milk
and allows the infant to receive ORS, drops, syrups MICRONUTRIENT SUPPLEMENTATION
(vitamins, minerals, medicines), but nothing else ● Purpose: add to the vitamins and minerals provided by a
○ – Predominant breastfeeding –infant's predominant normal diet
source of nourishment has been breast milk. ● Micronutrient supplementation is a short-term intervention
However, the infant may also have received liquids – for correcting high levels of micronutrient deficiencies until
water and water-based drinks, fruit juice, ritual fluids more sustainable food-based approaches can be used
and ORS – drops or syrups, such as vitamins, effectively
minerals and medicines ● Recommended for 0-59 month-old children, in addition to
○ – Complementary feeding – the process of giving the pregnant and lactating women and other women of
infant foods and liquids, along with breast milk, when reproductive age, or those within the ages of 15-49 years
breast milk is no longer sufficient to meet the infant’s old
nutritional requirements
○ – Bottle feeding – this means that the child is given
food or drink (including breast milk) from a bottle with FOOD FORTIFICATION
a nipple/teat. ● Fortification is defined as the addition of micronutrients to
○ – Early initiation of breastfeeding – initiating staple food such as rice, sugar, cooking oil, flour and salt.
breastfeeding of the newborn after birth within 90 ● Addition of micronutrients to processed foods at levels
minutes of life in accordance to the essential newborn above the natural state
care protocol ● Sangkap Pinoy seal is conferred by the DOH and affixed
to the packaging of food products that have been certified
as fortified either singly or in combination of the
NUTRITIONAL ASSESSMENT micronutrients vitamin A, iron and iodine
● Anthropometry is the measurement of physical dimensions
and gross composition of the body (Holland, et al., 2011)
○ – Weight-for-age used to determine whether child is DEWORMING
underweight ● Deworming of children aged 1 to 12 years is done every 6
○ – Length/height-for-age can help identify children who months
are short or stunted due to prolonged undernutrition or ● Possible adverse effects of the antihelminthic drugs and
repeated illness their respective management:
○ – Mid-upper arm circumference (MUAC) can be used ○ – Local sensitivity or allergy – give an antihistamine.
for rapid screening for malnutrition ○ – Mild abdominal pain – give an antispasmodic.
■ MUAC below 115 mm is an accurate indicator of ○ – Diarrhea – Give oral rehydrating solution.
severe malnutrition in children aged 6-59 months ○ – Erratic worm migration – Pull out worms from
(WHO, 2009). mouth/nose or from other body orifices.
● Clinical examination involves recognition of signs of ● Deworming is not advised if the child is known to have any
malnutrition. of the following conditions:
○ – useful in detecting micronutrient deficiencies and ○ – Serious illness, such as an illness that requires
severe forms of malnutrition referral to a hospital;
● Biochemical examination is the assessment of specific ○ – Abdominal pain;
components of blood or urine samples of an individual in ○ – Diarrhea;
order to measure specific aspects of one’s metabolism ○ – History of hypersensitivity to the drug;
(Holland, et al., 2011) ○ – Severe malnutrition.

RECOMMENDED IYCF PRACTICES MALNUTRITION IN CHILDREN

● National Policies on Infant and Young Child Feeding ● Protein energy malnutrition (PEM) consists of
advocate for the following practices (DOH, 2005): underweight, stunting, wasting, and overweight
● 1. Early initiation of breastfeeding;
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 UNDERWEIGHT IMCI PROCESS
● defined as weight for age < –2 standard deviations (SD) of
the WHO Child Growth Standards median

STUNTING
● defined as height for age < –2 SD of the WHO Child
Growth Standards median, stunting is growth retardation
as a result of poor diets or recurrent infections

WASTING
● defined as weight for height < –2 SD of the WHO Child
Growth Standards median; a symptom of acute
undernutrition; “baggy pants”

OVERWEIGHT
● defined as weight for height > +2 SD of the WHO Child
Growth Standards median; associated with a higher
probability of obesity in adulthood

SEVERE ACUTE MALNUTRITION (SAM)

● In children 6–59 months of age is defined as
weight-for-height less than -3 SD of the WHO Child SUMMARY
Growth Standards median, or the presence of edema of ● The nurse, being in direct contact with healthcare clients,
both feet, or a mid-upper arm circumference (MUAC) of is at the forefront in the delivery of public health services.
less than 115 mm ● The public health nurse is in the unique position of being
● For infants less than 6 months old, severe acute in the ‘middle’ of delivery of services to mothers, neonates,
malnutrition is detected by the presence of clinical signs of and young children.
visible severe wasting and edema, together with difficulties ● The health status of mothers, particularly during
in breastfeeding pregnancy, the postpartum period and the period of
lactation, is a major factor affecting the health status of
their children.
MICRONUTRIENT MALNUTRITION ● Maternal, newborn and child health and nutrition services
● Micronutrients are so-called because they are needed only yield effects that carry a tremendous impact on the
in very small amounts, i.e., they are present in the human well-being and, ultimately, the development of the nation.
body in amounts less than 0.005% of body weight
● Enable the body to produce enzymes, hormones and
other substances essential for proper growth and
development
● As tiny as the amounts are, however, the consequences of
their absence are severe.
● Iodine, vitamin A and iron are most important in global
public health terms; their lack represents a major threat to
the health and development of populations the world over,
particularly children and pregnant women

OVERVIEW OF INTEGRATED MANAGEMENT OF

CHILDHOOD ILLNESS (IMCI)
● (IMCI) strategy offers simple and effective methods for
child survival, healthy growth and development and is
based on the combined delivery of essential interventions
at community, health facility and health systems levels
● IMCI process includes preventive as well as curative
measures to address the most common conditions that
affect young children
● The strategy includes three main components (WHO,
2005a):
○ 1. Improvements in case management skills of
health-care staff;
○ 2. Improvements in the health system needed for
effective management of childhood illness; and
○ 3. Improvements in family and community practices

IMCI CASE MANAGEMENT

● IMCI clinical guidelines are meant to be used by the health
worker in the management of sick children from age 1
week up to 5 years
● IMCI case management process involves the following
elements: ASSESS, CLASSIFY, IDENTIFY, TREAT,
COUNSEL and FOLLOW-UP

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