Organization of pediatric care at the feldsher-midwife point

An important part of the feldsher's activity is the protection of children's health. A significant place in this work is patronage. According to the existing situation, the paramedic( midwife) visits the newborn in the first three days after discharge from the maternity hospital;if the first child was born in the family, then he is visited on the first day after discharge, and later - 2-3 days during the first week and weekly during the first month of life. On examination, attention is paid to the general condition of the child, as well as to the condition of various organs and systems, especially the nervous system, skin, umbilical ring, for the presence of developmental abnormalities. The paramedic( midwife) should see the child during the first year of life 12 times on preventive measures and 20 times with patronages at home. During the second year of the child's life, the paramedic gives a detailed opinion about his state of health, evaluates his physical and neuro-psychological development. This conclusion needs to be brought to the attention of the parents, focusing on the shortcomings, and giving recommendations but further education and health improvement of the child.

Medical assistants and midwives in the service of schoolchildren( where there is no school nurse) are required to:

• take part in medical examinations of schoolchildren conducted by a pediatrician, prepare medical cards and fill out their general part;

• record anamnesis, complaints, information about the transferred diseases, vaccinations;

• conduct anthropometric measurements, determine visual acuity and hearing;

• send, at the doctor's request, to treatment and prophylactic institutions for additional laboratory studies, consultations with medical specialists;

• inform the school teachers about the results of medical examinations with the recommendations of medical specialists;

• to control the organization of a rational mode of day and nutrition, hygienic education of students, the organization of labor education;

• to monitor compliance with the sanitary and anti-epidemic regime, the implementation of sanitary requirements for cooking technology, washing dishes, as well as the observance of the timing of the sale of food and ready-made meals;

• to work on the prevention of child injuries( including sports injuries), the recording and analysis( in conjunction with the doctor) of all injuries;

• carry out preventive vaccinations to the students after having examined the doctor and under his supervision, previously notifying the parents about it, keeping records and isolating the sick schoolchildren;examinations, thermometry and other measures for children in contact with infectious diseases, to inform the doctor of the rural medical station, the school director in SES about each case of an infectious disease;

• to examine the students for helminths and under the guidance of the pediatrician and epidemiologist to carry out deworming.

The work of a paramedic includes curative care at home for severely ill children or children with exacerbations of chronic diseases, rehabilitation and clinical examination of children with congenital and chronic illnesses without exacerbation.

Medical work at home includes the following duties:

• visiting a sick child on the day of the call;

• First-priority service for young children and with high body temperature, abdominal pain;

• Active supervision of sick children until full recovery.

Multiplicity and interval of visits to children depend on the child's age, the nature and severity of the disease, social conditions. Children of the first year of life are observed at home daily until they are fully recovered or hospitalized.

Indications for referral to sick children are as follows:

• children of the first three months of life with any diseases;

• children with infectious diseases that occur with moderate to severe disease;

• if the measures taken are ineffective in the first 3-5 days of treatment or worsening of the condition, which endangers the life of the sick child;

• in the presence of poor social conditions of the family.

In the direction of hospitalization, the paramedic should indicate the diagnosis, the severity of the disease, the concomitant diseases, the duration and severity of the

disease, the treatment and its effectiveness, the results of laboratory and instrumental research, the history of the disease, the individual characteristics of the child, the diseases that have been transferred, and the epidemiological environment.

After discharge from the hospital, not later than in 24 hours, it is necessary to visit the child at home and after the examination, taking into account the recommendations of hospital doctors, to carry out rehabilitation measures.

In the provision of medical assistance, the paramedic must have the ability to provide emergency care for various conditions and injuries, to know their characteristics in children, to have knowledge of post-dandruff therapy and the latest methods of healing and caring for children with various infectious diseases.

The organizational work of a paramedic consists of several sections. The main ones are: analysis and planning of activities, work with accounting and reporting documentation, introduction of best practices and forms of work, improvement of skills, work and interaction with public organizations.

The main accounting documents in the work with the children's population are: registration form No. 112 / y "Child Development History", form No. 63 / y "Karga prophylactic vaccinations", registration form No. 026 / y "Medical card for the incoming child to preschoolan institution, a school, a boarding school, etc. ";form No. 025-2 / y "Statistical coupon";form No. 058 / у "Emergency notification to an infectious patient", registration form No. 298 "Sanatorium-resort card", registration form No. 025 / y and 086 / у "Medical card of an outpatient patient";"Help for enrolling in secondary and higher education";form No. 027 / y "Extract from the medical card of an outpatient, inpatient patient";form No. 079 / у "Medical certificate for a schoolchild going to a health camp", form No. 039 / у "Diary of the work of the average medical staff of a polyclinic( dispensary), dispensary, a feldsher-midwife point";form No. 029 / y "Journal of Procedural Accounting".

In addition to filling in registration forms and statistical analysis of work with them, the paramedic on the site should have a children's census magazine, a site passport, a card file with registration forms No. 63 for each child, and a plan for their work with children. The plan is made in three versions: for the year, for the quarter and the most specific - for each month. The plan should reflect organizational arrangements, preventive work, treatment section, dispensary work, training and sanitation.

In the reporting forms of its activities, the medical assistant should reflect the following sections:

• number of children( every 6 months);

• indicators of monitoring of pregnant women and the structure of their morbidity;

• structure of morbidity in newborns;

• indicators of work with children of the first year of life;

• indicators of work with children of the 2nd year of life;

• indicators of work with children entering school;

• indicators of work with adolescents;

• indicators and percentage coverage of the child population with preventive vaccinations;

• Report on the incidence of nosological units;

• a report on the prophylaxis of the child population;

• Report on working with children from large families, guarded and socially disadvantaged families;

• Report on health education.

When working with children, a paramedic presumes that the main tasks in the care and protection of the child's health in the present and the future are to reduce the child morbidity and mortality, reduce the number of loss of work for parents in connection with the care of a sick child.