Preventive Paediatrics😊

Preventive Paediatrics

Child Survival Schemes

Under-Five Clinics:

• Elements:
• Promotive care
• Core
• Family planning
• Curative care
• Preventive care
• Health Education

Kangaroo mother care

• Elements (SAANS):
• Skin-to-skin (Hypothermia prevention)
• Airway disease prevention
• Ambulatory support
• Nutritional support (Exclusive breastfeeding)
• Support (Emotional)

Indication

• All stable low birth weight neonates

Components

1. Kangaroo position:
• Skin-to-skin contact

2. Kangaroo nutrition:
• Exclusive breastfeeding,
• no supplementation

3. Early discharge from hospital

Advantages

• Lesser chances of:
• Sepsis,
• Hypothermia
• Neonatal mortality

• Higher weight gain (better gain of anthropometric parameters)

• Earlier discharge from hospital

• Higher breastfeeding rates

STOP KMC

• baby attains 2.5 Kg or 37 weeks.

GOBI FFF

• Given by WHO/UNICEF.

• Aim: Promote child survival

• Components:
• Growth monitoring
• Oral rehydration solution
• Breastfeeding
• Immunization
• Female fertility
• Female literacy
• Food (Female nutrition)

BFHI, MAA, CLMC:

• Baby Friendly Hospital Initiative (BFHI):
• UNICEF initiative to promote child survival

• Mother’s Absolute Affection (MAA):
• Gov of India, MoHFW initiative to promote breastfeeding
• Normal delivery: Within 1 hour
• C-section: Within 4 hours

• Comprehensive Lactational Management Centers (CLMC):
• Promote breast milk donation
• CHCs & District hospitals:
• Breast pumps & breastmilk storage facilities (+)

Important Dates & Weeks

Date/Period	Event
April 14th	Ayushman Bharat Health & Wellness Centre Day
Last week of April	World Immunization Week
May 28th - June 8th	Intensified Diarrhoea Control Fortnight
August 1st - 7th	World Breastfeeding Week
September 1st - 7th	National Nutrition Week
November 15th - 21st	Newborn Week

Management of Childhood Pneumonia

WHO IMNCI PROTOCOL

• Cough/cold:
• No pneumonia.
• Home care advice.

• Fast breathing/chest indrawing:
• Pneumonia.
• Oral amoxicillin/home care advice.
• Reassessed after 48 hours.
• If the child has worsened, refer to a higher center.

• General danger signs:
• Severe pneumonia/very severe disease.
• First dose antibiotic/referral for injectable antibiotic
• 1st dose of Inj. Ampicillin and Gentamycin

SAANS PROTOCOL:

• Social Awareness & Action to Neutralize Pneumonia Successfully.

• Launched in 2019 to reduce deaths due to childhood pneumonia.

• For 2-59 months child with cough +/- difficult breathing.

Management

Condition	Signs → SAANS Protocol
Severe pneumonia/ very severe disease	General danger signs • Convulsions • Lethargy • Inability to drink or breastfeed • Persistent vomiting • Unconsciousness • Stridor in a calm child OR Chest indrawing
Pneumonia	Fast breathing: - < 2 months: ≥ 60 breath/min - 2–11 months: ≥ 50 breaths/min - 12–59 months: ≥ 40 breaths/min
No pneumonia/cough or cold	No signs of severe pneumonia or pneumonia

Severe Pneumonia

• ASHA:
• Pre referral dose of Oral amoxicillin + referral.

• CHO (Community Health Officer):
• Oral amoxicillin + IM Gentamicin + Hospitalization/Referral

Mission Indradhanush

2024 IMI 5.0
(INTENSIFIED MISSION INDRADANUSH)

Vaccine Applications	Role
ANMOL	• Track Pregnant females and children • Use Tablet to monitor
SAFE VAC	• Adverse effect following Vaccine
EVin ↳ Electronic Vaccine Intelligence Network	• To manage Immunization logistics • Electronic win → logistics
UWin	• Online immunisation card • 0 - 5 year old • U win a card
Kilkari	• Information sent out via Mobile App • For Pregnant females • Immunization compliance

Other Portals	Service provided
eHospital	Hospital records maintenance; OPD services
e-Sanjeevani	Telemedicine services
eRakt Kosh	Blood banks
NHP	National health portal for national guidelines
mera aspatal	For OPD registration (↑Hospital services)
mDiabetes	Diabetes awareness
m-cessation	To quit smoking
NIKSHAY	TB drug compliance, register TB cases
NIKUSHT	Leprosy drug compliance

New Updates:

1. Rotavirus vaccine:
1. Open vial policy

2. 3rd dose of fIPV: Newly introduced (2024)

3. JE killed vaccine

Diseases covered: 12

• Indra has 12 wives → 1 subnational

• 11 Nationally:
• DPT, Polio, MR, Severe TB, Rotavirus, HepB, Hib, PCV

• 1 Sub-nationally:
• JE

National Immunization Schedule

Number of doses:

• OPV:
• Birth dose + 3 primary + 1 booster
• Birth dose or zero dose is not considered Primary dose
• 2 drops of polio can save life
• Note: Rotavirus - associated with diarrhoea - 5 drops

• Pentavalent:
• 3 primary + 2 boosters

Schedule:

• Fractional IPV
• 1/5th of Full dose

• Polysaccharide vaccine against Streptococcus pneumonia (PPSV-23)
• Most beneficial in Sickle Cell Disease
• (Autosplenism → ↑risk of encapsulated organisms like Strep)

Site of Vaccine Administration

• Mixed vaccine: Preferred

• Vaccine type (by route):
• Oral
• Intradermal
• Subcutaneous
• Intramuscular
• Pentavalent

• Mnemonic:
• MRI → Right arm

• After 5 years, absorption from the leg decreases,
• so the DPT 2nd booster 1s given 1n either of the upper arms

Q. You are posted at a PHC, and you have to ensure that the routine vaccination process is carried out smoothly. All of the vaccines are given at 16-24 months except:
A. DPT booster
B. OPV booster
C. Japanese encephalitis 2™ dose
D. PCV booster

National Vitamin A prophylaxis program

• Dose:
• 6 monthly doses
• < 6 months: 50,000 IU
• 6 months - 1 year or Weight < 8 kg 1,00,000 IU
• > 1 year or > 8 kg 2 lakh IU

• Total dose: 
• 17 lac IU (9 megadoses)
• Starting at 9 months
• with measles rubella vaccine
• One dose is given.
• Then every 6 monthly intervals

• Storage: 
• Amber coloured bottle (Sensitivity to light > heat)

• Measurement:
• 2 mL = 2 lakh IU
• 1 mL = 1 lakh IU

Rx for documented vit. A deficiency

• Dose: 
• 3 megadoses on Day 0, 1 & 14

SPECIAL FEATURES

Measles Post Exposure Prophylaxis

• With in 3 days

Pentavalent Vaccine

• Freeze sensitive

• Contains: DPT + Hib + Hep B (mixed vaccine)
• Diphtheria: Toxoid
• Pertussis: Killed (Whole cell)
• Tetanus: Toxoid
• Haemophilus influenzae b (Hib): Conjugate
• Hepatitis B: Recombinant

• Side Effects (due to pertussis):
• Uncontrollable cry (>3 hours)
• Neurological deficits
• HHE (Hypotensive hyporesponsive encephalopathy)

• Contraindications (C/I):
• Acellular pertusis vaccine TDaP (Safer) if
• Progressive neurological deficits
• Progressive developmental delays
• Convulsions/epilepsy
• Successive dose of DT is given for both
• Anaphylaxis with previous dose
• Encephalopathy for pertussis

BCG Vaccine

• Immunization for severe TB forms

• Route, Dose, Site: 0.1 mL, intradermal, left upper arm

• Upper age limit: 1 year

• C/I to 0.1 mL dose:
• Prematurity & age <1 month
• Very low birth weight
• Give 0.05 mL due to skin rupture risk

Td/TT/DT

Tuberculin vs Insulin Syringe

• Tuberculin syringe has (0.1ml to 1 ml) markings

• Insulin syringe has units 10 to 100 units

• There is no interchangeability between the syringes

Side Effects (Vaccine)

• A. Give all immunization according to schedule

• B. Sibling should not be given with OPV

• C. Give killed vaccines

• D. Pneumococcal vaccine should ideally be given before commencing the treatment

Contraindications

Viability of Vaccines & Unimmunized Child

Cold Chain

Elements:

Vaccine Sensitivity

• Freeze Sensitive:
• Hep B > Pentavalent > PCV > IPV > DPT/Td
• HPPiT

• Heat sensitive:
• Reconstituted BCG > OPV > MR > BCG > Rota
• RB OMB R → Japan

• KILLED
• K → KFD
• I → IPV
• LL → Lu (flu) → (Influenza)
• E → Enceph → JE
• D → Dogs → Rabies

• I (Influenza) Love (Live) Chick (Chicken Pox) EMBRYO
• E: JE
• M: MR
• B: BCG
• R: Rota
• Y: Yellow fever
• O: OPV

Deep Freezer

• Top Part → Most Cold

Ice Lined Refrigerator (ILR)

• Bottom Part → Most cold

• Temperature Monitor by
• Dial thermometer
• Twice a day
• By MO

NOTE:

• 2 live vaccines should not be given together

• Minimum 4 weeks gaps should be present

• Avoid spirit wipe before Live vaccines

Vaccine Vial Monitor (VVM)

• Example of Appropriate technology

• Checks heat stability

• Discard point:
• Inner square same color/darker than outer circle
• Lighter than outer: Usable
• Same/darker: Discard

• For freeze dried/reconstituted vaccine
• VVM on cap

• For liquid vaccine
• VVM on body

Open Vial Policy

• Used up to 28 days after opening vial

• Indicators → P-Toluene sulphate / Diacetylene
• VVM Tola → Very very Magn Tola

• Measures cumulative heat exposure

• Indirectly tells about POTENCE

• Not Efficacy/expiry

Do not follow Open Vial Policy:

• MBJ/ Covid/ Yellow Fever

• Mnemonic: Open cheyth vachuda → Meals, Ruby and Bee (honeybee)

• To be used within 4 hours after dilution

Conditions to be met for open vial policy

• All aseptic techniques have been followed.

• Vaccine vial septum has not been submerged in water.

• Date of first time opening of vial is clearly mentioned on the label.

• Expiry date of vaccine has not yet reached.

• Cold chain (2 - 8 degree) has been maintained properly.

Rotavirus (under open vial):

• VVM on Cap → Don't follow Open Vial policy
• Use within 4-6 hours post-dilution

• VVM on side → OVP applicable

Shake Test

• For freeze sensitive vaccines:
• DPT, Hep B, Pentavalent, PCV
• Mnemonic: Shake but Dont (DPT) Hit (Hep B) People (Penta, PCV)

• Method:
• Shake vial, compare to freeze-destroyed control



• Clear liquid:
• Precipitates (Aluminium hydroxide)
• Discard vial
• DPT
• Preservative → Thiomersal
• (preserved in thee, give to mersal)
• Adjuvant → Aluminium hydroxide
• White amorphous liquid:
• Undamaged vial
• Usable

Universal Immunization Program Evaluation

• Fully Immunized Child
• Better indicator
• Received all due vaccines till first year of life
• Evaluated at age: 12-23 months

• Completely Immunized Child
• Received all due vaccines till 2 years of age
• Evaluated at 5 years of age

Order of giving vaccine

1. Oral vaccine

2. Intradermal vaccine

3. Subcutaneous vaccine

4. Intramuscular vaccine

5. Pentavalent vaccine

Unimmunized Child

Upper Age Limit to Start Vaccine

• Penta can be only given till 1 year
• After that, it is given in split as
• Hib
• DPT

• Vaccine that should be given beyond 9 years of age
• HPV.

• Vaccines that can be given to adolescents
• TT, Tdap, Td.
• HepB.
• Influenza.
• JE and Rabies.

• Vaccines contraindicated in egg allergy
• When vaccines are cultured, an egg yolk medium is used.
• Vaccines contraindicated are:
• Influenza vaccine.
• Yellow fever vaccine.

• Vaccine that can cause thrombocytopenia
• Measles vaccine.

• Vaccine that acts faster than the incubation period of the disease it prevents
• Varicella vaccine.
• Measles vaccine.