MATERNAL AND CHILD HEALTH

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MATERNAL AND CHILD HEALTH

• Jay H. Mayefsky, MD, MPH

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GOALS

• HEALTHY MOTHERS AND CHILDREN

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MCH

• MEDICAL SERVICES
• ENVIRONMENTAL ISSUES
• PSYCHOSOCIAL STRESSES
• INCOME

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FACTORS FOR EMERGENCE

• HIGH INFANT MORTALITY RATE
• HIGH MATERNAL MORTALITY RATE
• REFORM MOVEMENT
• CHILD LABOR CONCERNS
• INCREASED GOVERNMENT INVOLVEMENT

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FACTORS FOR EMERGENCE

• THE SHEPPARD-TOWNER ACT (1921-9)
• THE SOCIAL SECURITY ACT (1935)

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MATERNAL AND CHILD HEALTH BUREAU

• VisionA future America in which the right to
  grow to one's full potential is universally
  assured through attention to the comprehensive
  physical, psychological and social needs of the
  maternal and child health population. We strive
  for a society where children are wanted and born
  with optimal health, receive quality care and are
  nurtured lovingly and sensitively as they mature
  into healthy, productive adults. MCHB seeks a
  nation where there is equal access for all to
  quality health care in a supportive, culturally
  competent, family and community setting.

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MATERNAL AND CHILD HEALTH BUREAU - OBJECTIVES

• Woman and infants
• Eliminate barriers and health disparities
• Child health and safety
• Reduce illness and injury
• Promote health care and healthy environments
• Children with special health care needs
• Support coordinated care systems
• Adolescents
• Support comprehensive care

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MATERNAL AND CHILD HEALTH BUREAU - OBJECTIVES

• Health Promotion and Disease Prevention
• Genetics
• Newborn screening and increase knowledge
• ACCOMPLISHED BY
• Funding care and research
• Training
• Resource centers
• Guidelines and tips

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MATERNAL SERVICES GOALS

• HEALTHY WOMEN PRE AND POST PARTUM
• BIRTH OF HEALTHY BABIES WITH NO COMPLICATIONS FOR
  MOTHERS
• BONDING

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MATERNAL HEALTH SERVICES

• AGE OF FIRST SEXUAL ACTIVITY THROUGH OLD AGE

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PAP SMEARS

• START WITHIN 3 YEARS OF ONSET OF VAGINAL
  INTERCOURSE
• NO LATER THAN 21
• lt30 - YEARLY
• gt30 EVERY THREE YEARS AFTER 2-3 NORMALS
• IN HIGH RISK YEARLY
• WOMEN gt70 WITH 3 NORMALS AND NO ABNORMALS IN 10
  YEARS MAY STOP

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PELVIC EXAMINATION

• HEALTH ASSESSMENT
• EDUCATION

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BREAST EXAMINATION

• HEALTH ASSESSMENT
• EDUCATION

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DISEASE PREVENTION

• ABSTINENCE
• SAFER SEX

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IMMUNIZATIONS

• RUBELLA
• VARICELLA
• HEPATITIS B

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PREGNANCY PLANNING

• ALL PREGNANCIES SHOULD BE PLANNED TO REDUCE
  MEDICAL AND PSYCHOSOCIAL RISK FACTORS

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BIRTH CONTROL

• CONDOMS PLUS ANOTHER METHOD

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FOLIC ACID FOR REDUCTION OF NEURAL TUBE DEFECTS

• ALL WOMAN OF CHILDBEARING AGE WHO ARE CAPABLE OF
  BECOMING PREGNANT
• 0.4mg OF FOLIC ACID DAILY

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PRENATAL CARE

• START EARLY IN PREGNANCY
• SCREEN FOR MATERNAL RISK FACTORS
• EVALUATE MATERNAL PHYSICAL AND PSYCHOLOGICAL
  HEALTH
• EVALUATE RISK FOR DOMESTIC VIOLENCE

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PRENATAL CARE

• MONITOR GROWTH AND DEVELOPMENT OF FETUS
• PRENATAL DIAGNOSIS
• TRIPLE SCREEN
• ULTRASOUND
• AMNIOCENTESIS
• CHORIONIC VILLUS SAMPLING

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PRENATAL CARE

• EDUCATION
• PREGNANCY
• CHILDBIRTH
• BREAST FEEDING
• PARENTING

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POSTPARTUM CARE

• POST PARTUM PHYSICAL EXAMINATION
• ASSESSMENT OF MOTHERING
• SCREEN FOR POSTPARTUM DEPRESSION

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WELL WOMEN

• GENERAL STATE OF HEALTH
• CANCER SCREENING
• MENSTRUAL CYCLE ISSUES
• FOLATE
• PREVENTION OF OSTEOPOROSIS

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MAMMOGRAMS

• LOW RISK
• BASELINE AT AGE 40
• REPEAT EVERY 2-3 YEARS
• YEARLY AFTER AGE 50
• HIGH RISK
• BASELINE AT AGE OF CANCER IN RELATIVE
• YEARLY

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MENOPAUSAL WOMEN

• MENOPAUSE SYMPTOMS
• OSTEOPOROSIS PREVENTION AND TREATMENT
• CONTINUED CANCER SCREENING

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CHILDRENS HEALTH SERVICES
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CHILDRENS HEALTH SERVICES - GOALS

• REDUCE PREMATURITY AND CONGENITAL ABNORMALITIES
• PREVENT MAJOR CAUSES OF DEATH AND DISEASE
• PROVIDE SPECIALIZED TREATMENT
• ENSURE ACCESS TO CARE
• PREPARE CHILDREN TO BE HEALTHY ADULTS

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PRENATAL

• ESTABLISH RAPPORT
• ASSESS RISK FACTORS
• GENETIC COUNSELING
• INFANT CARE
• FAMILY ADJUSTMENT
• BREAST FEEDING
• SAFETY

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NEWBORNS

• PHYSICAL EXAMINATION
• ANTICIPATORY GUIDANCE
• IMMUNIZATION
• BACK TO SLEEP

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NEWBORNS SCREENING TESTS

• PKU
• Congenital hypothyroidism
• Congenital adrenal hyperplasia (CAH)
• Biotinidase deficiency
• Maple syrup urine disease
• Galactosemia
• Homocystinuria
• Sickle cell anemia
• Medium chain acyl-CoA dehydrogenase deficiency
  (MCAD)
• Hearing loss

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INFANTS AND CHILDREN

• THE NEW MORBIDITY

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INFANTS AND CHILDREN

• ANTICIPATORY GUIDANCE
• PHYSICAL EXAMINATION
• SCREENING TESTS
• IMMUNIZATIONS

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SCREENING TESTS

• HEARING
• VISION
• DEVELOPMENT
• CBC

• LEAD
• PPD
• URINALYSIS
• CHOLESTEROL

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ROUTINE IMMUNIZATIONS

• HEPATITIS B
• DIPHTHERIA
• TETANUS
• PERTUSSIS
• POLIO
• H. INFLUENZAE B

• MEASLES
• MUMPS
• RUBELLA
• VARICELLA
• PNEUMOCOCCUS
• (HEPATITIS A)
• (INFLUENZA)

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Recommended Childhood and Adolescent Immunization
Schedule United States, January June 2004
Range of Recommended Ages
Preadolescent Assessment
Catch-up Immunization
Age
Birth
1 mo
2 mo
4 mo
4-6 y
18 mo
24 mo
11-12 y
6 mo
12 mo
15 mo
Vaccine
HepB 1
only if mother HBsAg ( - )
HepB series
Hepatitis B1
HepB 2
HepB 3
Diphtheria, Tetanus, Pertussis2
DTaP
DTaP
DTaP
DTaP
Td
DTaP
Td
Haemophilus influenzae Type b3
Hib
Hib
Hib3
Hib
Inactivated Poliovirus
IPV
IPV
IPV
IPV
Measles, Mumps, Rubella4
MMR 1
MMR 2
MMR 2
Varicella5
Varicella
Varicella
Pneumococcal6
PCV
PCV
PCV
PCV
PCV
PPV
Vaccines below this line are for selected
populations
Hepatitis A7
Hepatitis A series
Influenza8
Influenza (yearly)
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ADOLESCENTS

• ANTICIPATORY GUIDANCE
• PHYSICAL EXAM
• SCREENING TESTS
• IMMUNIZATIONS

• ADOLESCENT ISSUES
• PUBERTY / SEX
• SUBSTANCE ABUSE
• RISK TAKING
• PEER PRESSURE
• FUTURE PLANS

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OTHER CHILDRENS PROGRAMS

• HEAD START
• FACILITY REGULATIONS
• PROGRAM FOR CHILDREN WITH SPECIAL HEALTH CARE
  NEEDS

• WELFARE
• WIC
• CHILD ABUSE SERVICES
• PL94-142
• PL99-457

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HOW WELL ARE WE DOING?
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WHATS MISSING?

• FATHERS

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HOW WELL ARE WE DOING?

• 11 MILLION CHILDREN LIVE BELOW THE POVERTY LEVEL
• INCOME lt17,603/YEAR FOR A FAMILY OF 4
• Improvement but still 71 higher than adults

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HOW WELL ARE WE DOING?

• 56 OF CHILDREN LIVING IN POVERTY ARE IN
  HOUSEHOLDS HEADED BY A SINGLE FEMALE
• 64 OF ALL MOTHERS OF PRESCHOOL CHILDREN ARE IN
  THE LABOR FORCE
• 11.6 OF CHILDREN HAVE NO HEALTH INSURANCE

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HOW WELL ARE WE DOING?

• In 2000, 879,000 children were victims of abuse
  or neglect (12/1000 children)
• 79 of perpetrators were the parents

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HOW WELL ARE WE DOING?

• 3 OF HEALTH EXPENDITURES ARE ALLOCATED FOR
  PREVENTION

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HOW WELL ARE WE DOING?

• HIGH SCHOOL STUDENTS
• NEVER WORE SEAT BELTS 19
• NEVER WORE BIKE HELMETS 88
• RIDDEN WITH ALCOHOL DRINKER 37
• DRIVEN AFTER DRINKING 17
• CARRIED A WEAPON 18
• SMOKED 37
• CONSIDERED SUICIDE 20
• ATTEMPTED SUICIDE 8

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HOW WELL ARE WE DOING?
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HOW WELL ARE WE DOING?

• 20 COUNTRIES HAVE LOWER MATERNAL MORTALITY RATES
  THAN THE UNITED STATES

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