SOCIO­CLINICAL CASE

PRESENTATION OF UNDER­5 CHILD
OF MY ALLOTTED FAMILY
SREYA CHAUDHURI
ROLL NO. : 108
6TH SEMESTER
KPCMCH
INTRODUCTION
The term child caring refers to the physical care of
the dependent so that they may survive up to
adulthood and perpetuate their family.

The childhood is divided as follows –

❑ Infancy ( up to 1 year of age)
❖ Neonatal period ( first 28 days of life)
❖ Post neonatal period(28th day – 1 year)
❑ Pre - school age (1 – 4 years)
❑ School age (5 – 14 years)
 IMPORTANCE OF UNDER 5
CHILD
➢ They are large and vulnerable group.
➢ Low level of immunity.
➢ High mortality and morbidity rates.
➢ They are priority members of the
family.
➢ They are future citizens of the country.
 COMPONENTS OF ASSESSING THE
HEALTH STATUS OF UNDER 5 CHILD
• Measuring the growth of the child by
anthropometric measurement and growth chart
• Assessing the development of the child
• Assessing the immunization status
• Assessing the feeding and child caring practices
• Clinical assessments
 ANTHROPOMETRY
Anthropometry or body measurements is the most used
means to assess nutritional status (particularly in
children).
THE VARIOUS ANTHROPOMETRIC MEASUREMENTS ARE
For children:
➢ Height/length
➢ Weight
➢ Head circumference
➢ Chest circumference
➢ Mid­upper arm circumference
 ANTHOPOMETRIC ASSESSMENT
Height:
1. The shoes should be removed.
2. Back of heel, calf muscle, buttock, shoulder blade & head should
touch the wall.
3. Lower margin of orbit and tragus should be in same plane i.e., the
Frankfurt’s plane should remain horizontal with respect to the
ground.
4. A cardboard is held on the head of the person parallel to Frankfurt’s
plane. The distance between the meeting point of the cardboard
with the wall and the floor is measured.
Length:Upto 2 years of age, length is ideally calculated with an
infantometer.
The procedure followed here is:
1. The child is made to lie down on a preferably hard surface (if not
possible bed) with feet against the wall.
2. A cardboard is placed at the head end in touch with the head of
the child.
3. The head, knee and ankle of the child are held tightly to prevent
the child from moving.
4. The length between the wall and cardboard is taken with a
measuring tape.
Weight:
1. The child should take off her/his shoes and socks
and there should be minimum clothing.
2. The zero reading is noted on the scale.
3. The bathroom weighing scale is first checked with
known standard weight.
4. The child is asked to stand on the bathroom
weighing scale and the weight is recorded.
5. If the child refuses to stand, the mother is asked
to stand on the bathroom weighing scale with the
child in her arms. The weight is recorded.
      Then the mother stands alone and her weight is recorded.
The mother’s weight subtracted from their combined
weight is the child’s weight.
6.  For children lesser than or equal to 2 years of age Salter’s
weighing machine is also used.
 HEAD CIRCUMFERENCE
Head circumference is a measurement of
child’s head around its largest diameter.
It measures the distance from the
glabella to the external occipital
protuberance, above the eyebrows and
ears.

Normal value at birth = 34 cm

 CHEST CIRCUMFERENCE
It is measured at the level of nipples.
Normally head circumference becomes
equal to chest circumference at 6 to 9
months and after that chest circumference
exceeds head circumference ( crossing
over).

Normal value at birth =32 cm

 MID UPPER ARM CIRCUMFERENCE
Measure in non dominant arm. Ask the subject
to semi flex his/her arm. Measure the length
from tip of acromion process of scapula to tip
of olecranon process of ulna. Then mark the
midpoint.
Ask the subject to hang his/her hand down
freely and then measure the mid upper arm
circumference at the midpoint level with the
help of non stretchable measuring tape.
VALUE OF INFERENCE
MUAC
>13.5 cm Normal
12.5­13.5 cm Mild to moderate
malnutrition
<12.5 cm Severely
malnourished
<11.5cm Severe acute
malnutrition(SAM
 GROWTH CHART
A growth chart is designed primarily for
longitudinal follow­up of a child so that
changes in weight over time can be
interpreted.
Use of growth chart:
➢ Growth monitoring
➢ Diagnostic tool
➢ Planning and policy making
➢ Tool for action
➢ Evaluation
➢ Educational tool
➢ Tool for teaching
 NATIONAL IMMUNIZATION
SCHEDULE
AGE OF THE CHILD VACCINES AND SUPPLEMENT

BCG,       Hepatitis B(birth dose),       OPV(0
At birth
dose)
Pentavalent1,   OPV1,  f­IPV1, *Rotavirus ­ 1,
 6 weeks
*Pneumococcal – 1
 10  weeks Pentavalent2,    OPV2 , *Rotavirus – 2
Pentavalent3,    OPV3,     f­IPV2, *Rotavirus
 14 weeks
– 3, *Pneumococcal­2
Measles Rubella­1, Japanese Encephalitis
  9 months ­1, *Pneumococcal­3         Vitamin
 NATIONAL IMMUNIZATION SCHEDULE

AGE OF THE CHILD VACCINES AND SUPPLEMENT

*Measles Rubella­2,   Japanese
16­24 months Encephalitis­2 ,     Vitamin A(2,00,000
st
IU), DPT 1  booster,  OPV booster
 5 years DPT 2 nd booster
  10 years & Tetanus Toxoid­1 & Tetanus Toxoid ­2
16 years respectively
NATIONAL IMMUNIZATION SCHEDULE
For pregnant women:

GIVEN AT VACCINE
Given as soon as Tetanus Toxoid 1
pregnancy is diagnosed
Given 4 weeks after the Tetanus Toxiod 2
Tetanus Toxoid 1
MILESTONES OF DEVELOPMENT OF
INDIAN INFANTS
AGE MOTOR LANGUA ADAPTIV SOCIO­
DEVELOP GE E PERSON
MENT DEVELOP DEVELOP AL
MENT MENT DEVELOP
MENTS
6­8 ­ ­ ­ LOOKS
WEEKS AT
MOTHER
AND
3 MONTH HOLD ­ BEGINNI ­
S HEAD NG TO
ERECT REACH
OUT
OBJECT
4­5 ­ LISTENIN ­ RECOGNI
MONTHS G ZES
MOTHER
6­8 SITS EXPERI
TRANSF ENJOYS
MONTH WITHOU MENTIN
ER  HIDE
S T G WITH
OBJECT AND
SUPPOR NOISES
 HAND SEEK
T TO
HAND
9­10 CRAWLI INCREA RELEAS SUSPICI
MONTH NG SING E OUS OF
S RANGE OBJECT STRANG
OF S ERS
SOUND
10­11 STANDS FIRST ­
MONTHS WITH WORDS
SUPPOR
T
12­14 WALKS ­ BUILDS
MONTHS WIDE
BASE
18­21 WALKS JOINING BEGINNI
MONTHS NARRO WORDS NG TO
W BASE EXPLOR
E
24 RUNS SHORT ­ DRY BY
MONTHS SENTEN DAY
CES
 OBJECTIVES
• To assess the health status of the under five child.
• To detect any health problem if any.
• To assess any socio­clinical factor to determine
health problems if any.
• To assess child rearing and child care practices.
• To give recommendations at individual, family and
community level if any deviation is present
➢ STUDY TYPE: Observational, Descriptive, Cross­
sectional
➢ STUDY PERIOD: 26.2.18-11.3.18
➢ STUDY AREA: 32,Goswami Para, P.O. Joka,
Kol­104
➢ STUDY POPULATION: 3 members
➢ STUDY TOOLS: Measuring Tape, Bathroom
Weight Scale, Stethoscope, Practical Guide
Book.
➢  STUDY TECHNIQUE : Data was collected by
1. Interviewing the mother regarding the child’s diet[Oral
questionnaire ­ 24 hour recall method] and child care
practices.
2. Recording his weight by bathroom weighing machine.
3. Recording the height, head circumference, chest
circumference and mid upper arm circumference.
4. Calculating the values required.
5. Clinical examination.
6. Review of records.
I) INTRODUCTION TO THE FAMILY
• NAME OF THE HEAD OF THE FAMILY: Mukul Das
• ADDRESS: 32 Goswami Para,P.O. Joka, Kol­104
• NO. OF FAMILY MEMBERS: 3
• TYPE OF FAMILY: Nuclear family in the phase of Extension
• RELIGION: Hinduism
• MOTHER TONGUE: Bengali
• PER CAPITA INCOME: Rs 3000
• SOCIO ECONOMIC STATUS ACCORDING TO INFLATION­RATE
ADJUSTED MODIFIED KUPPUSWAMY’S SOCIO ECONOMIC
STATUS SCALE (2014): Lower­middle Class (III)
 FAMILY
SL. NAME AGE SE MARITAL RELATIO EDUCATIO
NO.
CHART X STATUS N WITH N
HOF
1. MR. 29 M MARRIED HOF XII PASSED
MUKUL YEARS
DAS

2. MRS. 23 F MARRIED W/O HOF X PASSED

CHAMPA YEARS
DAS
3. AMIT DAS 36 M NOT S/O HOF NOT
MONT APPLICABLE APPLICABL
HS E
SL. NAME OCCU INCOME NATUR TYPE
ADDICT HISTOR HISTOR
NO. PATIO E OF OF
ION Y OF Y OF
N WORK WORK PRESE PAST
NT ILLNES
ILLNES S
S
1. MR. MUKUL SHOP Rs.9000 UNSKIL SEDEN NONE NONE ­­­­­­
         DAS OWNE LED TARY
R
2. MRS. HOME ­­­­­­­ UNSKIL SEDEN NONE NONE ­­­­­­
CHAMPA MAKE LED TARY
DAS R

3. AMIT DAS NOT ­­­­­­­ ­­­­­­­­­­ NOT NONE ­­­­­­­­­ ­­­­­­­­­­­

APPLI APPLIC ­
CABL ABLE
E
 PRIORITY MEMBERS
NAME AGE SEX CRITERIA
FOR
PRIORITY
CHAMPA DAS 23 YEARS FEMALE BELONGS
TO
REPRODUCT
IVE AGE
GROUP
AMIT DAS 36 MONTHS MALE UNDER 5
CHILD
SOCIO­ECONOMIC
STATUS
INFLATION­RATE ADJUSTEDMODIFIED KUPPUSWAMY’S SOCIO­ECONOMIC STATUS SCALE
A. EDUCATION OF HOF SCORE

1.PROFESSION OR 7
HONOURS
2.GRADUATE OR POST 6
GRADUATE
3.INTERMEDIATE OR 5
POST HIGH SCHOOL
DIPLOMA
4.HIGH SCHOOL 4
CERTIFICATE
5.MIDDLE SCHOOL 3
CERTIFICATE
6.PRIMARY SCHOOL 2
B.OCCUPATION OF HOF SCORE

1.PROFESSION 10

2.SEMI­PROFESSION 6

3.CLERICAL,SHOP OWNER, 5
FARMER
4.SKILLED WORKER 4

5.SEMI­SKILLED WORKER 3

6.UNSKILLED WORKER 2

7.UNEMPLOYED 1
FAMILY INCOME PER MONTH (IN Rs.) SCORE

1.  >36,997 12

2.  18,498­35,996 10

3.  13,874­18,497 6

4.  9249­13873 4

5.  5547­9248 3

6.  1866­5547 2

7.  <1865 1
TOTAL SCORE SOCIO­ECONOMIC CLASS

26­29 UPPER(I)

16­25 UPPER­MIDDLE(II)

11­15 MIDDLE LOWER­MIDDLE(III)

5­10 LOWER UPPER­LOWER(IV)

<5 LOWER(V)
SOCIO­ECONOMIC STATUS OF MY ALLOTTED
FAMILY ACCORDING TO MODIFIED
KUPPUSWAMY’S SOCIO­ECONOMIC STATUS SCALE
A. EDUCATION SCORE

1. HIGH SCHOOL CERTIFICATE 4

B. OCCUPATION
1. SHOP OWNER 5
C. FAMILY INCOME PER MONTH
1. 5547­9248 3

TOTAL SCORE SOCIO­ECONOMIC CLASS

12 LOWER­MIDDLE(III)
SOCIO­CLINICAL CASE :
UNDER­5 CHILD
INTRODUCTION
• NAME OF CHILD – Amit Das
• D.O.B. –02/03/2015
• AGE –36 months
• SEX – male
• PRESENT WEIGHT – 13kg
• HEIGHT –94cm.
 BIRTH HISTORY
DELIVERY DETAILS

• DATE OF DELIVERY –02/03/2015

• PLACE OF DELIVERY –ESI JOKA  
(INSTITUTIONAL DELIVERY)
• MODE OF DELIVERY- Normal
• BIRTH WEIGHT - 2.9 kg
• BIRTH COMPLICATIONS - None.
➢ Nothing was applied on the
umbilical stump
➢ First bath- a er 7 days
➢ First food o ered a er birth-
colostrum fed to neonate
within 1 hour
 FEEDING   HISTORY
TYPES OF FEED EXPLANATION FINDINGS

PRE-LACTEAL • It is the food given to The child was not

FEEDING the child before given any pre-
starting of the lacteal food.
mother’s milk/
colostrum. It includes
honey, water etc.
• Ideally it should not
be given to the child.
TYPES OF FEED EXPLANATION FINDINGS

COLOSTRUM • The first milk is called  

“colostrum” which is The child was
bright yellow, alkaline, fed with
viscous fluid and is rich in colostrum
proteins, other nutrients within an hour
and immunoglobulin and of delivery.
that protects the baby
from various diseases.
• After birth it should be
given to the child as soon
as possible.
 TYPES OF FEED EXPLANATION FINDINGS

EXCLUSIVE • “Breast-feeding, nothing The child was

BREAST but breast-feeding, not exclusively
FEEDING even a sip of water, until breast fed for
medically indicated.” six months.

• Breast feeding should be

started immediately or at
the earliest after birth and
should be continued
exclusively for at least the
first six months.
TYPES OF FEED EXPLANATION FINDINGS

ARTIFICIAL • These are breast-milk The child was given

FEEDING substitutes e.g. dried artificial milk at 6
whole milk powder, months in addition
fresh milk from a cow to breastfeeding.
or commercial The powder milk
formulae which are was dissolved in
crucial for the baby. drinking water in a
• But artificial feedings bottle. The bottle
should be avoided. was washed in
boiling water.
 TYPES OF FEED EXPLANATION FINDINGS
COMPLEMENT- It is the process of Complementar
ARY introduction of semi solid y feeding was
FEEDING or solid food after 6 months started after 6
of age. But breast feeding is months.
still to be continued  till the
age of two years.
It is done because after 6
months of age breast milk
cannot provide all the
nutrients for the growth of
the child.
Foods given are fruits, soft
boiled rice, mashed potato,
dal, etc.
 CURRENT   DIET
• Breakfast:  A glass of milk and puffed rice
• Lunch: Rice , daal, aloo­parwal sabji
• Evening Snacks: puffed rice with cucumber
• Dinner: Roti (1 and a half piece)
                 Daal
                 Egg curry
 ANTHROPOMETRY
The anthropometric measurements of Amit Das (Under 5 child)
are as follows:

MEASUREM NORMAL FINDINGS

ENTS (FOR 36
MONTHS)
WEIGHT 14.3 kg 13kg
(+/­ 2 S.D.)
HEIGHT 96.1 cm 94cm
(+/­ 2 S.D.)
MID UPPER ARM >13.5 cm 14cm
CIRCUMFERENCE
HEAD 50cm(+/­ 2SD) 52cm
CIRCUMFERENCE
CHEST More than head 54cm
CIRCUMFERENCE circumference

The anthropometric measurements of

the child are within normal range.
Findings: The child lies between 0 and ‑2 S.D. on the WHO growth
chart.
 CLINICAL EXAMINATION
General Appearance Normal Built
Hair Black, has normal lusture
Face No visible deformity
Eyes Conjunctiva – Normal
Cornea – Normal
Lips Normal
Tongue Normal
Teeth No Deformity Present
Gums Normal
Glands No Prominent Enlargement of Glands
 CLINICAL EXAMINATION
Skin Smooth, hydrated, no
abnormality
Nails No Deformity  Present
Oedema Absent
Rachitic Changes No Such Changes Present
Internal Systems :
         Cardiovascular System
  Respiratory System All the systems are functioning
         Central Nervous System within normal limits
         Gastro­Intestinal System

On clinical examination, no detectable abnormality was found

 IMMUNIZATION STATUS OF THE
CHILD
• The child Amit Das, as of 36 months of age has
received the following vaccines:
• Based on the National Immunisation Schedule:
BCG, HepB, OPV0; OPV1, OPV2, OPV3,
Pentavalent1, Pentavalent2, Pentavalent3,MR 1,
MR 2, JE 1, JE2, OPV booster dose, DPT 1st booster
dose, and 5 doses of Vit. A supplementation.

• The child is hence fully immunized as per his age.

 IMMUNISATION STATUS
REQUIRED VACCINE DUE DATE DATE OF
AGE AT OF ADMINISTRAT
VACCINATIO VACCINATI ION
N ON
At birth 1. BCG 2/3/15  Same as due
2. OPV – 0 dose 2/3/15 date
3. HEPATITIS B­ 2/3/15
birth dose
6 weeks 1. OPV – 1 16/4/15 for Same as due
2. PENTAVALEN all date
REQUIRED VACCINE DUE DATE DATE OF
AGE AT OF ADMINISTRAT
VACCINATIO VACCINATI ION
N
10 weeks 1. OPV ­2 ON
17/5/15 for Same as due
2. PENTAVALEN all date
T­2

14 weeks 1. OPV – 3 19/6/15 for Same as due

2. PENTAVALEN all date
T­3
3. IPV
AGE AT VACCINE AND DUE DATE DATE OF
VACCINATI SUPPLEMENT OF ADMINISTRATI
ON VACCINATI ON
ON
9 months 1. MEASLES ­1 10/12/15 Same as due
2. JAPANESE date
ENCEPHALITIS
­1
3. VITAMIN A
SUPPLEMENT
st
– 1  dose
AGE AT VACCINE AND DUE DATE DATE OF
VACCINATI SUPPLEMENT OF ADMINISTRATI
ON VACCINATI ON
16 – 24 1. MEASLES ­2 ON
11/7/16 Same as due
months 2. JAPANESE date
ENCEPHALITIS
­2
3. OPV –
BOOSTER
4. DPT –
BOOSTER
5. VITAMIN A
SUPPLEMENT­
nd
• He had also received 3 , 4   and 5 th doses
rd th

of Vit A on 12/3/17 , 11/9/17 and 10/3/18
respectively.

REMARKS  – The child has received all the vaccines due till
date
 GROWTH AND DEVELOPMENT

Neck Holding – 3 months
Sitting – 5 months
Crawling – 6 months
Standing with support – 8 months
Higher function (speech) – 12 months (normal)
 PERSONAL HYGIENE

Bath – Regular
Washing of hands before feeding – Yes
Washing of hands after defecation –
Yes
Cutting Nails ­ Regular
 SUMMARY
The allotted nuclear family of Mr. Mukul Das (HOF)
has three members and their family is in the Phase of
Extension . Their monthly income is Rs. 9000 and
they belong to lower middle class according to
Inflation­rate adjusted modified Kuppuswamy’s socio­
economic status scale (2014). The priority members
of the family are Mrs.Champa Das (belongs to
reproductive age group) and Amit Das (under 5 child).
 Amit Das , aged 36 months is an
apparently healthy child with a
satisfactory diet(except for the absence
of fruits), normal growth and
development. He has received all
vaccines till date.
RECOMMENDATION
S
RECOMMENDATIONS AT THE INDIVIDUAL
LEVEL
1. Proteinaceous food like daal, egg, fishes
should be given to the child.
2. Fruits such as banana and other seasonal
fruits should be included in the diet.
3. Artificial feeding should be avoided.
4. The child should be taken to the
Anganwadi centre for immunization,
health check­ups for the under 5 children.
 RECOMMENDATIONS AT THE FAMILY LEVEL
1. The family should maintain adequate hygiene
regarding the child’s feeding habits to prevent
infectious diseases of the gastro­intestinal tract.
2. They should reside in a clean surrounding free
from vectors.
3.  Mrs. Champa Das and Mr. Mukul Das should be
adopt family planning methods.
4. The family should go for regular health check ups.
 RECOMMENDATIONS AT THE COMMUNITY LEVEL
1. The Anganwadi Centre present nearby should be able
to provide immunization, health check­ups and also
referral services for the under­5 children.
2. The community should also organize campaigns
related to Integrated Management of Neonatal and
Childhood Illnesses.
3. The mother should be made aware of all health­
related aspects of under 5 children by health workers.
 ACKNOWLEDGEMENT
I wish to express my sincere gratitude to
our allotted family members for their co
operation. I am grateful to all the
respected teachers of the Community
Medicine department for giving us this
opportunity and their support and
guidance.
I would like to thank the field workers
and community leaders for their
guidance.
I am also thankful to my friends for their
 BIBLIOGRAPHY
Park K.Park’s Textbook of Preventive And
rd
Social Medicine.Nutrition And Health.23
Edition.Jabalpur:Bhanot
Publishers.2015.Pg 555­645.
THANK YOU