recommendation for practiceorigin.searo.who.int/.../topics/handbook_part_one.pdf · during...

Please bring this handbook with you every time you come in for servicesat the government and private hospitals.

Recommendation for practice

The birth certificate form (T.r. 1/1) in this handbook signedby health personnel to certify the birth of the child is neitheran official birth certificate nor birth registration. Parents shouldcontact the district or local registration officer at district/sub-district office, municipality office, or BangkokMetropolitan Administration Office to register the birth of thechild in order to get an official Birth Certificate and to add thechildûs name into the household record within 15 days afterbirth. Parents should bring with them this handbook, a copy ofhousehold record, and the identification card of the childûsmother or father when registering for the official BirthCertificate. If you register later than 15 days, you as theparents, will be fined for 1,000 baht by the law.

For your childûs well-being:

1. A copy of household record.2. Identification card of the childûs mother or father.3. Marriage license of the parents (if any).

Name-Surname of Child

Please do not losethis handbook

Documents required for official birth registration :

If the mother is physically and mentally

healthy, then the child will be healthy and happy.

Good physical and mental health of mother has resulted from the

good care of the husband.

This handbook can be used as a reference for obtaining your babyûs Birth Registration Certificate,This handbook can be used as a reference for obtaining your babyûs Birth Registration Certificate,This handbook can be used as a reference for obtaining your babyûs Birth Registration Certificate,This handbook can be used as a reference for obtaining your babyûs Birth Registration Certificate,This handbook can be used as a reference for obtaining your babyûs Birth Registration Certificate,and adding your childûs name into the household recordand adding your childûs name into the household recordand adding your childûs name into the household recordand adding your childûs name into the household recordand adding your childûs name into the household record

Ministry of Public Health 2555 (2012)Ministry of Public Health 2555 (2012)Ministry of Public Health 2555 (2012)Ministry of Public Health 2555 (2012)Ministry of Public Health 2555 (2012)

Good Practice of Mother for Bringing a Healthy Child1. Having children at the ages between 20-35

years2. Spacing between each child for at least 2

years.3. Together with the husband, having ANC

visit soonest before 12 weeks of gesta-tional age, following every appointment ofANC visits, and having the delivery bymedical and health personnel.

4. Receiving complete doses of T.T.vaccine.Having self-practice during the pregnancy

5. delivery, and postpartum periods as rec-ommended in MCH handbook.

6. The childûs birth-weight is 2,500 gramsor more.

7. Having the baby suck breastmilkinstantly after birth with exclusivebreastfeeding for at least 6 months,continuing breastfeeding for at least 24months along with other food for ages.

8. Bringing up a healthy child withoutmalnutrition and obesity.

9. Promoting the childûs age appropriatedevelopment as recommended in MCHhandbook.

10. Bringing the child to receive vaccina-tions on appointments.

Chaiman of Advisory groupChaiman of Advisory groupChaiman of Advisory groupChaiman of Advisory groupChaiman of Advisory groupDr.Vichai Tienthavorn Former Permanent Secretary, Ministry of Health

ConsultantsConsultantsConsultantsConsultantsConsultantsDr.Somyos Deerasamee Director-General, Department of HealthDr.Somsak Pattarakulwanich Deputy Director-General, Department of HealthDr.Sompong Sakulisariyaporn Director of Bureau of Health Promotion,

Department of HealthEditorsEditorsEditorsEditorsEditors

Dr.Nipunporn Woramongkol Bureau of Technical Advisors Department of HealthDr.Sirikul Issaranurak Professor Emeritus, Mahidol UniversityDr.Sarawut Boonsuk Chief of Maternal and Child Health GroupMrs.Nareeluck Kullurk Public Health Technical Officer, Senior Professional LevelMrs.Chailai Leartvanangkul Public Health Technical Officer, Senior Professional LevelMs.Sukjing Worngdechakul Nutritionist, Senior Professional LevelMrs.Jintana Pattanapongthorn Public Health Technical Officer, Senior Professional LevelMrs.Nongluk Roongsubsin Dissemination Technical Officer, Senior Professional LevelMrs.Prapaporn Jungpanich Public Health Technical Officer, Professional LevelMrs.Isaree Jedprayuk Public Health Technical Officer, Professional LevelMs.Chaweewan Tonputsa Public Health Technical Officer, Professional Level

Mother and Child Health HandbookPublishedPublishedPublishedPublishedPublished bybybybyby Bureau of Health Promotion, Department of Health, Ministry of Pubic Health, ThailandTotalTotalTotalTotalTotal 102 pages 1st Printing: 1400 copiesPrinting Office Printing Office Printing Office Printing Office Printing Office : The Veteran Press, Bangkok

General Identification Number ..........................................

(Pregnant woman)

General Identification Number (Child)................................

Firstly Issued at...................................................................

Name-surname of pregnant woman............................................................

Identification Number

Occupation............................. Religion................................................

Education (Highest educational attainment).......................................

Telephone number...............................................................................

Name-surname of the husband...................................................................


Occupation............................. Religion................................................

Education (Highest educational attainment).......................................

Telephone number...............................................................................

Current address No.............. Moo..............Name of village........................

Soi..............................Street...........................Sub-district.............................

District...................... Province...........................Zip Code

Name-surname of the child........................................ Blood group............

Date of birth.........Month................ Year 20...... time of delivery....... hrs.


Child's

Photograph

ID1

If anyone picks up or finds this handbook, please reture it to the above address

Introduction to the Use of MCH Handbook

This MCH handbook is a personal health record for the mother

during pregnancy, intra-partum, and post-partum periods, and for the

child since birth up until 6 years of age.

AdvantagesAdvantagesAdvantagesAdvantagesAdvantages™ A source of knowledge and record for the health of mother and

child from pregnancy up until the child is 6 years old.

™ Helping the father and mother to take appropriate care for their

child from birth up until 6 years olds.

™ Providing an evidence for notification of birth and obtaining a

birth certificate using the form T.R.1/1 signed by the birth at-

tendant presented in this handbook.

InstructionInstructionInstructionInstructionInstruction™ Read through and follow all the contents in this handbook.

™ Bring along this book whenever you receive services at any

health facilities.

™ Record the data all by yourself and have your husband record

the data on the pages as identified.

™ When your child attends school, hand over this book to the

teacher for continuous care of the childûs health.

™ If the book is torn or lost, obtain the new one from health

personnel.

If you have any doubts or questions about this

handbook, please ask the health personnel

2

CONTENTSPagePagePagePagePage

woman to give birth to a newborn> 2,500 g.

■ Advantage of nutritional graph 63

■ Nutritional graph for pregnant woman 64

■ Nutrition for pregnancy women: 65-66

Table for comparison of percentageof standard BMI values (BMI 21 = 100)

■ Illustration of sets of food exchange 67-68

for pregnant woman■ Fetal development 69

■ Thalassemia 70-71

■ What is hypothyroidism? 72

■ Prevention of mother-to-child 73

transmission of HIV■ Family planning 74

■ Self assessment and analysis 75-76

of stress

Part 4 Child related knowledge to bring 77up a healthy, brilliant, good, happy child

■ Breast-milk is the first drop of family 78

love bond■ Food for infant at birth › 12 months 79-80

■ Adequate amount of daily food intake 81

for a child 1 › 5 years■ Caring for your child 82

■ Caring for your child suffering from 83

respiratory tract infection■ Caring for your childûs teeth 84

■ Vaccinations guide 85

■ Miracle of reading 86

■ Guide to bringing up a brilliant, good, 87

happy child■ Suggestion for parents and guardian in 88

recording the childûs development■ Child development promotion 89-97

■ Risks and guide to prevention of 98-100

injuries in early childhood■ Childûs vaccination record 101

■ Next appointment date for health exam 102

PagePagePagePagePageGeneral I.D. number (pregnant woman) 1

Introduction to the use of MCH handbook 2

Part 1 Pregnancy 4■ Health history of pregnant woman 4

and family■ Risk assessment criteria for pregnant 5

woman at the 1st ANC visit■ History of current pregnancy 6

■ Pregnancy examination record 7

■ Checklists of care for quality pregnant 9

woman■ Checklists of service inclusion by 10

gestational age■ Uterine heigh graph 11

■ Fetal movement count 12

■ Maternal delivery record 15

■ Record of the newborn 16

Part 2 Child Care 17■ Risks assessment in mother and 17-18

newborn (prior to hospital discharge)■ Oral health for children aged 6 19

months › 5 years■ Child Development and service 20-39

activities for children aged 1 month›4 years■ Head circumference graph 40-41

(separated for male and female)■ Guide to the use of child nutritional graph42

■ Child nutritional graph 43-54

Part 3 Essential Knowledge for Safe 55and Quality Pregnancy

■ Discomforts during pregnancy 56

■ Maternal practice during pregnancy 57

■ Table of minimum weight for pregnant 58woman to give birth to a newborn of2,500 g.

■ Self care during pregnancy using 59-60

pregnancy pathway chart■ Table of minimum weight for pregnant 61

PART 1: PREGNANCY

Having been married for........yrs. Use......as a contraceptive method forÇ.years/Ç.months.Most recently stop using contraception before pregnancy forÇÇ.yrs./Ç.months.

Pregnancy History

PregnancyPregnancyPregnancyPregnancyPregnancy D/M/YD/M/YD/M/YD/M/YD/M/Ydelivery/delivery/delivery/delivery/delivery/abortionabortionabortionabortionabortion

Gesta-Gesta-Gesta-Gesta-Gesta-tionaltionaltionaltionaltional

age(wks)age(wks)age(wks)age(wks)age(wks)

Delivery/Delivery/Delivery/Delivery/Delivery/abortionabortionabortionabortionabortion

MethodMethodMethodMethodMethodofofofofof

delivery/delivery/delivery/delivery/delivery/abortionabortionabortionabortionabortion

Birth-Birth-Birth-Birth-Birth-weightweightweightweightweight

SexSexSexSexSex PlacePlacePlacePlacePlace of of of of of

delivery/delivery/delivery/delivery/delivery/abortionabortionabortionabortionabortion

Complica-Complica-Complica-Complica-Complica-tionstionstionstionstions

CurrentCurrentCurrentCurrentCurrentStatus ofStatus ofStatus ofStatus ofStatus ofinfantinfantinfantinfantinfant

1

2

3

4

5

6

Diabetes Hypertension Heart Disease Thyroid

Anemia Thalassemia Others................................History of surgeries ...................in the year........at.......................................Hospital

...................in the year........at.......................................HospitalHistory of drug allergy Name of the drug..........................Symptom.................................

Name of the drug..........................Symptom.................................History of illnesses and pregnancies of family members

Seizure Diabetes Hypertension Congenital anomaly

Multiple pregnancy Mental retardation Others....................History of menstruation cycle Regular/irregular menstruationÇÇÇand at everyÇ..days

History of Illnesses

4

(recorded by pregnant woman)Health History of Pregnant Woman and Family

PART 1: PREGNANCY

Past History

1. Stillbirth or neonatal death (first 1 month)

2. 3 consecutive abortions

3. Having baby with birth wieight < 2,500 g.

4. Having baby with birth wieight > 4,000 g.

5. Hospitalized for hypertension treatment during pregnancy or

toxemia of pregnancy

6. Undergone surgery of reproductive system organ such as

myoma, mypmecomy, cervical cerclage, etc.

Current History

7. Multifetal pregnancy

8. Age < 17 years (up to EDC)

9. Age > 35 years (up to EDC)

10. Rh Negative

11. Vaginal bleeding

12. Pelvic myoma

13. Diastolic pressure ≥90 mmHg

14. Diabetes

15. Kidney disease

16. Heart disease

17. Drug addiction, alcohol addiction

18. Other diseases of internal medicine such as anemia, thyroid,

SLE, tc. (please specify)..............................................................

ItemItemItemItemItem Criteria for AssessmentCriteria for AssessmentCriteria for AssessmentCriteria for AssessmentCriteria for Assessment NoNoNoNoNo YesYesYesYesYes

If any of the responses fall into çYesé, the new approach of pregnancy care is notIf any of the responses fall into çYesé, the new approach of pregnancy care is notIf any of the responses fall into çYesé, the new approach of pregnancy care is notIf any of the responses fall into çYesé, the new approach of pregnancy care is notIf any of the responses fall into çYesé, the new approach of pregnancy care is notapplicable to the pregnant woman and special care and/or additional assessmentapplicable to the pregnant woman and special care and/or additional assessmentapplicable to the pregnant woman and special care and/or additional assessmentapplicable to the pregnant woman and special care and/or additional assessmentapplicable to the pregnant woman and special care and/or additional assessmentshould be employed.should be employed.should be employed.should be employed.should be employed.

AssessorÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇ.ÇÇÇ.DateÇÇÇÇÇÇÇÇÇÇÇÇÇÇ

5

PART 1: PREGNANCY

Risk Assessment Criteria forPregnant Woman at the 1st ANC Visit

(assessed by health personnel)(assessed by health personnel)(assessed by health personnel)(assessed by health personnel)(assessed by health personnel)

History of Current Pregnancy

Pregnancy #........Last menstrual period.......................Expected due date.....................Weight before pregnancy.......kg. Height.......cms. BMI before pregnancy.................Number of C/S.......Number of living children.........Age of the last child........yrs.......months

Laboratory Test■ STIs (VDRL) 1st time Date...................... Result.......................

2nd time Date...................... Result.......................■ Blood test for HBsAg 1st time Date...................... Result.......................■ Blood test for Hematocrit 1st time Date...................... Result.......................

2nd time Date...................... Result.......................■ Screening for Thalassemia (Wife) Date......................

Result OF............DCIP..............MCV..............(Husband) Date......................

Result OF............DCIP..............MCV..............■ Blood group and (Wife) Blood group......Rh......Hemoglobin type....

Hemoglobin type (Husband) Blood group......Rh......Hemoglobin type....■ Other examination results...........................................................................................■ Couple counseling Pre-blood test Date......................

Pre-blood test Date......................■ Participation in parental school activities 1st time at gestational age............months

2nd time at gestational age............months

6

(recorded by health personnel)

PART 1: PREGNANCY

Tetanus Toxoid Vaccination(Recorded by health personnel)

Received vaccination before pregnancy..............times.Date of most recent vaccination.......................................................................................

Vaccination is not given for this pregnancy as the 3rd dose was given no morethan 10 years or with previous tetanus vaccinations for 5 times.1st Dose, date.............................................................................................................2nd Dose, date............................................................................................................Booster Dose, date......................................................................................................

Stories and tales promote your child's intelligence with the sense of morality

Diabetes screening..............................................................................................................

Record of Pregnancy ExaminationResult of U/S exam, day....................................BPD.......................................FL.............................Fetal position......................Gestational age.............

Corrected EDC...................By LMP PV U/S Ut SizeGA............wks Sign...............Date..................

Date

of

Exam

Weight

Kg.

Blood

Pressure

mm.Hg.

Size of

Uterure

(cm.)

Fetal

position/

presentation

Fetal

heart

sound

Fetal

movement

Gestational

age (wks.)

General physical

exam and risks

assessment

Diagnosis and

Treatment

Appointment Officer

Place

Urine ExamBacteria/

Protein/Sugar


Other special exam...............................................................................................................

87

.............................................................................................................................................................................................................................................................................................

PART 1: PREGNANCY PART 1: PREGNANCY

1. Check classifying form, no high risks

2. Check weight, height, blood pressure

3. General physical examination

4. Urine exam (Multiple dipstick) for protein, sugar,

asymptomatic bacteria

5. Transfer to the doctor for lung and heart

sounds exam

6. Pelvic exam (may postpone to the 2nd visit)

7. Test for Hb/Hct/OF/DCIP (every gestational age)

and test for VDRL, Anti HIV, blood gr, Rhtyping,

HbsAgr

8. Give the 1st dose of tetanus toxoid vaccine

9. Give iron and/or folic, and iodine supplementation

10.Give advice in case of emergency with

abnormal signs, with telephone number for

emergency contact

22222ndndndndnd Visit, Date..........................................(20 weeks) Visit, Date..........................................(20 weeks) Visit, Date..........................................(20 weeks) Visit, Date..........................................(20 weeks) Visit, Date..........................................(20 weeks)

1. Check weight, blood pressure

2. Pelvic exam (in case not performed at the 1st

visit)

3. Ultrasound exam (if applicable)

4. Give iron, iodine, calcium supplementation

5. Give the 2nd dose of tetanus toxoid vaccine

(at least 1 month interval of the 1st dose)

6. Give post-test counseling for the blood result

and abnormal signs, with telephone number for

emergency contact

Checklists of Service Inclusion by Gestational Age

<12 20 26 32 38

1. Check weight, blood pressure

2. Test urine for protein, sugar

3. General physical examination, check for anemia,

edema

4. Pregnancy exam, estimate gestational age,

measure uterine height, Listen to fetal heart

sound

5. Give iron, iodine, calcium supplementation

through the pregnancy period

6. Advice mother to observe fetal movement

7. Give advice in case of emergency with

abnormal signs, with telephone number for

emergency contact

44444ththththth Visit, Date...........................................(32 weeks) Visit, Date...........................................(32 weeks) Visit, Date...........................................(32 weeks) Visit, Date...........................................(32 weeks) Visit, Date...........................................(32 weeks)

1. Test for Hb/Hct, VDRL. Anti HIV

2. Give advice about delivery, breastfeeding plan,

contraception

55555ththththth Visit, Date............................................(38 weeks) Visit, Date............................................(38 weeks) Visit, Date............................................(38 weeks) Visit, Date............................................(38 weeks) Visit, Date............................................(38 weeks)

1. Check fetal position, if breech presentation,

refer to ECV or CS

2. Record in ANC booklet, remind of bringing it

along when coming for delivery

3. If delivery does not occur at 41 weeks of

gestation, give advice to come to the hospital

Checklists of Service Inclusion by Gestational Age

WeeksWeeksWeeksWeeksWeeks11111ststststst Visit, Date Visit, Date Visit, Date Visit, Date Visit, DateÇÇÇÇ.........(should be before 12 weeks)(should be before 12 weeks)(should be before 12 weeks)(should be before 12 weeks)(should be before 12 weeks)

<12 20 26 32 38

WeeksWeeksWeeksWeeksWeeks33333ndndndndnd Visit, Date Visit, Date Visit, Date Visit, Date Visit, DateÇÇÇÇ.........(should be before 26 weeks)(should be before 26 weeks)(should be before 26 weeks)(should be before 26 weeks)(should be before 26 weeks)

109


PART 1: PREGNANCY PART 1: PREGNANCY


Source : WHOûs guide to new approach of pregnancy care practice.

Uterine Height Graph

Figure 4 : Uterine height values by weeks of gestation


Gestational Age

11

PART 1: PREGNANCY

20 21 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 4122101214

1618

202224

26283032

3436

3840

101214

1618

202224

26283032

3436

3840

Uterin

e he

ight (cm

.)

Record of oral health exam at ANC visit Record of oral health service at prenatal

ë Tooth decay Yes(number....) No.

ë Ginggivitis Yes No.

ë Calculus Yes No.

Examiner .............................................Date of Exam ......./........./.......

Teaching on oral gem control

Number of fillng teeth..................Number of removing teeth ...............Scaling

Attendant .....................................Date of Exam......../............./..........

Oral Health Exam

Talk to the baby in your womb everyday to create your baby.


Date Morning(time)

Daytime(time)

Beforebedtime(time)

Date Morning(time)

Daytime(time)

Beforebedtime(time)

12345678910111213141516

171819202122232425262728293031

12

1. Counting fetal movement is to prevent fetal death possibly occurs especiallyin the mothers with complications such as diabetes, hypertension, toxemia ofpregnancy, approaching or beyond the due date of delivery.

2. Begin to observe and count the frequencies of fetal movement from 6 monthsof gestational age up until delivery.

3. Observe fetal movement everyday and record at least 3 times a day.4. Observe fetal movement when you are free from work such as after a meal,

before bedtime, or getting up in the morning, etc.5. Fetal movement is when you feel your baby moves in your abdomen, if you

only feel abdominal tense or your baby stretches up, it is not considered afetal movement.

6. If you are doubtful, not understand or unable to do so, consult your doctor ornurse immediately.

7. During 1 hour of observation, you should feel fetal movement at least 3times, if not or less than 3 times in 1 hour, see your doctor or nurse promptlyfor additional exam such as to check fetal heart rate with modern device.

MonthÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇ

Fetal Movement Count(Recorded by pregnant woman)

PART 1: PREGNANCY

13

Date Morning(time)

Daytime(time)

Beforebedtime(time)

Date Morning(time)

Daytime(time)

Beforebedtime(time)

12345678910111213141516

171819202122232425262728293031


Date Morning(time)

Daytime(time)

Beforebedtime(time)

Date Morning(time)

Daytime(time)

Beforebedtime(time)

12345678910111213141516

171819202122232425262728293031


When your baby moves 1 time, mark / in the gridmore then 3 /// should be marked in 1 hour of observation

PART 1: PREGNANCY

Record of Fetal Movement Count(continued)MonthÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇÇ

Date Morning(time)

Daytime(time)

Beforebedtime(time)

Date Morning(time)

Daytime(time)

Beforebedtime(time)

12345678910111213141516

171819202122232425262728293031

Abnormal signs during pregnancy to be promptly seenAbnormal signs during pregnancy to be promptly seenAbnormal signs during pregnancy to be promptly seenAbnormal signs during pregnancy to be promptly seenAbnormal signs during pregnancy to be promptly seenby the doctor or health personnelby the doctor or health personnelby the doctor or health personnelby the doctor or health personnelby the doctor or health personnel

■ Headache, blurred vision ■ Vaginal bleeding

■ Stomachache, abdominal pain ■ Fluid from vagina

■ Vaginal discharge ■ Less fetal movement

■ Irritable bowel Syndrome ■ convulsions and coma

■ Fever

14

PART 1: PREGNANCY

Maternal Delivery Record (record by health personnel

Abnormal signs during postpartum period to be promptly seenAbnormal signs during postpartum period to be promptly seenAbnormal signs during postpartum period to be promptly seenAbnormal signs during postpartum period to be promptly seenAbnormal signs during postpartum period to be promptly seenby the doctor or health personnelby the doctor or health personnelby the doctor or health personnelby the doctor or health personnelby the doctor or health personnel

■ Postpartum hemorrhage, blood clot ■ Uretritis, obstructed urine, retention■ High fever for 2 days of urine■ Lochia with foul smell, turbid, or ■ Perineum pain, edema, or broken

red color for more than 2 weeks wound■ Sore nipples or mastitis

Place of deliveryPlace of deliveryPlace of deliveryPlace of deliveryPlace of delivery.......................................bybybybyby( ) Doctor ( ) Nurse( ) Others (specify)...................................................................................

Gestational ageGestational ageGestational ageGestational ageGestational age...........................weeksweeksweeksweeksweeks Mode of deliveryMode of deliveryMode of deliveryMode of deliveryMode of delivery...............................Intrapartum complicationIntrapartum complicationIntrapartum complicationIntrapartum complicationIntrapartum complication

Yes (specify) No .............................................................Postpartum complicationPostpartum complicationPostpartum complicationPostpartum complicationPostpartum complication

Yes (specify) No .............................................................

Record of Postpartum Check-up

Date ofexam

BloodPressure

Levelof

Uterus

Lochia Breastand

Nipple

Flow ofBreast-milk

Hygiene ofUmbilical

cord

Name ofexaminer

Postpartum Check-up: Week 1 › 2, at least 1 time

Week 6, at least 1 time

15

Postpartum check-up, safe motherhood

PART 1: PREGNANCY

16

Record of the Newborn (recorded by health personnel)

Date/month/year of birth..........................Sex.............Birth-weight................grams

Length...................................cms. Head circumference.................................cms.

Apgar Score (1 minute)................................... (5 minutes)....................................Congenital anomaly Yes (specify).............................................................

No

Health condition at birth Healthy Abnormal (specify)..........................Date of hospital discharge.................Weight at the date of discharge.................Vitamin K injection Yes No

Newborn screening Date............................................- Thyroid deficiency Normal Abnormal

- PKU Normal Abnormal

■ Jaundice ■ Refuse suckling■ Raised body temperature, fever, ■ No urination within 24 hrs.

drowsiness■ Rapid breathing over 60 breaths/minute or difficult breasting■ Swelling, redness, leaking pus at the umbilicus, eyes or skin■ Diarrhea and/or vomiting

The newborn should be promptly seen by the doctor orThe newborn should be promptly seen by the doctor orThe newborn should be promptly seen by the doctor orThe newborn should be promptly seen by the doctor orThe newborn should be promptly seen by the doctor orhealth personnel if displays the following abnormal signshealth personnel if displays the following abnormal signshealth personnel if displays the following abnormal signshealth personnel if displays the following abnormal signshealth personnel if displays the following abnormal signs

PART 1: PREGNANCY

Yellow stool is normal in a child.

If your child had white or pale yellow stool as in the picture below,bring your child to the doctor promptly as he or she may have liver or

bile duct disease that needed to be treated before 2 months old.

PART 2: CHILD CAREAssessment of Risks in Mother and Newborn

(prior to hospital discharge) (recorded by health personnel)

Maternal HistoryMaternal HistoryMaternal HistoryMaternal HistoryMaternal History YesYesYesYesYes NoNoNoNoNo UncertainUncertainUncertainUncertainUncertain UnknownUnknownUnknownUnknownUnknown1. Risk group for 6-month exclusive

breastfeeding2. History of illness effecting child

raising3. Less than 17 years of age4. Father or mother or relative

raising the child alone.5. Blood test

- HBsAg+6. History of a genetic disease about

hearing7. BMI < 18.5 before pregnancy8. Malnutrition from 20 weeks of

gestation and beyond9. Other risk conditions

Additional detailsAdditional detailsAdditional detailsAdditional detailsAdditional detailsItem 1Item 1Item 1Item 1Item 1. Risk group for 6 ›month exclusive breastfeeding refers to the mothers

with abnormal nipples/working outside the home.Item 2Item 2Item 2Item 2Item 2. History of illness effecting child raising refers to requirement of regular

medication or mental illness.Item 9Item 9Item 9Item 9Item 9. Other risk conditions such as undesirable pregnancy, tobacco, alcohol,

and substance uses, etc.

17

PART 2: CHILD CARE

18

Child HistoryChild HistoryChild HistoryChild HistoryChild History YesYesYesYesYes NoNoNoNoNo UncertainUncertainUncertainUncertainUncertain UnknownUnknownUnknownUnknownUnknown

1. Premature birth (gestational age

< 37 weeks)

2. Birth-weigh < 2,500 grams.

3. Hypoglycemia

4. Hyperbilirubinemia

5. Birth Asphyxia at 5 mins ≤ 4 andwith complication

6. Sepsis

7. Convulsion, Meningitis

8. Difficulties in suckling-swallowing,

poor suckling

9. Down Syndrome

10.Congenital Anomaly (as determined

by the doctor)

11.Anemia Central Hct < 40% (at < 7

days of age)

12.Others (specify)..................................

Family historyFamily historyFamily historyFamily historyFamily history- History of genetic diseases, hearing,

mental retardation in the family

PART 2: CHILD CARE

RemarksRemarksRemarksRemarksRemarks If with more than 1 risk, indicating the high risk case, make an

appointment to see the doctor at 1 month old.If none of risks, make an appointment at 2 months old at well-baby clinic.

19

PART 2: CHILD CARE

Oral Health Record for Children Aged 6 Months-5 Years(recorded by health personnel)

Age

D/M/Y of CheckupHaving sweetenmilk

Using Bottlefeeding

Having sweetTime/day

Brushing teetheveryday byparents

Using fluoridetoothpaste

Having plaque

Initial stage oftooth aecay

Having toothcavities(number)Advice toothTreatment

6months

9months

1year

11/2 year

2year

21/2 year

3year

4year

5year

Attendant

Source : Bureau of Dental Health, Department of Health

20

YesYesYesYesYes NoNoNoNoNo

■ Child development

Stares at faces

Follows objects with eyes along the body midline

Makes sound (ask)

Lifts head (ask)

■ Food and nutrition

Exclusive breast-milk

■ Record of parents about the child and problems

that require counseling

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

Consult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel if the child tends to exhibit poordevelopment or any of the following signs.

■ At 3 months, no eye contact, no smiling back, no head lifting when lyingon stomach

■ Red or inflamed umbilicus■ Self rolling over before 3 months, may due to tight muscle

PART 2: CHILD CARE

Strat having your breastmilk pressed and kept in the fridge, when your child is 1 month old.

Child Development at 1 Month Old (± 7 Days)(recorded by parents or caregiver)

21

Service Activities for Children at 1 Month Old (± 7 Days)(Recorded by health personnel)

Date of examination............................................Weight............. kg. Length............ cm. Head circumference.........cm.

Nutritional status

.................................................................................................................

.................................................................................................................Check physical appearance, eyes, ears, mouth, heart, abdomen, sexualorgan, legs, arms, anterior fontanelle, posterior fontanelle (check

thoroughly), if not possible to complete all, check for the heart sound.

Additional check with the childûs development in case with doubts.

.................................................................................................................

.................................................................................................................Problems with child raising and health (ask from the caregiver) include:

.................................................................................................................Parental school arrangement Yes No

Advices given:

How to use MCH handbook

Exclusive breastfeeding

Food for mothers

Promoting child development in subsequent ages

Accident prevention............................................................................Refrain the child from wearing gloves, sucking finger, using pacifier,

traditional medicine, throat paint.

Others .............................................Referral in case of abnormalities and for care and treatment

No Yes, specify......................................

PART 2: CHILD CARE

Do not use bottle milk supplementation with an idea that you have lessbreastmilk because our body can produce sufficient milk supply for the baby.

Supplemrnted bottle milk will affect lower amount of breastmilkand eventually dried up.

22

Child Development at 2 Months Old (± 7 Days)(recorded by parents or caregiver)



Social smile (ask)

Follows through with eyes along the body midline

Babbles (ask)

Lifts the head 45



■ Record of parents about the child and problems

that require counseling

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

Consult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel if the child tends to exhibit poor

development or any of the following signs.

■ At 3 months, no eye contact, no smiling back, no head lifting in prone

position

■ Red or inflamed umbilicus

■ Self rolling over before 3 months, may be due to tight muscle

PART 2: CHILD CARE

Teach the caregiver to feed the baby with your breastmilk by drinking from the glass.

23

Service Activities for Children at 2 Months Old (± 7 Days)(Recorded by health personnel)


Nutritional status

.................................................................................................................

.................................................................................................................Check physical appearance, eyes, ears, mouth, heart, abdomen, sexualorgan, legs, arms, anterior fontanelle, posterior fontanelle (check thor-

oughly), if not possible to complete all, check for the heart sound.

.................................................................................................................Additional check with the childûs development in case with doubts.

.................................................................................................................


.................................................................................................................

.................................................................................................................Parental school arrangement Yes No

Advices given:


Exclusive breastfeeding

Food for mothers


Accident prevention suckling as drowning, scald.

Refrain the child from wearing mittens, sucking finger, using pacifier,

traditional medicine, throat paint.

Others ..........................................Referral in case of abnormalities and for care and treatment

No Yes, specify......................................

PART 2: CHILD CARE

Do not use false nipple or let the child suck finger as he or she will stick to it and it ishard to give up in the future, and your child may develop malocclusion and flatulence.

24

Child Development at 4 Months Old (± 15 Days)

(recorded by parents or caregiver)



Looks at his/her own hands (ask)

Follows objects with eyes at 180

Makes cooing sound (ask)

Lifts upper chest when lying on stomach



■ Record of parents about the child and problems that require counseling

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

Consult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel if the child tends to exhibits poor

development or any of the following signs.

■ At 4-5 months, does not lit the head, unable to grasp things.

PART 2: CHILD CARE

Prevent the child from falling out of bed as he or she begins to turn over and crawl.

25

Service Activities for Children at 4 Months Old (±15 Days)(Recorded by health personnel)


Nutritional status

.................................................................................................................

.................................................................................................................Physical check-up (If with doubts, check thoroughly)

.................................................................................................................


.................................................................................................................

.................................................................................................................Problems with child raising and health.

.................................................................................................................

.................................................................................................................Advices given:


Breast-milk and food at ≥ 6 months


Reading pictorial books with the child

No use of baby walker

Accident prevention such as drowning and scald.

Refrain the child from wearing gloves, sucking finger,

using pacifier, and baby walker.

Referral in case of abnormalities and for care and treatment

No Yes, specify......................................

PART 2: CHILD CARE

The child begins to turn over and talk, parents should frequently talk, smile,and play with the child.

26

Child Development at 6 Months Old (± 15 Days)(recorded by parents or caregiver)



Gets things to feed him/herself (ask)

Follows falling objects with eyes

Turns toward the calling voice

Holds head steady not flop


Breast-milk

Other food include.................................................................................


...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

Consult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel if the child tends to exhibits poordevelopment or the child displays any of the following signs.

■ At 6 months, does not follow objects with eyes, does not turn towardAt 6 months, does not follow objects with eyes, does not turn towardAt 6 months, does not follow objects with eyes, does not turn towardAt 6 months, does not follow objects with eyes, does not turn towardAt 6 months, does not follow objects with eyes, does not turn toward

voice, does not pay attention to the one who plays with, does not rollvoice, does not pay attention to the one who plays with, does not rollvoice, does not pay attention to the one who plays with, does not rollvoice, does not pay attention to the one who plays with, does not rollvoice, does not pay attention to the one who plays with, does not rollover in either front to back or back to frontover in either front to back or back to frontover in either front to back or back to frontover in either front to back or back to frontover in either front to back or back to front.

PART 2: CHILD CARE

Do not use baby walker as it induces the child ùs delayed walking andeasily falls from the high.

27

Service Activities for Children at 6 Months Old (± 15 Days)(Recorded by health personnel)

Date of examination............................................Weight............. kg. Length............ cm. Head circumference.........cm.Nutritional status.................................................................................................................The values of Hematocrit or Hemoglobin..................................................(Test performed when the child wasÇÇ.Çmonths)Check physical appearance, eyes, ears, mouth, heart, lung, abdomen, sexualorgan, legs, arms, skin.If time is not allowed, check for cross-eyes, tight muscles, and hearing..................................................................................................................Additional check with the childûs development in case with doubts..................................................................................................................Problems with child raising and health (ask from the caregiver) include:.................................................................................................................Giving iron supplementation Yes NoParental school arrangement Yes NoAdvices given:

How to use MCH handbookBreast-milk and age appropriate foodPromoting child development in subsequent agesReading pictorial books with the child, playing with the childAccident prevention such as drowning, electric shock, scald, aspirationNo use of baby-walkerOral health careTry to avoid feeding the baby after bedtime during 8.00 pm.-6.00 amand never put the baby to bed with breastfeeding

Referral in case of abnormalities and for care and treatmentNo Yes, specify ............................

PART 2: CHILD CARE

Watch out for the childûs domestic drowning,turn over water bucket and basin after use.

28

Child Development at 9 Months Old (±15 Days)(recorded by parents or caregiver)



Waives hands to bye bye (ask)

Holds a cube in each hand

Copies talking voices (ask)

Sits up (ask)


Breast-milk

Other food include................................................................................

Number of meals per day...........................................................meals


...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

Do not use baby walker as it frequently cause accidentsand the child may walk on tiptoe.

Consult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel if the child tends toexhibit poor development or the child displays any of thefollowing signs.

■ Stretched and tense legs when creeping and crawlingor sitting in W position.

■ At 9-10 months, does not turn toward the actual noise.

PART 2: CHILD CARE

Service Activities for Children at 9 Months Old (±15 Days)(Recorded by health personnel)


Nutritional status

...............................................................................................................Physical check-up (If with doubts, check thoroughly)

...............................................................................................................Dental check-up



.................................................................................................................

.................................................................................................................Giving iron supplementation Yes No

Advices given:


Breast-milk and 2 meals of food for ages


Reading pictorial books with the child, and plying with the childAccident prevention such as drowning, electric shock, scald, aspiration

Dental health care

No milk feeding after bedtime

No use of baby-walker

No watching T.V., CD, DVD until 2 years old


No Yes, specify....................................

29

Never let the child play with small toy less then 2 cm. as the child may putit into the month and be choked by it.

PART 2: CHILD CARE

Child Development at 12 Month Old (±15 Days)(recorded by parents or caregiver)



Expresses the need (ask)

Puts a cube in a container

Says meaningful words Pa-Ma (ask)

Says 1 meaningful word (ask)


Breast-milk

Other food include..................................................................................

Eat snack food Yes No


...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

Consult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel if the child tends to exhibit poor

developmentany or the child displays any of the following signs.

■ At 1 year, unable to walk holding on to something, unable to feed him/herself with fingers, unable to imitate posture or voice, unable to say asingle word.

30

Telling stories for your child everyday or at least 3 time a week.

PART 2: CHILD CARE

Service Activities for Children at 12 Month Old (±15 Days)(Recorded by health personnel)


Nutritional status

...............................................................................................................Check physical appearance, eyes, ears, mouth, heart, lung, abdomen,

legs, arms, skin, if not possible to complete all, check the heart, abdomen,

interior fontanelle.

...............................................................................................................Oral and dental check-up (advice given by dental officer)


.................................................................................................................Autism screening Normal Suspicious

Problems with child raising and health (ask form the caregiver) include:


Parental school arrangement Yes No

Advices given:


Giving the child 3 meals, continuing breastfeeding, no milk feeding

after going to bed.


Reading pictorial books with the child, and playing with the child

Accident prevention such as drowning, electric shock, scald, aspiration

No watching T.V., CD, DVD until 2 years old

Effects of television on the child


No Yes, specify.....................................

31

PART 2: CHILD CARE

Initiate the potty training and give up disposable diapers.

Child Development at 18 Months Old (±1 Month)(recorded by parents or caregiver)



Uses spoon to feed him/herself

Follows objects with eyes along the body midline

Makes sound (ask)

Lifts the head (ask)




...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

Consult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel ifConsult the doctor or health personnel if your 18-month-old child tends toexhibits poor developmentany or cannot follow simple instructions such as sayingor cannot follow simple instructions such as sayingor cannot follow simple instructions such as sayingor cannot follow simple instructions such as sayingor cannot follow simple instructions such as sayinghello, walking toward the mother.hello, walking toward the mother.hello, walking toward the mother.hello, walking toward the mother.hello, walking toward the mother.

32

Raise and play with your child on gender suitability, The father shouldparticipate in raising the child especially the son.

PART 2: CHILD CARE

Service Activities for Children at 18 Month Old (±1 Month)(Recorded by health personnel)


Nutritional status

...............................................................................................................Physical check-up especially the anterior fontanelle (if with doubts, check

thoroughly)

...............................................................................................................Additional check with the childûs development in case with doubts.

.................................................................................................................Problems with child raising and health problems (ask from the caregiver)

include:

Giving iron supplementation Yes No

Advices given:


Giving the child 3 meals, continuing breastfeeding, no milk feeding

after going to bed, allowing the child for food self-feeding.



Accident prevention such as drowning, electric shock, scald, aspiration,

falling over the high.

Caring for the childûs teeth twice a day in the morning and before

bedtime

Toilet training, give up disposable diapers.

No watching T.V./CD/DVD until the child is 2 years old

Effects of television on the child


No Yes, specify......................................

33

Train the child to help with easy household chores such as collecting toys,sweeping the floor.

PART 2: CHILD CARE

Child Development at 2 Years Old (±1 Month)(recorded by parents or caregiver)



Removes clothes (ask)

Stacks 4 cubes

Points at 6 parts of body organs

Says 2 words together (ask)

Throws a ball


Food intake........................................................................................

Number of meal per day.............................................................meals

Eating crunchy/crispy snacks Yes No

Having soft drinks Yes No


...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

Consult the doctor or health personnel if your 2-year-old child tends to exhibitpoor development or cannot speak 2 meaningful words together.

34

Teach the child about morality such as thoughtfulness, making merit,giving alms to monks, praying to the Lord Buddha,

telling stories teaching moral and ethics.

PART 2: CHILD CARE

Service Activities for Children at 2 Years Old (±1 Month)(Recorded by health personnel)


Nutritional status

...............................................................................................................Physical check-up (if with doubts, check thoroughly)

...............................................................................................................Additional check with the childûs development in case with doubts.

...............................................................................................................Problems with child raising and health, and behavioral problems



Advices given:


Giving the child 3 meals, allowing the child for food self feeding, and

drinking milk from the glass or box about 2-3 times/day.



Accident prevention such as electric shock, scald, aspiration by food

particles, falling from the stairs.Allowing the child to watch T.V. no more than 1 hour/dayToilet training, give up disposable diapers.Participation in religious activities.


No Yes, specify..................................

35

Do not allow your child to play computer games,and parents do not play them in presence of the child.

PART 2: CHILD CARE

Child Development at 3 Years Old (± 1 Mounth)(record by parents or caregiver)



Puts on T-shirt by him/herself (ask)

Stacks 8 cubes

Knows at least 2 adjectives

Stands on one leg for 1 second

Imitates in drawing a vertical line


Food intake........................................................................................

Number of meal per day..........................................................meals




...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

Consult the doctor or health personnel if your child tends to exhibit poor

development or delayed development for age.

■ Cannot follow simple instruction.

36

Parents play good role model without drinking alcohol, smoking, gambling,insulting, using domestic violence.

PART 2: CHILD CARE



Nutritional status

.................................................................................................................Physical check-up (if with doubts, check thoroughly)


.................................................................................................................Autism screening result

.................................................................................................................Emotional intelligence screening result

.................................................................................................................Problems with child raising and health, and behavioral problems


Advices given:


Giving the child 3 meals, no crispy and crunchy snacks and soda

drinks.



Teaching the child to help him/herself.

Teaching the child to collect the toys every time after playing them.

Participation in religious activities.

Accident prevention such as electric shock, scald, aspiration by food

particles, falling from the stairs.

Allowing the child to watch T.V. no more than 1 hour/day.


No Yes, specify......................................

37

PART 2: CHILD CARE

Do not allow your child to eat candies, soft drinks, crispy/crunchy snacks as theyare less nutritious, and cause tooth decay, feeling full and refusing to eat.

Child Development at 4 Years Old (±1 Month)(recorded by parents or caregiver)



Dresses by him/herself (ask)

Copies a picture

Tells 4 colors

Stands on one leg for 3 seconds

Copies a circle


Food intake........................................................................................

Number of meal per day...............................................................meals




...............................................................................................................

...............................................................................................................

...............................................................................................................

...............................................................................................................

Consult the doctor or health personnel if your child exhibits delayed developmentor nutritional disorder or tends to have poor development.

38

Train your child to do more things every by him/herself such as putting onclothes, scooping rice, putting the dish into the basin, washing his/her dish,

cleaning up the bedroom.

PART 2: CHILD CARE


Date of examination............................................Weight............. kg. Length............ cm. Head circumference.........cm.Nutritional status.................................................................................................................Physical check-up (if with doubts, check thoroughly).................................................................................................................Urine examEye examHearing examCheck blood pressureEmotional intelligence screening................................................................Additional check with the childûs development in case with doubts.................................................................................................................Problems with child raising and health, behavioral problems.................................................................................................................Parental school arrangement Yes NoAdvices given:

How to use MCH handbookGiving the child 3 meals and 2 boxes of milk per day, no soda drinksand crispy and crunchy snacks.Promoting child development in subsequent agesReading pictorial books with the child, and playing with the childAccident prevention such as drowning, electric shock, scald, falling

from the high, domestic toxicants.Allowing the child to watch T.V. no more than 1 › 2 hours per day.Effects of television on the child

Referral in case of abnormalities and for care and treatmentNo Yes, specif.................................

39

Teach Your child about disciplines such as eating on regular time,reading and doing homework on regular time everyday.

PART 2: CHILD CARE

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PART 2: CHILD CARE

42

Guide to the Use of Child Nutritional Graph(can be recorded by parents or guardian)

Child nutritional graph is used to continuously monitor the change of childûs weightand height whether the trends of childûs growth follow the standard criteria. Thegraphs are presented in 3 types:

1.Weight for age graph1.Weight for age graph1.Weight for age graph1.Weight for age graph1.Weight for age graph presents 5 levels of growth status:1)1)1)1)1) Under standard weight refers to having malnutritionUnder standard weight refers to having malnutritionUnder standard weight refers to having malnutritionUnder standard weight refers to having malnutritionUnder standard weight refers to having malnutrition.2)2)2)2)2) Relatively low weight refers to risk of having malnutritionRelatively low weight refers to risk of having malnutritionRelatively low weight refers to risk of having malnutritionRelatively low weight refers to risk of having malnutritionRelatively low weight refers to risk of having malnutrition, a warning sign,

if without appropriate care, overweight for age is likely.3)3)3)3)3) Standard weight refers to well growthStandard weight refers to well growthStandard weight refers to well growthStandard weight refers to well growthStandard weight refers to well growth. It should be promoted to maintain

the weight at this level.4)4)4)4)4) Relatively high weight: refers to risk of having over standard weightRelatively high weight: refers to risk of having over standard weightRelatively high weight: refers to risk of having over standard weightRelatively high weight: refers to risk of having over standard weightRelatively high weight: refers to risk of having over standard weight. It

should be check against the weight for height graph.5)5)5)5)5) Over standard weight does not identify whether the child is obeseOver standard weight does not identify whether the child is obeseOver standard weight does not identify whether the child is obeseOver standard weight does not identify whether the child is obeseOver standard weight does not identify whether the child is obese. It needs

to check for obesity against the weight for height graph.2. Height for age graph presents 5 levels of growth status2. Height for age graph presents 5 levels of growth status2. Height for age graph presents 5 levels of growth status2. Height for age graph presents 5 levels of growth status2. Height for age graph presents 5 levels of growth status:

1)1)1)1)1) Short refers to having chronic malnutritionShort refers to having chronic malnutritionShort refers to having chronic malnutritionShort refers to having chronic malnutritionShort refers to having chronic malnutrition, reflecting inadequate food in-take for a prolonged period or frequent illnesses, with minor or no increase of height,affecting low intelligence, more frequent illnesses. It requires immediate improvement.

2)2)2)2)2) Relatively short refers to risk of having chronic malnutritionRelatively short refers to risk of having chronic malnutritionRelatively short refers to risk of having chronic malnutritionRelatively short refers to risk of having chronic malnutritionRelatively short refers to risk of having chronic malnutrition, a warning sign,if without appropriate care, the height discontinues and the child is likely to becomeshort.

3)3)3)3)3) Standard height refers to well growthStandard height refers to well growthStandard height refers to well growthStandard height refers to well growthStandard height refers to well growth, reflecting adequate food intake, soit should be promoted to contiue at this level.

4)4)4)4)4) Relatively tall refers to very well growthRelatively tall refers to very well growthRelatively tall refers to very well growthRelatively tall refers to very well growthRelatively tall refers to very well growth. It should be promoted to maintainat this level.

5)5)5)5)5) Over standard age refers to excellent growthOver standard age refers to excellent growthOver standard age refers to excellent growthOver standard age refers to excellent growthOver standard age refers to excellent growth. It should be promoted tocontinue at this level.

3.3.3.3.3. Weight for height graphWeight for height graphWeight for height graphWeight for height graphWeight for height graph represents 6 levels of growth status:1)1)1)1)1) Thin refers to having short term malnutritionThin refers to having short term malnutritionThin refers to having short term malnutritionThin refers to having short term malnutritionThin refers to having short term malnutrition2)2)2)2)2) Relatively thin refers to risk of having malnutritionRelatively thin refers to risk of having malnutritionRelatively thin refers to risk of having malnutritionRelatively thin refers to risk of having malnutritionRelatively thin refers to risk of having malnutrition, a warning sign, if

without appropriate care, the weight will not increase or decrease to the thin level.3)3)3)3)3) Proportionate refers to well growthProportionate refers to well growthProportionate refers to well growthProportionate refers to well growthProportionate refers to well growth, reflecting appropriate weight for height.

The child should be promoted to continue at this level of growth.4)4)4)4)4) Moderate refers to risk of having obesityModerate refers to risk of having obesityModerate refers to risk of having obesityModerate refers to risk of having obesityModerate refers to risk of having obesity, a warning sign, if without

appropriate care, the weight will increase to the level of initiating fat.5)5)5)5)5) Initiating fat refers to the first degree of obesityInitiating fat refers to the first degree of obesityInitiating fat refers to the first degree of obesityInitiating fat refers to the first degree of obesityInitiating fat refers to the first degree of obesity. The child is likely to

become a fat adult in the future if without weight control.6)6)6)6)6) Fat refers to the second degree of obesityFat refers to the second degree of obesityFat refers to the second degree of obesityFat refers to the second degree of obesityFat refers to the second degree of obesity. The child has highly inappro-

priate weight for height, with risk opportunity to having diabetes, hypertension,hyperlipidemia, bowlegs, sleep apnea, and become even fatter adult in the future ifwithout weight control.

PART 2: CHILD CARE

4443

PART 2: CHILD CAREPART 2: CHILD CARE

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PART 3

ESSENTIAL KNOWLEDGE

FOR SAFE AND QUALITY PREGNANCY

■ Discomforts during pregnancy■ Maternal practices during pregnancy■ Minimum weight for pregnant women to give birth to a newborn of

2,500 grams. (VALLOP WEIGHT LOG)■ Self care during pregnancy through pregnancy pathway■ Minimum weight for pregnant women to give birth to a newborn of

>2,500 gram.■ Advantage of the nutritional graph■ Nutritional graph for pregnant woman■ Nutrition for pregnant woman: Table for comparison of percentage

of standard BMI values (BMI 21 = 100)■ Illustration of sets of food exchange for pregnant woman■ Fetal development■ Thalassemia■ Risk opportunity to have a child with thalassemia■ What is congenital hypothyroidism?■ Prevention of mother-to-child transmission of HIV■ Family planning■ Self assessment and analysis of stress

55

PART 3 ESSENTIAL KNOWLEDGE FOR SAFE AND QUALITY PREGNANCY

Morning sicknessMorning sicknessMorning sicknessMorning sicknessMorning sickness is commonly experienced in early period of pregnancy,with nausea and vomiting in the morning. The symptoms can be improved bymental adjustment, avoiding unfavorable food, eating small meal each time butseveral times, or having soft food and warm drinks. The symptoms willdisappear at 4 months of gestation.

Vaginal dischargeVaginal dischargeVaginal dischargeVaginal dischargeVaginal discharge will commonly increase during pregnancy. Take a usualbath, except if accompanied with itching and smelling, see the doctor.

ConstipationConstipationConstipationConstipationConstipation is found in some pregnant women and can be lessen bydrinking more water and eating more vegetables and fruits, if not improved,see the doctor.

Frequent urinationFrequent urinationFrequent urinationFrequent urinationFrequent urination is caused by the expansion of uterus which places morepressure on the bladder. If experiencing burning pain or obstructed urinating,see the doctor.

Fatigue and drowsinessFatigue and drowsinessFatigue and drowsinessFatigue and drowsinessFatigue and drowsiness is common early in pregnancy with feeling tired andsleepy.

Varicose veinsVaricose veinsVaricose veinsVaricose veinsVaricose veins usually disappear after delivery. Always change your gestureproperly, avoid long period of walking or standing, sit with your feet elevatedfor 15 › 20 minutes every day after walking or working, use legs support hoseto provide compression.

Stretch MasksStretch MasksStretch MasksStretch MasksStretch Masks should be applied gently with cream, avoid scratching.PigmentationPigmentationPigmentationPigmentationPigmentation or darken skin is due to the change of hormone. Try to avoid

sunlight. It will be faded after delivery.HeartburnHeartburnHeartburnHeartburnHeartburn is caused by the stomach acid refluxing into the esophagus, and

delayed functioning of digestive system. Consult the doctor for the use of

antacid.

Discomforts During Pregnancy

56

PART 3 ESSENTIAL KNOWLEDGE FOR SAFE AND QUALITY PREGNANCY