outpatient pediatrics. Cheat sheet: briefly, the most important

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Lecture notes, cheat sheets
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outpatient pediatrics. Cheat sheet: briefly, the most important

Lecture notes, cheat sheets

Directory / Lecture notes, cheat sheets

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Table of contents

Structure and organization of work of the pediatric department
The structure of the children's city polyclinic
The structure of the children's city polyclinic. First aid room and pediatric room
Antenatal protection of the fetus
neonatal period. First care for a newborn
Second patronage for a newborn
Third patronage for a newborn
Features of monitoring and rehabilitation of premature and post-term newborns
Goals, objectives, work program of the school for young parents
Risk factors for morbidity in children
Observation of the child in the postnatal period
Recommendations for care, milestone epicrisis
Observation of children of the early childhood period
Preparing a child for admission to a DDU (children's preschool institution)
Supervision of children of preschool age in the clinic
Determining the degree of functional readiness of children to enter school
Observation of school-age children in the clinic
The work of a pediatrician in a school
Organization and conduct of preventive vaccinations
Essential Vaccines
Contraindications for prophylactic vaccinations. Post-vaccination reactions and complications
Disability
rehabilitation process. Physiotherapy treatments
Stages of rehabilitation. Application of mineral water
Stages of rehabilitation. Secondary prevention
esophagitis
Duodenitis. Gastroduodenitis
Enteritis. Colitis (enterocolitis)
pancreatitis
Diseases of the biliary system
chronic hepatitis
Establishment of disability for children with diseases of the digestive system. Gastritis
Hypotrophy. Obesity
diathesis
Rickets. Spasmophilia
Congenital heart defects. congenital carditis
Acquired carditis
Rheumatism
arterial hypertension. Arterial hypotension
Hemorrhagic vasculitis (Schonlein-Genoch disease). Nodular periocteritis
Disability of children with diseases of the circulatory system. Rehabilitation of patients with heart failure
Juvenile rheumatoid arthritis. Systemic lupus erythematosus
Systemic sclerosis. Dermatomyositis
Acute glomerulonephritis
Chronic glomerulonephritis
pyelonephritis
urinary tract infection
Urolithiasis disease. Rapidly progressive glomerulonephritis. Disability of children with diseases of the urinary system
Железодефицитная анемия
hemolytic anemia. Hemophilia
Thrombocytopenic purpura
Leukemia. Disability of children with blood diseases
Bronchitis
chronic pneumonia
Alveolitis. Disability of children with diseases of the respiratory system
Bronchial asthma

1. Structure and organization of work of the pediatric department

Pediatric ward - provides medical and preventive care to children in the clinic, and at home. This system creates optimal opportunities for continuous monitoring of children by the same doctor and nurse, makes it possible to accurately assess the development and health of the child in dynamics, taking into account the conditions in which he lives and is brought up.

Goals of the local pediatrician: work to reduce morbidity and mortality in children of all ages; carry out activities aimed at creating optimal conditions for the physical, mental, sexual and immunological development of the child; carry out specific and non-specific prophylaxis.

Tasks of the local pediatrician:

1) ensuring contacts and continuity in work with doctors of the antenatal clinic for monitoring pregnant women, especially those at risk;

2) visiting newborns in the first 3 days after discharge from the maternity hospital;

3) admission of healthy children in the clinic, assessment of their physical and mental development, the appointment of rational nutrition, recommendations for specific and non-specific prevention of rickets, malnutrition, obesity, anemia;

4) organization at home and in the clinic of preventive monitoring of children;

5) drawing up a plan of vaccination work and monitoring its implementation, carrying out, together with other specialists, the rehabilitation of registered children;

6) organizing the examination and rehabilitation of children before they enter preschool institutions and schools;

7) visits to the parents of children at home in case of their illness, the provision of drug and physiotherapy care, exercise therapy, if necessary, active monitoring of the patient at home until his recovery, hospitalization or permission to visit the clinic;

8) sending children for treatment to a hospital, if necessary, taking all measures for emergency hospitalization of the patient;

9) informing the management of the polyclinic about cases when, for some reason, a seriously ill child remains non-hospitalized;

10) timely and in the prescribed manner informing about the detection of an infectious disease or suspicion of it, comprehensive prevention of infectious diseases;

11) selection and appropriate accounting of children in need of sanatorium and resort treatment for health reasons.

The doctor and nurse working at the pediatric site carry out planned sanitary and educational work with the child's parents, promote a healthy lifestyle, explain the harm of alcoholism and smoking in families.

The polyclinic organizes the work of the necessary specialists: an otolaryngologist, a surgeon, an oculist, a neuropathologist, a cardiorheumatologist, and a dentist.

2. The structure of the children's city polyclinic

In a children's city polyclinic, there should be provided: a filter with a separate entrance, an isolation room with a box, a reception desk, a wardrobe, offices (pediatricians, doctors of narrow specialties, medical and diagnostic, first-aid appointments, for raising a healthy child, X-ray, physiotherapy, procedural, vaccination , physical therapy, massage, social and legal assistance, statistics), laboratory, administrative part, other auxiliary premises.

A special stand should contain up-to-date information on cases of infectious diseases and quarantine periods in preschool institutions and schools, which allows you to quickly implement anti-epidemic measures.

Registry task - ensure the mutually coordinated activities of all departments.

On weekends and holidays, doctors on duty work at the polyclinic, who conduct outpatient appointments and provide home calls.

Doctor's house calls, transmitted by phone, during a personal visit to the registry or in the order of self-registration, are entered in the record book of doctor's house calls, separate for each section. When accepting a call to the house, the registrar necessarily specifies the patient's condition, main complaints, body temperature. He immediately informs the district pediatrician about cases of a serious condition, in the absence of the latter - to the head of the outpatient department or the head of the outpatient clinic.

Parents should know that a doctor should be called to the house in case of an acute infectious disease or suspicion of it, in a serious condition of the patient, in case of a primary disease, on an asset per child discharged from the hospital, in the presence of contact with an infectious patient.

Healthy child's office - a structural subdivision of the children's polyclinic - plays the role of a methodological center for preventive work among young children.

The main task of the healthy child's office is to teach young mothers theoretical knowledge and practical skills on care, upbringing, developmental features of healthy children of early and preschool age.

Of the visual aids, stands are needed that contain information about the nutrition and regimen of a pregnant woman and a nursing mother, prevention of hypogalactia, prenatal care, daily routine, indicators of physical development, age-related massage and gymnastics complexes, methods of hardening children in the first three years of life.

In the office of a healthy child, local pediatricians receive healthy children of the first year of life. Here it is advisable to organize group appointments for children of the same age or with the same deviations in health.

When the doctor accepts the second child, the nurse of the office teaches the mother of the first examined baby how to massage and gymnastics, gives her instructions, and the district nurse prepares the next patient for the reception.

After receiving the last of the children invited for a group examination, the doctor conducts a conversation with mothers about the upbringing of children of this age or with this type of deviation in health.

The office is working on the prevention of rickets.

3. The structure of the children's city polyclinic. First aid room and pediatric room

Pediatric cabinet placed in a room isolated from noise with sufficient lighting, good ventilation and uniform air temperature. The office is equipped with a table for the doctor, chairs, a changing table for examining young children and a couch for examining older children, a sink with hot and cold water, a height meter, and baby scales. It should have a small table for medical instruments, a spatula, a centimeter tape, toys.

Currently, the task of a pediatrician is to conduct preventive conversations among low-income and socially disadvantaged families about hygiene standards and care rules, as well as raising children of different age groups.

The most relevant topics of sanitary propaganda for the local pediatrician, depending on the age of the child:

1) rules for care, rational feeding, a set of measures for hardening, prevention of rickets - for parents with infants;

2) observance of the daily routine, methods of hardening measures, prevention of acute respiratory diseases, specific prevention of childhood infections - for parents of children of younger and older toddlers;

3) instilling personal hygiene skills, hardening methods and hygienic gymnastics, prevention of acute childhood infections, allergic and infectious-allergic diseases, childhood injuries - for parents with children of preschool age;

4) prevention of posture disorders, myopia, rheumatism and other infectious-allergic diseases, neuroses, issues of sexual education - for parents with school-age children, teachers and schoolchildren themselves.

In sanitary and educational work on hygienic education, the organization of schools for young mothers, fatherhood schools, and public universities for parents at preschool institutions is widely practiced.

Particular attention in matters of hygienic discipline should be given to children who have already suffered serious illnesses and are in remission.

Dieting, limiting physical activity, physiotherapy exercises and moderate hardening procedures prevent relapses. In these cases, one should not neglect conversations with the child himself, explaining to him the need for these temporary measures, preventing unforeseen psychological breakdowns.

First aid cabinet is an independent structural unit and reports to the senior nurse of the polyclinic.

Children and their parents turn to it for control feeding, treatment of microtraumas, issuance of certificates on the epidemiological situation in their place of residence, departure to children's sanatoriums and summer health facilities.

Anthropometric measurements, determination of body temperature and blood pressure in children before examination by a pediatrician are also carried out in the first aid room.

4. Antenatal protection of the fetus

After the pregnant woman is registered in the antenatal clinic, the information is transferred by phone to the children's clinic and recorded in a special journal.

First prenatal care to a pregnant woman is carried out by the district nurse of the children's polyclinic. The purpose of patronage is to collect an anamnesis and instruct the expectant mother.

When taking an anamnesis, it is necessary to pay attention to 3 groups of prenatal risk factors:

1) socio-biological;

2) obstetric and gynecological (including complications of pregnancy and the condition of the fetus);

3) extragenital diseases of the mother.

To assess the degree of risk, a scale of significance of prenatal risk factors is used.

The high-risk group includes pregnant women with a total assessment of prenatal risk factors of 10 points or more, medium risk - 5-9 points, low - up to 4 points. Over time, the low-risk group, as a rule, decreases by childbirth, while the middle and high-risk group increases. It is also necessary to pay attention to heredity, the moral and psychological climate in the family, to find out whether this pregnancy is desirable or accidental.

The briefing deals with healthy lifestyle issues and the possibility of reducing the identified risk factors. The nurse invites future parents to the "School of a young mother", which operates in the department of a healthy child.

The information received and these recommendations are carefully recorded in the history of the child's development (f. No. 112) under the heading "First prenatal care". The district doctor gets acquainted with the results of patronage, if necessary, visits a pregnant woman at home.

The second antenatal care is carried out at the 31-38th week of pregnancy by the district nurse. Its main goals are to verify the implementation of previously given recommendations, re-evaluate risk factors and prepare for the postpartum period.

When collecting an anamnesis, the nurse re-evaluates prenatal risk factors, clarifies information about heredity and the moral and psychological climate in the family, readiness to raise a child.

The briefing includes questions such as:

1) breastfeeding (advantages over artificial feeding);

2) organization of a zone for servicing a child;

3) acquisition of a dowry for a newborn;

4) the purchase of a first-aid kit for mother and child, which should contain: sterile cotton wool and bandages, baby powder and cream, potassium permanganate, 5% iodine solution, furatsilin tablets, vaseline oil, 1% aqueous solution of brilliant green, rubber heating pad, children's enema No. 3, gas tube, thermometer for measuring body temperature and water thermometer, pipettes;

5) information about the phone numbers of the polyclinic and pediatric emergency care;

6) conversations with the expectant mother and other family members, preparing for the birth of the child.

5. Neonatal period. First care for a newborn

After the newborn is discharged from the maternity hospital, information is transferred by phone to the children's clinic, where the full name of the mother, the address and date of birth of the child are recorded in the newborn visit log. During the first three days after discharge from the maternity hospital, the district doctor and the nurse nurse perform the first patronage of the newborn. Children with risk factors, congenital anomalies and diseases, premature or overdue children, as well as the first child in the family, should be examined on the first day after discharge from the maternity hospital.

Anamnesis includes the collection of social, biological and genealogical information. The exchange card contains information about pregnancy and childbirth, the state of the child at birth (Apgar score), the main parameters of physical development (body weight, body length, head and chest circumference), health group and risk group.

An objective examination is carried out according to the systems: skin, posture, head, chest, abdomen, genitals, limbs, nervous and mental development

Parents are instructed on child care, feeding and upbringing.

Recommendations for care. The crib should be placed in a bright place in the room, but not in a draft. The newborn is placed in the crib on its side, without a pillow.

Bathing is done daily in a special baby bath, which is not used for washing diapers or baby clothes. Duration of bathing - 10 min. It is good to add decoctions of herbs (sequence, chamomile) to the water. The child should be gradually immersed in water, wrapped in a diaper, so as not to cause anxiety.

Morning toilet - every morning after the first feeding, the child is washed with a cotton swab moistened with warm boiled water, eyes - from the outer corner to the inner, with a separate swab for each eye. The nose is cleaned with cotton turundas moistened with vaseline oil.

Swaddling is an important aspect of newborn care. Recommend free and wide swaddling. For free swaddling, the child is put on a vest with sewn-in sleeves. Legs are wrapped in a blanket.

Proper feeding of a newborn ensures its timely harmonious development and forms immunity. Attaching the baby to the breast immediately after birth stimulates lactopoiesis. It is necessary to explain to the mother the advantages of breastfeeding and to recommend breastfeeding at the request of the child during the period of lactation.

In the absence of women's milk, its substitutes can be prescribed - mixtures adapted to women's milk.

From the first days of life, the baby needs the correct daily routine (alternation in time of basic physiological needs: sleep, wakefulness, nutrition, walking, hygiene and hardening measures). This contributes to the formation of a certain rhythm of life.

At the first visit of a newborn, it is necessary to tell the mother about conditions that require urgent medical attention, and to tell where to go for help with illnesses.

6. Second patronage for a newborn

The second patronage for the newborn is carried out on the 14th day of the child's life. His goal - re-examination of the newborn by organs and systems to determine the state of health, monitoring the implementation of recommendations, answers to the mother's questions in connection with the problems that have arisen, briefing.

When collecting an anamnesis, it is necessary to clarify the issues of feeding, daily routine, and behavior of the newborn.

An objective examination is carried out in stages.

It is necessary to evaluate how the child is gaining weight. If there are regurgitation, then the mother should be explained that children under 1 year old have physiological insufficiency in the work of the sphincter apparatus of the gastrointestinal tract.

When swallowing air during feeding, the child should be held vertically for 10 minutes after feeding. If regurgitation is persistent, constant, there is vomiting in a fountain, the child is not gaining weight well, then it must be examined in a hospital.

From the age of two weeks, children may experience cramping abdominal pain (colic), which is due to the adaptation of the gastrointestinal tract to new living conditions. This is manifested by the sudden anxiety of the child.

The mother is obliged to report such symptoms to the local doctor, who evaluates whether these changes are functional abnormalities or are caused by organic pathology.

The mother is instructed on the importance of massage and gymnastics for the newborn. Massage and gymnastics are connected to hardening and recreational activities.

The main methods of massage are stroking, rubbing, kneading, tapping, vibration. At the initial stages, the massage should be light; of all the techniques, stroking is used mainly, as it helps to relax the muscles.

First exercise: the child lies on his back, the mother allows him to grab his thumbs with his hands, then spreads the newborn's arms to the sides and brings them together, crossing them on his chest. The exercise helps to relax the muscles of the chest and shoulder girdle.

The second exercise: the child lies on his back, the mother raises his arms above his head and lowers him down through the sides. Exercise relaxes the muscles of the shoulder girdle, upper limbs.

The third exercise: the child lies on his back, the mother takes him by the shins and gently bends his knees to his stomach, then unbends his legs. Exercise relaxes the muscles of the legs, helps the child free the intestines from gases.

The fourth exercise: the child lies on his stomach, the mother props up the child's feet with her hands, this makes the baby straighten his legs and crawl forward (reflex crawling). Exercise promotes the development of the muscles of the legs, arms and back.

For the upbringing and development of the visual concentration of the newborn, toys are hung above the crib at a distance of 40-50 cm from the face.

7. Third patronage for a newborn

The third patronage for a newborn is carried out on the 21st day of the child's life. His goals - observation in dynamics of the state of health and conditions of development of the newborn, feeding, conducting sanitary and educational work, treatment of identified developmental abnormalities.

When examining a newborn, it is necessary to pay attention to his behavior, well-being, reaction to the environment. In dynamics, indicators of body weight, height, head circumference, chest, the state of the large fontanel are evaluated.

On the oral mucosa there may be thrush with defects in child care. A newborn in the third week of life can already fix his gaze, respond with positive emotions to an affectionate appeal to him.

The skin is normally elastic, velvety, pink, clean. In the presence of pustules, treatment at home is necessary with a satisfactory condition of the child and the possibility of good care.

In a state of moderate severity or an unfavorable sanitary and cultural level in the family, the district doctor gives a referral for examination and treatment in a hospital.

The umbilical region should be epithelialized by the 21st day of a child's life. With purulent discharge from the umbilical wound, hyperemia around the navel, the child should be sent to the hospital.

To determine the condition of the newborn, the doctor re-evaluates the unconditioned physiological reflexes (Babkin, sucking, grasping, automatic gait, crawling), performs percussion and auscultation of the lungs, heart, and palpation of the abdomen.

Briefing. Then the doctor clarifies in a conversation with the mother the nature of the physiological functions of the child, gives recommendations on feeding and caring for the newborn, and answers questions that she had during the third week of the child's life.

During the third patronage, you should tell your mother about rickets in children and prepare her for the need to prevent this disease, inform her about the importance of ultraviolet rays, vitamin D for the life of the body and write out a prescription for purchasing an oil solution of vitamin D at a pharmacy in a prophylactic dose of 450 IU / day.

It is necessary to talk about deficiency anemia in children, the importance of breastfeeding and the prevention of anemia. The doctor discusses with the mother the issues of hardening the child's body and strengthening its resistance, introduces the method of teaching swimming.

At the end of the conversation, the district doctor invites the mother and child to an appointment at the clinic when the baby is one month old, brings to the attention of the schedule of work of the district doctor and specialists, and informs about the day of a healthy child.

By the end of the neonatal period, the district doctor must make a forecast of the child's health for the first year of life. Some children of risk groups can be removed from dispensary observation and from the second month they can be observed in the same way as healthy children.

8. Features of observation and rehabilitation of premature and post-term newborns

All premature and post-term newborns are at risk. They require increased attention of the local doctor: the first patronage for them is carried out the next day after discharge from the maternity hospital or hospital (departments of the I and II stages of nursing), as they need special care due to their weakness.

When collecting an anamnesis, it is necessary, if possible, to establish the etiological factors that led to the birth of a premature or overdue child, since the volume of rehabilitation measures depends on this.

An objective examination should be aware of the functional characteristics of premature babies. On the part of the nervous system, a syndrome of depression, a weak cry, a decrease in muscle tone, physiological reflexes, and imperfection of thermoregulation are characteristic.

Caring for premature babies is an extremely difficult task. To preserve their vital activity, it is necessary to create special conditions for care and feeding.

Feeding premature babies presents significant challenges. Due to the small capacity of the stomach, such children are recommended frequent feeding in small portions. For a premature baby, breastfeeding is especially important, since the secretion of its own digestive enzymes is not enough. Breastfeeding compensates for the low level of humoral immunity of the premature and nonspecific protective factors. The risk of developing anemia of prematurity with breastfeeding is lower. For artificial feeding, adapted mixtures can be used.

All premature babies are examined by a neuropathologist, otolaryngologist, ophthalmologist in the first month of life. If violations of the central nervous system, musculoskeletal system, hearing, visual impairment are detected, premature babies are under the supervision of a specialist of the appropriate profile.

Among postterm newborns, morbidity and mortality are also significantly higher than among full-term infants. They often have asphyxia, birth trauma of the central nervous system, aspiration syndrome, pyoderma, acute respiratory diseases, mental retardation, a tendency to overweight, viscerovegetative disorders (irritability, regurgitation, constipation, dyskinesia of the gastrointestinal tract).

The rehabilitation program, as in premature babies, is compiled on an individual basis in accordance with the identified risk factors.

Taking into account the propensity of post-term newborns to overweight, it is recommended to increase the number of feedings (7 instead of 6), but reduce the single amount of food in the first months of life. With severe dryness of the skin, its peeling, hygienic baths, softening and nourishing the skin, have a good effect.

9. Goals, objectives, work program of the school for young parents

The purpose of the school for young parents - involvement of future parents in the conscious and full participation in the upbringing of a healthy child.

Task The school of young parents is to expand the knowledge of parents on raising a healthy child through health education:

1) teaching parents how to care for a newborn child;

2) training in the method of natural feeding;

3) training in daily routines;

4) teaching methods of physical education (organization of bathing, gymnastics, massage, tempering procedures);

5) preparation of the mammary glands of the mother for feeding the newborn;

6) promotion of natural feeding;

7) recommendations on the daily routine and nutrition of a pregnant and lactating mother;

8) recommendations to future parents on organizing a healthy lifestyle;

9) recommendations for the prevention of health disorders of young parents;

10) measures to improve the health of future parents;

11) recommendation of relevant literature, issuance of leaflets, watching videos.

Work program schools of future parents includes the following points.

1. Measures to improve the health of expectant mothers and fathers:

1) registration of girls in the service region;

2) rehabilitation of girls who are registered with a dispensary for any disease, including treatment in day hospitals and sanatorium-and-spa treatment;

3) rehabilitation of young and future parents of chronic foci of infection;

4) giving a course of lectures to young parents on a specific program;

5) improving the quality and efficiency of monitoring socially disadvantaged families.

2. Activities to train young parents in the skills of caring for a newborn:

1) conducting preventive classes with future parents in the office of a healthy child for the care of newborns and small children;

2) training young parents in the technology of preparing baby food;

3) recommendations for young parents on organizing a home microstadium;

4) rehabilitation of children from risk groups for ENT diseases and orthopedic pathology.

3. Forecasting the health of the unborn child and organizing preventive measures in accordance with the risk group.

10. Risk factors for morbidity in children

Risk factors for health disorders during the period of social adaptation and the risk of increased incidence of acute respiratory viral infections:

1) the age of the mother is over 30 years;

2) mother's bad habits;

3) extragenital pathology of the mother;

4) pathology of pregnancy and childbirth;

5) toxoplasmosis and other latent infections in the mother and fetus;

6) acute infections of the mother at the end of pregnancy and during childbirth;

7) asphyxia of a newborn;

8) prematurity;

9) large fruit;

10) unsatisfactory living conditions;

11) III, IV, V groups of child health.

Risk factors for developing pathology:

1) mother's bad habits;

2) extragenital pathology of the mother;

3) SARS and other bacterial infections, especially transferred at the end of pregnancy and in childbirth;

4) mental retardation of the mother;

5) history of miscarriages, stillbirths, multiple pregnancies, infertility;

6) occupational hazards;

7) mother's age up to 16 years and over 40 years;

8) pathology of pregnancy and childbirth;

9) narrow pelvis;

10) toxicosis of the first half of pregnancy;

11) polyhydramnios;

12) pathology of the placenta;

13) intrauterine fetal hypoxia;

14) 4th pregnancy or more;

15) the period between previous and present births is 1 year or less;

16) weakness of labor activity;

17) premature detachment of the placenta;

18) use of obstetric methods of childbirth;

19) entanglement of the umbilical cord;

20) immunological incompatibility of blood of mother and fetus;

21) prematurity;

22) asphyxia of a newborn;

23) the child's body weight is 4 kg or more;

24) children with a stigmatization level of 5 points or more.

Newborn social risk groups:

1) children from socially disadvantaged families;

2) children from incomplete families;

3) children from large families;

4) children from families with a low level of material security;

5) children whose parents are students.

11. Observation of the child in the postnatal period

In the first year of life the local doctor monthly examines the child in the clinic. The examination includes the collection of anamnesis, an objective examination, instruction and registration of information in the history of the child's development (form No. 112).

When collecting an anamnesis, it is necessary to pay attention to the psychological climate in the family after the birth of the child, issues of feeding, care and upbringing.

During an objective examination, physical development is assessed by the method of centile characteristics, neuropsychic development along the lines of development. Particular attention should be paid to the proportionality and harmony of development, the formation of motor activity.

The small fontanel usually closes in the second month of life, the large fontanel - by 16 months. Unconditioned reflexes gradually disappear by 3 months of age. Cooing and babbling by 4-6 months acquires an emotional coloring (requirement, discontent), by the first year the child can speak simple words.

In the first year of life, congenital malformations of internal organs, congenital malformations of the heart, kidneys, central nervous system, digestive organs, lungs, hereditary metabolic disorders can be detected. If noise is detected in the heart area, it is necessary to appoint a consultation with a cardiologist, ultrasound, ECG, FCG.

Abdominal examination often reveals an umbilical hernia. In boys, when examining the genitals, dropsy of the testicle can be detected, which disappears in many by the end of the first year of life. By 3 months of age, the child should be examined by an orthopedist to rule out congenital dislocation of the hip.

Instructing parents concerns the issues of feeding, child care, education.

Feeding plays an important role in a child's development. During the first year of life, the child must receive breast milk.

In extreme cases, adapted milk formulas can be an alternative to it. However, by 5-6 months, when the growing needs of the child can no longer be met by an increase in the amount of breast milk or formula, complementary foods are introduced.

To adapt the child's gastrointestinal tract to a new type of food, complementary foods are introduced gradually over 2 weeks, starting with 5-10 ml and increasing its amount daily so that one feeding with breast milk is replaced by a new type of food. The next two weeks, the diet does not change.

At 6-7 months, a second complementary food is introduced, replacing it with another feeding with breast milk.

Complementary foods are a higher quality food than breast milk. It should be given before breastfeeding, while the baby is hungry.

Complementary foods should not be prescribed at an earlier date, as this may contribute to the further development of gastrointestinal diseases. Currently, there is a significant increase in erosive and ulcerative lesions of the stomach, duodenum.

By the time complementary foods are introduced, the baby's digestive organs should be sufficiently mature.

12. Recommendations for care, milestone epicrisis

An important role in the upbringing of a child is played by a rationally constructed daily routine, which takes into account the physiological capabilities of the baby and contributes to the active life of all its organs and systems.

It is an alternation in the time of feeding, sleep and wakefulness in accordance with the physiological capabilities of the child.

Properly selected daily routine helps the formation of the mental component of the child's personality. The unpredictability of behavior is replaced by the regularity of requirements already by 2 months of age. Timely reasonable satisfaction of the needs of the child develops attachment to parents, which manifests itself from the age of 3 months.

Wake time should be used for physical and mental development. For the purpose of harmonious physical development, special sets of exercises have been developed. Such activities are carried out by the mother with the child. It is better that they are performed at the same time of day and accompanied by positive emotions.

The physical and mental development of the child are closely interrelated. In the central nervous system, the centers of motor activity of the hands and speech are located nearby.

The main emotions of the child are associated with the desire for independence. Already in the second half of life, negativism and the spirit of contradiction appear. This may be the refusal of passive feeding from a spoon or an unwillingness to sit on the potty.

air hardening begin from the first days of a child's life during swaddling, airing, walking. In good summer weather, the child should be outside all day long. Babies fall asleep easily in the fresh air.

Water procedures dosed according to temperature and time. The impact of cold water on the skin contributes to the narrowing of the capillaries. Then their expansion occurs (the phase of active hyperemia). With prolonged exposure to cold, the capillary tone drops significantly, the skin becomes cyanotic, the number of heartbeats slows down, which is important to consider when monitoring hardening procedures.

The main methods of hardening with water are rubbing, dousing, showering and swimming. Hardening should begin with rubbing. Separate parts of the body are wiped with a flannel mitten soaked in water, then rubbed with a dry terry towel. Pouring is carried out from a jug. The shower affects the child's body by the difference in water temperature and massaging effect. When hardening with a shower and dousing, the water temperature can be reduced gradually or use a contrast method.

A staged epicrisis allows assessing the child's condition in dynamics, determining the effectiveness of ongoing recreational activities and identifying risk factors in the early stages of pathology development.

13. Observation of children of the early childhood period

In early childhood, the health of the child is monitored by the local doctor and the pediatrician of the preschool institution (DDU), if the child attends a children's group. In the second year of life, the doctor examines the child once a quarter, in the third year of life - once every six months. Examinations are carried out in the office of the district doctor of the children's polyclinic or in the doctor's office in the kindergarten.

When collecting an anamnesis, it is necessary to pay attention to the data of previous examinations, past diseases, childhood infections, information about vaccinations, allergic anamnesis, heredity, developmental abnormalities identified earlier.

An objective examination is carried out systematically. Particular attention is paid to the condition of the nasopharynx, since many children at this age often suffer from respiratory diseases with a protracted and recurrent course. The degree of hyperplasia and friability of the tonsils, nasal congestion, the presence of adenoids (the child breathes through the mouth) are revealed. At this age, children often have otitis media, which is due to the anatomical and physiological features of the structure of the ENT organs. You should pay attention to the order of teething and their number, caries can be detected.

When examining the legs, pay attention to the configuration of the arch of the foot to identify clubfoot.

The presence of noise over the region of the heart may be due to age-related features (the chest develops faster than the growth of the cardiovascular system occurs) or pathology.

When auscultating the lungs in children aged 3 to XNUMX years, puerile (close to hard) breathing is heard, which is due to the anatomical and physiological characteristics of the bronchopulmonary system.

Examination of the genital organs is carried out in each patient, and adrenogenital syndrome in boys can be detected - dropsy of the testicles, etc. If an adrenogenital syndrome is suspected, an endocrinologist is consulted. With dropsy of the testicles, surgical intervention is indicated by the age of 2.

Assessing neuropsychic development, the doctor pays attention to speech. At 1 year old, the child speaks simple words, and by 2-3 years old - sentences. At the request of the doctor, the child shows his eyes, mouth, fingers. Considering objects, the baby asks questions: "What is this?", "Why?", "When?", "Where?" At this age, children memorize simple verses and melodies well.

In the second year of life, the child begins to draw, by the age of two he adds blocks, plays hide and seek. Emotional experiences are improved: joy, resentment, love, fear. Easy suggestibility and obedience of the child are favorable for education.

Parent briefing concerns mainly the upbringing of the child.

You should accustom him to neatness: wash your face in the morning and evening, brush your teeth, wash your hands before eating.

Gymnastics classes are held in early childhood. In the second year of life, the child trains in walking, in the third year running and jumping are connected. In summer, exercises can be done outdoors, in the shade.

The body is trained by hardening.

14. Preparing a child for admission to a kindergarten (children's preschool institution)

Parents register the child in a children's team at the 2-3rd year of life. Admission to the kindergarten leads to a failure in adaptation, contributes to a decrease in immunological reactivity, which, under the conditions of new contacts, leads to infection and disease. The most common are acute respiratory diseases.

When preparing a child for admission to a kindergarten, he must be taught to communicate with new people. The child must eat and sleep on his own. The regime of the day is as close as possible to the regime of the day in the younger nursery group. General preparation activities relate to issues of care, physical and neuropsychic development, upbringing, hardening of the child.

Whole adaptation period divided into 3 stages: acute, subacute and compensation period. In the acute period, the emotional state changes, behavior is disturbed, sleep and appetite worsen, autonomic and hormonal changes occur. In the subacute period, the child actively learns a new environment, the biorhythms of various organs and systems are restored. Appetite normalizes faster, then sleep and emotions, and only then - the game and speech. During the period of compensation, systems and organs work in concert, which is manifested by positive emotions and balanced behavior.

According to the degree of severity, adaptation is light, moderate and severe. With mild adaptation, disturbances in behavior, appetite, sleep, communication, and speech activity last no more than a month. During the same period, functional deviations are normalized, diseases do not occur. With adaptation of moderate severity, the changes are more pronounced.

Sleep, appetite and motor activity are restored within a month, and speech activity - within two months. Functional deviations are expressed more clearly. ARI develops. Severe adaptation is noted for a significant duration - from 2 to 6 months, it can occur in two versions - recurrent acute respiratory infections or a neurotic state. Severe adaptation is a predictive test of a child's behavior in stressful situations, inappropriate behavior occurs in 90% of cases, such children are often registered with a psychoneurologist. Full adaptation of their state of health occurs in 1,5-2 years.

When a child enters a kindergarten, there must be documents: an extract from the history of the development of the child (detailed epicrisis), a certificate of the absence of contacts with infectious patients.

Scheduled preventive examinations of children conduct: for children 2-3 years old once a quarter, over 3 years old - once every six months. In-depth examinations of the pediatrician with the involvement of other specialists are carried out once a year (specialists go to the kindergarten).

The doctor of the kindergarten carries out anti-relapse and therapeutic measures. To increase the body's defenses, Eleutherococcus tincture, Echinacea, Estifan are prescribed. Sanitize the nasopharynx (UVI and UHF on the tonsils for children over 3 years old, inhalations, calendula, eucalyptus, rinsing the throat with sage solutions), prescribe vitamins.

Improving the system of preschool education makes it possible to improve the health of children and creates the prerequisites for teaching children at school.

15. Observation of preschool children in the clinic

Starting from preschool age, the child is observed by the local doctor once a year. When visiting a kindergarten, supervision is carried out by the pediatrician of this institution. In case of detection of deviations in the health of the child, they are sent for examination to the clinic.

During medical examinations, the district pediatrician evaluates the physical and mental development of the child, conducts a systematic examination, and also plans medical and educational activities.

For assessment of physical development study the anthropometric data of the child. Pay attention to the development of the spine, timely identify violations of posture, evaluate muscle development.

RџSЂRё assessment of mental development it is necessary to pay attention to the child's intellectual abilities, speech, memory, attention and thinking.

During this period, milk teeth are replaced by permanent ones. At the age of 5 years, the lower permanent incisors erupt, at 6 years old - the upper ones, at 5-8 years old - large molars. The skeletal system of children is richer in cartilage than adults.

The formation of physiological curves of the spine in the cervical, thoracic and lumbar regions continues throughout the entire preschool age. Incorrect body position in bed and when sitting at the table leads to a slight violation of posture. Uncomfortable shoes interfere with the correct formation of the arch of the child's foot.

In children of primary preschool age (4-5 years old), the extensor muscles are underdeveloped. As a result, the child often takes the wrong posture: head down, shoulders drawn together, stooped back. From this it follows that for the correct formation of posture, the state of the bone and muscle systems is important.

Education at this age is of particular importance, as the child is preparing for school. This requires significant changes in neuropsychic development, improvement of motor skills and hardening, strengthening of immunological reactivity.

For proper mental development, independence should be cultivated and the feeling of attachment to parents should be reduced if it is too developed in a child. Preparing for school, the child must painlessly part with his mother. It is necessary to develop in him the ability to control his desires, to behave in a balanced manner, to overcome the feeling of fear and separation. It is necessary to form the child's ability for collective games, communication with peers.

During classes, it is necessary to monitor the posture of the child and strengthen the muscles that hold the spine in the correct position.

With the development of motor activity, it is necessary to use more and more morning exercises, collective outdoor games.

You should teach the child to be neat: wash yourself in the morning, treat your clothes carefully, clean up after yourself after the game, wash your hands before eating, use a handkerchief, eat carefully.

At preschool age, a specific immune response to antigenic stimulation is formed. In frequently and long-term ill children, the formation of immunological reactivity is delayed and transient immune deficiency develops.

16. Determining the degree of functional readiness of children to enter school

К medical criteria for school maturity include a comprehensive assessment of the state of health (level of biological development, morbidity for the previous period, psychophysiological criteria). When issuing a medical opinion on readiness for learning, medical indications for postponing the education of children of 6 years of age should be taken into account.

Determination of the psychophysiological readiness of children to enter school is carried out in September-October of the year preceding the start of education.

Medical and Pedagogical Commission, including a psychologist, a pediatrician, and a teacher, identifies children who are not ready for learning.

Such children need special training, the effectiveness of which is determined in February-March of the year of admission to school during a repeated psychophysiological examination.

Psychophysiologically immature children stay for another year in kindergarten (in the kindergarten preparatory group). If the child has not previously attended kindergarten, he is assigned to a preparatory group for a year. The final decision of the medical and pedagogical commission is drawn up before the start of the academic year (in July-August).

Child's readiness for school considered at three levels.

First level - morphofunctional (physical development, resistance, neurodynamic properties, development of speech, muscles, performance).

Second level - mental readiness (perception, memory, thinking, imagination).

Third level - personal readiness (attitude towards school, educational and cognitive activity, peers and adults, the ability to build relationships, learn and implement moral standards).

Determination of psychophysiological maturity is carried out according to special diagnostic programs. They include a variety of tests that are constantly being improved and updated.

The modern diagnostic program includes an awareness questionnaire: full name, address, addition of phrases of the started sentence, motivational readiness (attitude towards school). They use tests in pictures, children are invited to play a game.

When conducting psychological research, they also evaluate the development of speech (stories from pictures), the level of self-regulation (according to various game methods), motor skills of the hand, and the level of physical fitness.

As a result of the survey, children are identified with a high level of psychophysiological development, with an average level (insufficient development of motivation and volitional qualities) and with a low level.

The further program of preparing the child for school is carried out by the teacher of the kindergarten group in a differentiated manner depending on the results of the survey. If necessary, specialists participate in the preparation of the child: a speech therapist, a psychologist, a pediatrician.

17. Observation of school-age children in the clinic

The school period is divided into junior school period (6-9 years old), middle school period (10-14 years old) and adolescence period (15-17 years old). A pediatrician works with junior and middle school age, and an adolescent doctor works with adolescents. Examination of school-age children is carried out during scheduled examinations with the invitation of specialists in accordance with the scheme of dynamic observation of healthy children. For a more thorough history taking, more frequent interviews of children should be conducted. Pay attention to past illnesses, behavioral patterns, rates of physical and mental development.

When examining organs and systems, the most attention is paid to the condition of the skin (there may be acne), the condition of the teeth (caries). It is necessary to assess the posture of the child and identify its violations in the early stages, and timely correction of visual impairment is also important.

Middle and senior school age is a period of significant hormonal changes in the body of a teenager, the period of puberty, which affects the state of all organs and systems. Obesity, hypothalamic syndrome, vegetovascular dystonia, hypertensive and hypotensive states should be identified and treated. This pathology often appears against the background of existing chronic foci of infection in the nasopharynx, biliary and urinary tract. It is necessary to assess the correct (in accordance with the sex and age of the child) development of secondary sexual characteristics.

To assess physical development, anthropometric data and motor skills are taken into account. When assessing neuropsychic development, academic performance, behavioral characteristics at school and at home, development of speech, memory, and independence in thinking are taken into account.

A system-by-system examination during puberty should be carried out especially carefully, since at this age, against the background of hormonal changes, adaptation often fails, which can cause changes in various organs and systems. It is mandatory for all children to assess the state of the thyroid gland, lymph nodes, respiratory organs, blood circulation, digestion and urination. Recommendations are made based on the survey data.

Recommendations for caring for a child include organizing a workplace for the learning process with good lighting and a comfortable position for correct posture. For physical education, you should purchase a sports suit and comfortable sports shoes.

During the school period, the children's team breaks up into groups. An important event in the life of a child is the appearance of a friend. The growing influence of peers can challenge family values.

The correct attitude of parents to the sexual education of the student is necessary. Such education is carried out in the form of unobtrusive conversations that arise by chance as the child shows interest.

18. The work of a pediatrician at school

The child is brought up with a negative attitude towards smoking, alcoholism and drug addiction, supporting negative emotions for bad habits.

This is opposed to a healthy lifestyle, orienting the child on the importance of maintaining his own health. Education of a healthy lifestyle cannot be carried out by order.

They educate and consolidate in the child a healthy interest in physical exercises in the fresh air, hobbies for sports, books, travel, organized leisure activities in their free time.

Puberty is accompanied by a transient immunodeficiency state. At this age, hardening procedures should be actively continued, a daily routine should be observed to exclude physical and psychological overload, multivitamins should be taken in spring and autumn, and chronic foci of infection should be sanitized in a timely manner.

Prevention of obesity, psychoneurosis, thyroid dysfunction should be carried out in a timely manner. Early diagnosis of gynecological pathology in girls, its treatment in the initial stages are important.

At school age, the improvement of motor functions continues. Physical exercises for speed (speed running, fast games, dressing, undressing, etc.) at 6-9 years old contribute to the development of high-speed processes in mental activity.

The school doctor works under the guidance and supervision of the head of the preschool and school department of the polyclinic.

В duties of a pediatrician includes:

1) timely medical examinations of children with a conclusion on the state of health, determination of a medical group for physical education and drawing up a plan of medical and recreational activities;

2) based on the analysis of medical examinations, the preparation of an action plan to improve the health of schoolchildren, which is considered by the pedagogical council, is approved by the head physician of the polyclinic and the director of the school;

3) implementation of medical control over physical education at school, working hours, labor training, catering, sanitary and hygienic and anti-epidemic measures;

4) carrying out work on the professional orientation of schoolchildren, taking into account their state of health, preparing materials for the commission on exempting students from transfer and final exams;

5) outpatient reception at school, provision of medical care to those in need;

6) conducting sanitary and educational work, prevention of injuries and their accounting;

7) observation of dispensary patients, their recovery.

19. Organization and conduct of preventive vaccinations

Vaccination work in the clinic is organized and carried out in accordance with the order, which approved the calendar of preventive vaccinations, instructions on the tactics of immunization, the main provisions on the organization and conduct of preventive vaccinations, a list of medical contraindications to immunization, the procedure for registering information about complications from vaccinations.

Preventive vaccinations should be carried out at the time set by the calendar. In case of their violation, the simultaneous administration of several vaccines is allowed, but in different parts of the body and with separate syringes.

With separate vaccinations, the minimum interval should be at least a month. If the vaccination against hepatitis B is not carried out on the same day as other vaccinations, then the interval between their administration is not regulated.

Preventive vaccinations are carried out in appropriately equipped vaccination rooms in polyclinics or other premises with strict observance of sanitary and hygienic requirements.

Vaccination room of the polyclinic should consist of rooms for vaccinations and storage of vaccination files and have a refrigerator for storing vaccination preparations, a cabinet for tools and a set of medicines for emergency and anti-shock therapy, boxes with sterile material, a changing table or a medical couch, a table for preparing vaccination preparations, a table for storage of medical records. The office should have instructions for the use of vaccinations and a reminder for emergency care.

To avoid contamination, it is forbidden to combine vaccinations against tuberculosis with vaccinations against other infections. It is forbidden to carry out vaccinations against tuberculosis and the Mantoux test at home.

Preventive vaccinations are carried out by medical workers trained in the rules of vaccination technique and emergency care.

Health workers are required to notify parents in advance about the day of preventive vaccinations. All persons to be vaccinated should be examined by a doctor or paramedic, taking into account the anamnesis (previous diseases, allergic reactions to vaccinations, drugs, food).

Immediately before vaccination, the child is examined and body temperature is measured to exclude an acute illness. A record of the vaccination performed is made in the working journal of the vaccination room, the history of the development of the child, the card of preventive vaccinations, the medical record of the child attending the children's institution, the register of preventive vaccinations. After vaccination and revaccination against tuberculosis, after 1, 3, 6, 12 months, the nature of the papule, scar, and the state of regional lymph nodes are recorded.

20. Essential vaccines

First vaccination carried out within 24 hours after the birth of the child. This is hepatitis B immunization.

The vaccine is administered intramuscularly into the deltoid muscle region of older children or into the anterolateral thigh region in newborns and young children.

As an exception, in patients with thrombocytopenia and other diseases of the blood coagulation system, the vaccine can be administered subcutaneously.

Second vaccination is carried out at the age of 1 month, the third - at 5 months, simultaneously with DTP and OPV. Premature babies weighing less than 2 kg are vaccinated from two months with similar intervals between vaccinations.

Primary vaccination against tuberculosis is carried out for newborns on the 3rd-4th day of life. The BCG vaccine is live dried bacteria of the BCG vaccine strain No. 1. One inoculation dose - 0,05 mg BCG - is dissolved in 0,1 ml of the solvent, injected intradermally at the border of the upper and middle third of the outer surface of the left shoulder.

Premature babies weighing less than 2 kg, as well as children not vaccinated in the maternity hospital for medical contraindications, are vaccinated at the clinic with BCG-M vaccine. Children older than two months, not vaccinated during the neonatal period, are vaccinated in the clinic after a tuberculin test with a negative result.

At the age of 7 years, children who have a negative reaction to the Mantoux test are subject to revaccination. The interval between the Mantoux test and revaccination should be at least 3 days and not more than 2 weeks.

Vaccination against poliomyelitis is carried out with a live polio oral vaccine containing attenuated strains of human poliomyelitis virus of three immunological types (I, II, III). The vaccine is available in the form of a solution and sweets.

Vaccination is carried out from three months three times with an interval between vaccinations of a month, revaccination - at 18 months, 24 months and 7 years once.

Vaccinations against diphtheria, whooping cough, tetanus are carried out with the DTP vaccine (adsorbed pertussis-diphtheria-tetanus vaccine), which consists of a mixture of phase I pertussis microbes killed with formalin or merthiolite, purified and concentrated diphtheria and tetanus toxoids adsorbed on aluminum hydroxide.

Vaccinations with DTP vaccine are carried out simultaneously with immunization against polio. Revaccination is carried out once every 18 months. Vaccinations against whooping cough are done from 3 months to 4 years. Children who have contraindications to DTP are vaccinated with ADS-anatoxin according to the scheme: vaccination - at 3 and 4 months, revaccination after 9-12 months.

The second revaccination (6 years) is carried out with ADS-antitoxin once, the third (11 years) - with ADS-M-anatoxin once. Children over 6 years old, not previously vaccinated, are vaccinated with ADS-M-toxoid: 2 vaccinations with an interval of a month, revaccination is carried out once after 9-12 months.

21. Contraindications to preventive vaccinations. Post-vaccination reactions and complications

Contraindication to all vaccinations there is a complication of the introduction of the previous dose of the drug - allergic edema that developed within 24 hours after vaccination, immediate anaphylactic reactions, encephalitis, convulsions.

Vaccinations are contraindicated in children with immunodeficiency, immunosuppression, malignant neoplasms.

Vaccines: BCG is contraindicated in premature babies weighing less than 2 kg, with regional lymphadenitis, regional abscess, keloid scar after a previous vaccination, history of tuberculous sepsis, generalized BCG infection.

There are no absolute contraindications for OPV. For DTP, contraindications are progressive diseases of the nervous system, uncontrolled epilepsy, infantile spasms, progressive encephalopathy.

There are no absolute contraindications for ADS, ADS-M, AD and AS, for ZhKV, ZHPV, Trimovax - an anaphylactic reaction to aminoglycosides and egg protein, for a monovaccine against rubella - an anaphylactic reaction to aminoglycosides, for a vaccine against hepatitis B - hypersensitivity to yeast and other components of the vaccine.

Post-vaccination reactions - these are changes in the functional state of the body that do not go beyond the physiological norm.

A strong general reaction consists in an increase in body temperature above 40 ° C, a strong local reaction in the appearance of an infiltrate at the injection site with a diameter of more than 8 cm or an infiltrate in the presence of lymphangitis with lymphadenitis.

Post-vaccination complication - a pathological condition of the body that develops after vaccination and, in its manifestations, goes beyond the physiological norm.

Complications include:

1) anaphylactic shock on DTP, ATP, ZhKV, which occurs within 24 hours after the introduction of the vaccine;

2) collaptoid state on DPT after 5-7 days from the introduction of the vaccine;

3) encephalopathy on the introduction of DTP, ATP in terms of 3 to 7 days;

4) residual convulsive state (an episode of convulsions at a temperature below 39 ° C, if they were absent before and repeated after vaccination) on DTP, ATP, AD-M within 3 days;

5) paralytic poliomyelitis on OPV up to 30 days in a vaccinated person, up to 6 months and later in an immunodeficient person, up to 75 days in a contact person;

6) after vaccination with tuberculosis - lymphadenitis, regional abscess, keloid scar and other complications that have arisen during the year;

7) chronic arthritis on "Trimovax", rubella vaccine within 42 days;

8) neuritis of the brachial nerve on DTP, ATP, AS, ATP-M and other vaccines in terms of 2 to 28 days.

22. Disability

According to WHO experts, life criteria are:

1. orientation;

2. communication;

3. self-service;

4. movement;

5. work activities;

6. control over their behavior;

7. training.

Life restriction is characterized by the absence of one or a combination of several of these criteria.

The restriction of the child's life activity is determined by a violation of the functions and is divided into three degrees: sharp, significant, pronounced.

Disability in a child - a state of persistent social maladjustment caused by the restriction of his life activity due to a violation of the functions of organs or their systems.

WHO experts have developed survival criteria that characterize disability:

1) orientation in the surrounding world;

2) physical independence;

3) mobility;

4) communication;

5) classes;

6) economic independence.

There are four degrees of limitation of survival criteria: insignificant, moderate, significant, sharp.

A minor degree is characterized by the possibility of complete compensation of the corresponding criterion when using assistive devices or with constant medication, as well as with a periodic disorder of this criterion.

A moderate degree is defined in cases of achieving partial compensation when using assistive devices or medications. A significant degree is observed in cases where the help of others is needed. A sharp degree of limitation requires constant assistance in a special institution. This is a person in need of social assistance and protection in connection with the restriction of his life due to the presence of any physical or mental disabilities.

An individual rehabilitation program is a document binding on the relevant state bodies, enterprises, institutions and organizations, regardless of their form of ownership.

The reason for the establishment of disability is not the disease or injury itself, but their consequences. The consequences can manifest themselves in the form of violations of any mental, physiological or anatomical structure or function, which in turn leads to a limitation of the life and social insufficiency of the child.

23. Rehabilitation process. Physiotherapy treatments

Rehabilitation - complete elimination of pathological changes in the child's body that caused the disease, and ensuring its further harmonious development. Rehabilitation differs from treatment in that it helps the patient to restore normal life activity in accordance with his age.

Goals of rehabilitation:

1) restoration of functions;

2) social rehabilitation;

3) professional activity, and in children - the ability to learn.

There are medical, social and labor rehabilitation.

medical rehabilitation provides a step-by-step treatment from the onset of the disease to the full restoration of health. Its tasks are to restore and compensate for the functional capabilities of the body.

To do this, with the help of psychotherapy, it is necessary to form an adequate attitude of the child to the disease, give him the necessary training, orient the disabled person or the patient with the help of psychological methods to restore health through their own training efforts, restore lost functions and learning abilities.

Social rehabilitation ensures the organization of the day regimen appropriate for the age and lifestyle of the child, the rules of care for close family members or the relevant staff of preschool or school institutions.

This type of rehabilitation forms in the child a conscious attitude towards himself in case of illness, a positive perception of the family and society. Social rehabilitation is aimed at providing social assistance and services for adaptation to the social sphere, providing auxiliary technical means, home care, material assistance, and, if necessary, education and training in specialized institutions.

Occupational rehabilitation is to prepare the child for the learning process, the assimilation of the school curriculum or the program of a preschool institution, to provide funds for education, career guidance, vocational training.

Physiotherapy treatments are selected taking into account the clinical manifestations of the disease, tolerability and effectiveness in this patient. In this case, electrical procedures can be used.

Under the influence of electric currents, a complex complex of both local and general body reactions occurs in the form of changes in blood circulation, metabolism, tissue trophism in a diseased organ, and others, which contributes to the disappearance of the inflammatory process.

For therapeutic purposes, electrotherapy methods include galvanization, pulsed electrotherapy, and high-frequency electrotherapy.

Sanitation of foci of chronic infection is carried out at all stages of rehabilitation by conservative methods, but at the sanatorium stage, surgical methods can also be used against the background of appropriate drug treatment.

24. Stages of rehabilitation. Application of mineral water

Early rehabilitation provides for improving the results of treatment, restoring the functionality of the diseased organ and body. It is carried out in the period of acute manifestations of the disease in a hospital or clinic, and is the preparation of the whole organism for the next stage.

late recovery, or the sanatorium stage, consists in the complete elimination of pathological changes, the restoration of the possibility of the physical and mental activity of the child, taking into account his individual abilities.

Factors of rehabilitation of the sanatorium stage:

1) gentle-training mode of physical activity;

2) exercise therapy;

3) massage;

4) curative pedagogy;

5) nutrition;

6) intake of mineral water;

7) physiotherapeutic effects;

8) sanitation of foci of infection;

9) continuation of the treatment prescribed in the hospital.

A gentle training regimen is selected individually depending on the capabilities of the child with a gradual expansion of the load.

Therapeutic exercise is of great importance in all diseases.

Under its influence, oxidative processes in the body increase, and overall metabolism improves.

Physical exercise has a regulatory effect on vascular tone.

At the same time, blood flow and lymph outflow are accelerated, and therefore congestion in the liver, spleen and skin is reduced. At the same time, the hemoglobin content and the number of red blood cells increase in the blood, and the phagocytic function of the blood increases.

Physical exercises have a positive effect on the emotional tone of the child, improve his mood, make him more active, sociable.

Exercise therapy should be carried out simultaneously with massage, which is one of the types of passive gymnastics.

The nutrition of a sick child should be complete, should provide the need for food ingredients, as well as calories in accordance with age. Spicy, fried, canned foods and extractives are excluded from the diet.

Mineral water. Bottled mineral water can be used for drinking. Take it 30-40 minutes before meals, 4-5 ml / kg 3 times a day for 3-4 weeks. In the treatment of intestinal diseases, mineral water is taken cold.

The chemical components of mineral waters, absorbed through the mucous membrane of the gastrointestinal tract, directly affect metabolic processes, the pH of digestive juices, as well as enzymatic activity.

Hydrocarbonate waters normalize the motor and secretory functions of the digestive tract, reduce the effects of dyspepsia. Sodium chloride waters stimulate metabolic processes, have a choleretic effect.

Silicon has anti-inflammatory, antitoxic and analgesic properties. Fluoride strengthens the tissues of the teeth.

25. Stages of rehabilitation. Secondary prevention

secondary prevention, or rehabilitation treatment, at the outpatient stage of rehabilitation is a complex of therapeutic and educational activities aimed at restoring or compensating for morphological and functional changes in the child's body resulting from a disease or injury, as well as the patient's mental status, and ensures complete restoration of health, return child to normal living conditions.

Resort rehabilitation is carried out at the appropriate resorts or in specialized summer camps for children, where potent resort factors and hardening are used, which the child can endure if there is a sufficient supply of strength and provides for the prevention of relapses of the disease.

The goals of outpatient rehabilitation are complete recovery, prevention of chronic pathology and disability of children or compensation for functional changes in the child's body resulting from the disease, as well as restoration of the patient's mental status in order to return him to his usual way of life as soon as possible.

Balneotherapy - use of natural (natural) water sources or artificially prepared mineral waters for external use.

Balneotherapy includes bathing and swimming in the pool, general and local baths.

Mud therapy - the use of natural organo-mineral colloidal formations containing active substances with the properties of heat carriers.

Muds have a thermal, mechanical and chemical effect, provide a gradual release of heat, causing active hyperemia not only of the skin, but also of deeply located tissues and organs, improving their blood circulation.

Phototherapy (phototherapy) - the use of electromagnetic oscillations of the optical range (light) for therapeutic purposes. The absorbed energy has a biological effect.

Ultraviolet radiation - electromagnetic oscillations with a wavelength from 180 to 400 nm. They are characterized by low penetrating ability, are absorbed by the surface layers of the skin, cause photochemical processes in it, as a result of which biologically active substances (histamine, acetylcholine, prostaglandins, etc.) are released, the activity of peroxidase, histaminase, tyrosinase and other enzymes increases.

There is an improvement in the functions of organs and systems, endocrine glands and immunity, the formation of vitamin D, and the processes of pigment formation are stimulated.

Laser therapy - use of low-energy laser radiation for therapeutic purposes (amplification of light by stimulated radiation).

The depth of laser radiation does not exceed a few millimeters, it irritates the skin receptors. There are degranulation of mast cells, proliferation of fibroblasts, and intensification of trophoregenerative processes.

26. Esophagitis

Esophagitis is an inflammation of the lining of the esophagus.

The severity of inflammation.

Grade I - one or more erythematous bands on the mucosa with exudate or sometimes erosions on the surface.

II degree - merged edematous erythematous bands, but not closed in a circle (with the presence of erosion).

III degree - the entire mucosa of the esophagus in the lower third looks edematous, erythematous with erosions.

IV degree - ulceration of the mucosa with (or without) the formation of stricture, metaplasia of the epithelium, cicatricial changes, shortening of the esophagus.

Early rehabilitation is aimed at preventing the development of complications, such as bleeding, scarring, strictures, changes in the relief of the mucous membrane of the esophagus. It provides for the elimination of predisposing factors, active etiological and pathogenetic treatment, a diet within the first table with the additional administration of vitamins, lysozyme, which improve the regeneration of damaged esophageal mucosa.

Etiological agents are prescribed₂- histamine blockers.

Psychotherapy is indicated and, if necessary, psychotropic drugs are used.

late rehabilitation is carried out in a local sanatorium or in a clinic using all methods of sanatorium treatment. Rational nutrition, mineral water of low and medium mineralization, heated to 38-39 ° C at the rate of 3-4 ml / kg 30 minutes before meals 3 times a day, are prescribed, psychotherapy, exercise therapy are carried out, pulsed currents of low frequency are prescribed according to the electrosleep method.

Rehabilitation treatment in the clinic includes hardening of children and prevention of relapse. In this case, sedatives, therapeutic pedagogy, coniferous baths, exercise therapy, walking and sleeping in the air, SMT (sinusoidal modulated currents to the epigastric region) are used.

6 months after the completed sanatorium stage of rehabilitation, the child can continue rehabilitation at the resort or use resort rehabilitation factors in a polyclinic.

Further rehabilitation treatment in a polyclinic continues, if necessary, after the spa treatment. General strengthening and hardening measures are prescribed.

Rehabilitation monitoring or dynamic monitoring is carried out until deregistration. At the same time, the terms for anti-relapse treatment in a hospital are determined.

The frequency of observation: after inpatient treatment, when conducting sanatorium treatment in a polyclinic, it is necessary to see a doctor every 10 days, when conducting rehabilitation treatment - 1 time per year; when using spa treatment - 1 time per week, subsequently - 1 time in 6 months. The child is removed from the register 2 years after the spa treatment.

Observations of other specialists (dentist, otolaryngologist) are carried out once a year, the rest - according to indications.

27 Duodenitis. Gastroduodenitis

Duodenitis is an inflammation of the duodenum. Gastritis is an inflammation of the mucous membrane of the stomach and duodenum.

Early rehabilitation should be aimed at normalizing mental disorders by psychotherapy, which is also carried out at other stages of rehabilitation, since the disease itself can also cause a neurotic state.

Psychological rehabilitation consists in overcoming mental reactions, gaining psychological comfort, eliminating the conditions of neuroticism.

At the same time, in addition to etiological treatment (antibiotics, metronidazole preparations), it is necessary to strengthen the mechanisms of sanogenesis. (biotransformation - biochemical defense of the body) to increase the resistance of the mucous membrane of the stomach and duodenum by regulating the pro- and antioxidant properties of gastric juice, use dietary factors.

Rational nutrition is shown - products with a high content of biotransformation enzymes, vitamins C, group B are recommended. Electrophoresis of novocaine, papaverine, sedatives are recommended.

With increased acidity of gastric juice, antacids, anti-inflammatory H blockers are prescribed.₂histamine receptors.

late rehabilitation is carried out in the conditions of a clinic or a sanatorium using all the factors of sanatorium treatment.

Secondary prevention It is carried out in a polyclinic using resort rehabilitation factors that contribute to the complete elimination of the disease and its exacerbations, as well as hardening of the child's body.

Dynamic Surveillance children with chronic gastritis, gastroduodenitis are carried out up to 4 years in the absence of complaints and signs of illness.

Patients are removed from the register when the functions of the stomach and duodenum are fully restored.

Peptic ulcer of the stomach and duodenum

Early rehabilitation provides for:

1) etiological treatment;

2) antisecretory agents;

3) H blockers₂- histamine receptors;

4) antacids;

5) agents that normalize the motor function of the stomach and duodenum;

6) antispasmodics;

7) sedatives;

8) tranquilizers.

late rehabilitation It is carried out in a sanatorium where psychotherapy, curative pedagogy continue, children receive good nutrition, use mineral water. Other methods of sanatorium rehabilitation are used (physiotherapy, exercise therapy), but more carefully than with gastritis.

Rehabilitation treatment - secondary prevention is carried out in the clinic, a full-fledged diet, a sparing regimen are prescribed, according to indications - sedatives, adaptogens: tincture of ginseng 1 drop per 1 year of life, tincture of Eleutherococcus.

Dynamic observation. After the rehabilitation, children suffering from peptic ulcer should be observed by a doctor once a quarter, and with stable remission - 1 times a year with hospitalization for examination and anti-relapse therapy 2-1 times a year.

28 Enteritis. Colitis (enterocolitis)

Enteritis is an inflammation of the lining of the small intestine.

Early rehabilitation consists in the organization of nutrition, corresponding to the possibilities of assimilation of food, psychotherapy, the use of electrophoresis with novocaine for pain, the use of astringents, enveloping, adsorbing agents. In nonspecific ulcerative colitis, psychotherapy, sedatives, salazopyridazine, prednisolone are indicated in severe forms of the disease. Antibacterial drugs are used simultaneously with lactobacterin, bifidumbacterin. Microclysters with sea buckthorn oil, solcoseryl are used.

At the stage of late rehabilitation, in addition to psychotherapy and therapeutic pedagogy, mineral waters, physiotherapeutic factors, physiotherapy exercises are used, it is necessary to normalize the motor function of the intestine.

With the phenomena of intestinal stasis and constipation, the water should be at room temperature. Mineral waters of low or medium mineralization are used with a predominance of hydrocarbonate, sulfate, calcium ions, weakly carbonic or not containing carbonic acid.

The motor activity of the colon is enhanced by more mineralized and cold waters containing magnesium ions and sulfates. Intestinal stasis is eliminated by intestinal washing with mineral water. 5-6 procedures are prescribed every other day. Intestinal lavage is contraindicated in acute processes in the intestines, ulcerative colitis, intestinal bleeding, polyps, rectal prolapse.

physiotherapy factors. Inductothermia is considered the most effective at a dosage until a slight warmth is felt on the abdomen, the duration of exposure is 10-15 minutes, the number is 8-10 procedures. It is also recommended a low-thermal dosage for 10-12 minutes, 8-10 procedures are carried out every other day. UHF is effective, the duration of the procedure is 15 minutes, 10-12 procedures every other day.

Light therapy (UV irradiation, laser radiation) has a good effect.

The appointment of physiotherapeutic procedures for patients with exacerbations of enterocolitis or colitis and extensive erosive and ulcerative processes is contraindicated.

At the stage secondary prevention spa treatment factors are widely used, among which one of the most powerful is mud therapy, which has an anti-inflammatory effect, improves bowel function.

Muds increase the reactivity of the body, trigger mechanisms that ensure the cleansing of the body from the pathogenic flora weakened by antibiotics. Such treatment can be prescribed 6 months after the exacerbation.

Spa treatment can be carried out at a resort or in a summer holiday camp, since a favorable environment, positive emotions, the influence of landscape and climate have a beneficial effect on the condition of patients.

The use of medications increases the effectiveness of resort factors and, according to a number of authors, is appropriate.

29. Pancreatitis

Pancreatitis is an inflammatory disease of the pancreas. Most often, pancreatitis occurs with infectious diseases, such as mumps, herpes infection. A predisposing factor is a violation of the outflow of pancreatic juice in the presence of stones in the versungian duct or obstructions in the region of the Vater papilla.

In the development of chronic pancreatitis, a long-term persistence of pathogens or the action of a predisposing factor that contributes to stagnation of the juice with subsequent stretching of the ducts, the development of a discrepancy between the activity of pancreatic enzymes and their inhibitors can play a role.

Early rehabilitation It is aimed at eliminating the factors of violation of the outflow of pancreatic juice, as well as at reducing inflammation, which leads to an improvement in the function and blood supply of the gland.

In the presence of pain, antispasmodics, peripheral M-anticholinergics, myotropic agents, narcotic analgesics, aminophylline are prescribed. It is advisable to carry out electrophoresis of novocaine solution using a sparing method, when the strength and duration of exposure are reduced.

Inductothermia and UHF can be used, but in an athermic dose, with a duration of exposure of 5-8 minutes, every other day, taking into account the clinical manifestations of pancreatitis.

Rational nutrition with partial parenteral nutrition is prescribed. Alkaline drinking, vitamins C, A, E, group B, infusion therapy are shown; enterosorbents; intravenous administration of antienzymes.

To reduce the exocrine function of the gland, H blockers are prescribed.₂histamine receptors.

late rehabilitation is carried out in a local sanatorium or in a polyclinic using the factors of sanatorium treatment. Rational nutrition, mineral waters of low and medium mineralization are shown.

The most effective are waters containing magnesium and calcium ions. They stimulate the secretion of pancreatic juice and normalize the activity of enzymes in it. Water must first be heated to 38-39 ° C and taken 1 hour before meals, the course of treatment is 21 days.

Secondary prevention with the use of spa treatment is carried out in the remission phase. Spa treatment is carried out in a clinic or resort 6 months after the completed sanatorium stage of rehabilitation. It is possible to carry out spa rehabilitation in a holiday camp using bottled mineral water, mud (carefully) and other factors of spa treatment.

Spa treatment is contraindicated in patients with stenosing papillitis and impaired patency of the pancreatic ducts.

Dynamic observation. In the first year after the spa stage, the pediatrician observes the patient once a month, then 1 times a year. Laboratory studies (blood test, coprogram, determination of urine amylase) in the first year are carried out 2 time in 1 months, then 3 times a year, glucose tolerance test for insulin - 2 time per year.

30. Diseases of the biliary system

Diseases of the biliary system in children are of microbial origin. A predisposing factor is a violation of the outflow of bile, which develops with biliary dyskinesia.

Dyskinesias can be associated with dysfunction of the sphincter apparatus, blockage of the ducts or their compression. Subsequently, the presence of an inflammatory process in the ducts may be accompanied by a violation of the outflow of bile.

The contractility of the gallbladder is also important.

Clinical studies have shown that chronic cholecystocholangitis occurs in two forms: simple and immunocomplex.

The pain syndrome is usually accompanied by dyspeptic disorders (nausea, belching, unstable stools, constipation). An important symptom is an enlarged liver associated with bile stasis.

There are positive symptoms of Ortner, Murphy, Kera, phrenicus-symptom of Mussy-Boas, muscle resistance in the right hypochondrium, etc.

There are no symptoms of chronic intoxication and changes in other organs. Physical development corresponds to age. In some children, the main symptom of the disease is an enlarged liver without pain. Only a comprehensive examination can diagnose cholecystocholangitis.

All patients in this group have changes in the cardiovascular system, manifested by the expansion of the boundaries of the heart, muffled tones, systolic murmur, heart rhythm disturbances, and changes in blood pressure. An electrocardiographic study recorded muscle changes, rhythm disturbances.

When rheography of the liver, there is a violation of its blood circulation, characterized by a decrease in arterial and venous blood flow, more pronounced in children 7-10 years old.

Early rehabilitation patients with cholecystitis, cholecystocholangitis is to improve the function of the biliary system.

When the painful symptoms subside, drugs that stimulate bile formation and hydrocholeretics are used.

Polyalcohols have cholekinetic and choleretic properties. Antibacterial therapy is carried out.

Of the physiotherapeutic measures during the period of acute manifestations of the disease, only electrophoresis is prescribed for the gallbladder area.

late rehabilitation provides for treatment in a local sanatorium using mineral water of low and medium mineralization and other factors of sanatorium treatment, continuation of antibacterial therapy according to the scheme developed in the hospital.

Secondary prevention is carried out in a polyclinic using the factors of spa treatment or in a resort.

One of the most effective resort factors is mud therapy, which has a positive effect on the functional state of the gallbladder, as well as an analgesic, anti-inflammatory effect.

Period dynamic observation with a simple form of the disease, it can be limited to two years, with an immunocomplex - three.

31. Chronic hepatitis

Chronic hepatitis in children in most cases is a consequence of past viral hepatitis or is a primary chronic anicteric viral hepatitis. HG form:

1) chronic viral hepatitis indicating the virus that caused it (B, d-, C, G, F) or it is noted that the virus has not been identified;

2) autoimmune hepatitis;

3) chronic toxic or drug-induced hepatitis.

HCG activity.

I - minimal (increase in the normal level of ALT activity up to 3 times).

II - moderate (AlT activity in blood serum increased up to 10 times).

III - severe (ALT level is more than 10 times higher than normal).

CG stages.

I - mild periportal fibrosis.

II - moderate fibrosis with portoportal septa.

III - severe fibrosis with portocentral septa.

IV - violation of the lobular structure.

V - the formation of cirrhosis of the liver.

Phases of virus development:

1. replication;

2. integration.

Early rehabilitation provides for the improvement of liver function at the hospital stage of treatment, when there are complaints of weakness, malaise, tearfulness, there are deviations in liver function tests, changes in blood biochemical parameters (dysproteinemia, bilirubinemia, increased enzyme activity).

Etiological and pathogenetic treatment is shown, the main attention is paid to the regimen (sick leave) and diet (table No. 5), anti-inflammatory and antitoxic therapy.

To improve blood circulation in the liver, it is recommended to use magnetic fields on the liver area. However, this procedure is carried out carefully, in the stage of reducing inflammatory-necrotic processes. The motor mode gradually increases, exercise therapy is used.

late rehabilitation children with hepatitis is carried out by methods of sanatorium rehabilitation in a clinic or sanatorium. This stage corresponds to the stage of attenuation of the activity of the process, which is characterized by the absence of complaints, but there is an increase in the size of the liver without an increase in the spleen, slight deviations in liver function tests.

Rehabilitation treatment in the clinic is carried out by the district doctor, immunomodulatory therapy (hardening) is carried out. Vitamins, choleretic agents are prescribed for 1 week every month after recovery.

32. Establishment of disability for children with diseases of the digestive system. Gastritis

There are the following terms of disability:

1) for a period of 6 months to 2 years - with a complicated course of gastric ulcer and duodenal ulcer;

2) for a period of 2 to 5 years - for diseases, pathological conditions, malformations of the gastrointestinal tract, liver, biliary tract, cirrhosis of the liver, chronic hepatitis, continuously recurrent ulcerative process, terminal ileitis. Clinical characteristics: persistent pronounced violations of the digestive or liver functions;

3) for a period of 5 years - for diseases, injuries, malformations of the esophagus, gastrointestinal tract (after total resection of the stomach or 2/3 of the small intestine, chronic intestinal adhesive obstruction with multiple fistulas, obstruction of the esophagus with and without gastrostomy, artificial esophagus , celiac disease). Clinical characteristics: persistent pronounced disorders of the digestive function, persistent severe fecal incontinence, fecal fistulas that are not amenable to surgical correction or are not subject to surgical treatment in terms of time;

4) for a period up to the age of 16 - with cirrhosis of the liver, chronic hepatitis with severe activity, persistent irreversible liver dysfunction in congenital, hereditary, acquired diseases.

Gastritis - an inflammatory disease of the stomach wall, characterized by abdominal pain and dyspeptic disorders.

The etiological factor is more often Helicobacter pylori infection, but it can be Salmonella, Yersinia, rotovirus infections.

Predispose to the development of gastritis emotional lability (conflicts in the family, school, some kind of disaster, stressful situations), malnutrition, allergic processes. With the elimination of the pathogen and predisposing factors of the disease, the function of the organ can be restored; then one speaks of an acute process.

Long-term persistence of the pathogen or the action of a predisposing factor leads to a persistent dysfunction, as a rule, to a chronic process. The functional class is determined by the degree of inflammation activity.

Based on the Sydney classification, gastritis is divided into acute and chronic.

In acute gastritis, according to the severity of neutrophilic infiltration, three degrees of activity of the process are distinguished, in chronic gastritis - according to the level of lymphocytic-plasmatic infiltration - four.

Depending on the degree of activity, the prevalence of the inflammatory process, antral, fundic gastritis and pangastritis are distinguished.

33. Hypotrophy. Obesity

Hypotrophy - protein-calorie insufficiency, characterized by weight loss, disorder of growth and development of the child.

According to clinical manifestations, malnutrition is divided into cachectic and edematous, according to severity - into I, II, III degrees, hypostatura is separately distinguished. Hypostatura can be considered as a manifestation of malnutrition II-III degrees, but with a small amount of subcutaneous fat remaining, with a uniform lag of the child in length and body weight.

Early rehabilitation is carried out in parallel with the treatment and ensures the restoration of the criteria for the child's vital activity in accordance with age. The functional class corresponds to the degree of malnutrition. The rehabilitation program is evaluated according to the general condition of the child. Rehabilitation provides for the organization of a rational daily routine, proper care.

late rehabilitation carried out in the clinic and at home, subject to sufficient heat, proper hygiene regime, stay in the fresh air. General massage is of great importance. For weakened children, a stroking massage is performed, very gently and easily for 2-3 minutes 2-3 times a day.

Rehabilitation treatment includes a combination of massage and gymnastics, starting with simple exercises, then gymnastics takes a dominant place, complemented by massage. These procedures are prescribed 1,5-2 hours after eating. Continued ultraviolet exposure. Hardening procedures are gradually introduced: rubbing, dousing with water, outdoor games that do not tire the child.

Dynamic Surveillance necessary within a year with the elimination of predisposing factors. Inspection of children of the first year is carried out monthly, in subsequent ages - 1 time per quarter.

Obesity - a chronic eating disorder characterized by excessive accumulation of fat, accompanied by a disorder in the growth and development of the child.

Early rehabilitation is carried out simultaneously with the elimination of the cause and the organization of rational feeding, the method of increasing the activity of the child and the use of water procedures and physiotherapy exercises.

The complex of physical therapy exercises depends on the child's ability and gradually moves from light physical exercises to more difficult ones.

Rehabilitation treatment in a polyclinic, it provides for the organization of rational nutrition, psychotherapy, dosed physical activity.

Dynamic observation. Obese children in the first year of life are examined by a pediatrician once a month, in the second year of life - once a quarter, then 1 times a year. An endocrinologist and a neuropathologist examine obese children once a year, other specialists - according to indications.

During dynamic observation, the weight and length of the body are monitored, the general condition of the child, the dynamics of sexual development, the level of sugar in the blood and urine, total lipids, cholesterol (3-lipoproteins of the blood - once a year, with III-IV degrees obesity - 2 times a year) are assessed. year).

34. Diathesis

Exudative catarrhal diathesis - age-specific dysmetabolic reaction, characterized by infiltrative-desquamative processes in the skin and mucous membranes of the body.

Early rehabilitation carried out simultaneously with symptomatic treatment by normalizing water-mineral metabolism and CBS under the control of biochemical studies, as well as eliminating hypovitaminosis and functional adrenal insufficiency.

Late rehabilitation and rehabilitation treatment consist in the organization of rational feeding with the addition of dietary supplements and vitamins, as well as digestive enzymes (in case of stool disorder).

Dynamic Surveillance carried out in the same way as in healthy children.

Lymphatic-hypoplastic diathesis - a generalized increase in lymphatic formations against the background of a decrease in the functions of the adrenal glands, mainly their chromophin apparatus.

Children are pasty, pale, lethargic, tissue turgor is lowered, muscles are poorly developed. Lymph nodes, thymus gland, spleen are enlarged. With strong exogenous and endogenous stimuli, fainting, collapse, and death develop.

Early rehabilitation It is aimed at normalizing the functions of the adrenal glands, which is achieved by prescribing ascorbic acid, improving blood circulation in them as a result of physiotherapeutic effects (ultrasound, thermal procedures). With a sharp increase in lymph nodes (bronchopulmonary, mesenteric), thymus, short-term glucocorticoids and ACTH are indicated.

Late rehabilitation and rehabilitation treatment are carried out in a polyclinic using a balanced diet with dietary supplements, prescribing courses of adaptogens, vitamins, dibazol, pentoxyl in age dosages.

Nervous-arthritic diathesis - violation of purine metabolism, manifested by the precipitation of uric acid crystals in the tissues of the joints and other organs, characterized by pain and increased nervous excitability.

The main symptom is indomitable vomiting, accompanied by abdominal pain, the smell of acetone from the mouth as a result of ketoacidosis. More often it occurs with the use of fatty foods and foods low in carbohydrates. At the same time, an acetone crisis develops. It can last 1-2 days. Due to frequent vomiting, exsicosis develops. Older children complain of headache, joint pain. They often have stones in the gallbladder or renal pelvis.

Early rehabilitation carried out against the background of treatment and ensures the normalization of metabolic disorders. With vomiting, acidosis and dehydration are fought. Allopurinol, which reduces the synthesis of uric acid, vitamins are used.

late rehabilitation consists in hardening the child - constant gymnastics, sports, and exposure to fresh air are necessary.

Rehabilitation treatment in a clinic provides for rational feeding.

35. Rickets. Spasmophilia

Rickets (hypovitaminosis D) is characterized by a violation of mineral (mainly phosphate-calcium) metabolism, manifested by insufficient mineralization of bones, dysfunction of the muscular, nervous systems and internal organs.

Early rehabilitation is carried out simultaneously with vitamin D treatment and is aimed at eliminating functional disorders of organs and systems and improving the synthesis and metabolism of vitamin D in the child's body. For this purpose, long-wave ultraviolet spectrum is used.

late rehabilitation carried out against the background of ongoing treatment of rickets with vitamin D and citrates. Apply massage and therapeutic exercises. They have a beneficial effect on metabolism, improve blood circulation, respiration, and gas exchange. Especially indicated for hypophosphatemic and mixed variants of rickets. Hydrotherapy is used with a gradual transition from warm, indifferent douche temperatures to cool ones. Salt baths are used with sea or ordinary table salt at the rate of 100 g of salt per 10 liters of water. The temperature of the first bath is 38 °C, the duration is 3-8 minutes, after every 2-3 baths the duration of the procedure is increased by 1 minute. In total, the course of treatment requires 12-15 baths every other day. Coniferous baths are recommended for restless children.

The duration of the procedure is 10 minutes, 12-15 procedures are performed per course. During the period of convalescence of rickets, calcium chloride electrophoresis is used.

Recovery treatment. 1 month after the first course of UVR is completed, a second course of treatment can be carried out. Further rehabilitation treatment and dynamic monitoring are carried out as the prevention of rickets with a frequency of observation corresponding to healthy children.

Spasmophilia - a disease of children characterized by increased neuromuscular excitability, convulsive syndrome due to a decrease in the content of ionized calcium in the blood against the background of alkalosis.

Early rehabilitation It is carried out against the background of the treatment of spasmophilia with calcium preparations, anticonvulsants (with an explicit form) and the normalization of feeding. UVR is used to improve the synthesis of vitamin D in the skin, starting from 1/8 of the dose to 1,5 of the biodose, which is increased gradually, as in rickets.

late rehabilitation begins with the disappearance of the main symptoms of explicit spasmophilia. Dibazol, pentoxyl, glutamic acid in age dosages, vitamins of group B are prescribed. General massage, gymnastics, outdoor exposure are shown.

Rehabilitation treatment in a polyclinic, it provides for rational feeding, the appointment of prophylactic doses of vitamin D.

Dynamic Surveillance carried out with the same frequency of examinations as in healthy children.

36. Congenital heart defects. congenital carditis

Congenital heart defects (CHD) - the presence of certain defects in the development of the heart and great vessels resulting from exposure to the embryo and fetus of various harmful factors during pregnancy.

RџSЂRё early rehabilitation surgical care is a radical method, but even after it, changes in the functions of the cardiovascular system persist for a long time. The main tasks are to improve and train the functions of the cardiovascular system, sanitize foci of chronic infection, and increase the body's resistance. Physical therapy matters.

late rehabilitation is carried out in a local sanatorium with the use of exercise therapy, a gradual expansion of the motor regimen, hydrotherapy and other factors of sanatorium rehabilitation. Climatorehabilitation includes a long stay of children in the air, which improves the nonspecific resistance of the body.

Rehabilitation treatment in the clinic provides for hardening of the child's body using the factors of resort rehabilitation. At the same time, exercise therapy is important in the form of individual or small group classes, walks. Hydrotherapy is widely used: coniferous, oxygen, chloride, sodium, iodine-bromine, carbon dioxide baths according to a sparing method. Other factors of resort rehabilitation are also applied.

Further dynamic surveillance with conservative management of children with congenital heart defects, it is aimed at maintaining compensation and preventing decompensation of cardiac activity.

Dynamic observation is carried out by a pediatrician, a cardiologist, an ENT doctor and a dentist, they examine children 2 times a year, other specialists - according to indications.

Unoperated children remain on the register permanently, after the operation - 1-2 years.

congenital carditis

Early congenital carditis occurs before the 7th month of fetal development. Its mandatory morphological substrate is fibroelastosis or elastofibrosis of the endo- and myocardium.

Late congenital carditis develops in the fetus after the 7th month of gestation without fibroelastosis and elastofibrosis.

Early rehabilitation provides for the prevention of heart failure. Non-steroidal anti-inflammatory drugs, drugs that improve myocardial trophism, as well as UVR with an individually selected biodose are prescribed.

late rehabilitation at the stage of sanatorium treatment is carried out with an individual approach to the choice of rehabilitation factors. Sanitation of foci of infection is carried out.

Rehabilitation treatment in the conditions of the clinic provides for hardening of children. For this purpose, resort treatment factors are used.

Further dynamic monitoring is carried out with early carditis constantly, with late carditis - within 5 years after the disappearance of signs of the disease. Examinations by a pediatrician in the first year are carried out 2 times a month, by a cardiologist - 1 time in 2-3 months; ENT doctor, dentist - 2 times a year.

37. Acquired carditis

Non-rheumatic carditis is an inflammatory lesion predominantly of the myocardium, which develops against the background of an immunological deficiency of the body.

Acute non-rheumatic carditis manifests against the background or 1-2 weeks after any infectious disease, characterized by carditis with damage (or without damage) to the conduction system of the heart. Based on the classification, the course of carditis can be acute, subacute or chronic; clinical manifestations differ in mild, moderate and severe forms of the disease.

Subacute carditis is more common in older children. They can be initially subacute, when signs of heart failure gradually increase. For subacute carditis, all manifestations of acute are typical, but they are persistent.

Chronic carditis also more common in older children. It can be primary chronic, it is detected during a routine examination of children or when signs of heart failure appear. Chronic carditis can be formed against the background of acute and subacute carditis. More often it proceeds without complaints of the patient.

Early rehabilitation provides for the prevention of heart failure, which is achieved by etiological and pathogenetic treatment, elimination of predisposing factors and foci of chronic infection. Corticosteroid drugs and derivatives of quinolonic acids are prescribed.

At this stage of rehabilitation, timely expansion of the regimen to a training one, exercise therapy under the control of the state, changes in the heart, positive dynamics of the disease and laboratory and instrumental indicators are important.

late rehabilitation It is carried out using sanatorium rehabilitation methods in a polyclinic or in a local sanatorium of a cardiological profile, where the restoration of the functional capabilities of the heart is achieved by using all the methods of sanatorium rehabilitation in a complex (therapeutic pedagogy, regimen, exercise therapy, diet).

The purpose of this stage of rehabilitation is the prevention of complications of carditis (cardiosclerosis, myocardial hypertrophy, conduction disorders; lesions of the valvular apparatus, constrictive myopericarditis, thromboembolic syndrome).

Rehabilitation treatment in the clinic provides for the prevention of relapses. It is carried out by the hardening method using the factors of spa treatment in a clinic or at a resort.

These rehabilitation methods are used in the absence of signs of circulatory failure. After the spa treatment, rehabilitation treatment continues according to an individually designed program.

Dynamic Surveillance and examinations are carried out in the process of rehabilitation. Observation is carried out by a pediatrician and a cardiologist once every 1 months - in the first year, then 2 times a year. An ENT doctor and a dentist also examine the child 2 times a year, other specialists - according to indications.

38. Rheumatism

Rheumatism is an immunopathological process that develops mainly in the connective tissue of blood vessels and the heart due to infection with group A hemolytic streptococcus. Most children with rheumatism recover, but with prolonged and massive streptococcal infection, chronic rheumatic disease develops with a tendency to recurrence of rheumatic heart disease.

Early rehabilitation is aimed at restoring the functions of the affected organs, taking into account the activity of the process. Assign antirheumatic treatment (penicillin, non-steroidal anti-inflammatory drugs, steroid hormones in severe forms of the disease, vitamins C, A, E), protective regimen, psychotherapy.

UVR is used in an erythemal dosage with an individually selected biodose. With polyarthritis, erythema is localized in the area of \uXNUMXb\uXNUMXbthe joints; if the phenomena of polyarthritis are absent, then exposure to UV rays is carried out on the reflex-segmental zones.

Contraindications for UVI are hemorrhagic syndrome, heart defects with circulatory failure. Calcium electrophoresis is used according to the method of general influence of Vermel, which helps to equalize the ratio of blood electrolytes, improve the tone of the heart muscle, and reduce vascular permeability.

Electrosleep is recommended at a low frequency of impulses, which improves the psycho-emotional state. With chorea, warm fresh or coniferous baths are used in alternation with electrosleep. When stabilizing the activity of rheumatism, physiotherapy exercises are prescribed.

late rehabilitation is carried out in local cardiological sanatoriums in the active phase of rheumatism with and without heart disease.

In the sanatorium, against the background of treatment, the whole complex of sanatorium rehabilitation factors is used, the foci of infection are sanitized. Sanatorium rehabilitation provides for the complete recovery of the child.

Rehabilitation treatment carried out in the clinic in order to prevent recurrence of the disease with constant year-round bicillin prophylaxis. Spa treatment is indicated 8-12 months after the end of the acute period in the absence of signs of activity and circulatory failure. It can be carried out in resorts, in holiday camps of a resort type, in a clinic. At the same time, natural factors, mineral waters, therapeutic mud, exercise therapy, hardening procedures are used.

Further dynamic surveillance for children with rheumatism, the district pediatrician and cardiorheumatologist carry out quarterly for 2 years, then 2 times a year. Examination by an ENT doctor and a dentist is necessary 2 times a year, by other specialists - according to indications. Twice a year, children under dynamic observation can be hospitalized for examination, diagnosis clarification and clinical rehabilitation. Bicillinoprophylaxis is carried out for 3-5 years.

39. Arterial hypertension. Arterial hypotension

Primary arterial hypertension (hypertension) - a disease characterized by a persistent increase in blood pressure.

Stage IA - transient increase in systolic pressure up to 130-150 mm Hg. Art. at normal diastolic pressure.

Stage IB - labile systolic hypertension within 130-150 mm Hg. Art., in some cases, increased diastolic pressure up to 80 mm Hg. Art. There are complaints of headache, tachycardia.

Stage IIA - systolic pressure reaches 160-180 mm Hg. Art., diastolic - 90 mm Hg. Art., there are signs of left ventricular hypertrophy, frequent complaints of headache, ringing in the ears.

Stage IIB is characterized by a persistent increase in blood pressure. There may be hypertensive crises that proceed according to the sympathoadrenal type, characterized by a sharp headache, decreased vision, and vomiting.

Stage III does not occur in children.

Early rehabilitation carried out simultaneously with treatment. Physical therapy, walks in the air, therapeutic baths - coniferous, oxygen are prescribed.

Medicinal electrophoresis with magnesium sulfate, bromine, aminophylline on the collar zone, galvanization according to the reflex-segmental technique are used.

Inhalations of aerosols of dibazol, obzidan, etc. are recommended. Electric sleep, sinusoidal modulated currents (SMT) are used.

late rehabilitation is carried out in a local sanatorium, where all the factors of sanatorium rehabilitation are used.

Restorative rehabilitation aims to eliminate predisposing factors. A diet, psychotherapy, physical education are prescribed, the daily routine is adjusted. Spa treatment is shown in the conditions of a holiday camp.

Dynamic Surveillance carried out for 2-3 years by a district doctor and a cardiologist once a quarter with the right to hospitalization for examination and rehabilitation 2 times a year.

Arterial hypotension is diagnosed with a decrease in blood pressure in school-age children below 90/48 mm Hg. Art.

Early rehabilitation performed during treatment. Physical factors are used to improve the functional state of the nervous and cardiovascular systems: electrosleep, drug electrophoresis, massage, exercise therapy. Rehabilitation of children after fainting begins with a galvanic collar according to Shcherbak. Apply electrophoresis of calcium, mezaton on the collar zone.

late rehabilitation is carried out in a local sanatorium, where all the factors of sanatorium rehabilitation are important. Oxygen, pearl, chloride, sodium and other baths are used with a water temperature of 35-36 ° C, which stimulate the function of the sympathetic nervous system, increase the contractile activity of the myocardium, and have a tonic effect on the central nervous system. Of great importance are exercise therapy, massage.

40. Hemorrhagic vasculitis (Schonlein-Genoch disease). Nodular periocteritis

Hemorrhagic vasculitis - systemic disease of the walls of microvessels as a result of damage to them by immune complexes.

The diagnostic criterion is hemorrhagic syndrome, which determines the clinical variant of the disease: skin, articular, abdominal, renal, mixed.

Early rehabilitation, contributing to the improvement of vascular function, includes the appointment of antiplatelet agents (chimes), fortified rational nutrition, psychotherapy.

late rehabilitation is carried out through the gradual use of the factors of sanatorium rehabilitation (therapeutic pedagogy, walks in the fresh air, calm games, exercise therapy). Electric sleep is prescribed, foci of infection are sanitized.

Restorative rehabilitation - secondary prevention is carried out by hardening, using individually selected factors of resort rehabilitation.

Dynamic Surveillance carried out by the local doctor for 5 years during the examination 2 times a year in a hospital. In the presence of renal syndrome, the same observation is carried out as with glomerulonephritis.

Nodular periarteritis - a systemic inflammatory disease of the arteries, predominantly of small and medium caliber, characterized by ischemia of the corresponding zones of the organs.

Diagnostic criteria are focal (in various organs) pain syndrome, arterial hypertension, fever, weight loss, sweating, the presence of nodules on the skin, polymorphism of complaints.

Early rehabilitation carried out simultaneously with treatment (prescribed prednisone 2 mg / kg per day, non-steroidal anti-inflammatory drugs, antihypertensive drugs), provides for the improvement of the functions of the affected vessels.

Electrophoresis with drugs can be used at the site of ischemia. It is necessary to treat intercurrent diseases and foci of chronic infection.

late rehabilitation begins after the manifestations of the disease subside and the signs of process activity decrease. All factors of sanatorium rehabilitation are used.

Psychotherapy and therapeutic pedagogy matter, food should contain vitamins, microelements, biologically active additives. Exercise therapy, massage, water procedures are prescribed.

Restorative rehabilitation carried out for a long time. Hardening procedures, exercise therapy, massage are used. With the disappearance of signs of activity of the inflammatory process, factors of resort treatment are used to completely eliminate residual effects after ischemia, heart attacks, thrombosis, gangrene.

Dynamic Surveillance carried out constantly by the local doctor and cardiologist with a frequency and a complete examination at least 2 times a year.

41. Disability of children with diseases of the circulatory system. Rehabilitation of patients with heart failure

Disability for children from 6 months to 2 years is not established.

1. Disability for a period of 2 years is established with hemorrhagic vasculitis.

Clinical characteristics: a combination of two or more syndromes with a course of the disease for more than 2 months, annual exacerbations. The following diseases are also taken into account: pathological conditions of the cardiovascular system, congenital and acquired defects of the heart and large vessels (inoperable and not subject to surgical intervention until a certain age), conditions after surgery on the heart and large vessels, heart rhythm disturbances, including after pacemaker implantation.

2. Disability for up to 5 years is established in case of heart failure.

Clinical characteristics: congestive heart failure II-III degrees and more or chronic severe hypoxemia.

3. Disability for a period up to the age of 16 is established for diseases, pathological conditions, congenital and acquired heart defects, inoperable patients with circulatory disorders of the II degree, with malignant hypertension.

Heart failure - loss of the ability of the heart to provide hemodynamics necessary for the normal functioning of the body.

Early rehabilitation is carried out simultaneously with treatment at the hospital stage by eliminating the cause of the disease, organizing the regimen and nutrition within table No. 10, prescribing cardiac glycosides, dopamine, cardiotrophic drugs, diuretics, vasodilators.

late rehabilitation (sanatorium stage) - carried out in a local sanatorium or in a clinic. The motor mode is regulated, exercise therapy is prescribed in accordance with the general condition of the patient.

Continues taking drugs that improve metabolic processes in the myocardium. Sanitation of foci of infection, medical pedagogy are being carried out. It is recommended that the patient stay outdoors.

Restorative rehabilitation carried out in a clinic with the subsequent use of spa treatment, where the motor regimen is expanded, hardening is carried out, walks in the fresh air.

Dynamic Surveillance in the first year is carried out monthly. The cardiologist examines the child every 2-3 months, in the second year - once a quarter, then once every 5 months.

Twice a year the child can be hospitalized for examination and rehabilitation. Laboratory and instrumental studies are required 2 times a year (general analysis and biochemical blood test, ECG, FCG, ultrasound of the heart), functional tests - according to indications. Children who have had heart failure are not removed from the register.

42. Juvenile rheumatoid arthritis. Systemic lupus erythematosus

Juvenile rheumatoid arthritis (JRA) is an immunopathological process with systemic joint damage.

Early rehabilitation carried out in a hospital. Biogenic stimulants are prescribed - apilac, anabolic hormones. Against the background of treatment, physical factors are used: UV rays on the affected area of the joints (in turn, the affected joints are irradiated daily, but not more than two large or a group of small joints) after 2-3 days. In case of trophic disorders, the skin of the collar or lumbosacral zone is irradiated. Effective UHF electric field on the joints. Apply massage, exercise therapy, novocaine electrophoresis on the joints.

late rehabilitation carried out in a local sanatorium or clinic. Microwave therapy, ultrasound on the joints, diadynamic currents on the joints and reflexogenic zones are used. Other factors of sanatorium treatment are also applied. Particular attention is paid to exercise therapy, massage.

RџSЂRё rehabilitation treatment resort treatment factors are used, among which thermal procedures predominate. With restriction of movements in the joints, mechanotherapy, exercise therapy, massage, balneotherapy in the form of chloride, radon baths are indicated.

Orthopedic care started at the stage of early rehabilitation, movement treatment continues at the stage of rehabilitation treatment.

At all stages of rehabilitation, it is necessary to carry out sanitation of foci of infection, timely treatment of intercurrent diseases.

Dynamic Surveillance carried out within 5 years after the exacerbation of the disease by the local doctor and orthopedist (if necessary). The frequency of observation is once a quarter. A complete examination and clarification of the diagnosis are carried out in stationary conditions 2 times a year.

Systemic lupus erythematosus (SLE) - an immunopathological disease of the connective tissue, characterized by a predominant lesion of the nuclei of cellular structures by universal capillaritis.

Early rehabilitation starts from the moment of diagnosis; its goal is to reduce the activity of the pathological process, which is achieved by the appointment of glucocorticoids and cytostatics, good nutrition with the addition of dietary supplements.

late rehabilitation - sanatorium stage. Maintenance therapy with glucocorticoids prescribed in the hospital is carried out, and all individually selected factors of sanatorium rehabilitation are used. Sanitize foci of chronic infection. Set the daily routine corresponding to the age of the child, with an increase in the number of hours of sleep. Complete nutrition is required.

RџSЂRё rehabilitation treatment constant hardening is carried out, factors of spa treatment are carefully used, but only in the same climatic zone (it is necessary to avoid sunlight, hypothermia, overheating).

43. Systemic sclerosis. Dermatomyositis

Systemic sclerosis (scleroderma) - a connective tissue disease with a predominant lesion of collagen, characterized by fibro-sclerotic processes in the affected organs and tissues.

Early rehabilitation begins after the diagnosis is established and is consistent with treatment. Means that improve microcirculation, anti-inflammatory drugs and glucocorticoids are prescribed.

late rehabilitation - after discharge from the hospital, the treatment prescribed in the hospital continues in maintenance doses. It is better to carry it out in a local sanatorium, using all the factors of sanatorium treatment with their individual selection.

Of great importance are massage, exercise therapy, nutrition with the mandatory appointment of dietary supplements. The mode provides for an increase in hours of sleep. It is important to carry out timely rehabilitation of foci of infection and the prevention of other diseases.

RџSЂRё rehabilitation treatment (secondary prevention) eliminate predisposing factors, harden children. When stabilizing the process, the factors of resort treatment (balneo-mud therapy) are widely used.

Dynamic Surveillance carried out continuously. Examinations by the local doctor and, if necessary, by other specialists are carried out once a quarter. Twice a year, the child can be hospitalized for a complete clinical examination, diagnosis and rehabilitation.

Dermatomyositis - a systemic connective tissue disease with a predominant lesion of muscles and skin.

Early rehabilitation carried out after the diagnosis of the disease and corresponds to the treatment. Corticosteroids, non-steroidal anti-inflammatory drugs, ATP, vitamins are prescribed. As a result of treatment, the function of the affected organs improves. Physiotherapy in the acute period is contraindicated. Exercise therapy and massage should be prescribed immediately after the pain syndrome has decreased.

late rehabilitation is carried out after discharge from the hospital using all the factors of sanatorium rehabilitation and simultaneous treatment (prevention) of calcifications, contractures. Supportive drug therapy prescribed in the hospital is carried out. Nutrition is of great importance.

Rehabilitation treatment is being actively pursued. Rehabilitation of calcifications, contractures, supporting anti-relapse treatment, and hardening continue. The factors of resort treatment or the stay of children in resorts with the use of balneotherapy, exercise therapy, massage, mechanotherapy are used. Medical pedagogy and psychotherapy are important.

Dispensary observation carried out constantly. It is necessary to exclude insolation, hypothermia, physical and mental overwork. Children should constantly engage in exercise therapy.

Patients are examined depending on the presence of residual effects once a month or quarter.

44. Acute glomerulonephritis

Acute glomerulonephritis is an inflammatory disease of the kidneys of an immunopathological nature with a predominant lesion of the renal glomeruli and involvement of the renal tubules, interstitial tissue, and vessels in the process.

Early rehabilitation is a successful treatment of an acute process in a hospital. In order to improve kidney function, bed rest, diet, drugs that improve renal blood flow (curantil, eufillin), electrophoresis with a 1% solution of nicotinic acid or heparin are prescribed.

late rehabilitation includes a sanatorium stage, which is carried out in a polyclinic or in a local sanatorium. The previously prescribed therapy, diet within table No. 7, physiotherapy, exercise therapy, sanitation of foci of chronic infection and treatment of concomitant diseases continue.

A therapeutic-motor regime is shown with limitation of physical activity and the inclusion of morning exercises according to an individual plan, exercise therapy, games, and music lessons. A day break is recommended.

Diet matters a lot. It should be complete, taking into account the age of the patient. Physiological norms of protein, fats and carbohydrates are prescribed with the inclusion of complete proteins, unsaturated fatty acids, vitamins. Extractive substances, essential oils, smoked meats, spicy seasonings, spices are excluded from the diet.

Physiotherapy occupies an important place in sanatorium treatment. Paraffin applications are applied to the lumbar region. To eliminate renal ischemia, novocaine electrophoresis is used on the lumbar region.

Expanding blood vessels, increasing diuresis, magnesium has a positive effect on the course of the disease and the patient's well-being. Also shown are irradiations of the lumbar region with solar lamps or infrared rays. In order to desensitize the body, reduce inflammation in the kidneys, calcium electrophoresis is used. At the stage of sanatorium treatment, an important role is given to therapeutic pedagogy and psychotherapy.

Rehabilitation treatment, or secondary prevention, is carried out in a polyclinic using the factors of spa treatment or at a resort. However, treatment at the resort is indicated for children with no signs of exacerbation of the process in the kidneys during the year.

At the stage of spa treatment, children are hardened using all methods of spa treatment: balneotherapy, mud applications, and climatotherapy; rehabilitation of chronic foci of infection.

Dynamic Surveillance carried out within 5 years after the transferred acute process. The child is observed by a pediatrician and a nephrologist. Inspection is carried out once a quarter on the 1st year, in the subsequent - 2 times a year.

A complete examination is carried out 2 times a year at the time of hospitalization for rehabilitation and includes the study of urine, blood, performing a biochemical blood test.

45. Chronic glomerulonephritis

Chronic glomerulonephritis is a long-term diffuse inflammatory disease of the glomerular apparatus of the kidneys, leading to sclerosis of the parenchyma of the organ and renal failure, occurring in a hematuric, edematous-proteinuric (nephrotic) or mixed form.

Early rehabilitation - this is an inpatient treatment of an exacerbation of the disease using bed rest, rational nutrition, anti-inflammatory therapy, hormones, cytostatics, anti-sclerotic drugs, anticoagulants and antiaggregants.

late rehabilitation - treatment in a local sanatorium or sanatorium treatment in a polyclinic. The goals of sanatorium rehabilitation are the continuation of maintenance therapy started in the hospital, the correction of the regimen and diet, taking into account the form, stage of the disease, the degree of renal dysfunction, sanitation of foci of infection, prevention of intercurrent diseases, hardening.

A sparing regimen is recommended with the exclusion of physical and mental stress, additional daytime rest, and an additional day off per week is introduced for schoolchildren. It is necessary to avoid cooling, contact with infectious patients.

The diet depends on the clinical form of the disease. In the hematuric form of chronic glomerulonephritis, the diet is hyperchloride, complete with a maximum content of vitamins. With a nephrotic form, it is necessary to slightly increase the amount of protein and include foods rich in potassium salts in the diet.

The purpose of physical factors is limited. Inductothermy of the kidney area is recommended.

In the preuremic and uremic period (in the absence of heart failure and cerebrovascular accidents), coniferous baths are used, in the presence of skin itching, starch baths with a water temperature of 37-38 ° C are used.

Rehabilitation treatment, or secondary prevention, - carrying out hardening procedures in a clinic or at a resort using balneo-mud therapy, exercise therapy, climatotherapy. Children in the inactive phase of the disease, with impaired renal function no more than I degree, a year after the exacerbation of the disease, are subject to resort rehabilitation.

Children with nephrotic form of glomerulonephritis are treated in a dry and hot climate in the summer. In such a climate, the increased release of water through the skin leads to a decrease in diuresis, as a result, conditions are created for the release of more concentrated urine.

Dynamic Surveillance. The local doctor observes the child at least once every 1,5-2 months. Nephrologist consultations are carried out as needed. Children are not removed from the dispensary. Scope of research: general and Addis-Kakovsky urinalysis, Zimnitsky test, general and biochemical blood tests, total protein, fractions, urea, creatinine, cholesterol, electrolytes, CRP, sialic acid, determination of endogenous creatinine clearance, renal ultrasound, X-ray testimony.

46. Pyelonephritis

Pyelonephritis is a microbial-inflammatory process in the pyelocaliceal system and tubulointerstitial tissue of the kidneys.

Diagnostic criteria: intoxication, fever, dysuria, pain in the lumbar region, leukocyturia, bacteriuria, microhematuria, changes in the blood (accelerated ESR, leukocytosis, neutrophilia).

Early rehabilitation - this is a successful treatment of a child during the period of acute manifestations of the disease using a protective regimen, rational nutrition, rational antibiotic therapy, taking into account the sensitivity of the microflora, the properties of the drug and the reactivity of the macroorganism, the acidity of the urine, the allergic mood of the body.

late rehabilitation takes place in a local sanatorium or clinic. Sanatorium treatment has a general strengthening effect, increases immunological reactivity, and has a positive effect on the child's psyche.

Intermittent (10 days of each month) antibiotic therapy continues while taking biologics and choleretic agents.

An important condition is to ensure regular outflow of urine (urination at least once every 3 hours), the functioning of the intestines.

When conducting herbal medicine, one should take into account the properties of herbs to have an anti-inflammatory effect, enhance the regeneration of the epithelium (rose hips, immortelle) or give a diuretic effect (parsley, bearberry, birch buds).

With hypertension and atony of the urinary tract, as well as to improve renal blood flow, you can use a decoction of oats.

The child is on a sparing regime with the exception of great physical exertion, sports competitions. Physical education classes are shown in a special group, hygienic gymnastics is mandatory in the morning. Sanitize chronic foci of infection.

The diet includes a full-fledged balanced diet with protein intake in the first half of the day and a sufficient introduction of liquid in the form of fruit drinks, juices, mineral waters.

Salt restriction is recommended only in the presence of hypertension. Foods rich in extractive substances, spices, marinades, smoked sausages, canned food, and spices are excluded from the diet for the entire period of dispensary observation.

Medicinal electrophoresis of a 1% solution of furadonin, urosulfan, UHF, microwave on the kidney area, diathermy, paraffin, ozocerite or mud applications on the lumbar region are recommended.

restorative treatment, or secondary prevention, carried out in a clinic and at a resort. Spa treatment is indicated for children who do not have signs of renal failure, or for patients with only grade I renal failure.

At the stage of spa treatment, hardening procedures, mineral, coniferous, air, sun baths, therapeutic mud, exercise therapy, and thermal procedures are widely used.

Dynamic Surveillance carried out within 5 years after acute pyelonephritis and constantly - with chronic pyelonephritis.

47. Urinary tract infection

Urinary tract infection - infection of the organs of the urinary system without a special indication of the level of damage to the urinary tract, leading to the appearance of neutrophilic leukocyturia and bacteriuria.

Diagnostic criteria: there may be fever, dysuric phenomena, pain syndrome, urinary syndrome.

Early rehabilitation at the stage of inpatient treatment includes bed rest, diet, drinking plenty of fluids, taking antispasmodics, sitz baths, herbal medicine.

late rehabilitation takes place in a clinic or in a local sanatorium.

A sparing regimen with limited physical activity, a diet with the exclusion of products that irritate the urinary tract (extractive and pungent substances) are shown. To increase diuresis and better flushing of the urinary tract, drink plenty of water (tea with sugar and vitamin juices). It is advisable to use mineral waters.

From physiotherapy, thermal procedures, UHF, microwave, electrophoresis with anti-inflammatory drugs on the area of the bladder, pelvis are shown. In chronic cystitis, installations with tomycin, collargol, protargol are recommended. Measures are being taken to prevent intestinal dysfunction, helminthiases, and the state of the genital organs is monitored.

Rehabilitation treatment, or secondary prevention, includes the use of spa treatments. Of great importance are hardening with the appointment of therapeutic mud, balneotherapy, air and sunbathing; intake of mineral waters.

Dynamic Surveillance carried out within 1 year after the postponed process. Examinations are carried out the same as for pyelonephritis.

Interstitial nephritis - inflammation of the connective tissue of the kidneys with involvement in the process of tubules, blood and lymphatic vessels, renal stroma.

Clinical picture: abdominal pain, increased blood pressure, leukocyturia, microhematuria, oliguria, hyperoxaluria.

Early rehabilitation includes rational nutrition, intake of membrane stabilizers (vitamins A, E), agents that improve tissue trophism, anti-sclerotic drugs.

late rehabilitation - sanatorium stage with the use of all factors of sanatorium treatment. A rational regimen, diet, physiotherapy procedures (microwave, electrophoresis with novocaine, nicotinic acid on the lumbar region) are recommended. It is advisable to prescribe medicinal herbs (collection according to Kovaleva). Sanitation of chronic foci of infection is being carried out.

Rehabilitation treatment includes hardening, spa rehabilitation, exercise therapy, gymnastics, herbal medicine courses (lingonberries, strawberries, phytolysin).

Dynamic Surveillance after an acute process, 3 years are carried out, with a chronic one - constantly.

48. Urolithiasis. Rapidly progressive glomerulonephritis. Disability of children with diseases of the urinary system

Urolithiasis disease - a disease of the kidneys and urinary system, due to the presence of stones.

Diagnostic criteria: pain in the abdomen or side, hematuria, dysuria, repeated urinary tract infections.

Early rehabilitation provides for a balanced diet, taking into account the type of stone, taking antispasmodics, analgesics.

late rehabilitation carried out in a clinic or in a local sanatorium. A sparing regimen, restriction of physical activity, diet therapy aimed at maximizing the reduction in urine of salts that made up the stone, increasing diuresis due to the additional administration of liquid, highly fortified food are shown; phytotherapy.

RџSЂRё rehabilitation treatment, or secondary prevention, resort methods of treatment, diet, various methods of hardening, balneotherapy, vitamin therapy are used (vitamins A, groups B, E are shown).

Dynamic Surveillance carried out within 5 years. The scope of examinations: blood, urine, Zimnitsky, Addis-Kakovsky test, determination of urea, residual nitrogen, ultrasound of the kidneys, excretory urography, bacteriological examination of urine according to indications.

Disability of children with diseases of the urinary system.

1. Disability for children with kidney pathology for a period of 6 months to 2 years is determined with persistent, pronounced impairment of kidney function, a high degree of activity of the pathological process in the renal tissue.

2. Disability for a period of 2 to 5 years is determined with sclerosing, sluggish, therapy-resistant variants of glomerulonephritis, confirmed by the results of a kidney biopsy or examination in a specialized hospital.

3. Disability for a period of 5 years is determined for diseases, injuries and malformations of the urinary tract; partial or complete aplasia of organs.

4. Disability before the age of 16 is determined for kidney diseases, including hereditary pathological conditions, malformations of the kidneys and urinary organs with chronic renal failure and malignant hypertension, diabetes insipidus syndrome, renal diabetes insipidus.

Rapidly progressive (malignant) glomerulonephritis - a disease characterized by the rapid development of renal failure.

Diagnostic criteria: increasing severity of clinical manifestations of glomerulonephritis, the development of renal failure, the symptoms of which are rapidly progressing.

Early rehabilitation consists in the immediate hospitalization of children with suspected acute glomerulonephritis, strict adherence to all doctor's prescriptions, which in many cases prevent the rapid progression of the disease.

49. Iron deficiency anemia

Железодефицитная анемия - This is hypochromic anemia, which develops as a result of iron deficiency in the body.

Diagnostic criteria: pallor of the skin and mucous membranes, trophic disorders, taste perversion, a decrease in the concentration of hemoglobin in the blood, a color index.

Early rehabilitation is reduced to the successful treatment of the disease, the corresponding regimen, a diet with the introduction of foods rich in iron and vitamins, drug therapy, and the treatment of helminthiasis.

late rehabilitation provides for a regimen with sufficient motor activity, maximum exposure to fresh air, balanced nutrition, massage, gymnastics, sanitation of foci of chronic infection, treatment of diseases accompanied by impaired intestinal absorption, bleeding, and treatment of helminthiasis.

A diet is prescribed using foods rich in iron (such as meat, tongue, liver, eggs, tangerines, apricots, apples, dried fruits, nuts, peas, buckwheat, oatmeal).

Secondary prevention includes rational feeding, prevention of colds and gastrointestinal diseases, detection and treatment of helminthiases, dysbacteriosis, hypovitaminosis, allergic diseases, various hardening methods.

Dynamic Surveillance required within 6 months. Examination scope: general blood test, biochemical study.

Deficiency anemia

Protein deficiency anemia - Anemia, which develops as a result of a deficiency in food of animal proteins.

Early rehabilitation includes the correct mode, physical education, massage, diet in accordance with age, sufficient exposure to fresh air, sanitation of foci of infection, treatment of helminthiasis, normalization of the functions of the gastrointestinal tract.

Secondary prevention provides for rational feeding, hardening, prevention of infectious (including gastrointestinal) diseases, dysbacteriosis.

Dynamic Surveillance carried out within 6 months. Examination scope: general blood test, biochemical.

vitamin deficiency anemia develop as a result of a lack of vitamin B12 and folic acid, vitamin E.

Diagnostic criteria: pallor of the skin and mucous membranes, glossitis, detection of megaloblasts, a decrease in hemoglobin in the blood; color index greater than 1,0; erythrocytes with Jolly bodies.

Early rehabilitation consists in correcting the diet (vitamin B12 is found in meat, eggs, cheese, milk, folic acid in fresh vegetables (tomatoes, spinach), a lot of it in yeast, as well as in meat, liver), eliminating the causes that caused anemia, prescribing vitamins .

RџSЂRё late rehabilitation active motor mode, massage, good nutrition, treatment of helminthiases, sanitation of foci of chronic infection are shown.

50. Hemolytic anemia. Hemophilia

Hemolytic anemia - anemia resulting from increased destruction of red blood cells.

Diagnostic criteria: pallor, yellowness of the skin and mucous membranes, splenomegaly, a decrease in erythrocytes and hemoglobin with a normal color index, defective erythrocytes, reticulocytosis.

Early rehabilitation - Successful treatment of exacerbation of the disease.

late rehabilitation carried out in a clinic or local sanatorium and is reduced to the prevention of hemolytic crises, which are most often provoked by intercurrent infection.

A rational regimen, gymnastics are necessary, but with the exception of large physical exertion, sudden movements, shaking, carrying weights, playing sports. Exercise therapy, physical education in a special group, morning exercises, sufficient exposure to fresh air are shown.

Secondary prevention provides for a sparing regimen, diet, active treatment and prevention of acute infectious diseases, chronic diseases of the gastrointestinal tract and sanitation of focal infection, the use of all types of hardening, genetic counseling for hereditary hemolytic anemia.

Dynamic Surveillance carried out constantly. Examinations: general blood test, determination of the shape and osmotic stability of erythrocytes, reticulocytes, biochemical blood test (bilirubin and protein fractions, proteinogram), urinalysis, abdominal ultrasound.

Hemophilia - a hereditary disease characterized by a sharply slow blood clotting and increased bleeding due to a lack of certain blood clotting factors.

Diagnostic criteria: repeated episodes of hematoma-type bleeding, hemorrhages in the joints, nosebleeds, prolongation of blood clotting time, low levels of coagulation factors VIII, IX, XI.

Early rehabilitation - successful treatment of an exacerbation of the disease in a hospital using replacement therapy, vitamins.

late rehabilitation carried out in a local sanatorium or clinic.

A sparing regimen is recommended, all sports associated with jumping, falling, hitting, including cycling, are prohibited.

It is very important that the child has regular (at least 4 times a year) dental cleaning, as this significantly reduces the number of bleeding episodes due to tooth extractions and caries. Sanitation of chronic foci of infection is carried out, physiotherapeutic treatment of the joints is indicated (phonophoresis with hydrocortisone, lidase).

Secondary prevention consists in adherence to the regimen, prevention of limb injuries, a full-fledged diet, hardening, psychological, social adaptation and career guidance (the exclusion of labor that requires a lot of physical activity).

51. Thrombocytopenic purpura

Thrombocytopenic purpura is a disease characterized by a tendency to bleeding due to thrombocytopenia.

Classification

With the flow:

1) acute (lasting less than 6 months);

2) chronic:

a) with rare relapses;

b) with frequent relapses;

c) continuously recurring.

By period:

1) exacerbation (crisis);

2) clinical remission (lack of bleeding with persistent thrombocytopenia);

3) clinical and hematological remission.

According to the clinical picture:

1) "dry" purpura (there is only skin hemorrhagic syndrome);

2) "wet" purpura (purpura in combination with bleeding).

Diagnostic criteria: hemorrhagic syndrome; characterized by polymorphism, polychromy of hemorrhage, bleeding, a decrease in the level of platelets in the blood.

Early rehabilitation - treatment of the disease in a hospital using drugs that improve the adhesive-aggregation properties of platelets.

late rehabilitation carried out in a clinic or local sanatorium. Children are shown a sparing regimen, exercise therapy, a diet with the exception of allergenic foods, canned food, it is recommended to keep a food diary. Include peanuts, spinach, dill, nettle in the diet. Sanitation of foci of infection, deworming, prevention of infectious diseases, and the fight against dysbacteriosis are carried out, since all these factors can provoke an exacerbation of the process.

Within 3-6 months after discharge from the hospital, it is advisable to use hemostatic herbal preparations in combination with alternating two-week courses of drugs that stimulate the adhesive-aggregative function of platelets, choleretic agents.

The hemostatic collection includes yarrow, shepherd's purse, nettle, intoxicating hare lip, St. John's wort, wild strawberry (plants and berries), water pepper, corn stigmas, wild rose.

Secondary prevention comes down to following a hypoallergic diet, various hardening procedures, active treatment and prevention of infectious diseases.

Within 3-5 years, climate change is inappropriate.

On recovery dynamic surveillance for a child is carried out for 2 years, with a chronic course of the disease - constantly. The scope of examinations: complete blood count, determination of the duration of bleeding, coagulogram, general urinalysis.

52. Leukemia. Disability of children with blood diseases

leukosis - a group of malignant tumors arising from hematopoietic cells.

Diagnostic criteria: hemorrhagic, hepatolienal syndrome, generalized enlargement of lymph nodes; changes in the peripheral blood: the presence of leukemic cells, changes in the myelogram.

Early rehabilitation- timely detection of the disease and active treatment in the hospital.

late rehabilitation carried out at the stage of sanatorium treatment. The mode is determined by the patient's condition and his hematological data.

The diet should be high-calorie with a protein content 1,5 times higher than the norm, enriched with vitamins and minerals.

Animal fats are limited. Products that have the properties of non-specific sorbents are recommended (carrots, plums, sea buckthorn, black currants, cherries, legumes, pumpkins, zucchini, melons).

Courses of complexes of vitamins A, E, C, B are prescribed₁, AT₆ in therapeutic doses for a month 4-6 times a year.

Medicines that increase the number of leukocytes are recommended (Eleutherococcus extract, sodium nucleinate, dibazol, pentoxyl, metacil). It is necessary to control the processes of digestion and assimilation of food, the activity of the liver and pancreas.

Sanitation of foci of infection, prevention of infectious diseases are carried out. Psychological and social adaptation and rehabilitation play an important role.

Secondary prevention comes down to the exclusion of physical and mental stress in children, a full diet, hardening. Children are exempted from physical education, in the spring-winter period, it is better to study according to the school curriculum at home. It is necessary to protect the child from contact with infectious patients.

Climate change is not recommended.

Dynamic Surveillance carried out constantly. Scope of research: general blood test at least 1 time in 2 weeks with platelet and reticulocyte count, biochemical blood test (bilirubin, proteinogram, alanine and aspartic transaminases, urea, creatinine, alkaline phosphatase are determined), urinalysis, abdominal ultrasound.

Disability of children with blood diseases.

1. Disability of children with blood diseases for a period of 6 months to 2 years is established with hematological conditions that occur with hemorrhagic vasculitis with a duration of more than 2 months and annual exacerbations.

2. Disability for a period of 2 to 5 years is established for hereditary and acquired blood diseases.

Clinical characteristics: at least 1 crisis during the year with a decrease in hemoglobin less than 100 g / l.

3. Disability for 5 years is established for acute leukemia, lymphogranulomatosis.

Clinical characteristics: from the moment of diagnosis until the age of 16.

53. Bronchitis

Acute bronchitis - proceeds without signs of bronchial obstruction.

Early rehabilitation includes drug treatment initiated at the first manifestations of bronchitis, leading to an improvement in bronchial function. To improve the general condition, adaptogenic preparations, vitamins, microelements are used. At this stage, exercise therapy, breathing exercises, iontophoresis with anti-inflammatory action are prescribed.

late rehabilitation carried out in a local sanatorium or in a polyclinic using all the factors of sanatorium treatment, respiratory gymnastics, exercise therapy are prescribed.

Rehabilitation treatment includes exercise therapy, the appointment of membrane-stabilizing drugs, reparants.

Dynamic Surveillance carried out by the local doctor during the year.

Acute obstructive bronchitis, bronchiolitis - proceeds with a syndrome of bronchial obstruction. For bronchiolitis, respiratory failure and an abundance of small bubbling rales are characteristic; for obstructive bronchitis - wheezing.

Early rehabilitation - Against the background of etiological treatment, secretolytic, bronchodilator, expectorant drugs are prescribed, unloading the pulmonary circulation, restoring microcirculation of the bronchial mucosa and submucosa, reparants, vitamin therapy. Breathing exercises, exercise therapy, iontophoresis of medicinal substances are used.

late rehabilitation - factors of sanatorium treatment, methods of restoration of bronchial trophism are applied, immunity is corrected, stimulating immunotherapy is carried out.

Rehabilitation treatment - for the prevention of relapses, immunomodulators, adaptogens are prescribed. Training breathing exercises and other factors of spa treatment and hardening are shown.

Dynamic Surveillance carried out by a local doctor together with a pulmonologist. Inspection is carried out once a quarter with a study of the function of external respiration. ENT doctor examines 2 times a year. Sanitation of foci of chronic infection is being carried out. The duration of observation is one year.

Recurrent bronchitis - bronchitis without obstruction, episodes of which are repeated 2-3 times within 1-2 years against the background of acute respiratory viral infections. Episodes of bronchitis are characterized by the duration of clinical manifestations (2 weeks or more).

Recurrent obstructive bronchitis - obstructive bronchitis, episodes of which are repeated in young children against the background of acute respiratory viral infections.

Early rehabilitation - against the background of etiological treatment, interferonogenic anti-inflammatory drugs, bronchodilators, secretolytic drugs, expectorants, protective and training regimen are prescribed.

late rehabilitation - all factors of sanatorium treatment are assigned. Immunotherapy is carried out with adaptogens of plant and animal origin.

54. Chronic pneumonia

chronic pneumonia - a chronic inflammatory non-specific process, which basically contains irreversible morphological changes in the form of bronchial deformation and pneumosclerosis in one or some segments, accompanied by relapses of inflammation in the bronchi, as well as lung tissue.

Diagnostic criteria: the presence of characteristic clinical symptoms of varying severity, cough with sputum, stable localized wheezing in the lungs, recurrent exacerbations. X-ray revealed signs of limited pneumosclerosis, bronchography - deformation and expansion of the bronchi in the lesion.

Early rehabilitation - during exacerbation, antibacterial drugs, secretolytic and expectorant drugs, bronchodilators, postural drainage, exercise therapy, breathing exercises, vitamin therapy, reparants, general and chest massage are prescribed, physical activity is recommended. Physiotherapy includes high-frequency electrotherapy, inhalation of mucolytic agents.

late rehabilitation carried out at the sanatorium stage. All factors of sanatorium rehabilitation, microelement therapy, phytotherapy, general massage, high-frequency methods not used at the first stage of rehabilitation, galvanization of the lungs and drug electrophoresis are used.

Rehabilitation treatment - apply immunocorrective therapy; biologics to eliminate intestinal dysbiosis, drugs that restore tissue trophism, immunomodulation by physical factors of influence, resort rehabilitation.

Dynamic Surveillance children with chronic bronchopulmonary diseases are constantly carried out by the district doctor and pulmonologist, examination - once a quarter. A complete clinical and laboratory-instrumental examination is indicated 2 times a year during hospitalization of children. The child needs constant exercise therapy, hardening procedures.

Acute pneumonia - acute inflammatory disease of the lungs, caused by bacterial, viral pathogens, some chemical influences, as well as allergic factors.

Diagnostic criteria: violation of the general condition, fever, cough, shortness of breath of varying severity and characteristic physical changes. X-ray confirmation is based on the detection of focal infiltrative changes in the lungs.

Early rehabilitation - Against the background of etiological treatment, secretolytic agents, substitution immunotherapy, exercise therapy, breathing exercises, immunomodulatory treatment with adaptogens are used.

RџSЂRё late rehabilitation sanatorium factors, vitamin therapy are used, if possible, infectious allergies are eliminated.

At the stage of rehabilitation treatment, elimination of dysbacteriosis, sanitation of foci of chronic infection are carried out, resort rehabilitation factors, and hardening are used.

The duration of observation is one year.

55. Alveolitis. Disability of children with diseases of the respiratory system

Exogenous allergic alveolitis is an immunopathological disease caused by inhalation of organic dust containing various antigens, and manifested by diffuse damage to the alveolar and interstitial tissue of the lung, followed by the development of pneumofibrosis.

Diagnosis criteria: acute, subacute or chronic lung disease, accompanied by cough, diffuse crepitating and small bubbling rales, shortness of breath, restrictive and obstructive ventilation disorders in the presence of indications of contact with a causally significant allergen. Radiologically it is characterized by diffuse infiltrative and interstitial changes.

Toxic fibrosing alveolitis - a disease caused by the toxic effect of chemicals, as well as certain drugs on the lung tissue.

Idiopathic fibrosing alveolitis is a primary chronic disease of unknown etiology with the localization of the main pathological process in the interstitium of the lung, which, progressing, leads to diffuse pulmonary fibrosis.

Early rehabilitation - for all alveolitis, antihistamines, glucocorticoids, tissue respiration enzymes, inhibitors of allergy mediators, vitamins, microelements, a protective regime for contacts with allergens and chemical agents are prescribed.

late recovery, or a sanatorium stage, is carried out in a clinic or sanatorium using all the factors of sanatorium treatment. Antimediators, membrane stabilizing agents, histamine, histoglobulan, antiallergic globulin, exercise therapy, massage, oxygen aerosol therapy are prescribed.

Rehabilitation treatment It is aimed at general strengthening of the body, hardening.

Dynamic Surveillance carried out by a local doctor and an allergist when examined once a quarter. The survey is carried out 2 times a year.

Disability of children with diseases of the respiratory system. Disability for a period of 6 months to 2 years is not established.

1. Disability for a period of 2 years is established for congenital and acquired diseases of the respiratory organs (including the condition after lung resection).

Clinical characteristics: persistent respiratory failure of II degree or more or severe and frequent attacks of bronchial asthma (4 or more per year).

2. Disability for a period of 5 years is not established.

3. Disability for a period up to the age of 16 is established once for diseases, pathological conditions and malformations of the respiratory organs that are not subject to surgical treatment, with symptoms of respiratory failure of the II degree and heart failure; hormone-dependent bronchial asthma; pulmonary heart failure III degree.

The objectives of the medical rehabilitation of people with disabilities since childhood are to improve or stabilize the criteria for survival and life.

56. Bronchial asthma

Bronchial asthma - a disease characterized by reversible bronchial obstruction, the pathogenetic basis of which is allergic inflammation of the respiratory tract. Bronchial hyperreactivity is noted, in typical cases - periodic occurrence of attacks with impaired bronchial patency as a result of their spasm, mucosal edema and mucus hypersecretion.

Bronchial asthma also occurs in the form of asthmatic bronchitis without typical attacks, spasmodic cough, asthma of physical exertion.

Diagnostic criteria: asthma attacks, status asthmaticus, asthmatic bronchitis, spasmodic coughing attacks, accompanied by acute lung distention and difficulty in exhalation. X-ray during an attack, swelling of the lungs is observed, against the background of which an increase in the bronchovascular pattern is often detected.

By severity, asthma is divided into mild, moderate and severe. When assessing the severity, along with the criteria of international consensus, one should also take into account the patient's condition in the non-attack period, the presence of functional changes in the external respiratory apparatus and the cardiovascular system.

Complications: lung atelectasis, pneumothorax, mediastinal emphysema, cor pulmonale, pulmonary emphysema (if the latter two are present, other chronic obstructive pulmonary diseases, which are a more common cause of these complications, must be excluded).

Within the framework of this classification, like any other, with the accumulation of new data, further in-depth characterization of the clinical manifestations of lung disease in children is possible.

Early rehabilitation provides for the relief of an attack, the appointment of antimediators (ketofen, ketotifen, zaditen, ketasma - early age 1/4 tablet 2 times 1-2 months, the rest 1/2 tablet 2 times 1-2 months; terfenadine - up to 3 years, 15 mg 2 times a day, older children - 30 mg 2 times a day, 14-16 years old - 60 mg 2 times a day for a month; Zyrtec - 2 mg 1 time a day for 10-14 days for children under 3 years old, older children - 3-5 mg, course up to 10-14 days); inhibitors of inflammatory mediators are combined with prolonged theophyllines (up to 3 years - 1/4 tablet 2 times a day, older children - 1/4-1/2 tablets 2 times a day, if necessary - up to a month).

late rehabilitation - use of intal in capsules and aerosol; sodium nedocromil aerosol (1-2 breaths 2 times a day for 6 weeks or more), autoserotherapy against the background of other factors of sanatorium treatment with the use of breathing exercises (according to Buteyko, etc.), specific hyposensitization.

At the stage rehabilitation treatment correction of immunological disorders, membrane stabilization, rehabilitation with histoglobulin, lysates of leukocytes, autolymphocytes are carried out. Resort factors of rehabilitation, transition to physical activity, exercise therapy are used.

Dispensary observation carried out until the age of 15. Examinations of the local doctor and allergist after the attack period are carried out once a quarter, with a stable remission - 2 times a year. Promotion is underway.

Authors: Drozdov A.V., Drozdova M.V.

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