0-3岁儿童健康体检 2

0-3岁儿童健康体检 2 0-3岁儿童健康体检、 一、0---3儿童健康体检: 1.时间:0---1岁每季度一次，共4次。1---3岁每半年一次，共计6次; 2.体格检查常用指标:体重、身长、坐高、头围、胸围。 二、体 重: 定义:指器官、系统、体液的综合重量，是反映儿童生长与营养状况的灵敏指标; 1、测量方法:进食后2小时以上，排空大便，脱去衣帽.鞋、袜后称重; 2、正常小儿出生体重约3kg，前半年平均每月增加700g，后半年平均每月增加约300---400g，1岁时约9kg; 公式: 1---6个月: 体重=出生体重(kg)+月龄*0.7(kg) 7---12个月: 体重=出生体重(kg)+月龄*0.4+1.8(kg) 2---10岁 : 体重=年龄*2+8(kg) 3、意义:主要用于评价体格生长、衡量营养状况，计算摄入营养的量、用药量及输液量等。 体重的规律: 关键年月 实际体重 体重增加 较出生时增加(倍) 出生 3KG/+- 4月 6KG/+- 3kg 1倍 12月 9KG/+- 3kg 2倍 24月 12KG/+- 3kg 3倍 2岁后到青春期前 2KG/年 青春期 4—5KG/年 三、身 长: 1、测量方法:指头顶到足底的全身长度，小儿脱去衣帽、鞋、袜后测量。3岁以下卧位测量，3岁以上站位测量; 2、正常小儿出生时身长约50cm，第一年增长约25cm，第二年增长约10cm,2---10岁每年平均增长5---7.5cm; application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image checki recovery operation wash stomach operation catheter operation chest abdominal puncture operation lumbar puncture operation heart electric guardianship electrical cardioversion law operation breathing machine using tracheal intubation operation moving vein puncture operation critical patients life support technology (including heart lung recovery and trauma patients life support) 3. high requirements (1) learning disease species and the cases number requirements: heart lung recovery Hou integrated syndrome 5 cases, and more organ function obstacles integrated levy 3 cases (2) clinical knowledge, and skills requirements: three cavity two SAC tube oppression bleeding operation; mechanical ventilation of indications, and Different characteristics of the illness and the offline method. (3) foreign language, teaching, research and other requirements: foreign literature review or book report 1. (Nine) heavy syndrome guardianship Ward 2 months 1. Rotary purpose master: common species of diagnosis and emergency processing; common emergency drug (heart lung recovery and the vascular activity drug, and buck drug, and anti-rhythm disorders drug, and solutions spasm flat breath drug, and anti-epilepsy drug) of refers to levy, and side effects and clinical 公式:2---10岁:身高(cm)=年龄*7+70cm 身长的规律: 关键年龄 实际身高 增长情况 出生 50CM 3月 61—62CM 11—12 12月 75CM 12—13 24月 85CM 10 2岁后到青春期前 5—7CM/年 青春期 男9—13CM/年 女 8—9CM/年 四:坐 高 坐高(顶臀长)是指头顶到坐骨结节的长度，坐高的增长代表脊柱和头的长度的增长; 坐高(顶臀长)/身高(长)比值 出生 1岁 2岁 6岁 10岁 14岁 坐高 33.5 47.9 53.3 64.7 73.2 86 身高 50.2 76.5 87.9 116.2 136.6 162.5 坐高/身高 0.67 0.63 0.61 0.56 0.54 0.53 随着年龄的增长,坐高身高的比例逐步降低; 坐高/身高的意义:在某些肢体短小的病病,如软骨发育不良,先天性甲状腺功能减低症等,坐高/身高比值明显增大,这类短小,称为非匀称性短小。 五、头 围 1、测量方法:用软尺紧贴头皮，经眉弓上线和枕骨结节，左右对称环绕一周，精确读数0.1cm; 2、新生儿头围平均约34cm，在一岁内增长最快，6个月时达44cm，1岁时为46cm，2岁时48cm; 3意义:2岁前测量头围最有价值，若过大常见于脑积水，过小见于脑发育不良及头小畸形。 年龄 实际头围 增长 出生 34 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image checki recovery operation wash stomach operation catheter operation chest abdominal puncture operation lumbar puncture operation heart electric guardianship electrical cardioversion law operation breathing machine using tracheal intubation operation moving vein puncture operation critical patients life support technology (including heart lung recovery and trauma patients life support) 3. high requirements (1) learning disease species and the cases number requirements: heart lung recovery Hou integrated syndrome 5 cases, and more organ function obstacles integrated levy 3 cases (2) clinical knowledge, and skills requirements: three cavity two SAC tube oppression bleeding operation; mechanical ventilation of indications, and Different characteristics of the illness and the offline method. (3) foreign language, teaching, research and other requirements: foreign literature review or book report 1. (Nine) heavy syndrome guardianship Ward 2 months 1. Rotary purpose master: common species of diagnosis and emergency processing; common emergency drug (heart lung recovery and the vascular activity drug, and buck drug, and anti-rhythm disorders drug, and solutions spasm flat breath drug, and anti-epilepsy drug) of refers to levy, and side effects and clinical 3月 40 6 12月 46 6 24月 48 2 5岁 50 2 六、胸 围: 胸围:平乳头经肩胛角下绕胸一周的长度;反映胸廓、肌肉、骨骼和肺的发育。 头胸围的关系: 头键年月 际胸围 与头围比较 出生月 32 小于是—2 1岁 46 约相等 7岁 头围+年龄-1 7年龄-1 颅骨、牙齿发育: 1(颅骨:通过头围的测量、囟门大小及骨缝的闭合情况来衡量颅骨的发育。婴儿出生时骨缝与后囟已闭合或很小(最迟后囟2---3个月闭合，骨缝3---4个月闭合)。前囟正常1---1.5岁闭合;测量以对边中点连线为准; 意义: 1)(前囟若闭合过早常见于小头畸形，脑发育不良; 2)(前囟闭合过迟常见于佝偻病、呆小病、脑积水; 3)(前囟饱满常见于颅内压增高，凹陷见于脱水。后囟闭合过晚，常见于先天性甲状腺功能低下。 2、牙齿:乳牙于生后4--6月开始萌出。若10个月以后仍未萌牙，可能与先天性缺钙有关。2---2.5岁乳牙出齐，共计20颗。 牙齿=月龄一(4~6) 神经运动发育: 1、3(月)抬头笑认妈; 4、5(月)学翻(身)辨声佳; 6、7(月)会坐学咿呀; 8、9(月)爬行10(月)叫爸; application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image checki recovery operation wash stomach operation catheter operation chest abdominal puncture operation lumbar puncture operation heart electric guardianship electrical cardioversion law operation breathing machine using tracheal intubation operation moving vein puncture operation critical patients life support technology (including heart lung recovery and trauma patients life support) 3. high requirements (1) learning disease species and the cases number requirements: heart lung recovery Hou integrated syndrome 5 cases, and more organ function obstacles integrated levy 3 cases (2) clinical knowledge, and skills requirements: three cavity two SAC tube oppression bleeding operation; mechanical ventilation of indications, and Different characteristics of the illness and the offline method. (3) foreign language, teaching, research and other requirements: foreign literature review or book report 1. (Nine) heavy syndrome guardianship Ward 2 months 1. Rotary purpose master: common species of diagnosis and emergency processing; common emergency drug (heart lung recovery and the vascular activity drug, and buck drug, and anti-rhythm disorders drug, and solutions spasm flat breath drug, and anti-epilepsy drug) of refers to levy, and side effects and clinical 15(月)行走; 看图画在18(月); 3岁学穿鞋和袜。 其 它: 1、血红蛋白测定:6月、1岁、1.5岁、2.5岁; 2、维生素D用法用量:生后2—4周开始添加，vitD400—600Iu/日; 3，辅食:添加原则:由少到多，由细到粗，由稀到稠。 评价的基本要求: 测量的生长指标数据必须可靠，定期纵向观察生长指标，请选择参考标准。2006年标准，工具的选择。称、身高计、坐高计等。 评价内容:1、发育水平 2生长速度 3、匀称度 发育水平:将在某一年龄所测得的体格生长指标与同性别参考人群值进行横向比较，即为此儿童该项体格生长指标在此年龄的发育水平。 生长速度:是对某一项体格生长指标定期连续测量所获得的该项指标在某一年龄阶段的增长值，将其与参考人群值的生长速度比较，得出加速、正常、不增、下降、增长不足的结果。 匀称度:是对各发育指标之间关系的评价，体型匀称、身材匀称。 体格检查: 生长障碍原因常常涉及内分泌疾病(甲状腺功能减低，中枢性肥胖，生长激素缺乏等等)与非匀称性骨骼发育不良疾病，一些隐晦的体征:如五官、四肢畸形等可帮助医生联想到有关系统等等。 涉及与体格发育有关的其它系统发育异常。 颅骨:不对称大小，头、缝 颅骨，颅骨缝最早闭合; 眼:先天性白内障，近视; 口:悬雍垂裂、高腭弓，腭裂; 耳:耳廓肿胀，低耳位; 牙齿:缺如，发育迟缓; 肢体:多指趾，搭车样拇指，畸形足，指趾甲—指甲发育不良，短、宽指甲; application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image checki recovery operation wash stomach operation catheter operation chest abdominal puncture operation lumbar puncture operation heart electric guardianship electrical cardioversion law operation breathing machine using tracheal intubation operation moving vein puncture operation critical patients life support technology (including heart lung recovery and trauma patients life support) 3. high requirements (1) learning disease species and the cases number requirements: heart lung recovery Hou integrated syndrome 5 cases, and more organ function obstacles integrated levy 3 cases (2) clinical knowledge, and skills requirements: three cavity two SAC tube oppression bleeding operation; mechanical ventilation of indications, and Different characteristics of the illness and the offline method. (3) foreign language, teaching, research and other requirements: foreign literature review or book report 1. (Nine) heavy syndrome guardianship Ward 2 months 1. Rotary purpose master: common species of diagnosis and emergency processing; common emergency drug (heart lung recovery and the vascular activity drug, and buck drug, and anti-rhythm disorders drug, and solutions spasm flat breath drug, and anti-epilepsy drug) of refers to levy, and side effects and clinical 关节:多关节脱位。 婴儿营养的三个关键期: 母乳喂养 是第一个关键期 儿童喂养的第二个关键期 4—6个月 儿童营养的第三个关键期 10—12个月 母乳喂养: 母乳喂养:建立与喂养的方法; 产前准备:精神、身体、乳房; 产后措施:尽早开奶，按需哺乳，吸空乳房; 母乳喂养时不用奶瓶，不用糖水喂婴儿，生后一至两周是建立母乳的关键期; 不宜哺乳的乳母:急性传染病、精神病、癫痫病，慢性消耗性疾病、乙肝病毒携带者等。 部份母乳喂养: 补授法:喂母乳，再补充母乳代用品，6月内最好用补授法; 代授法:用母乳代用品代替一次或数次母乳喂养，6月以后用代授法; 人工喂养:完全采用母乳代用品喂养，不喂母乳 。 儿童喂养的第二个关键期4—6个月: 过渡期泥糊状食物是人类生态学发展中不可逾越的食物形态，抓好这个阶段的喂养不仅是营养的意义，对小儿吃、咀嚼功能的发育，正确饮食行为培养均有重要意义。 过渡期食物的选择:原则上讲容易消化，容易缺乏，不易过敏，不好吃的食物先加。 4—6个月 泥 6次奶 过渡食物渐加至一次 用勺喂 7—9个月 末 4次奶 吃饭1次水果 学用杯 10—12个月 碎 2次饭 2—3次奶，1次水果 抓食，自己用勺，断奶瓶; 添加原则:少—多，稀—碉、细—粗、一种—多种; 儿童营养的第三个关键期10—12个月: 10月—12月婴儿咀嚼和吞咽功能已发育较好，自我意识开始萌芽，自我进application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image checki recovery operation wash stomach operation catheter operation chest abdominal puncture operation lumbar puncture operation heart electric guardianship electrical cardioversion law operation breathing machine using tracheal intubation operation moving vein puncture operation critical patients life support technology (including heart lung recovery and trauma patients life support) 3. high requirements (1) learning disease species and the cases number requirements: heart lung recovery Hou integrated syndrome 5 cases, and more organ function obstacles integrated levy 3 cases (2) clinical knowledge, and skills requirements: three cavity two SAC tube oppression bleeding operation; mechanical ventilation of indications, and Different characteristics of the illness and the offline method. (3) foreign language, teaching, research and other requirements: foreign literature review or book report 1. (Nine) heavy syndrome guardianship Ward 2 months 1. Rotary purpose master: common species of diagnosis and emergency processing; common emergency drug (heart lung recovery and the vascular activity drug, and buck drug, and anti-rhythm disorders drug, and solutions spasm flat breath drug, and anti-epilepsy drug) of refers to levy, and side effects and clinical 食欲望增加，如用手抓物放入口中，奶类已不足，主要食物应由流; 质、半流质饮食逐渐过度到饮食，培养良好饮食习惯及自我服务能力尤为重，可有意识的训练自己用勺喂养，用杯子喝水，断离奶瓶，这不仅有利于口腔的发育，而且有利于培养婴儿自信，自立的精神。为自己独立用勺、筷子进食作准备，此期为婴儿进食行为训练，可避免小儿在幼儿期仍依赖吃饭要人喂，饭包在口中不吞，吃饭注意力不集中等坏习惯。 各类维生素及矿物质的主要来源 种类 来源 维生素A 肝、牛乳、奶油、鱼肝油;有色蔬菜中的胡萝卜素 维生素B1 米糠、麦麸、豆、花生;瘦肉、内脏;肠内细菌和酵母可合 成一部分 维生素B2 肝、蛋、鱼、乳类、蔬菜、酵母 维生素PP 肝、肉、谷类、花生、酵母 维生素B6 各种食物中，及肠内细菌合成 维生素B12 动物性食物 叶酸 绿叶蔬菜、肝、肾、酵母较丰富，肉、鱼、乳类次之，羊乳 含量较少 维生素C 各种水果及蔬菜 维生素D 鱼肝油、肝、蛋黄;人皮肤日光合成 维生素K 肝、蛋、豆类、青菜 钙 乳类、豆类、虾皮、绿色蔬菜 铁 肝、血、豆类、肉类、绿色蔬菜、杏、桃 锌 鱼、蛋肉、禽、全谷、麦胚、豆、酵母等 镁 谷类、豆类、干果、肉、乳类 碘 海产品 application; infection and antibacterial drug of clinical application; transfusion refers to levy; nutrition support of adapted card and clinical application; common life support technology (as cycle breathing support, and nutrition support,) and emergency technology of application; common guardianship instrument using. Look: shock, cardiac respiratory arrest and acute organ failure, systemic inflammatory response syndrome and severe infection and multiple organ dysfunction syndrome (MODS), severe disturbance of body fluid environment such as critical theory and progress of the illness. 2. basic requirements (1) species and cases of study requirements: severe pneumonia in disease-disease myocardial infarction ... 3. high requirements (1) learning disease species: disease species disease species image radiation: rheumatic heart congenital heart intestinal Crohn's (Crohn) disease intestinal tuberculosis bile duct cancer chronic pancreatic inflammatory urinary system stone urinary system tumor adrenal disease thyroid disease cranial within infection nervous system tumor nuclear medical: Digest road bleeding explicit like brain blood flow perfusion explicit like testicular blood pool explicit like salivary glands explicit like (2) clinical knowledge, and skills requirements: understand various image checki recovery operation wash stomach operation catheter operation chest abdominal puncture operation lumbar puncture operation heart electric guardianship electrical cardioversion law operation breathing machine using tracheal intubation operation moving vein puncture operation critical patients life support technology (including heart lung recovery and trauma patients life support) 3. high requirements (1) learning disease species and the cases number requirements: heart lung recovery Hou integrated syndrome 5 cases, and more organ function obstacles integrated levy 3 cases (2) clinical knowledge, and skills requirements: three cavity two SAC tube oppression bleeding operation; mechanical ventilation of indications, and Different characteristics of the illness and the offline method. (3) foreign language, teaching, research and other requirements: foreign literature review or book report 1. (Nine) heavy syndrome guardianship Ward 2 months 1. Rotary purpose master: common species of diagnosis and emergency processing; common emergency drug (heart lung recovery and the vascular activity drug, and buck drug, and anti-rhythm disorders drug, and solutions spasm flat breath drug, and anti-epilepsy drug) of refers to levy, and side effects and clinical