Chandrakant Development Friendly Wel Baby Clinic

Development Friendly Well Baby Clinic
Background:
Increasing incidence of miraculous salvaging of very low birth weight babies has increased
the incidence of developmental delay and deviances. About 10% of the world’s population
has some form of disability(WHO). In India, 3.8% of the population has some form of
disability and the same was found to be more common among children of the lowest
socioeconomic class families when compared with the next-to-lowest class families. The
prevalence of developmental delay, deviation, deformity or disability among the under-five
children .
Early Child Care and Development (ECCD) is a comprehensive approach specially aimed at
providing opportunities for the development of children at the age group of 0-8 years.
Varied strategies have been used, singly or in combination for the betterment of the
children’s health, nutritional status, psychological development, early childhood education
or child education. ECCD programs, whether parent focused or child centred, help
disadvantaged children directly or indirectly, to combat to a certain extent, the detrimental
effects of poverty on child development especially during the crucial first six years of life.
ECCD programs in most of the developing countries are not always planned and
implemented with a clear understanding of the issues specific to the urban poor living in
slums and peri-urban settlements; with the result that a greater percentage of under fives in
the poor urban areas still remain un-reached by any early child development programs.
Developmental status - an early child development indicator (WHO):
A country’s future human resource development is determined on the basis of the

developmental indices like infant mortality, morbidity, prevalence of disability, living
conditions and education of children, especially the under fives. As early child development
is objectively reflected in the developmental status of children, any delay, dissociation or
deviation in the development of children and its causes/contributory factors may be
indicative of the need for strengthening the existing programs or the need for exploring and
initiating newer possibilities.
Rrisk factors for development delay:
A. Biological risk factors
Low birth weight is the single most important biological risk factor for developmental
delay.Health care practices like incomplete immunization, insufficient check up during
pregnancy, unsafe deliveries at home and improper post-natal care of mothers and
newborn increase the risk factors for developmental delay. Infection with rubella in the
first trimester of pregnancy, intrauterine infections, premature delivery, perinatal
problems like birth asphyxia, hypothermia, and hypoglycaemia, post asphyxial
encephalopathy is the best clinical marker for outcome.
B. Environmental risk factors

The primary environment of any individual especially during infancy, is the family and more
so, the mother.Hence a child with environmental risk of living in deprived settlements may
sometimes present with developmental delay. As child development is said to be the
interplay between genetic and environmental factors, a child living in deprived
environmental settlements(Poverty, substandard housing, overcrowding, inadequate water,
sanitation and sewage disposal facilities) may present with developmental delay.
Early Child Development Programs and Their problems:
1) Integrated Child Development Services (ICDS) ; The largest and most important
network of services for rural poor but limited for urba
2) Urban Basic Services (UBS)
3) Anganwadis
4) Mobile crèches( which aim to relieve the older child from the burden of rearing the
younger ones by providing services like creche, preschool education and primary
schools)
5) The Balwadi program functioning in the urban areas on a moderate scale under the
Central Social Welfare Board and Indian Council for Child Welfare focuses on natal
and postnatal services, arts and crafts training, elementary medical services and
preschool program for children between two and a half to five years.
The problems faced by the ECCD programs of urban settlements are; inadequate
infrastructure due to minimal funds, poor honorarium of workers, unqualified and poorly
skilled staff, lack of services for the under three, over importance to one or more
components thereby neglecting other vital components of early child development,
worker’s lack of knowledge and skill in infant stimulation, early identification of
developmental delay in children, lack of community participation and ownership of the
program and absence of outreach programs. In India, a feasible and sustainable model for
early developmental intervention would be through community owned early child care and
development facilities, preferably within the ambit of current national programs viz., NRHM,
ICDS and the Sarva Shiksha Abhiyan.
Following are the Replicable working models/services to strengthen early child
development:i )Infant stimulation ii) A community based model of early identification and
intervention of developmental delay iii) Community Extension Services iv) Child development
referral units (CDRU) v) Development friendly well baby clinic vi) Developmental screening for
toddlers vii) Community owned ECD centres viii) Skill assessment of preschool children ix) School
readiness program x) Child to child approach xi) Primary education enhancement program
xii)Identification of mental sub-normality in primary school children.
Development Friendly Well Baby Clinic:

It is now well appreciated that there are great many children presenting with developmental
delay and spasticity, who do not have identifiable risk factors. Hence, ideally all babies should be
assessed at least once during infancy. Well Baby Clinics, now functioning for a number of years as a
facility meant for comprehensive preventive health care for infants and children have over the years
been reduced to only an immunization clinic. The well baby clinics functioning in connection with
urban health centres may be an ideal place to offer developmental assessment using tools like. An
ideal Child Development Centre(CDC) has the following components:(i) Monitoring (ii)
Assessment (iii) Early intervention(iv) Therapy (v) Integration (vi) Research, and (vii)
Community/social application. Comprehensive and Integrated management are the keystones of a
successful CDC.
Guidelines:
1) Screening and assessment should be viewed as services- as part of the intervention
process and not only as a means of identification and measurement.
6) Process, procedures, and instruments intended for screening and assessment should
only be used for their specified purposes.
7) Multiple sources of information should be included in screening and assessment
processes.
8) Developmental screening should take place on a recurrent or periodic basis. It is
inappropriate to screen young children only once during their early years. Similarly,
provisions should be made for re-evaluation or reassessment after the need for
services has been initiated.
9) Developmental screening should be viewed as only one path to insure in depth
assessment. Failure to qualify for services based on a single source of screening
information should not become a barrier to further evaluation for intervention
services if other risk factors (e.g. environmental, medical, familial) are present.
10) Screening and assessment procedures should be reliable and valid.
11) Family members should be an integral part of the screening and assessment process.
Information provided by family members is critically important for determining
whether or not to initiate more in depth assessment and for designing appropriate
intervention strategies. Parents should be accorded complete informed consent at
all stages of the screening and assessment process.
12) During screening and assessment of developmental strength and problems, the
more relevant and familiar the tasks and setting are to the child and the child’s
family, the more likely it is that the results will be valid
13) All tests, procedures and processes intended for screening or assessment must be
culturally sensitive.
14) Those who screen and assess very young children need extensive and
comprehensive training.
Periodicity:
The frequency and content foe well child care activities are derived from evidence based
practice and research. It is guide to paediatric health providers to perform certain services
and make observations at age specific visits and it designates the standard for preventive
services for children and youth.
Tasks:
The well child visit encounter to promote the physical and emotional wellbeing of children
and youth. Child health professional should take advantage of the opportunity well child
visits provide to elicit parental questions and concerns, gather relevant family & individual
health information perform physical examination and initiate screening tests.
Tasks of well baby care visits include – Disease detection, Disease Prevention, Health
Promotion and Anticipatory Guidance. To achieve these outcomes, following strategy
should be followed.
Developmental Surveillance: This is the ongoing process of monitoring individual children’s
developmental status and should be incorporated at each maintence visit. Involves eliciting
and attending to parental concerns about their children’s development e.g. age specific
queries like child is walking, talking, pointing. It is a kind of a developmental growth chart.
Recognition of children who are at risk of developmental delay is the goal of developmental
surveillance.
Developmental screening: is the administration of a brief standardized tool to identify
children at risk of a developmental disorder. It should be performed when developmental
surveillance elicits a risk factor for developmental delay. AAP (American academy of
Paediatrics ); in spite of parental concern or in the absence of established risk factors,
recommends application of tools at the 9,18 and 30 months health visit. In addition to
general screening tools, autism specific screening tool should also be administered at the
age of 18 months. Screening instruments should have a broad developmental focus and
should be brief, inexpensive, valid and reliable.
Commonly used developmental tools include – DDST II (Denver developmental screening
test II), DOC (developmental observation card),TDSC(Trivandrum developmental screening
chart),DASSI(Developmental assessment scale for Indian infants), neurodevelopmental
evaluation – Amiel Tison method, STYCAR vision tests, identification of retinopathy of
prematurity.
Developmental Evaluation (Assessment): is performed when surveillance and screening
identifies a child as being at risk of a developmental disorder. The main aim is to identify the
specific developmental disorder or disorders affecting the child. It is performed by trained
persons.
Developmental Therapy: Therapist should give therapy to minimize the disability or to
prevent further delay. Therapy includes speech therapy, physiotherapy, occupational
therapy, neuro developmental therapy and prevention of retinopathy of prematurity.
The Benefits of Well-Child Visits:

 Prevention: Your child gets scheduled immunizations to prevent illness. You also can
ask your paediatrician about nutrition and safety in the home and at school.
 Tracking growth and development: See how much your child has grown in the time
since your last visit, and talk with your doctor about your child's development. You
can discuss your child's milestones, social behaviours and learning.
 Raising concerns: Make a list of topics you want to talk about with your child's
paediatrician such as development, behaviour, sleep, eating or getting along with
other family members. Bring your top three to five questions or concerns with you to
talk with your paediatrician at the start of the visit.
 Team approach: Regular visits create strong, trustworthy relationships among

paediatrician, parent and child. The AAP recommends well-child visits as a way for
paediatricians and parents to serve the needs of children. This team approach helps
develop optimal physical, mental and social health of a child.

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Development Friendly Well Baby Clinic

Developmental status - an early child development indicator (WHO):

A country’s future human resource development is determined on the basis of the

Rrisk factors for development delay:

A. Biological risk factors

B. Environmental risk factors

Early Child Development Programs and Their problems:

2) Urban Basic Services (UBS)

xii)Identification of mental sub-normality in primary school children.

Development Friendly Well Baby Clinic:

The Benefits of Well-Child Visits:

 Team approach: Regular visits create strong, trustworthy relationships among

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