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TRIPURA INSTITUTE OF PARAMEDICAL SCIENCE

NURSING SECTION
SUBJECT- Advanced nursing practice
Visit report- under five clinic(madhupur phc)

SUBMITTED TO:-
SUBMITTED BY: -
MRS. SUKLA RANI PAUL SUSMITA SEN
ASSISTANT PROFESSOR M.Sc. NURSING ,1ST SEMESTER
(COMMUNITY HEALTH NURSING) ROLL NO-15
TIPS, NURSING SECTION

DATE OF SUBMISSION:- 11/12/2023

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INTRODUCTION :
The first five years of life form the foundations of the child's physical and mental growth and
development.

The mortality and morbidity are high among this age group. The Department of Health
established the Under Five Clinic Program to address this problem.

HISTORY OF UNDER FIVE CLINIC :

Three models of Under Fives' Clinic were tried successively at the Malavani Health Centre,
beginning in 1978. Model I: This was a Centre- based model which was established in 1978.
The venue was the same centre where outpatient department was located for the convenience
of the mothers.

DEFINITION :

Under five clinic –

Under-five Clinic: It is a centre where preventive, promotive, curative, referral, and

educational services are provided in a packaged manner through trained nurses to under 5
children.

OBJECTIVES AND GOALS OF UNDER FIVE CLINIC :

It provides comprehensive health care to young children in a separate specialized
facility and supervision of health of all the children up to 5 years of age.

I. Monitor growth and development of the child until 5 years of age.

II. Identify factors that may hinder the growth and development of the child.
III. Preventive, primitive, curative, referral, educational services in a package-one roof
IV. Services through: trained nurses-economical, available to large proportion of
population

COMPONENTS OF UNDER FIVE CLINIC :

1. Care of illness – children are treated for acute and chronic illness.
2. Growth monitoring
-child is weighed periodically every month during 1st year.
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-measure height, mid arm circumference

-growth chart prepared for monitor the growth of the child.
3. Preventive care
Timely physical examination
o Here's a list of common components of a physical examination:
o Vital signs assessment (blood pressure, heart rate, respiratory rate,
temperature)Head and neck examination (eyes, ears, nose, throat)
o Heart and lung examination (auscultation of heart sounds, lung sounds)
o Abdominal examination (palpation, percussion)
o Extremities examination (checking for strength, range of motion)
o Neurological examination (reflexes, sensation, coordination)
o Skin examination (checking for abnormalities, lesions)
o Musculoskeletal examination (assessing joints, muscles)
o Genitourinary examination (if necessary, for specific complaints or concerns)
o Breast examination (for breast health in females)

 Immunization
The specific immunizations offered at a Maternal and Child Health (MCH) clinic may
vary depending on the location, resources, and local health guidelines. However,
here's a general list of common immunizations provided in many MCH clinics:
DTP: Protects against diphtheria, tetanus, and pertussis (whooping cough)
MMR: Protects against measles, mumps, and rubella.
Varicella (chickenpox): Protects against chickenpox.
Hepatitis B: Protects against hepatitis B virus.
Hepatitis A: Protects against hepatitis A virus.
IPV: Protects against poliovirus.
Rotavirus: Protects against rotavirus infection, a common cause of severe diarrhea in
infants and young children
.Pneumococcal conjugate vaccine (PCV): Protects against pneumococcal bacteria,
which can cause pneumonia, meningitis, and other infections.
Inactivated poliovirus vaccine (IPV): Protects against poliovirus.
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Hib: Protects against Haemophilus influenzae type b bacteria, which can cause
serious infections in children.
Meningococcal conjugate vaccine (MenACWY): Protects against meningococcal
bacteria, which can cause meningitis and bloodstream infections.
Influenza (flu) vaccine: Annual vaccine to protect against seasonal influenza.
HPV: Protects against human papillomavirus (certain types that cause cervical cancer
and genital warts).TT: Booster vaccines for tetanus, diphtheria, and pertussis in
adolescents and adults.
MMRV: Combined vaccine for measles, mumps, rubella, and varicella.

Nutrition

Maternal and Child Health (MCH) clinics often offer a range of nutritional services
tailored to the specific needs of mothers, infants, children, and families. Here are
some common nutritional services provided by MCH clinics:

Prenatal Nutrition Counseling: Guidance on maintaining a healthy diet during

pregnancy to support maternal health and fetal development. This may include
recommendations for nutrient-rich foods, prenatal vitamins, and managing pregnancy-
related symptoms like nausea or heartburn.

Breastfeeding Support: Education and assistance for mothers on breastfeeding

techniques, proper latch, milk supply, and addressing common breastfeeding
challenges. MCH clinics may also provide lactation counseling and support groups.

Infant Feeding Education: Information on introducing solid foods, age-appropriate

feeding schedules, and promoting healthy eating habits in infants. This may include
guidance on transitioning from breast milk or formula to solids and managing food
allergies or intolerances.

Child Nutrition Assessment: Evaluation of a child's growth and nutritional status,

including monitoring weight, height, and body mass index (BMI). MCH clinics may
offer nutrition counseling for children with specific dietary needs, such as those with
food allergies, intolerances, or chronic conditions like diabetes or obesity.
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Nutrition Education: Classes, workshops, or individual counseling sessions on

topics such as healthy meal planning, portion control, reading food labels, and making
nutritious food choices on a budget.WIC Program: Many MCH clinics participate in
the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC),
which provides nutritious foods, nutrition education, breastfeeding support, and
referrals to other healthcare services for eligible pregnant women, breastfeeding
mothers, infants, and young children.
Nutritional Screening and Referrals: Assessing nutritional risk factors and
providing referrals to additional support services or specialists as needed, such as
registered dietitians, food assistance programs, or community resources

.Nutritional Support for Special Populations: Tailored nutrition services for

families facing unique challenges, such as those with multiple births (twins, triplets),
premature infants, infants with feeding difficulties, or children with developmental
delays or special healthcare needs.
Oral rehydration therapy

Oral rehydration solution (ORS) therapy is a vital component of maternal and child
health (MCH) clinics, particularly in managing dehydration due to diarrhea, vomiting,
or other causes in infants and children. Here's how MCH clinics typically incorporate
ORS therapy:

Education and Counseling: MCH clinics provide education to parents and caregivers
on the importance of ORS therapy for rehydrating children who are experiencing
dehydration due to illnesses like diarrhea or vomiting. They offer guidance on
preparing and administering ORS solutions at home.

Assessment and Monitoring: Healthcare providers at MCH clinics assess the

severity of dehydration in infants and children and monitor their hydration status
during clinic visits or through telehealth consultations. They determine the
appropriate dosage and frequency of ORS based on the child's age, weight, and degree
of dehydration.
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Prescription and Distribution: MCH clinics may prescribe ORS packets or solutions
to families, ensuring they have access to this essential treatment for managing
dehydration at home. In some cases, ORS may be provided free of charge or at a
reduced cost through government programs or partnerships with public health
agencies.

Follow-up and Support: MCH clinics offer follow-up care to monitor the child's
response to ORS therapy, assess hydration status, and provide additional support or
guidance as needed. They emphasize the importance of continuing ORS therapy until
dehydration resolves and encourage parents to seek medical attention if symptoms
persist

4. Family planning
Maternal and Child Health (MCH) clinics often provide comprehensive family
planning services to support individuals and couples in making informed decisions
about contraception and reproductive health. Here are some common components of
family planning services offered by MCH clinics:

Contraceptive Counseling:
Healthcare providers offer personalized counseling to individuals and couples to
discuss contraceptive options, including efficacy, benefits, potential side effects, and
suitability based on individual preferences and health considerations.

Contraceptive Methods:
MCH clinics offer a range of contraceptive methods, including hormonal methods
(birth control pills, patches, injections), long-acting reversible contraception
(intrauterine devices - IUDs, contraceptive implants), barrier methods (condoms,
diaphragms), fertility awareness methods, and permanent methods (tubal ligation,
vasectomy).

Access to Contraceptives:
MCH clinics provide access to contraceptive supplies, including prescription
medications, over-the-counter contraceptives, and contraceptive devices. They may
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offer on-site dispensing or prescriptions for obtaining contraceptives from pharmacies

or family planning clinics.Contraceptive

Education and Training: MCH clinics offer educational materials, workshops, and
training sessions to educate individuals and healthcare providers about contraceptive
methods, proper use, effectiveness, and strategies for addressing common concerns or
misconceptions.

Preconception Counseling: MCH clinics provide counseling and support to

individuals and couples who are planning to conceive, offering guidance on
optimizing reproductive health, addressing pre-existing health conditions, and
preparing for a healthy pregnancy.

STD/HIV Prevention:
Family planning services often include education and counseling on sexually
transmitted infections (STIs) and HIV/AIDS prevention, risk reduction strategies, and
the importance of dual protection (using condoms along with other contraceptive
methods) for preventing both pregnancy and STIs.Postpartum Contraception: MCH
clinics offer counseling and support to women during the postpartum period,
discussing contraceptive options, breastfeeding considerations, and contraceptive
initiation timing after childbirth.

Referrals and Linkages:

MCH clinics collaborate with other healthcare providers, community organizations,
and social services to facilitate referrals for specialized family planning services,
reproductive healthcare, STI testing and treatment, and related support services.
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Health education -this clinic educate the mother about child care, breast
feeding, nutrition, growth monitoring and immunization etc…

ACTIVITIES AND STRATEGIES :

 Regular height and weight determination/ monitoring until 5 years old.
o year old-monthly 1 year old and above =quarterly
 Recording of immunization, vitamins supplementation, deworming and feeding.
 Provision of IEC materials (ex. Posters, charts, and toys) that promote and enhance
child's proper growth and development.
 Provision of a safe and learning - oriented environment for the child.
 Monitoring and Evaluation.
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ROLE OF HEALTH CARE PERSONNEL :

o selection of place and days of clinic.

o arranging equipment.

o arranging the entertainment facilities.

o providing immunization services.

o giving warm welcome to mother and children.

o maintaining growth chart, immunization card.

o recording general examination, nutritional level and weight of the child.

o assessing growth and development of the child.

o carry out physical examination.

o prevention and treatment of general diseases and injuries and referring the
critical patients.

o providing health education to mothers.

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VISIT REPORT OF UNDER FIVE CLINIC :

Under five clinic of MCH is located at Madhupur PHC, Shipahijala District.

AS per our course requirement we have been posted for field experience at Madhupur CHC
from 12/10/2023 to 18/10/23. We reported at 9 am on 13/10/23 to the MCH clinic and we
explained our purpose of visit with the staff of MCH.

OBJECTIVES OF VISIT

 Observe various activities of under five clinic

 Participate in the various activities of under five clinic programmes
 To give health advice to mothers regarding their child health eg. Breast
feeding technique, immunization, hygiene, etc.
 To gain vast knowledge about under five clinic
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ACTIVITIES DONE DURING VIST

During this visit we checked some children’s height, weight, advice some mothers about
breast feeding technique, immunization, cleanliness and about nutrition of children’s and
their self.

We recorded clinics immunization register and about few children’s health condition report.

GROWTH MONITORING :

During this visit we checked some children’s weight, height etc.

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RECORDING AND REPORTING:

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HEALTH EDUCATION:

This clinic we try to educate the mother about child care, breast feeding, nutrition, growth
monitoring, immunization, cleanliness etc...

HEALTH ADVICE REGARDING DENGUE

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 Here are a few measures that parents must take to reduce the risk of infection in
infants: Use mosquito nets or screens on the doors and windows of the home. Make
the baby sleep under a mosquito net only. Mosquitoes are highly active at dusk and
dawn.
 Wear protective clothing.
 Do not let water stagnate anywhere around home.
 Keep your house airy and well lighted.
 Stay in well screened houses
 Pomegranate is the healthiest fruit for dengue.

CONCLUSION

After the visit of under five clinic we learned about the main objective and aims of the clinic
and we gained knowledge about how this clinic running.

After the visit we learn that the main objective of this clinic is to reduce the mortality and
morbidity rate of under five children’s.

Nurse can play a important role in this clinic.

Reference:

1.Keshav Swarnkar.CommunityHealth Nursing.second edition.indore.N R Brothers.2007

2.K Park.Essentials Of Community Health Nursing.Fourth edition.M/S Banrsidas Bhanot

publishers.2004.