0~6歲兒童健康管理服務規范

一、服務對象

轄區內常住的0~6歲兒童。

二、服務內容

(一)新生兒家庭訪視

新生兒出院后1周內,醫務人員到新生兒家中進行,同時進行產后訪視。了解出生時情況、預防接種情況,在開展新生兒疾病篩查的地區應了解新生兒疾病篩查情況等。觀察家居環境,重點詢問和觀察喂養、睡眠、大小便、黃疸、臍部情況、口腔發育等情況。為新生兒測量體溫、記錄出生時體重、身長,進行體格檢查,同時建立《母子健康手冊》。根據新生兒的具體情況,對家長進行喂養、發育、防病、預防傷害和口腔保健指導。如果發現新生兒未接種卡介苗和第1劑乙肝疫苗,提醒家長盡快補種。如果發現新生兒未接受新生兒疾病篩查,告知家長到具備篩查條件的醫療保健機構補篩。對于低出生體重、早產、雙多胎或有出生缺陷等具有高危因素的新生兒根據實際情況增加家庭訪視次數。

(二)新生兒滿月健康管理

新生兒出生后28~30天,結合接種乙肝疫苗第二針,在鄉鎮衛生院、社區衛生服務中心進行隨訪。重點詢問和觀察新生兒的喂養、睡眠、大小便、黃疸等情況,對其進行體重、身長、頭圍測量、體格檢查,對家長進行喂養、發育、防病指導。

(三)嬰幼兒健康管理

滿月后的隨訪服務均應在鄉鎮衛生院、社區衛生服務中心進行,偏遠地區可在村衛生室、社區衛生服務站進行,時間分別在3、6、8、12、18、24、30、36月齡時,共8次。有條件的地區,建議結合兒童預防接種時間增加隨訪次數。服務內容包括詢問上次隨訪到本次隨訪之間的嬰幼兒喂養、患病等情況,進行體格檢查,做生長發育和心理行為發育評估,進行科學喂養(合理膳食)、生長發育、疾病預防、預防傷害、口腔保健等健康指導。在嬰幼兒6~8、18、30月齡時分別進行1次血常規(或血紅蛋白)檢測。在6、12、24、36月齡時使用行為測聽法分別進行1次聽力篩查。在每次進行預防接種前均要檢查有無禁忌癥,若無,體檢結束后接受預防接種。

(四)學齡前兒童健康管理

為4~6歲兒童每年提供一次健康管理服務。散居兒童的健康管理服務應在鄉鎮衛生院、社區衛生服務中心進行,集居兒童可在托幼機構進行。每次服務內容包括詢問上次隨訪到本次隨訪之間的膳食、患病等情況,進行體格檢查和心理行為發育評估,血常規(或血紅蛋白)檢測和視力篩查,進行合理膳食、生長發育、疾病預防、預防傷害、口腔保健等健康指導。在每次進行預防接種前均要檢查有無禁忌癥,若無,體檢結束后接受疫苗接種。

(五)健康問題處理

對健康管理中發現的有營養不良、貧血、單純性肥胖等情況的兒童應當分析其原因,給出指導或轉診的建議。對心理行為發育偏異、口腔發育異常(唇腭裂、誕生牙)、齲齒、視力低常或聽力異常兒童等情況應及時轉診并追蹤隨訪轉診后結果。

三、服務流程

四、服務要求

(一)開展兒童健康管理的鄉鎮衛生院、村衛生室和社區衛生服務中心(站)應當具備所需的基本設備和條件。

(二)按照國家兒童保健有關規范的要求進行兒童健康管理,從事兒童健康管理工作的人員(含鄉村醫生)應取得相應的執業資格,并接受過兒童保健專業技術培訓。

(三)鄉鎮衛生院、村衛生室和社區衛生服務中心(站)應通過婦幼衛生網絡、預防接種系統以及日常醫療衛生服務等多種途徑掌握轄區中的適齡兒童數,并加強與托幼機構的聯系,取得配合,做好兒童的健康管理。

(四)加強宣傳,向兒童監護人告知服務內容,使更多的兒童家長愿意接受服務。

(五)兒童健康管理服務在時間上應與預防接種時間相結合。鼓勵在兒童每次接受免疫規劃范圍內的預防接種時,對其進行體重、身長(高)測量,并提供健康指導服務。

(六)每次服務后及時記錄相關信息,納入兒童健康檔案。

(七)積極應用中醫藥方法,為兒童提供生長發育與疾病預防等健康指導。

五、工作指標

(一)新生兒訪視率=年度轄區內按照規范要求接受1次及以上訪視的新生兒人數/年度轄區內活產數×100%。

(二)兒童健康管理率=年度轄區內接受1次及以上隨訪的0~6歲兒童數/年度轄區內0~6歲兒童數×100%。

附件:
            附件1新生兒家庭訪視記錄表.docx
            附件2 1~8月齡兒童健康檢查記錄表.docx
            附件3 12~30月齡兒童健康檢查記錄表.docx
            附件4 3~6歲兒童健康檢查記錄表.docx
            附件5 男童生長發育監測圖.docx
            附件6女童生長發育監測圖.docx
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