To maintain good health, timely medical diagnosis is needed to identify underlying illnesses and the causes within the human body. Also because of fragile immune systems, it is advised that infants visit health facilities for routine check-ups to avoid falling victim to common infections. Sadly, most individuals continue to visit hospitals after falling sick.

Dr Achile Manirakiza, a trainee in clinical oncology in Mubimbili, Tanzania, says that going for regular check-ups is a common practice in the western world but not in the developing world.

For babies particularly, it should be taken more seriously as there is need to treat them before they get weakened by the infection, he says.

Like the adage that ‘prevention is better than cure,’ medical experts suggest that without regular prophylactic paediatric check-ups, parents risk surprises from several infections.

Dr Manirakiza adds that prophylactic check-ups not only save mothers the burden of worrying, but help healthcare professionals anticipate underlying illnesses.

"Instead of rushing at the last minute, information collected during the checkups provides a starting point. This approach assists both the doctor and parents,” he adds.

Prophylactic medical check-ups for children range from common diseases to dental problems. In many cases where dental prophylaxis is provided, individuals avoid hefty expenditures on dental repairs, tooth loss and issues of gum bleeding.

Also children who receive regular prophylactic check-ups and medical care rarely fall victim to the respiratory syncytial virus which is the leading cause of the lower respiratory tract infections in children below the age of two years, according to a study published in the European Journal of Pediatrics,

Dr Narine Matevosyan, a pediatrician at Minas Medical Centre in Kabeza, Kigali, explains that both physical and mental problems in children can be prevented with timely prophylactic check-ups.

"I see children with physical and mental problems that could/would have been solved on time during prophylactic check-ups. Children aged below one year need a medical check-up once a month. It helps to follow child’s physical and mental growth,” says Dr Matevosyan.

Deciding on proper diets

After six months of breast-feeding, solid foods, which are introduced to infants need to be monitored because the child’s preference may lie in one dish and not the rest. During this period, mothers also have to keenly follow-up on immunisation schedules.

Dr Matevosyan adds that prophylactic check-ups provide parents an opportunity to understand the right time to deal with immunisable diseases and to decide on proper diets for their children.

"Through such medical check-ups, follow-ups on immunisation are made and organising the right nutrition depending on the needs and the age of the baby is done at the same time. Other health issues are identified as well,” she adds.

Kibagabaha Hospital nutritionist Isaac Bikorimana advises that mothers should not wait for adverse warnings before dealing with nutritional problems in infants.

"It may only require visiting a nutritionist at least once a month. From the appearance of the child or discomfort witnessed on uptake of certain diets, proper diets can be designed to suit the child. These can be adjusted with regular visits to the hospital,” he explains.

Solving childhood obesity

Childhood obesity is a serious public health concern especially in low and middle-income countries. The World Health Organization in 2013 estimated that overweight children under the age of five were close to 42 million in developing countries.

Against this background, Dr Osee Sebatunzi, the medical director of Kibagabaga Hospital, notes that paediatric check-ups are recommended for parents to ascertain several aspects, especially those pointing to non-communicable diseases and risk factors to cardio-vascular complications.

"Issues like blood pressure, diabetes and childhood obesity are common in infants and the best way to identify them is through carrying out regular check-ups,” explains Dr Sebatunzi.

He further suggests that even during regular check-ups, parents need to ensure follow-up in cases where problems have been identified in the child.

"Combined efforts from both the mother and the father are needed and in any case an underlying illness is determined, parents need to adhere to all sorts of recommendations,” he adds.

What to look out for during regular check-ups

Dr Angela Mattke from the American Academy of Pediatrics says that paediatric screening should focus on depression, which is screened every year from age 11 through 21; high cholesterol at age 9 and 11, while in mature teenagers HIV status needs to be determined.

"Depression screening is so important because mood disorders and suicide rates have increased over the last couple of decades,” she says, adding that: "At least 10 per cent of my practice is treating children with depression and anxiety. If we don’t ask them about it in a safe manner, they may not disclose.”

Although most parents feel no burden of rushing to hospital at the last minute, most studies suggest that preventive paediatric check-ups would reduce this burden of running back and forth and the huge financial expenditure.

editorial@newtimes.co.rw

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AIMS AND PURPOSES OF PAEDIATRIC EXAMINATION

It is important to distinguish between:

* The routine examination of well babies (to screen largely for abnormalities of growth and development).

* The examination of ill babies (to establish the nature and cause and extent of any illness or injury).[1] 

* The examination of children for other specific purposes such as:

* To establish fitness for education or certain activities.

* To examine for signs of sexual abuse in child protection cases.

* However, this is not an absolute distinction. Whether ill or well, the examining doctor should have a good working knowledge of routine examination and normal findings in children at different ages.

* Problems with development, behaviour and growth may thus be identified opportunistically whilst examining an ill child.

* Doctors working with children should have a good knowledge of normal developmental milestones, as well as routine physical development and findings at different ages.

General points

* It is important to have established rapport with parents and child when taking the history.

* The approach to the examination will be determined by the age, level of development and level of understanding of the child.

* Inspection and observation are the most important parts of the examination. Observations can be made whilst taking the history and establishing rapport. For example:

* Observe the child’s behaviour and level of awareness and take these into account with the parent’s or parents’ own reports.

* Consider if the child’s appearance is unusual at all and in what way.

* Note the shape of the head, mould of ears, position of eyes, body proportions, posture.

* Note whether the child looks like the parent/s.

* Establish whether there any recognisable major or minor anomalies.

* Record the nature and distribution of skin lesions and rashes.

* Note the colouring, shape and positions of bruises. If they have suspicious appearance, consider the possibility of non-accidental injury.

* Avoid waking sleeping children.

* Approach the child at their level; if necessary kneel on the floor. It may be impossible to examine pyrexial, irritable children without provoking crying and they should be carefully observed before attempting closer examination.

* Start examining peripherally (hands and feet), as this is less threatening.

* Make the examination fun to help with their anxiety. Sometimes a toy may help, either one that the child has brought with them or something in your consulting room. Even a pen torch or an ear speculum rattling in a urine container can be a useful distraction.

* Make sure the child is comfortable, and that your hands, stethoscope and other instruments are warm.

* Ask parents to assist with dressing or undressing children and be aware of sensitivities about this.

* Wherever possible avoid unpleasant procedures such as rectal examination

* These are seldom necessary and can put children off being examined for a lifetime.

Agencies

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THEIR SAY...

Alloys Mugisha, a parent

There are some diseases that can be just prevented, for instance those related to poor hygiene. I always make sure my children are safe from diseases by maintaining a good hygiene everywhere.

Diana Nawatti, a head teacher

In school, preventable diseases can spread easily because of the large number of students. Besides,students are exposed to germs in playing grounds. We have put water points for students to wash their hands after using toilets. We encourage students to apply the same practices at home.

Emily Masawa, a business woman

Maintaining a balanced diet for my children is essential since some conditions like malnutrition and obesity are brought about by the poor lifestyle parents expose their children to. I always take my children for checkups once in a while even if they are not ill just to make sure they are healthy. They also sleep under a treated mosquito nets.

Victor Kalisa, a Kigali resident

I do yoga with my children in the mornings and after work because it helps us to stay away from diseases such as hypertension,obesity and other diseases that may be caused by lack of enough exercise.

Joselyne Uwamahoro, a mother of one

Making sure that my five-months-old baby gets all the vaccinations that are necessary is important, because this is the best prevention measure that should be practised by any parent to protect their children from diseases like polio and hepatitis. I also go for cancer screening often and I maintain good hygiene where I live.

Compiled by Lydia Atieno.