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https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis i CONTENTS Page ii https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis h i «ys C53 Ó5 CJt Co ÓS 03 03 tO tS3 IO M (S5 ts5 I“ * I-4 Letter of tran sm itta l.________________________________ ___________ ______ Importance of uniform records----- ------ - — _______ . i . ii. . ------------ ---------General standards.------------------------------------ -------- ----------------------------------Attendance----------------------------------------- ------------------ — - -----------------------General rules_______________________________ _— ,----------------r --------Regularity--------------------------------- '-------------------------- -----------------------Appointment s y s t e m_ _ _ l --------- - - - - ------------------------ :- - — - r - -------Conduct of the conference------------------------------------ --------------------------------Weighing------ ------------------- -------------------------- ------------------------ - — History tak in g.------------------------------------------------ - - - ------------------------Examinations__ ________________________________ ___________ K --------Action on defects -------------------------------- -------- ------- ------------------Determining the nutritional sta te ------ --------------------------------------------Feeding recommendations-------------- *------------------------------------ ------- - Sun baths_________________________________ _______________ ________ Record keeping----------- -----------------------------■-#,----------------------------------Terminology___________________________ r — t ---------- r -----------------------Outline for history and physical examination of infants and pre school children------------------------------------------------------------------ ------- Report to m o th e r s ..---- ------------------------------------------ * - ------------------Report to physicians_________».------------- - - i ------------------------------------Family folder______________________________________________________ 11 11 11 UViC. * 1*4 a: LETTER OF TRANSMITTAL U. S. D epa rtm en t o f L abo r, C h i l d r e n ’s B u r e a u , Washington, September 28, 1925. S i r : I transmit herewith a report on Standards for Physicians Conducting Conferences in Child-Health Centers. At a conference of State directors of maternity and infant hygiene the Children’s Bureau was requested to appoint a committee to for mulate standards which could be used by physicians in conducting child-health conferences. The standards were drafted by the pedi atric advisory committee of the Children’s Bureau, which consists of Dr. Richard Smith, of Boston, representing the American Pediatric Society; Dr. Julius Hess, of Chicago, representing the pediatric section of the American Medical Association; and Dr. Howard Childs Carpenter, of Philadelphia, representing the American Child Health Association, together with Dr. Martha M. Eliot, director of the child-hygiene division of the Children’s Bureau. They have been submitted to and'approved by Dr. Lawrence T. Royster, professor of pediatrics, University of Virginia; Dr. William Palmer Lucas, of the pediatric department, University of California Medical School; and Dr. J . PI. Mason Knox, jr., director bureau of child hygiene, State department of health, Baltimore, Md. Respectfully submitted. Hon. Grace A bbo tt, C hief. J a m e s J . D a v is , Secretary o f Labor. in 64006°— 2 6 t https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis STANDARDS FOR PHYSICIANS CONDUCTING CONFERENCES IN CHILD-HEALTH CENTERS IMPORTANCE OF UNIFORM RECORDS The following standards for physicians conducting conferences in child-health centers are proposed in an effort to bring about uni formity in the work being done for infants and preschool children in the various States which are working, through their child-hygiene divisions, in cooperation with the United States Children’s Bureau. The value of the records kept in any State is much greater if the same standards of examination and record keeping are used by all physi cians in that State. Such identity of standards will permit compari sons between the condition of children in one county or city and that of children in another. In the same way the value of comparison of the records kept by the different States would be increased if the standards used throughout the country were uniform. Uniform statistical records of children from all parts of the country would be of very great value. GENERAL STANDARDS 1. The conferences must be limited to well babies or well children. Sick children must be referred to family physicians or dispensaries. 2. Complete physical examinations of all children must be made at their first visit to the center, and records must be kept by the physician. 3. Children with physical defects must be referred to the family physician with recommendations; if the family can not afford a private physician some arrangements should be made for free treat ment at a dispensary. If a dispensary is not available some other provision for care should be made. 4. Examinations by specialists should be recommended through the family physician. 5. No medicine should be given by the conference physician. 6. Regularity in attendance on the part of the physician is of the utmost importance for a successful conference. I f a physician is unable to be present a substitute must be provided. I t is preferable that the same substitute should come to the center each time that the regular attending physician is absent. 7. Promptness is essential. The physician should be present at the hour of the opening of the center or at the time of the first ap pointment, if an appointment system is followed. 1 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 2 STANDARDS TOR PHYSICIANS CONDUCTING CONFERENCES ATTENDANCE GENERAL RULES Mothers should be urged to bring infants under 1 year of age to the child-health center every week; they should bring infants between 1 and 2 years at least every two weeks, and preschool children every month. Normal infants under 1 year should be weighed by the nurse every week, but if they gain weight steadily they need be seen by the physician only every four weeks. Any infant who does not gain regularly each week should be seen by the physician, as well as weighed, at each conference. Also during the period when formulas are being changed and during the weaning period it may be necessary for the infant to be seen more often. REGULARITY Regularity in children’s attendance at the center depends on the quality of medical advice offered, the regularity and promptness of the physician, and the interest of both the physician and the nurse in each individual child. APPOINTMENT SYSTEM The physician will find that he can plan the conferences best and do the hest work under an appointment system. The mothers will appreciate such a system, and the physician will also be able to plan his private activities to better advantage. Group appointments may be made; that is, three or four patients may be given appoint ments at 1 o’clock, three or four at half past 1, etc., so that the children will be brought at intervals throughout each conference. CONDUCT OF THE CONFERENCE The number of children seen by one physician during the con ference at a center should be limited. One physician can not handle adequately more than 20 to 30 infants or 10 to 15 preschool children in one afternoon, the number seen depending on the number of physical examinations to be made. I f more than this attend, a *second physician should assist or a second conference be established. The allotted time for a conference should not exceed two and one-half hours. Physicians should be aided during conference by the nurse or nutrition worker who has the home supervision of the children under her personal charge. Much help is obtained from her reports. WEIGHING Infants under 2 years of age should be weighed without clothes. Those attending the center for the first time should remain undressed until seen by the physician. Prolonged exposure should be avoided. For preschool children it is more accurate to take weights without clothes and heights without shoes, but in some preschool conferences this can not be done. All children to be seen by the physician should be wholly undressed at each visit to the center. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN CHILD-HEALTH CENTERS 3 HISTORY TAKING The history outline for new children (see pp. 1 and 4 of outline) should be filled out by the nurse, or as much as possible by a lay assistant under the direction of the nurse, at the first conference attended. The section on personality and behavior should be checked by the physician. The physician should also review the rest of the history and make any necessary additions in the space allowed for remarks on the third page. EXAMINATIONS N o child should be examined unless accompanied by the mother or some responsible friend or relative to whom recommendations can be made. Every child should have a complete physical examination at the first conference attended. Infants should have repeat examina tions every fo u r months. Preschool children should have them every six months and as much oftener as necessary. ACTION ON DEFECTS All defects should be noted by the physician and reported to the mother at his discretion. A complete written report should be sent to the physician whom the mother names as the family physician. If a physician can not be employed by the family, arrangements should be made by the nurse to have the necessary treatment given at a dispensary or free clinic, or other provisions may be made for free care. Detects must be remedied before a child can be expected to gain and be well. DETERMINING THE NUTRITIONAL STATE The state of a child’s nutrition can be determined only by an examination of the child stripped and by comparison of the child’s height and weight with the average standards set forth on the accom panying height-weight-age tables. Use of these tables alone, without observation of the amount of subcutaneous fat, the tone of the tissues and muscles, and the general appearance of the child, may give false impressions of the child’s nutrition. The following heightweight-age tables give standards for average boys and girls from 1 month to 6 years of age. These tables may be used for children weighed without clothes. Having been based on average children, the tables are somewhat low for normal children. Any child falling 10 per cent below the average here given should probably be con sidered undernourished. Any child 20 per cent above the average may be too fat. Examination of children without their clothes will bring additional evidence to bear on the individual cases. Heightweight-age tables should never be used without an examination of the child. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 4 STANDARDS FOR PHYSICIANS CONDUCTING CONFERENCES Weight-height-age table fo r girls fro m birth to school age Height (inches) 20 ................. 21 ................ 2 2 ..................... 23....................... 24 25....................... 26 27 28 29 30 ................ 31 32 ............. 33 ......... 34 35 ............. 36 ......... 37 38 ................ 39 40 _ ......... 41 ......... 42 43 44.. 45....................... 46 47 48 1 mo. 3 mos. 8 9 10 11 12 13 10 11 12 13 14 15 16 6 mos. 13 14 15 16 17 19 19 21 9 mos. 14 15 17 18 19 20 21 22 12 mos. 17 18 19 20 21 22 23 18 mos. 19 20 21 23 24 25 26 29 24 mos. 21 23 24 25 26 29 30 31 30 mos. 23 24 25 26 29 30 31 33 34 36 mos. 48 mos. 25 26 27 29 30 31 33 34 35 29 30 31 33 34 36 37 39 40 60 mos. 31 32 33 34 36 37 39 41 42 72 mos. 34 36 37 39 41 42 45 47 50 52 Weight-height-age table fo r boys fro m birth to school age Height (inches) 20 21 22 .................... 23 24 25 26 27 -28 29 30 31 32 ... 33 . . 34 ... 3 5 ..................... ~36..................... 37 38....................... 39 — 40 ................... 41__ 42 . 43__ 44 __ 45....................... 46 — 47 .................... 48 .................... 49....................... 1 mo. 3 mos. 8 9 10 11 12 13 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 10 11 12 13 14 15 16 6 mos. 13 14 15 17 18 19 20 22 9 mos. 16 17 18 19 21 22 23 24 12 mos. 18 19 20 21 22 23 24 26 18 mos. 20 21 22 23 24 26 27 29 24 mos. 22 23 25 26 27 29 30 32 30 mos. 24 25 26 27 29 31 32 33 35 36 mos. 26 27 29 31 32 33 35 36 48 mos. 29 31 32 33 35 36 38 39 41 60 mos. 32 34 35 36 38 39 41 43 45 72 mos. 36 38 39 41 43 45 48 50 52 55 IN For Infants. C H IL D -H E A L T H CEN TERS 5 FEEDING RECOMMENDATIONS I t is important that the feeding of normal infants, whether breast fed or artificially fed, be supervised regularly, in order that serious disturbances may be prevented by remedying minor ones. Mothers who are nursing their infants often need simple advice quite as much as those whose infants are artificially fed. Seeding recommendations may be given for all well babies or those with minor digestive dis turbances such as constipation or spitting up. The importance of breast feeding for infants can not be overemphasized. I t is desirable that an infant be breast fed for eight or nine months. One substitute feeding after four months may be advisable. The following measures be s£esSd mtenanCe °f ^ quantlfcy and fiuality of breast milk must 1. Regularity of feedings. 2. Complete emptying of the breasts either by the infant or bv manual expression.1 3. An adequate diet for the mother. This includes 1 quart of milk, a leafy vegetable, a citrous fruit, and ah egg daily. H 4. Daily exercise for the mother out of doors in the sun, preferablv durrng midday, or m very hot weather before 12 and after 3. 5. Doth breasts should be given at each nursing period if one does not furnish sufficient milk for the baby’s needs This mav be done by giving each breast for 10 minutes or one breast for 15 minutes and the second for 5 minutes. Alternate breasts must be given first at successive periods. I t is important that the first breast be emptied before the second is given. nf £ . ti® E Ui ply ?f, br5ast is inadequate, complemental feedings after each breast feeding will tend to keep up the supply, whereas artificial feedings substituted for two or more feedings may tend to i-he- S-UPPly*^ ° ne substitute feeding can usually be given without d im im sW the supply of breast milk. Formulas m fy be recommended and the u suaf changes made as the child grows oiler . Wben £ beco.mes necessary to give artificial food to an infant’ r pieAWh°le- ^ k m o d f fic ations are usually satisfactory and can be made up easily by the mother. Formulas made from condensed milk and proprietary foods are unsuited to the needs of growing infants and frequently are dangerous. All milk for infants a n l young c lldren should be boiled. Boiling kills all pathogenic bacteria a iif t!ll° ^ ai ! eS th® mfik more digestible. Pasteurization, rightly done bacteri.a, but it does not increase the digestibility of food all 9 ° ^ 1Yer sbould be recommended as an additional fiHal/v fpd1 badlei ° VS l m°nt^ ° f wbetber breast fed or artihcmlly fed, and should be continued for two years. On extremelv bath yA^CW h? i 011 T 7* hG ° mitted * tbe bab7 receives T s u i b^tb; - Au 15 fant 1 month of age can take V2 teaspoonful of cod-fiver ? df y%a? infan1t of 2 months 1 teaspoonful twice a day and an infant of 3 months i y 2 teaspoonfuls twice a day. Orange juice should also be given as an additional food to all artificiafiv-ffd babies. It may be given to breast-fed babies. An in fa^ T m on th of age can take ^ ounce of orange juice daily. This should be « ¡ M f ’ J ‘ P " “ A StUdy of breast feedinS in the « ty of Minneapolis.” Archives of Pediatrics, July, https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 6 STANDARDS FOR PHYSICIANS CONDUCTING CONFERENCES increased rapidly to 1 ounce daily if the infant is artificially fed. When it is impossible to obtain orange juice, tomato jrnce may be substituted in like amounts. For suggestions whole-milk formulas see Infant Care, United states umidren s Bureau Publication No. 8. For Preschool Children. Diet advice should be given for all they are obese, well nourished, or undernourished. Eating habits sleeping habits play habits, and home discipline must be inquired into? fialnutritfon and obesity are frequently t r a c e a b k t o b a d habits The nurse or nutrition worker can teach the mother to Drepare the right foods. Help must also be given the mother in teaching her cM d good health habits.- For diet outhnes for pre school children see Child Care, Umted States Childrens Bureau Publication No 30. For proper habits and training see Child M ^ ag em Sit United States W d r e n ’s Bureau Publication No. 143. SUN BATHS I t is important to teach mothers that ah babies should be placed in the sumfor a part of every sunny day. The rays of the sun should reach the skin directly, not through glass or clothing. The length of the sun bath should gradually be increased, beginning with 10 minutes on the arms and legs and increasing to 1 horn ¿wice daily if nossible The face also may be exposed if the head is turned so t h K e eyes are not directly toward the sun. In the op mer and fall these sun baths may be given out of doors. In the winfpr it mav be best to give the sun baths indoors in front of an open window. The child must lie in the patch of sunlight whic comes through the open space. RECORD KEEPING Records must be kept for each infant or child. These should in clude the child’s previous history, all physical examinations, notes on the feeding or diet recommended by the physician, and notes o home conditions observed by the nurse or nutotwm w ^ notes made by the physician or nurse should be made on the same sheet ^the order hewing chronological. Notes made, by the .nurse may be in red ink and those made by the physician m black mk so that thev mav be quickly differentiated. The nurse in charge of the conference should l e responsible for the records. She should always keep a record of her instruction or advice to the mother about seeing herPfamily physician, with the date of such instruction and a note as to whether the family physician was seen. TERMINOLOGY Where physical examinations are being made and records kept by a large nmnbe> of different physicians it is of great importance that all t h f physicians should use the same terminology upon these records. I f records are ultimately to be of statistical is essential. For instance, it has been found that.in one S t a t e alone 35 different terms have been used to describe the tonsils. Simplm https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis [Page 1] INFANT AND PRESCHOOL CONFERENCE RECORD Family No. NURSE’S OBSERVATIONS Date opened Name Age ! yrs. Address 1. S t. 2. S t. 1 / mos. Sex M. F . Color W. B . Nationality Guardian Family physician Family Name Age State Name C ity State Address Town | Sex C ity Town Health, or cause of death Age at death Birth history f I Birth date Il •... Birth weight lbs. ox. Birth condition: G. F. P. Injury. Malformation (spec.) J Full term Premature Delivery spon. Physician mos. difficult Midwife operative (spec.) Neither. Eye prophylaxis: Yes. No. Birth certificate received: Yes. No. .......J i Prenatal care of mother: No. Yes. for _____ mos. Wass. Pos. Neg. Economic status of family: Good. Fair. Poor. NEONATAL PERIOD— NURSE’S RECORD Cord Home= H Temp. Conf.=C Date Eyes Skin Stools R=Red R=Rash Weight 0 = 0 ff B= Bleeding S=Swollen D=Dry 1 = Inflamed D=Discharge J=Jaundice Hemor rhages Cya nosis - Feeding Give No. daily Convul Breast sions Snuffles N=Normal D= Diarrhea fed B=Blood Formulas—Specify Comp. Substi Amount No. of Interval Vomit tute feedings ing Nurse's initials | 1 ) — — ________________ __________ INFANCY AND PRESCHOOL RECORD ©ate Previous illness Measles N. Y . yrs. Pertussis N. Y . yrs. Diphtheria N. Y . Digestive dis. N. Y . yrs. Scarlet fever N. Y. i (spec.) yrs. "ore throat N. Y . Date Rheumatism N. Y . yrs. Respiratory dis. N. Y . mos. Done by Date Test Wass. Schick Tuberculin T . A. T . Result Done by Vaccin, (sm.) Blood (spec.) Development: First tooth at Result Test Urine Sat up at Walken at_____mos._____Talked at_____mos. HAIBITS (check at each examination) "1 w b a. ,bt b J-O « 3a c/ b i 1 i i- t/5.2 1"ts g b s g I .3 set 1a w ^_______ _ V ' f I f 1 See text for further definitions. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis U. S. Department of Labor, Children's Bureau. C. B . 106. 64006°—26f. (Face p. 6.) No. 1 b b d a S 3 b G.F.P. Other Obedience: ( i 1 1 Speech defect Ï mO M J Masturbation; H a a* J i Undesirablehabits Tantrums 33 \3 b J** d à I Inferiority fc Ì •L 1 Jgf -o Personality traits1 Indifferent ¡J o praise or blaljne shed twice ily Vied before ing 2-0 g 3 -Q "I a a !?* Intelligence Unresponsive (sedusive) as ! 9i3 Food Average a a •1X» 32 j No. baths wej mi Hygiene | Superior___ j Sun aSI Too little= 1 Enough=E Too much21 i Exercise I Sleep: G. F. 1 : 1 jn°IV • a Goes to bed 1 Date Windows op^ Sleep i rab |b ao ¿a cn b PHYSICAL EXAMINATIONS [Page 2] f l j| Date 1 GENERAL APPEARANCE: Nor. Abn. Nor. Abn. Nor. Abn. Facial expression (spec.) Nor. A.bn. Nor. Abn. Color of skin and M. M. Good. Pale. Good. Pale. 1 Good. Pale. Good. Pale. Good. Pale. Nor. Abn. Nor. Abn. f Nor. Abn. Nor. Abn. Nor. Abn. Nor. Abn. Nor. Abn. f Nor. Abn. Nor. Abn. Nor. Abn. MUSCULAR D EVELO PM EN T* Subcutaneous fa t* SKELETAL DEVELOPMENT: " Type: Thin, intermed., stocky (spec.) 1 Posture: A, B , C, D (spec.) Nor. Abn. Nor. Abn. Nor. Abn. Nor. Abn. Nor. Abn. EVIDENCES OF R IC K E T S* None. None. None. None. None. HEAD: Asymmetrical* N. Y . Spine, spec. Lord. Scol. Kyph. N. Y N. Y. N. Y. N. Y . Fontanelle open N. Y . ___cm. N. Y .......... cm. N. Y .......... cm. N. Y .......... cm. N. Y .......... cm. Craniotabes * N. Y N. Y . N. Y N. Y . N. Y. Cranial bosses* N. Y N. Y . J N. Y. N. Y . N. Y . N. Y N. Y . f N. Y . N. Y. N. Y . Flat. Pigeon. Funnel (spec.) N. Y N. Y . N. Y. N. Y . N. Y. Beaded ribs * N. Y N. Y . N. Y. N. Y . N. Y. N. Y N. Y . \ N. Y. N. Y. N. Y. N. Y N. Y . N. Y . N. Y . N. Y. CH EST: Asymmetrical* Harrison’s groove* E X TREM ITIES: Epiphyses en l.* Bowlegs* N. Y. N. Y. N. Y. N. Y. N. Y . Knock-knees* N. Ÿ. ' N. Y. N. Y . N. Y. N. Y. Feet pronated* N. Y N. Y. N. Y. N. Y. N. Y. N. Y. N. Y. N. Y. N. Y . N. Y . N. i N. Y . N. Y. N. Y . N. Y . N. Y. N. Y . N. Y . N. Y . N. Y. N. Y. N. Y . N. Y. N. Y. N. Y . N. Y. N. Y. I N. Y. Nor. Abn. Nor. Abn. SKIN : Dry Rash (describe) LYMPH NODES: Enlarged* Spec. Cerv. Epi. Ax. Ingu. E Y ES: Strabismus Other defects EARS: Discharge Hearing* N. Y. N. Y . Nor. Abn. Nor. Abn. Nor. Abn. i Drums N. Y. N. Y. N. Y . N. Y. N. Y . Discharge (describe) N. Y . N. Y. ] n . Y. N. Y . N. Y . Adenoids N. Y. N. Y. Jn. N. Y. N. Y. N. Ì N. Y. N. Vr. Rt. Lt. N. Y . Rt. Lt. THROAT: Tonsils enlarged * N. Y. N. Y. In . y . f SN. Y . Rt. Lt. 1 ¡ N. Y. Tonsils diseased* N. Y. N. Y. NOSE: Obstruction Septum deviated TEETH : Clean. Number (X=carious; A=abscess; F=filled; 0=out. Indicate condition over no. of tooth.) N. Y. No. 5 4 3 2 1 5 4 1 2 3 4 5 2 1 1 2 3 4 5 y . N. Y. N. Y. No. 5 4 3 2 1 1 2 3 4 5 4 3 2 1 1 2 3 4 5 N. Y N. Y. N. Y. Rt. Lt. N. Y . Rt. Lt. N. Y. N. Y . N. Y. N. Y. No. N. Y . 1 2 3 4 5 5 4 3 2 1 1 2 3 4 5 5 4 3 2 1 1 2 ;5 4 3 2 1 1 2 3 4 5 5 4 3 2 1 5 4 3 2 1 1 2 N. Y . No. N. Y . Na 5 ¡5 4 3 2 1 1 2 3 4 5 TONGUE T IE ; PALATE DEFECT (spec.) Nor. Abn. Nor. Abn. ■\i Nor. Abn. Nor. Abn. Nor. Abn. GUMS: Bleeding; inflammation N. Y. N. Y. W. Y. N. Y. N. Y. HEART (if abnormal make note on p. 3) Nor. Abn. Nor. Abn. INor. Abn. Nor. Abn. Nor. Abn. LUNGS (if abnormal make note on p. 3) Nor. Abn. Nor. Abn. INor. Abn. Nor. Abn. Nor. Abn. ABDOMEN: Muscles* Nor. Abn. Nor. Abn. Nor. Abn. Nor. Abn. Aviver emargëu-J Umbilicus infected HERNIA: Umb. Ingu. Fern, (spec.)* Phimosis Vaginal discharge NERVOUS SY ST E M : Chvostek Knee jerks ......... ...... ■rJffp ---------- — — «MM*'Y r X N. Y. N. Y . . I N. Y. N. Y . N. X . N. Y . jN. Y. N. Y . N. Y . / N. Ü 2 N. Y. N. Y. N. Y . N. Y . | N. Y. N. Y. N. Y . N. Y . N. Y . Jr N. Y. N. Y. N. Y. N. ri N. Y . N. Y . N. rt N. Y. N, Y. N. Y. N. Y. N. Y. N. Y. N. Y . / _ N. Y . j ___ N. Y . 1__ N. Hydrocele JNor. Abn. - V ,. r ‘ 'N. Y. r. r. N. Y. # . Y . .. N. Y. N. Y. N. Y. N. Y. N. Y. Près. Abs. Eres. Abs. Près. Abs. Pres. Abs. N. Y . ¡5 N. Y . | N. Pres. Abs. Spasticity N. r. N. Y . » f Y. N. Y. Paralyses (describe) N. r. N. Y. m .y . N. Y . Nor. Retarded. Nor. Retarded. Nor. Retarded. Nor. Retarded. Nor. Retarded. MENTALITY: Examined by * Indicate degree of impairment as follows: X.=Slight abnormalit Check all items at each examination^)- N=No. Y=Yes. Nor.=Normal. Abn.= Abnormal https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis [Page 3] POSITIVE FINDINGS Date HEART (if abnormal) : Size......... cm. fr. M. S. L. in 1......... i. s. (left). Nor. Abn. Recommendations by Physicians and Additional Laboratory __________ ____________Examinations ......... cm. fr. M. S. L. in L......... i. s. (rt.). ^ood. Pale. Apex i n ......... i. s............. cm. fri M. S. L. Sounds: Clear. Soft. Sharp. ' Murmurs: Systolic. Diastolic. Presys. At apex. Pulmonic. Aortic. Rhythm: Reg. Irreg. B . P. ( 7or. Abn. or. Abn. LUNGS (if abnormal) : Percussion, t Auscultation. D’Espines sign t o ____ Dorsal vert. HEART (if abnormal)*: j Size......... cm. fr. M. S. L. in L......... i. s. (left). ------- cm. fr. M. S. L. in j.____ i. s. (rt.). Apex i n ......... i. s........... . cm. fr . M. S. L. Sounds: Clear. Soft. Sharp. 1 Murmurs: Systolic. Diastolic.! Presys. At apex. Pulmonic. Aortic. Rhythm: Reg. Irreg. B . P. ' LUNGS (if abnormal): Percussion./ Auscultation. I D’Espines sign t o ......... Dorsal vert HEART (if abnormal): Size......... cm. fr. M. S. L. in L........ i. s. (left). ......... cm. fr. M. S. L. in 1........ i . s. (rt.). Apex in ......... i .s .............cm.fr•( M. S. L. Sounds: Clear. Soft. Sharp. j Murmurs: Systolic. Diastolic.j Presys. At apex. Pulmonic. Aortic. Rhythm: Reg. Irreg. *B. P. 1 Y. LUNGS (if abnormal): Percussion./ Auscultation. j D ’Espines sign t o ......... Dorsal verlt. HEART (if abnormal): Size......... cm fr. M. S. L. in!...........i. s. (left). ------- cm. fr. Rt. Lt. Y. M. S. L. in)_____ i. s. (rt.). Apex i n ......... i .s .............cm .fr. M S. L. Sounds: Clear. Soft Sharp. Murmurs: Systolic. Diastolic. Presys. At apex. Pulmonic. Aort ic. Rhythm: Reg. Irreg. B . P. , No. 4 3 2 1 1 2 3 4 5 3 2 1 1 2 3 4 5 LUNGS (if abnormal): Percussion.' Auscultation. D’Espines sign t o ......... Dorsal ver t. HEART (if abnormal) : f. Abn. Size......... cm. fr. M. S. L. in - i. s. (left). . S "Tll,.4W — — i- s- frt.). Apex i n ------- i , s , _____ cm. f M. S. L. Sounds: Clear. Soft. Sharp. . Murmurs: Systolic. Diastolic.! Presys At apex. Pulmonic. Aortfc Rhythm: Reg. Irreg. B . P. LUNGS (if abnormal): Percuss on. Auscultation. D ’Espines sign t o ......... Dorsai v eri N. Y. N. Y. HEART (if abnormal) : N. Y Size___ . . cm. fr. M. S. L. i N. Y. I Y. N. Y. N. Y. Pres. Abs. N. Y. f N. Y. Nor Retarded. . . cm. fr. M. S. L. i ......... i. s. (rt.). Apex in -- ___ i. s. ___ cm. fJ M. S. L. Sounds: Clear. Soft. Sharp. Murmurs: Systolic. Diastolic.j Presys. At apex. Pulmonic. Aort:\c Rhythm: Reg. Irreg. B . P. LUNGS (if abnormal): Percussion. Auscultation. D’Espines sigh t o ____ Dorsal verlf not requiring medical attention. 2X=Moderate abnormality requiring further eximinofjnT, fniinwnn nor« v . . . -pmmauon ana roiiow-up care. 3X=Marked abnormality requiring immediate medical attention. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis j 64006°—261 (Face p. 6.) No. 2 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis PHYSICIAN’S AND NURSE’S FOLLOW-UP NOTES— Continued https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN CHILD-HEALTH CENTERS 7 terminology is suggested on the outline for physical examination which follows. With such uniform terminology valuable studies can be made by comparing records from different counties of the same State or by comparing records from different States. OUTLINE FOR HISTORY AND PHYSICAL EXAMINATION OF INFANTS AND PRESCHOOL CHILDREN» The accompanying outline has been compiled after study of the forms used by a large number of States, ideas from many of which have been adopted. The outline is intended to be printed on a sheet 11 by 8% inches in size. History. The first page and the upper third of the fourth page of the outline cover the history of the infant or preschool child. This history should be filled in by the nurse or by a lay assistant under her direction. Every item applicable to the infant or preschool child should be checked. The section on the neonatal period is to be filled in at each visit by the nurse who cares for the infant at this time. The section on intelligence, personality traits, and habits should be checked by the physician. If the history is being taken for an infant some items under these sections will not be applicable. The items under intelligence and personality traits have been selected from a list suggested for this pamphlet by Dr. D. A. Thom, director of the habit clinics of Boston and director of the division of mental hygiene in the department of mental diseases of Massachusetts. They are included in the outline to indicate to the examining phy sician some of the traits of early childhood which have» a direct bearing on the development of the mental life of the child and adult. The list is not intended to be complete. Other traits also suggested by Doctor Thom which might be considered are the following: Desire for approbation as well as attention; vindictiveness, malicious ness, and grudge holding; purposefulness—that is, interest in the end desired and not the means; pleasure seeking— that is, interest in the means of attaining an end; sullenness, resentfulness; whining, discontent; feelings of inadequacy because of physical handicaps. When submitting the list of personality traits Doctor Thom made the following comments: “ To the suggestible and imitative child environment takes on an added importance. “ Fears in children may be expressed simply in a marked general timidity or may be crystallized in the child *s definite phobia. “ A child may feel inferior and inadequate to meet the everyday problems. He may manifest his inferiority complex in several ways; l. e., physical illness, delinquency, paranoid tendencies or by becoming a dreamer. u The pleasure seekers as opposed to the purposeful find satisfac tion only in the means, whereas the purposeful child works toward a definite end. ” For further suggestions along these lines see Child Management, United States Children ;s Bureau Publication No. 143 (a pamphlet 1 These forms may be obtained from the Superintendent of Documents, Government Printing Office, Washington, D. O. https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 8 STANDARDS FOR PHYSICIANS CONDUCTING CONFERENCES for mothers) and Habit Clinics for the Child of Preschool Age United States Children’s Bureau Publication No. 135. The child’s habits and his feeding histoiy should be rechecked at each physical examination in order that the history may be kept up to date. Spaces are provided for the six physical examinations. Illness occurring after the record has been started should be recorded on page 4 in the space provided. Physical Examination. The second and third pages of the outline are for the use of the physician. Headings for the physical examination are given in the left-hand column. These headings cover a simple routine examina tion. Symbols are arranged in each of the six parallel columns so that a nurse or lay assistant can check each item under the physician’s direction. Much of the physician’s time can be saved if his examina tion follows the outline so that someone else can check it as he pro ceeds. All items should be checked. The terminology suggested under the headings or in the footnotes should be used in each exam ination. The degree of impairment of all starred items should be indicated as follows: x Slight abnormality not sufficient to be called to the attention of the parent nor to warrant further medical attention a t the time of examination. 2x— Moderate abnormality requiring further medical examination and follow up care. 3x— Marked abnormality requiring immediate medical attention and follow-up. This terminology corresponds in part with that recommended by the committee on school health problems of the American Public Health Association in its instructions for the classification of physical defects. All positive findings and defects should be noted, and de scribed if necessary, in the spaces provided on page 3. One space is provided for each examination. When the defect has been removed or positive findings have disappeared the original notation should be underlined (preferably with red ink) and the date of removal or return to normal added. Any additional findings not allowed for under the printed headings should be described in the spaces on page 3. The following items should be noted in connection with the physical examination: Posture.— The posture of preschool children may be indicated A, B , C, D, according to the standards shown in the accompanying charts. The skeletal type may also be indicated as thin, interme diate, or stocky. A set of six charts showing these standards and types can be obtained from the United States Children’s Bureau. They should be placed in a conspicuous position in the preschool conference room so that the physician may refer to them constantly. The mother’s interest in her child’s posture should be aroused. Nose and throat.— 1. The presence of adenoids may be determined by the following: (a) Evidence of nasal obstruction—mouth breathing; (6) enlarged posterior cervical glands; (c) appearance of throat—presence of adenoid tissue on posterior pharyngeal wall and restric tion of motion of soft palate; (d) facial expression— the so-called adenoid facies.” 2. The size of the inferior turbinates should be noted and any deviation of the septum toward the right or left. In the preschool https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis m CHILD-HEALTH CENTERS 9 POSTURE STANDARDS Intermediate-Type Boys GOOD POSTURE POOR POSTURE BAD P O STU R E l.Head up-Chin in (Head balanced above shoulders, hips,arid ankles) l.H e a d slightly fo rw a rd r 1. Head forward. l.Head markedly forward. Z- Chest up (B rea st bone th e pairt of body farthr est forward!) z. Chest slightly lowered. a. Chest flat- s. Chest depressed (Sunken) 3. Low er abdomen in, and flat. a Low er abdomen in (b u t not flat) 4 BacK curves w ith in normal limits. 4.BacK curves Slightly increased. & Abdomen, complete 3. Abdomen relaxed ly relaxed ana pro (Part of body farth tub erant. est fo rw a rd ) <4. BacK curves exag 4 Back curves extreme gerated. 6 ly exaggerated. EXCELLENT POSTURE Children’s Bureau, United States Department of Labor,W ashington,DC,1925. [The figures shown in these posture charts are obviously those of children of school age, but they will assist the physician in classifying the posture of the preschool children according to page 2 of the form. The set of six charts was prepared by the Children’s Bureau for use m posture clinics, child-health cen ters, and schools, and may be obtained from the Superintendent of Documents, Government Printing Office, Washington, D. C., at 50 cents per set.] https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis 10 STANDARDS FOR PHYSICIANS CONDUCTING CONFERENCES POSTURE STANDARDS Intermediate-Type G irls Excellent Good EXCELLENTPOSTURE GOOD POSTURE 1. Head up-chin, in (Head balanced above shoulders, hips,and ankles) & Chest up (B rea st bone the part of body farth e s t fo rw a rd ) S. Chest slightly low ered * 3. Lower abdomen in, and fla t. 3^ Low er abdomen in (b u t not flat) Poor Bad POOR POSTURE BAD P O S TU R E 1. Head forward. i.He&d markedly forward. J a.Chest fla t. B. Chest depressed 3. Abdomen relaxed a Abdomen complete (Part of body farth ly relaxed and pro est forw ard.) tub erant. 4 Back curves w ith A Back curves slightly 4\ Back curves exag 4> Back curves extreme in normal limits. increased. gerated. 8 ly exaggerated Children’s Bureau, United States Department of Labor, W ashington, D.C.,1985 https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis Father’s name Surname [Lip of folder.] FAMILY FOLDER State •City Famüy No..„__ Date opened Village Township Directions Address Date Tear of birth Housing Owned Health or cause of death Country of birth Rented Ins. Co. Rent per mo. Sanitation Economic status Occupation Family physician Milk suppig Speaks Eng. Reads Eng. Remarks Father Mother Pregnancies ★ 1 2 r 3 4 5 6 7 8 9 19 « Others in household Kinship \ Addresses Other rdathes Kinship 1 2 3 Other agencies interested: ADDITIONAL SOCIAL DATA AND REM ARKS Date https://fraser.stlouisfed.org ★ Check in this space all individuals having records in folder. Federal Reserve Bank of St. Louis Date TJ. S. Department of Labor, Children’s Bureau. C. B. 105. 64006°—26t- (Face p. 10.) Religion https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis IN CHILD-HEALTH CENTERS 11 child, however, enlarged turbinates or deviated septum are not indi cations for operations. The enlarged turbinate may indicate a chronic ethmoid sinusitis. Heart.—If the heart is normal check “ normal.” If it is abnormal check “ abnormal” and fill in the details for which space is given on page 3. Lungs.— Check “ normal” or “ abnormal.” If they are abnormal fill in the details for which space is given on page 3. Follow-Up Notes. The fourth page is to be used by both physicians and nurses for follow-up notes whenever the child is seen, whether at the center or at home. Diet advice and formulas should be noted by the physician at each conference which the child attends. Help and advice given by the nurse at home visits must be recorded so that the physician may see at a glance what has taken place since the child’s last appearance at a conference at the center. These notes should be kept chronologically. An insert sheet ruled in the same manner as the lower two-thirds of page 4 should be provided for a continuation of such follow-up notes. REPORT TO MOTHERS I t is advisable to. give the mother a written report of the child’s condition. I t should contain the child’s name, age, height, weight, state of nutrition (whether obese, normal, or undernourished), and of the examining physician has so advised, mention of defects that may be present. The average weight for the child’s height may also be given. A written report which can be taken home will be appreciated by the parents and will help to stimulate interest in improving the child’s condition. REPORT TO PHYSICIANS A complete detailed report of the physical findings should also be sent to the family physician, and the mother should be told that such a report will be sent. I t is important that a form be available for this purpose and that it be filled out by the examining physician as a matter of routine. If an examination by a specialist is necessary, this fact should be stated to the mother, but the recommendation must be made through the family physician. FAMILY FOLDER 2 A form for a “ family folder” is shown opposite page 10. The folder should be approximately 9 by 113^ inches in order to hold the history and physical-examination outline, which is 8 ^ by 11 inches. Suggestions on such items as housing, sanitation, and milk supply are included on this form, and space is left for any social data which apply to the whole family or to any one member. Both the family surname and the father’s first name should be given on the tab of the folder so as to facilitate identification of families having the same surname. a These folders, on manila paper, may be obtained from the Superintendent of Documents, Government Printing Office, Washington, D. C. o https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis - https://fraser.stlouisfed.org Federal Reserve Bank of St. Louis
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