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THE UNDER F8VE
&
ACKNOWLEDGEMENT
We thank the following persons for their feedback on the revised card.
Dr J.S. Gill, AHMS, New Delhi
Dr Kamala Jayarao, NIN, Hyderabad
Dr Shanthi Ghosh, WHO, Geneva
Dr David Morley, Institute of Child Health, London
Dr William Cutting, University of Edinburgh, Scotland
Dr Samir Choudhary, CINI Calcutta
Dr Ravi Narayan, St. John's Medical College, Bangalore
A
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Card. Design. Nalini Bhanot
© Voluntary Health Association of India.
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1
Designed and produced by Parallel Lines Editorial Agency, E-8 Kalkaji for VHAI, C-14, Community CentrezSafdarjung Development Area, New Delhi
COMM*
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-
'Jhe Under-Five Booklet
The under-five cardyis designed to help health workers
give proper and continuous care to all children below the
age of five. This card is based on the concept of weightfor-age as measurement of the child's growth.
Even before a child shows obvious signs of under
nutrition the child will have stopped increasing in weight.
Therefore weighing a child every month is a good way
of measuring the child's health and nutritional status.
A Healthy Child Increases In Weight
Every Month
*
ct-mo
1
(INSTRUCTIONS FOR USE OF THE CARD
This is how baby Kamala's weight card was filled
-flow To Fill
... When you first see an
under five child, fill in the
identification details of
the child, that is,
Clinic Name
Child's No.^
Child's Name
Boy/Girl
Mother's Name/Father's
Name
Occupation
Date of Birth: Month &
Year
Caste/Community
Village
House No.
Details of Brothers &
Sisters
a-n
5 ana
CHILD HEALTH RECORD
Birth to Five Years
*ft
Clinic
Sub C(?N
FPiLODft
TT dlH
3FH
v ’TUT
Birth
order
Names of Brothers
& Sisters
Child's Number
23
fan
W1W
Age
Sex
State of Health
H74
F
1
Child's Name
4IR.Lvt cjj i /vr&ft
Boy/Girl
•HI •FT HIH Mother's Name
£^^£4./
pRTT
/3z?/
szFnrnr
Occupation
IA/p*K5 O ri
on* ffitsv
3
HTR Father's Name
LfiL
Occupation
5 piCV5$ Of
l-Pr N D
ftffa Date of Birth
HTH Month
*TPT ’FT ?TTK
Year
Caste or Community
GL
y p
Village
t>
<
House No.
MfiLfiRlA
____________ 2£_
<
F
This is an example of a Local Events Calendar
I
'
2. Next make a calendarfor
child on the card. The !
way to make the calendar/
is as follows:
a. Find out the month
and year in which the
child was born. If the
mother does not know
the exact month her
baby
was
born
estimate the month of
birth as correctly as
you can. It may be
easier for the mother to
remember that her
child was bom
— before or after a par
ticular festival
— before or after the
harvest or sowing
season
— before or after some
major event in her
village.
It will be helpful for you to
prepare your own calendar
of local events.
Indigenous Calendar for Mother and Child Clinics
Seasof
Crops
W
1
N
T
E
R
S
P
R
1
N
G
CALENDAR
Hindi
Western
DEC
JAN
JAN
FEB
FEB
MAR
MAR
APR
Harvest
S
U
M.
M
E
R
APR
MAY
MAY
JUNE
Festival & Local Events
Amavasya ’ff'TTSW
Lohn
Guru Gobmd Singh B'Day
iftfcR fag qrr
Republic Day
Purnima
Amavasya
Basant Panchami
Purnima gfaqr
Shiv Ratri fa< ?ifa
Amavasya
Hoh (PURNIMA)
(^WT)
Dhulendi (HOLA)
Amavasya
Good Friday
q>rf
Ram Navami
Mahavir Jayanti
Purnima
Baisakhi
Amavasya
Budh Purnima
^fanr
Amavasya
Guru Arjan Dev's Shahid Din
srsfa
Nirjala Akadashi fasfar
Purnima gfaqr
Amavasya strrsztf
Purnima
_____
for
1978
9 Jan
13 Jan
15 Jan
26 Jan
24 Jan
7 Feb
12 Feb
22 Feb
7 Mar
9 Mar
24 Mar
25 Mar
7 Apr
24 Apr
16 Apr
21 Apr
23 Apr
13 Apr
7 May
22 May
5 Jun
10 Jun
17 Jun
20 Jun
1979
1980
13 Jan
4 Jan
26 Jan
13 Jan
28 Jan
1 Feb
11 Feb
25 Feb
26 Feb
13 Mar
14 Mar
28 Mar
13 Apr
5 Apr
10 Apr
12 Apr
14 Apr
26 Apr
12 May
26 May
30 May
6 Jun
10 Jun
24 Jun
13 Jan
25 Dec
26 Jan
2 Jan
17 Jan
22 Jan
1 Feb
14 Feb
26 Feb
1 Mar
2 Mar
16 Mar
4 Apr
24 Mar
29 Mar
31 Mar
13 Apr
15 Apr
30 Apr
14 May
18 May
25 May
29 May
12 Jun
28'Jun
1981
6 Jan
13 Jan
12 Jan
26 Jan
20 Jan
4 Feb
9 Feb
18 Feb
4 Mar
6 Mar
20 Mar
21 Mar
4 Apr
17 Apr
12 Mar
17 Apr
19 Apr
13 Apr
4 May
18 May
2 Jun
17 Jun
3
COMMUNITY HEALTH CELL
b. Once you know or
have estimated the
birth month and year,
write this month and
year in .the box on the
extreme left of the
card. This box has
dark lines and "At
Birth" is written next
to the box.
c. You will also find a box
with dark lines at the
beginning of each of
the five years. Write
the birth month and
the following year in
each of these boxes.
d. Now, write the names
of the remaining
months and years in
between the dark
boxes. (REMEMBER
TO CHANGE THE
YEAR EACH TIME
JANUARY IS REACH
ED) You will now have
a calendar of the child
for five years.
326, V Main, I Block
Koram-ngala
Bangalore-560034
India
SECOND YEAR
4
3. Weigh the child. Enter
the weight by putting
large dot with pen on
the chart. The dot must
be on the same level as
the weight (the horizon
tal line). The dot must
be directly above the
month ot weighing For
example, Kamala was
first seen in May 1981
f=E&
4. When the child comes
next month weigh the
child again. Enter the
weight
by putting
another dot in the ap
propriate place on the
card.
Kamala was
weighed again in June
1981. Her weight was
3.5 kg.
HFT
FIRS!
YEAR
5
Note
y-
If a child is weighed At Birth
ora few days later, enter the
weight in the first column.
This child was bom and also
weighed for the first time in
June 1982. Her weight was
3—
2_ _
,85
Oq
1j
.1 3
1
'f a
Ct KJ
5. Join the new dot to the
previous dot.
6. The line thus formed by
joining the two dots is the
growth line of the child.
6
B. MOW TO USE THE CAR'S
There are two dark curved
lines printed across the card.
These lines are the growth
reference lines. The growth
reference lines show the
general direction of growth
in healthy children. The
monthly increase in the
weight of a healthy child
(growth line) should follow
the general direction of these
reference lines.
12
12
EiMCE JhES
THIRD YEAR
Upper Lire : SOth Centile Boys
Lower Line : 3rd Centile Girls
Growth Chart for International use, WHO, Genev
SECOND YEAR
fwrcr
fap; hrr
i
fa:
Watch the direction of the line showing the child’s growth. For example :
3T^r GOOD
^>T f^RTH DANGER SIGN
|
qrfSr fa>
t I Means the child is
growing well
X «TTT tflsR
VERY DAF
for Sr
Suggests feeding
the ch.ld atleast 5 times each d,«.y
| I
special care
May be HI,
COMMUNITY HEALTH CclL
326, V Main, I Block
7
Koranic ng~la
Bangalore-560034
In your clinic the monthly increase in weight of many of
the children will fall between
these two reference lines.
But there may be some„
children whose weights fall
below the lower reference
line. This does not mean that
these children are under
nourished. It may be possi
ble that these children are
genetically smaller, but are
growing well according to
their genetic make up. It is
more important to see
whether the increase in
weight of these children
follows the direction of the
growth reference line.
It does not matter if
the growth line of a
child falls above, bet
ween or below the
reference line.
REMEMBER: It is important
to take the weight of a
child for at least 2 con
sec utive months (one
after
the other)
to
decide
whether the
child is growing
well or
not. A single weight is not
enough.
Hhese are the growth lines of two children. Both of them
are growing well.
-8
8
grams
10
R
8
7
9
S—
8
grams
7
7
6
6
6
5
5
4
3
5
3
2
IT
TO
FIRST YEAR
8
1. The growth line for a
healthy child should go up
like this.
Complement the mother
on her child's growth and
ask her to continue giving
the same care.
2. If the child's growth line
is flat, this means the
child is not gaining
weight. THIS IS A
DANGER SIGNAL. You
should find out from the
mother if the child is:
— eating well
— active or not
— has any symptoms of
illness eg. cold, cough,
fever
Examine the child. The
flat growth line may in
dicate one of the follow
ing diseases:
— Tuberculosis
— Whooping cough
— Chronic
urinary
infection
FIRST YEAR
9
3. If the child's growth line
goes down, this means
the child is losing weight.
This is very dangerous,
even if the child's growth
tine is within the two
reference lines of the
chart. This child is ill. Find
out from the mother the
reasons for the loss of
weight. It could be that
the child had an illness
the previous month or is
ill at present. Examine the
child and give appropriate
treatment. Record the
diagnosis on the chart.
A downward growth line
indicates an acute illness,
for example:
— Acute Diarrhoea
— Respiratory infection
— Measles
— Tuberculosis
Tell the mother to give the
child special care and feed
the child well. You should
also make it a point to
give this child special
attention.
10
11
c. OTHER IMPORTANT USES OF THE CARD
Reasons for Special Care
In any village, there are some
children who will have
greater chances of becoming
undernourished. These are
the "at risk" children. The
reasons could be social,
economic or cultural.
Family Planning
I*
Vitamin A
Reasons for Special Care
The following are some of
the "at risk" factors or
reasons for giving special at
tention to a child;
— Mother undernourished
— Mother has TB
— Child was born with low
birth weight
— Premature child
— Twins
— When mother is not able
to breastfeed the baby
— Mother gets pregnant
before the child is 2 yrs.
old
— Infection in the child
— whooping cough
— measles
— chronic diarrhoea
- TB
— Too many children in
family
— No spacing between the
children
— Female child
— One parent dies
- Disturbance in the family
— The child is under the
care of an older child
— Deaths of more than one
child in the family.
— Extreme poverty.
Identifying children at risk is
the first step in preventing
them from becoming under
nourished. Children who are
"at-risk" need to be given
special attention.
O2_^CDMMJNlTY
12
Family Planning
The column on Family Plan
ning on the card is mainly
meant to remind you, to give
F.P. advice to the parents of
the under five child. Often a
mother gets pregnant again
before her last child has
completed 2 years. This may
affect the child's growth,
because:
— themother may stop
breastfeeding the child
— the mother may neglect
the child.
Family Planning
Vitamin A
OTFT
Family Planning is a sensitive
subject. Therefore advice
related to family planning
should be given only after
the mother has got to know
you well. You can start by
finding out from the mother
if she is using any method.
If yes, record the method be
ing followed, on the card.
You could use six alphabets
to indicate planning status:
P = Pregnancy
L = Lactation
C = Conventional
contraceptive
(Condom, Foam, Jelly
etc.)
0 =Oral contraceptive
pills
I = IUD
V = Vasectomy
T = Tubectomy
If the mother is not using any
family planning method, you
should give her complete in
formation on all the methods
available and encourage the
mother to use a method that
she thinks is suitable for her.
Reasons for Special Care
13
Vitamin A:
Every year
children in India become
blind because of Vit. A defi
ciency. Therefore it is impor
tant to remember to give
every child in our pro
gramme Vit.A Solution.
Vit.A Solution is given once
in every 6 months. This is
available free from the
Government. Put a (V) in the
appropriate column against
the month on which the
dose was given. This will
help you estimate correctly
when the next dose should
be given.
Immunization:
You should make an effort
to immunize every under five
child in your programme
against
TB,
Polio,
Diphtheria,
Whooping
Cough and Tetanus. In the
space provided for im
munization note down the
dates on which the 1st, 2nd,
3rd, doses are given. This
will help you estimate cor
rectly when the next dose is
due and also to know when
the booster dose should be
given. Do not put a (7) in
these columns.
Writ® date given
BCG against T B
WOT (Mlfaql)
Polio
TTvTT
Triple (D PT)
enw
Typhoid
Other
Other
1
r
2
3
4
5
14
Health Education:
The mother should keep the
under five card with her.
Every time she comes to the
under five clinic she should
bring the card with her. You
should explain the impor
tance of the card to the
mother. When you record
the monthly weight of her
child you must discuss the
health status of her child
with her. Important nutri
tional messages are given on
the card. Remember to
discuss these also, with the
mother.
Weigh the child every month
O
A healthy child's weight will increase every month
O
This card must be kept with the mother
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15
How to weigh the child
• Always use SALTER
scale to weigh the under
five children. Model No,
235 T is available in In
dia. This can be used to
weigh children upto 20
kgs in weight.
• A cloth trouser with a
hanging strap is attach
ed to the bottom hook.
• The sack is hung from
a branch of a tree ora
beam in the roof.
• After the scale is hung
check to see if the nee
dle is on zero. If not, this
can be corrected by tur
ning the screws present
on the scale.
• The dial of the scale
should be at the eye
level of the person tak
ing the weight.
• The child should be
weighed without the
clothes on.
• The child's feet should
not touch the ground
• Wait for the child to
stop struggling before
taking the weight.
• The child should not be
held or touched while it
is being weighed.
The other weighing scales
are usually not accurate for
weighing children.
Family Planning
VHamin A
15
Hh| <vj Reasons for Special Care
WIH
13
12
10
10
fWtm
9
9
faHTVTJT
8
KILOGRAMS .
8
I
7
KILOGRAMS
6
6
5
cfhru
THIRD YEAR
Upper Lino : 50th Centile Boys
Lower Line : 3rd Centile Girls
Growth Chart for International usa, WHO. Geneva.
<W<I
anfa
ffaq
fk^rr
tfn tirrR
i
fa?:
Watch the direction of the line showtng the child's growth. For example :
If co i
dC
SECOND YEAR
kHTH first year
GOOD
cMt
Qrfk fa
I Means the child
growing well
*FT frRTR DANGER SIGN
FTHT
Fq K fir tft5R £
Ft fcf
F*
Suggests feeding
the child atleast 5 rimes each day
VERY DANGEROUS
iYxrO Ft Hniurn
Ft 5TFT<T
I
special care
fa^tS
May be ill, needs
af arCta fexft
1
Write date given
4
5
Y*7T
aavr
Polio
Birth to Five Years
Clinic
3
an z
BCG against T B
a-H & 5 Hra aar
CKI5LO HEALTH RECORD
tf-E<
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(m)Ri4Y)
cj-o^- 4> i H *-<4 t
aar ata, maY ^raY,
Child's Number
Triple (D P T)
EISWiJB
Typhoid
cpo^ qn r||U
’
Child's Name
Boy/Girl
?mT Mother's Name
a^a
Other
a^r
Other
STatf FT
Occupation
REMEMBER
fW an HTH Father’s Name
STaHTT
Occupation
I
i fd ar HYar
a*a frFla Date of Birth
nrH Month
o aH arr
mffe ^rar arf|fe
Weigh the child every month
snfe an a^ra
®
a<fe atm
A healthy child's weight will increase every month
Caste or Community
Year
o at a?Y
fearH arfe qra war
This card must be kept with the mother
»rra
ara
village
ax aT H*a <
House No.
3TT^TT
afe
Wl:
Birth
order
^Ym Ria
HM
FOURTH YEAR
FIFTH YEAR
Voluntary Health Association of India
C-14, Community Centre. S. D. A.,
New Delhi-110016.
ara
arg
faa
Names of Brothers
& Sisters
Age
Sex
ar^/a^a
•
State of Health
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HR—1 HINDI/ENGLISH
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