Petite enfance, jeunesse, adolescence - Prévention en pratique médicale

Young children and poverty (Français)

By listening without judgement to the answers to non-intrusive questions
- "Are you working at present? How are things at work?"
- "How are things at home at the moment?"
- "Are you managing on your income? How are things at the end of the month?"
By paying attention to attitudes, behaviour and conditions often resulting from longstanding poverty

Poverty

Basic needs

If the patient is receiving income security, find out whether she is receiving supplementary benefits for:
- pregnancy : the physician must complete a medical certificate (SR-40) for his patient, confirming that she is pregnant; the certificate must be presented to the agent at the centre local d'emploi (CLE)
- breastfeeding : (up to one year): the physician must provide the patient with a certificate confirming that she is breastfeeding; the certificate must be presented to the agent at the centre local d'emploi (CLE)
- infant formula (up to nine months ): a medical certificate is required only if the baby needs soy-based or lactose-free formula
Refer the patient to local resources, directly or through the CLSC, for basic necessities such as food, clothing, housing, support and solidarity
Refer the patient to a dentist soon as jer baby begins cutting his first teeth
Take into account the cost of prescribed drugs

Bond of trust

Remember that a solid bond of trust encourages compliance and, consequently, affects health
Take the time to listen carefully to the request, encourage questions and answer them
Establish with the parent realistic, gradual objectives, e.g. reduce the number of cigarettes instead of stopping smoking
Give simple instructions and make sure that they are understood
Display understanding if the patient has difficulty following advice:
- the patient is doing her best
- emphasize assets and effort instead of shortcomings and failures
- attentive listening eases the suffering engendered by difficult living conditions

Social support

Ask about:
- the presence of a spouse
- the type of interaction: collaboration, support and sharing or control and conflict
- the father's collaboration if it is the mother who is consulting the physician

Encourage:
- the use of day care and neighbourhood respite services
- participation by the spouse or the child's father in follow-up and his involvement in family dynamics (if the relationship has positive elements)
- recourse to professional and community psychosocial resources (refer if need be)

Diet

Promote breastfeeding (except if the patient is HIV positive or if other rare counter-indications)

Inform the patient of the advantages, even more important if she is impoverished:
- fewer risks of anemia, allergies and infections
- if the patient smokes, give the usual advice
- if she cannot stop, nursing is still preferable to infant formula

Encourage breast-feeding exclusively up to the age of 4 to 6 months
Verify nursing technique and the frequency of nursing, key factors in the maintenance of breast-feeding
Listen to questions and answer them
Ask the mother if she has contacted support services
Vitamin D (400 IU/day)
Only prescribe medication that is compatible with nursing (see IMAGe, resource fact sheet)

Up to the age of 9 to 12 months: iron-enriched formula
whole cow's milk (3.25%):
- not before 9 to 12 months and until at least 2 years old

Prevention of anemia, from the age of 4 to 6 months: iron-enriched cereals
- in the absence of iron-enriched cereals and formula à iron 1-2 mg/kg/24 h PO
Test for anemia between the ages of 6 and 8 months:
- if Hb < 105 g/L à iron: 3-6 mg/kg/24 h PO (treatment x 3 months)