Maternal, child and adolescent health
Scope
Questions cover antenatal, perinatal, child and adolescent preventive care, growth and development, and the organisation of maternal and child health services.
Core rules
- WHO recommends eight antenatal contacts, with the first before 12 weeks. Preconception folic acid 400 µg daily reduces neural tube defects; higher doses are used with specific risk factors.
- Pre-eclampsia is new hypertension after 20 weeks with proteinuria or organ dysfunction; danger signs include severe headache, visual disturbance, epigastric pain and reduced fetal movements.
- Exclusive breastfeeding is recommended for six months, with complementary foods from six months and continued breastfeeding to two years or beyond.
- Growth monitoring uses serial measurements plotted on centiles; a fall across two major centiles or a weight-for-age trend that flattens warrants assessment.
- Immunisation follows the national schedule; catch-up is preferable to restarting a course. Developmental surveillance covers motor, language, social and cognitive domains, with referral for persistent loss of skills.
- Adolescent health addresses puberty, mental health, substance use, sexual health and injury. Confidentiality supports help-seeking, within safeguarding limits. The service model combines community health visitors, paediatric primary care and hospital care, with clear referral pathways.
Worked example
A 9-month-old breastfed infant has weight falling from the 50th to the 10th centile over three months. The reasoning: crossing centiles suggests inadequate intake, illness or absorption, not normal variation. Assess feeding (frequency, complementary food quality and quantity), nappies, chronic illness, and maternal mood. Check haemoglobin and consider coeliac disease if diarrhoea and failure to thrive persist. Refer to a paediatric dietitian and arrange review in two weeks rather than changing formula blindly.
Traps
Do not use adult BMI thresholds for children; do not interpret a single growth point as a trend; do not advise stopping breastfeeding during maternal illness in most cases; do not overlook maternal depression, which affects child outcomes.