The topic of this article is children's health groups and their characteristics. We will try to figure out why this division is needed, what categories are generally there, and how to classify your baby as one of them.
Greetings, dear readers. If you went to the pages of my blog, then most likely you are a parent. Children grow up very quickly. It would seem that just a week ago the baby just learned to crawl, just yesterday he went and spoke. And today it's time to get ready for kindergarten, or even school. On the one hand, this is great! First, an important event for a child who almost feels like an adult. Secondly, it is a relief for the parents. Mommies can go to work, grandmothers can relax, because the child is under the supervision of teachers for at least half a day. But on the other hand, admission to a children's institution is always a huge number of formalities. Parents are forced to study all the intricacies of the internal rules of educational institutions.
It would seem that all children who begin their educational path are equal to each other. However, this is not always the case. And here we are talking not only about individual characteristics of character, temperament and psychological type. One of the main criteria for “classifying a child” is the level of his health.
Children's health groups and their characteristics - what are we talking about?
Health groups are conditional categories that unite children with different levels of physical condition. Referring a person to a particular group, the doctor, as it were, gives a conditional sign to those people who will still work with the baby. First of all, the health group determines whether the child needs to be admitted to a specialized educational institution or not. On the basis of this figure, in the card for the child, a suitable type of physical activity, a table (diet) is selected, restrictions are set on engaging in this or that activity.
The distribution of children by health groups, which logically follows from the above, is the prerogative of the pediatrician. And it is right. After all, only a doctor can assess the condition based on a complete, comprehensive examination, the results of analyzes and functional tests.
It should be noted that there are newborn health groups. They are assigned to babies who are discharged from the hospital. Based on this indicator, it is determined how many times during a given period of time a mother and child must visit a pediatrician. However, most often the doctor at the appointment indicates the date of the next visit. Therefore, these data are not so important for parents. Basically, the category begins to be “required” upon admission to a kindergarten or school.
Formation of health groups
A natural question is how these groups are formed in general? In order to refer a small patient to one or another, the doctor must "characterize" him on several points. The most complete list looks like this:
- Were there any abnormalities in the fetus during intrauterine development, recorded by ultrasound or using another method of prenatal diagnosis?
- Does the baby have chronic diseases, developmental defects (congenital defects)?
- How well are the human organs and systems functioning?
- What is the level of neuropsychic development?
- What is the body's resistance, how correct is the immune response (here it is taken into account, among other things, how many times a year the baby suffers from colds and other diseases)?
However, most often, to determine the group, the first of the listed criteria is not taken into account. It is taken into account to a greater extent for setting a category of health for a newborn.
Of course, not only the district pediatrician is involved in examining the little person. The kid undergoes a full examination, which includes the consultation of the following specialists:
- surgeon;
- eye doctor;
- cardiologist;
- neurologist;
- dentist.
If specialists find certain deviations from the norm, an additional examination with the participation of doctors of other profiles is mandatory.
Is it infringement of rights ?!
Some of the parents, given the current trends of love of freedom and individualism, can say: is this not an infringement of the rights of my child? Why can someone do physical education, eat what they cook for everyone, but we can't ?! So, this opinion is completely wrong!
Children's health groups and their characteristics were developed by pediatricians exclusively in the interests of the children themselves!
After all, bans are not put on a whim or for money, but focusing on the state of the baby, his physical capabilities take into account possible negative consequences.
Unfortunately, this system is not perfect. Often, an apparently healthy child is not examined often enough or very thoroughly. In addition, teachers and parents are in no hurry to take into account the recommendations of doctors. This is partly why there are episodes of infant death right in physical education lessons (which is unacceptable!), The development of complications as a result of malnutrition. And the aggravation of the baby's condition is possible due to non-compliance with the regime.
That is why it is necessary to realize the importance of such a distribution! This is not done at the whim of doctors and not for the sake of “making life easier” for teachers. Not so that the teacher could do physical education with only half of the class, because the rest go to the “preparatory group”. Not with the aim of dividing children into “healthy” and “not so”, and then depriving some of the care, focusing on others.
This practice was introduced in order not to miss the development of a disease or complication in a baby predisposed to a pathological process. In order to protect him from an unbearable load for him, giving time to the body to rehabilitate and form. In order, in the end, to eliminate too obvious a difference in class between those who easily cope with the standards for physical education, and those who, not being lazy and irresponsible, purely physically cannot fulfill them!
What are the options?
First of all, you need to find out what health groups children have. There are five of them in total, but some authors distinguish subgroups 2a and 2b in the second category. Analyzing the second group, I will mention them, but to a greater extent this division is typical, again, for newborns.
First category
Children's health groups and their characteristics start with healthy children. To our great regret, the crumbs that could be attributed here are less and less common. I must say that already in the maternity hospital, less than 15% of babies born can be called completely healthy (focusing only on the Apgar * Newborn condition assessment scale), because only a few receive a rating of 10/10 or at least 8/10. Accordingly, at an older age, the indicators leave much to be desired.
Apgar: there are 5 criteria - breathing, heartbeat, muscle tone, reflex irritability, skin color. Each indicator can "get" from 0 to 2 points. Such a mark is given at 1 and 5 minutes after birth. If at 1 minute the baby gets from 0 to 3 points, or 5 to 6 points, this means that he needs urgent resuscitation.
So who is considered to be in the first health group? These are children who did not get sick or rarely got sick during the study period (usually the examination is carried out once a year). They do not have chronic diseases, as well as functional or anatomical problems in the work of all organs and systems of the body.
It is important that children should not lag behind in their neuropsychic development from age norms. Here we are not talking about individual character traits (for example, someone is slower), but only about objective signs. There are norms and rules for assessing the compliance of the baby's behavioral reactions with these norms. Including for the purpose of determining neuropsychic health, everyone is shown a consultation with a neurologist. And only if this doctor detects any abnormalities, the mother and child are referred to narrower specialists - a psychologist, speech therapist.
Such children do not have developmental defects and abnormalities. It should be borne in mind that the little ones that, for example, have a defect in the structure of the auricle that does not affect hearing (protruding, elven ears), belong here. That is, it is permissible that it absolutely does not in any way worsen a person's condition and does not require medical intervention.
Second category
What does the 2nd (second) health group mean for a child? Such a "diagnosis" is made in cases where the baby has functional deviations from the norm. This means that the problem is not organic (not a tumor, inflammation or tissue destruction), but only in the functioning of the organ. This happens when biochemical mechanisms, immunity fail, the body's ability to adapt decreases. Most often, violations are due to the fact that the crumb grows very quickly, and the organ systems (especially the cardiovascular) do not have time to rebuild. After all, they now need to work for greater growth (the systemic circulation increases), but they still lack strength.
Another criterion by which it is possible to determine that there is a health group 2 in a child is frequent acute diseases. “Frequent” is more than 4 times a year. They are characterized by a long period of recovery and recovery. For a long time, the appetite does not return to the baby, there is lethargy, drowsiness. Often, after colds, there are complications in the ears. An integral part is functional disorders in the work of the gastrointestinal tract after any treatment.
Children of the second group should not have severe deviations from the norms of mental development. The indicators are either within the permissible limits, or are very slightly distant from these limits. But chronic diseases, defects and developmental anomalies in these children are absent altogether.
According to some reports, there are two subgroups of this category - A and B. The child's health group 2b is just the children that fall under the description above. Here are some conditions that allow the baby to be attributed to group 2b:
- damage to the central nervous system during childbirth, resulting in minor deviations in mental development;
- anomalies of the constitution (diathesis);
- functional heart murmurs;
- decreased hemoglobin (pre-anemic state);
- disruption of the gastrointestinal tract.
Subgroup A includes those who do not have the above abnormalities, but have a burdened history.
Anamnesis (from the Greek ἀνάμνησις - memory) - a set of information obtained during a medical examination by questioning the subject himself and / or those who know him.
This may mean that:
- the family has children with serious developmental disabilities;
- the mother was over 35 at the time of the birth of her son or daughter;
- there were complications during pregnancy and childbirth;
- there was a multiple pregnancy;
- the baby is premature / premature;
- low or too high birth weight;
- there was an intrauterine infection;
- the state of rehabilitation after severe conditions, operations, diseases.
In fact, this is to some extent the most favorable “company”. Such babies do not get sick with anything, but they are under the close supervision of doctors, much more attentive than the guys from group 1. The chance of missing a developing pathology is very low.
Third category
What does the 3rd (third) health group mean for a child? This is the so-called state of compensation. As you can see, the health groups of children and their characteristics reflect not only the presence of certain diseases in children, but also the degree of their severity. In this case, we are talking about the fact that there is a chronic pathology. However, it implies its rare exacerbations, which are not difficult, easily stopable (removed with the help of drugs or manipulations).
It can also be developmental defects that do not entail a significant limitation of opportunities. Functional changes in the body's work are quite possible here. However, they concern only the system that is not developed correctly (“sick”). These deviations have little or no effect on the general standard of living and activity of a person.
Acute diseases in such babies occur quite rarely, they are not difficult. An extended recovery period is possible (especially if the pathology is associated with the initially affected system). With regard to psycho-physical development, it may be normal or somewhat lag behind the norm.
Significant deviations are usually not observed, kids from group 3 are quite socially adapted, easily find a common language with their peers. However, such crumbs are characterized by a 1 or 2 degree underweight, short stature, and some muscle weakness.
Health group 3 in a child is not a sentence at all. The most important thing is not to miss visits to the doctor, to follow the recommendations. Children of this category usually do not have incurable diseases, everything is amenable to medical correction. But parents are required to provide maximum care and attention. This is also important in order to prevent the development of existing diseases.
Fourth category
The fourth (4) health group in children is an “intermediate” stage, the so-called subcompensation. This term implies the absence of life-threatening conditions, does not mean that patients are incurable.
The guys of this “company” are characterized by rather serious congenital malformations. They already have an impact on a person's life rhythm. Pathological changes affect not only the initially “wrong” system, but also organically healthy organs. There are chronic diseases (often more than one). Exacerbations of these disorders develop frequently, usually with complications.
Acute disorders are difficult to treat, after which the child recovers for a long time, he needs special conditions of rehabilitation. Often such children are in a society with difficulty, because their diagnoses leave an imprint on their character, their perception of the world, and their physical capabilities.
With regard to neuropsychic development, it can be absolutely normal. Deviations are completely optional, such children, on the contrary, are often more intelligent than others (due to the lack of the opportunity, for example, to run and play around). However, deviations, from minor to severe, are not uncommon. Characterized by a deficiency in body weight, height, muscle strength.
Very often, these guys need training in specialized institutions. And even if this is not the case, they are shown significant restrictions on educational and physical activity. Almost always, some kind of supportive therapy is required on an ongoing basis (medicines, exercise therapy, etc.).
It is worth recalling that children's health groups and their characteristics do not oblige parents to give their baby to specialized institutions. But if such advice sounded, it is better to heed it. Contrary to popular belief, a not quite healthy child who is in the society of “ordinary” peers does not recover faster. On the contrary, he begins to realize some kind of inferiority, complexes develop, the little person withdraws into himself (and if he is also subjected to ridicule?). But being in a special institution where trained teachers are engaged with him, he can make great strides. And no one said that in a couple of years such a kid will not be able to study in an ordinary school!
Fifth category
What does the 5th (fifth) health group mean for a child? This category includes children with very serious deviations in their physical condition. Whether it is severe chronic illness, with rare periods of clinical remission (no symptoms), or developmental abnormalities. These babies are at risk of disability or have already received it.
Such children have damage to all (or almost all) organs and systems, and pathology is both functional and organic. Frequent infectious and inflammatory processes with a large number of severe complications.
Acute diseases are a condition that is practically permanent for them. This means that they seek medical help more than 8-10 times a year.
I must say that developmental anomalies can be not only congenital. This group includes children who have undergone severe mutilation operations, injuries, diseases. Without fail, the fifth health group in a child includes cancer patients. Moreover, both during treatment and at the stage of early rehabilitation, and in the post-rehabilitation period (up to 5 years).
The education of such kids in general education school and preschool institutions is excluded. They need an individual approach. For such kids, it will be optimal to study at home, or in highly specialized educational institutions. These children require continuous supervision, constant help and care. Most often they are socially unadapted (especially at an early age, when they spend most of their time in hospitals).
Health groups and risk groups - is there a difference?
Separately, I would like to mention two similar concepts: a health group and a risk group. Despite their similarities, they are about different things. In the first case, we are talking about the real, present, present state of a person. And the second concept characterizes children who have “more opportunities” to get this or that disease, more pathogenic factors.
When divided by the degree of risk, this is a category of children prone to the development of a particular pathology. This division is quite old, back in the 90s of the XX century, but sometimes these data are still referred to today. There are 5 main risk groups and 4 additional ones. If the patient is classified as a risk category, then the schedule of his clinical examination is changed, consultations of narrow specialized specialists are added to the recommendations.
In fact, group unit 2a is one risk group. And it includes all the crumbs predisposed to the formation of this or that pathological process.
Determine the health group
As already mentioned, the pediatrician is responsible for categorizing children. Every baby registered at the site must be “classified” on this basis.
And how to determine the child's health group on your own, can this be done? In principle, yes, although it doesn't make much sense. After all, in front of the kindergarten and school, your child will still have to undergo a medical examination. However, materials on the topic of children's health groups and their characteristics are available to everyone. To avoid confusion, let's try to derive a strict algorithm for determining categories.
To begin with, each parent needs to know that the group affiliation is set for the most serious disease. If, for example, the baby does not have any diseases, except for a heart defect, which does not cause concern, he should be assigned to group 3.
Second, the table can help with the definition. In fact, this is the same data that was presented above in text form, but more succinctly.
Health group in children - table by diseases
| Health group | Chronic diseases | Acute diseases | Developmental anomalies | Functional deviations | Neuropsychic development |
|---|---|---|---|---|---|
| 1 (first) | Not | Rarely (up to 4 times a year) | Not | Fine | |
| 2 (second) | Not | Often (4 to 6 times a year), the treatment is long, the rehabilitation period is delayed | No or insignificant, not affecting the quality of life | There is | OK / slightly lagging behind |
| 3 (third) | Yes, not severe, rarely aggravate, give a good response to treatment | Often, with severe course | There is, slight limitation of capabilities | Yes, but only in the system where there is chronic pathology | OK / slightly lagging behind |
| 4 (fourth) | Yes, frequent exacerbations, are difficult to treat, cause disturbances in the rhythm of life, require activity restrictions | Often, they are difficult, take a long time to heal, almost always complicated | There is a tangible limitation of possibilities. Specialized care is often required | There is, and not only in an already affected system, but also in one where there is no malformation or chronic disease | Normal / slightly lagging / noticeably lagging behind |
| 5 (fifth) | Yes, heavy, with rare relief | They occur frequently, rehabilitation periods are prolonged, frequent complications | Yes, heavy. Training only in specialized institutions. | Yes, they affect not only the anatomically affected organ or system, but also “healthy” elements | Normally, there may be a slight or significant lag |
It is worth mentioning that such distributions by category are relevant up to 17-18 years old. Upon reaching this age, a person enters the adult network, and there is already his own division.
Defining a category is an important step. You cannot “relax”, even if your child has been assigned 1 group. It is necessary to undergo a medical examination on time. Be sure to remember that setting a category number is not the signing of a verdict. There is a way out of every situation. Children's health groups and their characteristics are serious, but not final. Most diseases today are treatable, but this needs to be dealt with - scrupulously, for a long time, every day. And then parental work will be rewarded with the health of the child.
Natalia Govorova
Reading time: 9 minutes
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One of the main school subjects responsible for the health of the child is, as you know, physical education. Without it, the full-fledged physical development of our children is impossible - especially in a school environment, where children spend most of their time motionless, at their desks.
As a rule, the whole class is "kicked out" for physical education, offering exercises that, according to the development program, are "prescribed" for all healthy children. And few people today remember that there are 3 medical groups for physical education, and not all children get into the main one - healthy.
How many physical health groups do schoolchildren have - the principles of dividing into health groups
First of all, it should be understood that health groups and health groups for physical education are not the same thing.
- Under health groups understand 5 groups in which children are enrolled, in accordance with the assessment of their health.
- Concerning medical health groups for physical education- there are 3 of them.
They matter when the child participates in school physical education lessons:
- The main one. Healthy children who do not have serious health problems and meet developmental standards.
- Preparatory. Children with minor health problems.
- Special (A, B). Children with serious disabilities in the work of the main body systems and with chronic diseases.
Many parents (and even teachers) do not know, but for each physical culture health group there are contraindications, indications, a set of classes and even the time that is allowed for these classes.
Not everyone understands that special medical groups are different from conventional exercise therapy. And the difference is simple: exercise therapy is carried out by doctors, while physical education classes for medical groups are conducted by teachers, but taking into account the optimal training methods.
What else do you need to know about exercise health groups?
- The choice of a group for physical education is carried out before entering school - and must be indicated in the medical record.
- The assessment of the child's condition is given exclusively by the pediatrician (or therapist, adolescent specialist). It is he who defines the child after examination into one of 3 groups. When enrolling in a special group, the doctor is obliged not only to indicate the diagnosis, but to establish the degree of disturbances in the work of the body. In certain cases, a medical opinion may be required.
- The health group should be confirmed annually.
- The health group can be changed if the annual examination reveals that the child's condition has improved or worsened.
Children from the first 2 medical physical education groups usually work out together, but for children from the preparatory group, both the volume of the load and its intensity are reduced.
As for the composition of the special group, it is formed by the order of the school director and at the conclusion of the visiting team of specialists. Classes for this group are held at school twice a week or three times, but for half an hour.
Physical culture groups of schoolchildren's health in Russia - statistics
The main 1st health group of schoolchildren in Russia
The main physical health group includes healthy children with the 1st and 2nd health groups:
- Without health problems.
- Having mild impairments that do not entail developmental delays compared to their peers. For example, overweight, VSD, dyskinesia, or mild allergies.
Children from this group are allowed up to ...
- Delivery of the TRP standards.
- Training sessions in full.
- Delivery of standards.
- Trainings in sports sections.
- Participation in competitions, tournaments, olympiads.
- Participation in hiking trips.
- Classes in DYUSSH and DYUKFP.
Of course, it is also important to remember when allowing children to play sports, and about relative contraindications.
In particular:
- With a round back, boxing, rowing and cycling will be contraindicated.
- With astigmatism and myopia - diving, boxing, motorcycling and weightlifting, alpine skiing.
- For perforation of the eardrum - any kind of water sports.
Preparatory group for the health of schoolchildren in physical education
Children with the 2nd health group are assigned to the preparatory physical culture group (according to statistics, more than 10% of all students in Russian schools):
- Poorly trained physically.
- With morphofunctional health disorders.
- Included in risk groups for certain diseases.
- Those with chronic diseases in remission, which lasts about 3-5 years.
Children from this group are allowed up to:
- Classes according to the usual program, but with the exception of certain types of training and exercises.
- Passing the TRP, test and routine control tests, participation in sports events - only with the special permission of a specialist.
Children from this physical culture group are not allowed to participate in sports competitions.
They are also prohibited from:
- Large amounts of high-intensity physical activity.
- Long run.
- A large number of repetitions of exercises.
The teacher is obliged to choose a special set of exercises for children, in accordance with the medical record, which contains all the contraindications.
The medical certificate must also indicate the period for transferring the child to the main group.
- Alternating complex exercises with special breathing exercises.
- Replacing running with walking.
- Conducting calm games without sudden movements.
- Increased rest breaks.
The conclusions of the commission for assigning a child to this group is not required - just a certificate from the district pediatrician is enough, which must be attended by:
- Stamp and signature.
- Recommendations based on the recommendations of a narrowly focused specialist, as well as specific restrictions.
- Diagnosis.
- And also the period for which the child is assigned to the preparatory group.
Special group of children's health for physical education at school - do physical education lessons with children of special groups "A" and "B"?
This physical culture group is divided into two more - A and B.
Children with the 3rd health group are enrolled in special physical culture group A:
- Having chronic diseases, malformations, etc.
- With developmental disorders that require mandatory limitation of physical activity.
- Having serious disturbances in the work of the body, which do not interfere with studies, but are contraindications to physical education.
Children from special group A are allowed up to:
- Classes on a specially designed program.
- Classes in certain types of school curriculum with a mandatory reduction in standards.
The following exercises are imperatively limited:
- Acrobatic.
- Power.
- High-speed.
- Moderately intense outdoor games.
Forbidden:
- Participation in competitions.
- Participation in mass sports events.
- Visiting sports sections.
- Delivery of standards.
Children from special group A do not work with the rest of the children - they should be given separate lessons, which should be led by specially trained instructors in special programs.
Children with the 4th health group are enrolled in special physical culture group B:
- Those with chronic diseases without pronounced signs of impaired general well-being.
That is, children from this group are allowed to general theoretical studies, but they are generally exempted from physical education at school.
Children from special group B are allowed to:
- Exercise therapy classes.
- Classes on a complex special program developed by a specialist - at home, independently.
A child can be assigned to this group only by a decision of a medical commission, and a certificate is issued exclusively for a certain period, after which it must be reissued with a commission and examination of the child.
Each district pediatrician maintains a child's medical record, studying which you can find out that this baby belongs to the first, second, third, fourth or fifth group. This division carries information about the state of health of the baby at the current moment, and in some cases, about the events preceding his birth.
What is it
Not all parents know what a health group is and why it is needed. Dividing children into health groups makes it easier for teachers and doctors. With their help, you can more accurately determine the conditions in which a small person will learn, engage in strengthening or health-improving physical education, and eat.
All children have a different state of health, and on the basis of this, the district pediatrician assigns such a group to each child. This division by health categories shows whether the child needs any restrictions in anything, up to placement in a special institution. Based on the health group indicated in the children's medical record, the diet or type of physical education necessary for the baby is selected. 
The primary distribution of children by health category is carried out by the district pediatrician, who observes the baby with. Neuropathologists, surgeons, orthopedists, psychiatrists are also being monitored. When assigning a health group, the complex results of the examination of the baby by other specialists are taken into account, including tests, age tests are carried out.
Did you know? Chris Nolan is an Irishman with infantile cerebral palsy since birth. Was absolutely motionless for many years. Thanks to the mother, who believed in the possibility of his healing, and looked for ways to this, a cure was found. After the treatment, Nolan was able to move his neck muscles. This gave him the opportunity to master the typewriter and the man who did not say a single word in his life became a famous poet. The first collection of his poems was published on the fifteenth birthday of the author. Over time, the poetry of Chris Nolan took a place on a par with such famous poets as Joyce, Keats and Yates.
The infant is initially assigned to a category shortly after birth, usually when the young mother is discharged from the hospital. In the future, the assigned health group may change and be adjusted after each visit to the district pediatrician. If the child has no visible deviations in health, then an entry in the medical card will only be needed when submitting documents to kindergarten, and later to school. 
How is the assessment going
To assign a baby to any of the groups, you need to correctly and comprehensively assess the state of his health and mental development.
To do this, a specialist, after examining the child, must answer the following questions:
- are there any defective deviations in mental and physical development;
- does it often get sick, are there any chronic diseases;
- are the internal organs and systems of the body working normally;
- whether the development of the nervous system is age appropriate;
- how high is the immunity to viral diseases.
- surgeon and orthopedist;
- ophthalmologist and ENT;
- cardiologist and neuropathologist;
- to the dentist.
If, during the examination, the doctor notices the development of the baby, he makes an appropriate entry about this in the medical record and the little patient is prescribed additional examinations and tests. If necessary, doctors of another medical specialization are included in the examination process. For a preliminary determination of the health group of a newborn, the following are taken into account:
- whether there were pathologies during the intrauterine development of the baby;
- whether there were complications in the process, and how it proceeded;
- hereditary diseases on the lines of the father and mother;
- whether the child was sick in;
- whether the development is in line with the standard.
The main groups of child health and their characteristics
Children's health groups have certain characteristics, where such indicators are taken into account: the development of the child (neuropsychic and physical), the presence of chronic diseases or their complete absence. Assignment to any of the groups may be temporary; after a while, the child may be transferred to another category. 
What factors can affect the assessment of the child's condition by the pediatrician:
- if the child was sick at the time of the examination;
- how the cardiovascular, nervous and other systems of the body work;
- the work of internal organs (kidneys, liver, heart, pancreas, etc.);
- physical development (, head circumference);
- mental development (does he know how to eat, etc.);
- resistance to viral disease (frequency and duration of the disease).
The first
This group includes children who are little susceptible to disease (statistics are taken for 12 months). Observation of such babies shows: the child does not have chronic diseases, he has no deviations from the age norm in the development of motor skills, growth. Internal organs develop and function correctly, the observed monthly gains in weight. 
Timely development of the nervous system and psyche is very important. An experienced pediatrician can easily distinguish whether the child is somewhat inhibited by character traits, or there are problems in neuropsychic development. Every little patient must be examined by a neurologist. If deviations from the norm are noticed by the neurologist, then other doctors (psychologist and) begin to communicate with the baby. This is a small deviation and such children grow and develop normally, it is just that the crumbs have an insignificant need for the attention of doctors.
Did you know? The phrase "physical culture" was an invention of the British and first appeared on the pages of English newspapers at the end of the 19th century. This concept came to Russia long before the revolution and became extremely popular in society and in state educational institutions, where it was introduced as a separate discipline.
If a child has a small defect that does not prevent a person from living, and his body to function, then he will be referred to the first group of health. For example, the crumbs have too large or very protruding ears, this slight deviation from the norm does not prevent him from hearing well, does not require surgical intervention and does not affect his health for the worse.
The second
If the child was assigned to the 2nd health group, then this means that the baby has deviations from the existing standards in the work of any body. Such pathologies are of inorganic origin, that is, it is not a neoplasm or an inflammatory process, but a failure in the functioning of internal organs or one of the systems (cardiovascular and others). 
The impetus for the development of such pathologies can be given by a violation of biochemistry in the human body, the baby's immune system begins to work poorly, he does not adapt well to new conditions. Often the reason for the beginning disturbances in the work of the body is the rapid growth of a small person, after which the cardiovascular system does not have time to rebuild. Rapid growth increases body weight and the volume of the systemic circulation, the body has not yet reorganized, and the child does not have the strength for this.
One of the indicators that a child should be attributed to the second health group is frequent (more often four times a year) viral and colds. The child becomes weakened, he needs a long time to get out of the disease and recuperate, much more than is needed for a child of his age. The baby loses appetite for a long time, becomes lethargic and sleepy. After colds, such children often have complications: they hurt, the stomach and intestines do not work well.
Babies belonging to the second group have no pathologies in how they develop (or they are quite insignificant), there are no anomalies and defects in the development of internal organs, and there are no chronic diseases. 
Pediatricians divide the second health group into two subcategories:
- Group A- the child does not have any obvious and hidden deviations in development, but there are cases of the appearance of children with developmental defects in the family; if the baby's mother was at the time of delivery; there was a pathology of pregnancy or childbirth; in these births two or more children were born; or post-term pregnancy; deviations in one direction or another in the body weight of the newborn. Group A can be assigned if a mother or an unborn baby has been infected with a viral disease or the baby has been recovering for a long time after surgery, illness and other serious conditions.
- Group B- during obstetrics, the baby suffered damage to the central nervous system, which led to small deviations from the norm in the development of the psyche. The crumbs may have heart murmurs, blood levels below normal, malfunctioning of the stomach and gastrointestinal tract.
The third
If your child was assigned the 3rd health group, then this means that the child is in a state of compensation. Classification by health groups is needed in order not only to note the diseases present in the child, but also to record the severity of their development. 
This category is a beacon for doctors that the crumbs have a chronic illness or developmental pathologies, but such diseases rarely worsen and proceed easily, they are simply relieved by drugs or other methods.
Children from this category may have developmental abnormalities, but these deviations will not become an obstacle to a normal lifestyle and will not greatly limit the baby's capabilities. The development of the psyche and physical condition is usually within the normal range or slightly lagging behind it. Children from the third health group feel great in the company of other babies, they easily and quickly adapt in society.
Characteristic features for this group:
- excessively low weight of the child (first-second stage);
- insufficient;
- weak muscles of the body.
Diseases belonging to the 3rd group:
- chronic;
- chronic duodenitis;
- chronic;
- stuttering;
Important! If the child was assigned to the third category, this does not mean at all that you can put an end to his health, the main thing is to go to an appointment with a specialist on time, take his recommendations seriously - and gradually the health of the crumbs will return to normal. This category is not assigned to children who have incurable diseases, but in order for the child to recover, parents must provide him with love, care and attention. Inattention on the part of parents can serve as an impetus for the development of existing pathologies for the worse.
Parents are often concerned about whether their child can go in for physical exercise if they have a third health group in their medical record. Such kids are engaged in physical education, but not on a general basis. On the recommendation of the attending physician, the child is sent to physical therapy or to special groups, where the peculiarities of the health of the little patient are taken into account. 
Fourth
The category unites children who have complex congenital pathologies in development (complicating human life). Such pathologies affect not only the initially diseased organs and systems, but also negatively affect other organs. Sometimes such children simultaneously have a whole "bouquet" of chronic diseases, the exacerbation of which proceeds with complications, they are poorly treated and after them the child recovers for a long time.
This also includes babies in remission after a serious illness and forced to constantly take medications. Children who have consequences after injuries and surgical interventions experience some limitations in intellectual and physical exertion. 
In society, such children feel uncomfortable, their illness affects their character and physical capabilities, the perception of the world. At the same time, their psyche and nervous system can develop absolutely normally, but in some cases, pathology in development (from minor to critical) may also be present here. For children of the 4th group, a lack of muscle mass and body weight is common, they often need to live in special boarding schools, in which all the conditions for the life of such babies are provided.
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If the child can easily live at home, he needs constant supportive therapy:
- Regular courses of therapeutic and prophylactic physical education.
- Taking the recommended medications.
- hypertonic disease;
- thyrotoxicosis;
- progressive.
If doctors have established the fourth health group for your child, then this is not at all a recommendation to place your baby in a specialized boarding school. 
But parents still need to heed the advice of doctors: a sick child does not always benefit from the society of healthy peers, an inferiority complex may develop. The kid understands that he is different from other children, cannot run like them or memorize new poems, does not understand the conditions of the game. Such feelings do not benefit the child's mental health and self-esteem, because even an adult can be pecked at by ridicule.
Studying with specially trained teachers, the kid does not feel his problem, learns easier, and, quite possibly, in a few years he will be able to study with healthy children.
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The fifth
This category includes children with the most serious diseases and disabilities (physical, mental and mental). Such children usually have chronic diseases in a constant stage of exacerbation, they are on disability or will soon get it. In such small patients, many (or all) of the internal organs and systems of the body are sick, their diseases are constantly at their peak of activity, their parents turn to doctors for this more than ten times a year. In addition to the general weakness of the body, such patients often develop mental retardation, but there are exceptions. 
Pathologies in development are not only congenital, the fifth group additionally includes:
- children with cancer diagnoses;
- babies after complex crippling surgical interventions;
- who have suffered severe injuries or illnesses.
Children with the 5th health group do not attend kindergartens or schools, they need individual home schooling. If parents cannot provide a child with disabilities with special care and education, then he is transferred to a permanent place of residence in a specialized boarding school. Such boarding schools provide for medical care, constant supervision and custody of trained personnel. Children of this category of health are often not adapted in society, especially the smallest ones - after all, most of their life is spent in hospitals.
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Bottom Line: Comparison Chart
For categorization among pediatricians, there is a comparative table of health groups in children. Guided by such a table, it is easier to correlate the characteristics of the health of a child with the indicators inherent in one of the groups. 
From all of the above, it becomes clear that the division of children into health groups has the ultimate goal - to choose the right methods of mental and physical education for a little person, to determine the correct daily routine, based on individual characteristics, to determine the boundaries of physical activity. All this is aimed at not harming the baby in any way. The distribution into health groups is valid until the person reaches the age of majority (up to 18 years), after which his health leaves the field of pediatrics and doctors of other areas are engaged in it.
Health groups.
Very often, when studying a child's card, parents find an entry in it - the first health group (or the second, the third ...). But what kind of group it is and on what basis it is exhibited - not all parents know. Although in reality - this is only a record for a doctor or teacher. Informing about the peculiarities of the baby's state of health, allowing you to rationally draw up a plan of measures for his health improvement or training.
What are health groups?
Health groups - this is a specific scale that takes into account the health and development of the child, it also includes all the risk factors that have influenced or influence him, and a forecast for the future is made. The health group is set by a district pediatrician or a medical worker of a preschool institution, this is based on 6 established criteria.
The first criterion evaluates heredity. At the same time, it should be noted whether there are diseases in the family that are transmitted from generation to generation, to determine the baby's predisposition to them. After asking the parents in detail, the doctor will make a conclusion and determine whether the child is at risk of getting sick or not. In addition, it is important to assess the course of pregnancy, the birth itself and, of course, the first month of the baby's life. Complications of pregnancy, childbirth and the first illness of the baby are very important for the correct regulation of the health group.
The second criterion is, this includes height, weight, head circumference, chest and other parameters. In addition, the child's neuropsychic development is assessed - this is the third criterion. The child's skills, speech development, communication are assessed. To help the doctor, there are tables that reflect the baby's skills by months and years, but deviations in one direction or another are not considered a pathology, in order to determine whether it is a pathology or not, it is necessary to evaluate the entire set of skills. After the child's behavior is assessed, the child's communication with others is taken into account, how he eats, his emotionality, bad habits. The last but very important criterion is the child's chronic illness or developmental defects and anomalies. Particular attention is paid to those vices that affect the life and existence of the baby. The health group is not a static indicator. It can change during the child's life, but, alas, most often in the direction of deterioration - from the first to the second, and more often from the second to the third.
The state of health of children.
After collecting all the data and evaluating, the doctor establishes a health group at a given point in time. The health of the child population is characterized by both the presence or absence of diseases, as well as harmonious and age-appropriate physical and mental development, a normal level of all body functions, and the absence of a tendency to disease. The criteria for assessing health have been developed:
The presence at the time of the examination of any diseases (that is, they came to the reception sick or healthy);
- the level of the functional state of all body systems (how well all organs and systems work);
- compliance of physical and mental development with age (how the child grows and what he can do);
- the degree of the body's resistance to adverse influences (how often and for how long it is sick).
Based on the results of the medical examination, the children are divided into five groups.
I group- healthy children, physically and mentally developing normally, without functional deviations. Children of this group during the observation period can rarely get sick, but at the time of the examination they must be healthy, the body's resistance must be high. In fact, the first health group unites absolutely healthy babies, but children with this health group are very rare, literally a few. During my years of practice, I have only exhibited this health group a couple of times.
II group- healthy children, but with functional and some morphological deviations, with reduced resistance to diseases. Such children should not have chronic diseases, but they can suffer acute diseases more than 4 times a year.
The second group has several subgroups, and the whole group includes healthy children, but with some nuances. Group "A" includes healthy babies, but either there is a burdened heredity, or mother's pregnancy and childbirth were complicated. Group "B" includes children who are often ill, with some functional abnormalities with a possible risk of developing chronic diseases.
The rest of the groups include sick children with various diseases in terms of severity. Such children are sure to be examined by specific specialists. For them, special programs for health improvement and treatment are being developed. So the third group includes babies with developmental defects in the stage of compensation, if the defects are in the stage of subcompensation, then such children already belong to the fourth health group, and the stage of decompensation is the fifth health group.
III group- children with chronic diseases in a state of compensation (that is, in a state without exacerbation, do not manifest themselves in any way). This group unites children with congenital abnormalities or chronic diseases, in which there may be rare and not severe exacerbations of the underlying disease. The body's resistance in such children is somewhat reduced. Such diseases, in which the 3rd group will be put, include - chronic gastritis or duodenitis, FDH, chronic bronchitis, pyelonephritis, anemia, obesity, stuttering, flat feet and adenoids.
IV group- children with chronic diseases in a state of subcompensation. This group includes children with congenital pathology or chronic diseases, in which, after an exacerbation of the main disease, the general condition and well-being are disturbed for a long time. The body's resistance in children is sharply reduced. These are epilepsy, hypertension, thyrotoxicosis, progressive scoliosis.
V group- children with chronic diseases in a state of decompensation. These are children with severe disabilities who cannot walk, cancer patients and other serious conditions. Children of this group have severe malformations or chronic diseases with significantly reduced functional capabilities. These children usually do not attend general child and adolescent institutions and often have disabilities.
Depending on the diagnosis itself, babies with the third and fourth health groups may be advised to reduce stress or even homeschool.
How do you know if the group is right?
When determining a health group, it is necessary to take into account all the criteria that characterize the health of a given child. A comprehensive assessment of the state of health is carried out at the time of the medical examination. The functional state of the body's systems is revealed by clinical methods, using functional tests. The correspondence of the physical and mental development of the child's body by biological age is carried out. The body's resistance is judged by the number of acute diseases and exacerbations of chronic ones in the previous year. When examining children and adolescents, one should not forget about functional deviations in the state of health, which can occur at a certain age and are not a true pathology, but reflect age-related physiological changes in the body.
So there is a regularity of the occurrence of functional deviations in the state of health of children:
- in infancy, there are abnormalities in the composition of the blood (anemia), allergic manifestations,
- at an early age, digestive disorders appear (especially if the child is not properly fed);
- at preschool age, there are dysfunctions of the nervous, respiratory and urinary systems, the musculoskeletal system and ENT organs;
- at school age, there are violations of cardiovascular activity, functions of the organs of vision.
Most frequently asked questions.
If a child belongs not to the first group of health, but to the second, is it dangerous?
Not really, but this child requires attention from both the doctor and the parents, even more from the parents. The fact is that this health group suggests that the baby's body is working to its limit. In order to maintain your health, or that it is affected by too many harmful factors, the negative influence of which may not appear immediately - for example, severe hypoxia during childbirth can only make itself felt in 2-3 years, cooling down in development. The second group is a signal for observation and active exercises with the child by hardening, massage, gymnastics - but this is not a sick child. Earlier, there was an opinion - to restrict children with the second health group in physical activity in kindergarten and school, a kind of "blow off the dust", but this recommendation is unjustified. You just need to monitor the tolerance and gradualness of the loads, but not limit them.
The third health group is children with chronic pathology and is this forever?
No, the third health group, if there have been no exacerbations of the disease for a long time, and the terms of its dispensary observation have passed, they are transferred to the second group, that is, the child is considered healthy, with the reservations that he was sick at some time. This happens with allergy sufferers, children under three years of age - as they say, "outgrow", with children with pyelonephritis, children with anemia who have recovered and hemoglobin is at stable numbers.
Children with the third health group do not go to physical education?
No, they go - but usually to a preparatory or special group, it all depends on the disease. They are shown courses in physiotherapy exercises and gymnastics.
Topic 3.2. Prevention of noncommunicable diseases
Disease- a process that occurs as a result of exposure of the body to a harmful stimulus of the external or internal environment, characterized by a decrease in the adaptability of a living organism to the external environment while simultaneously mobilizing its protective forces. The disease is manifested by an imbalance between the body and the environment, expressed in the occurrence of side (inadequate) reactions, and in a person - by a decrease in his ability to work for the duration of the illness.
Pre-illness- This is a latent, latent period of the disease or the stage of the body's functional readiness for the development of a certain disease.
Adaptive capabilities of the body- are one of the fundamental properties of a living system. Health as a certain level of the organism's adaptive capabilities (adaptability, or adaptive potential) includes the concept of homeostasis, which should be considered as the end result of the activity of numerous functional systems, as the target function of multi-level hierarchical control in the body.
The main risk factors for the development of a non-communicable disease
It is known that many noncommunicable diseases share common risk factors, such as smoking, overweight, high blood cholesterol, high blood pressure, alcohol and drug use, low physical activity, psychosocial disorders, and environmental problems. The experience of developed countries convincingly shows that the result of vigorous measures to limit the prevalence of risk factors for noncommunicable diseases is an increase in the average life expectancy of the population.
Targeted programs for the prevention of diseases state and regional
1.the federal target program "Prevention and control of socially significant diseases (2007 - 2012)", including the subprograms "Diabetes mellitus", "Tuberculosis", "HIV infection", "Oncology", "Sexually transmitted infections "," Viral hepatitis "," Mental disorders "," Arterial hypertension "and" Vaccine prophylaxis ".
2. Federal target program "Prevention and fight against socially significant diseases (2007 - 2011)" of the Ministry of Health and Social Development of Russia, state customers - Roszdrav, Rospotrebnadzor, Federal Penitentiary Service of Russia and the Russian Academy of Medical Sciences.
3. federal target program "Social development of the village until 2013" (hereinafter referred to as the Program). (as amended by Resolutions of the Government of the Russian Federation of 05.03.2008 N 143, of 28.04.2011 N 336)
Regional:
¡Long-term target program of the Moscow region "Clean water of the Moscow region" for 2013-2020 "
¡Regional target program "Improving the provision of medical care to the population, preventing and combating socially significant diseases in the Sverdlovsk region" for 2011-2015.
Clinical examination is a set of measures, including a medical examination by doctors of several specialties and the use of the necessary examination methods, in order to:
Early detection of chronic non-communicable diseases, which are the main cause of disability and premature mortality of the Russian population and risk factors for their development,
Formation of health status groups and development of recommendations for patients.
Clinical examination is carried out once every three years.
Adult health groups
I group- Citizens who have not been diagnosed with chronic non-infectious diseases, there are no risk factors for these chronic non-infectious diseases, or there are specified risk factors with a low or medium total cardiovascular risk, and who do not need dispensary observation for other diseases.
Such citizens are provided with brief preventive counseling, correction of risk factors by a general practitioner, a doctor (paramedic) of a department (office) of medical prevention or a health center.
II group- Citizens who have not been diagnosed with chronic non-communicable diseases, have risk factors for these chronic non-communicable diseases and a high or very high total cardiovascular risk, which do not need dispensary observation for other diseases.
For such citizens, correction of risk factors for chronic non-infectious diseases is carried out in the department of medical prevention or health center, if necessary, the prescription of drugs for medical use is carried out.
Subject to dispensary observation by a doctor (paramedic) of the department (office) of medical prevention.
III group- Citizens with diseases requiring dispensary observation or the provision of specialized, including high-tech medical care, as well as citizens with suspicion of a disease requiring additional examination (Upon completion of the examination, the citizen's health group may change).
Such citizens are subject to dispensary observation by a general practitioner, other specialist doctors with the implementation of medical, rehabilitation and preventive measures.
Citizens with risk factors for chronic non-communicable diseases are corrected in the department (office) of medical prevention or health center.
"Card of dispensary observation" (f. 030 / y) allows you to examine a given contingent of patients by sex, age, profession, length of service, duration of observation.
For the analysis of dispensary work, three groups of indicators are used:
1) indicators of coverage with dispensary supervision;
2) indicators of the quality of dispensary observation;
3) indicators of the effectiveness of dispensary observation.
The data required to calculate these indicators can be obtained from accounting and reporting documents (f. 12, 030 / y, 025 / y, 025-2 / y).
1. Frequency indicators.
Coverage of the population by prophylactic medical examination(per 1000 inhabitants):
is on "D" -observation during the year x 1000 / the total number of the served population.
The structure of patients under "D" observation, by nosological forms(%):
the number of patients under "D" observation for this disease x 100 / the total number of dispensary patients.
2. Indicators of the quality of clinical examination.
Timeliness of taking patients to "D" -accounting(%) (for all diagnoses):
the number of patients newly diagnosed and taken under "D" -observation x 100 / the total number of newly diagnosed patients.
With proper organization of work, this indicator should approach 100%: hypertension - 35%, peptic ulcer - 24%, coronary artery disease - 19%, diabetes mellitus - 14.5%, rheumatism - 6.5%.
Completeness of coverage "D" - observation of patients (%):
the number of patients on the "D" -registration at the beginning of the year + newly taken under the "D" -observation - never showed up x 100 / the number of registered patients in need of the "D" -record.
This indicator characterizes the activity of doctors in organizing and conducting medical examination and should be 90 - 100%.
Frequency of visits:
number of visits to the doctor made by patients in the dispensary group / number of persons in the dispensary group.
Compliance with the terms of dispensary examinations(planned observation),%:
the number of dispensaries who observed the deadlines for attendance at D-observation x 100 / the total number of dispensaries.
The percentage of those who “come off” (who have never come to the doctor in a year) are normally admissible from 1.5 to 3%.
Completeness of medical and recreational activities(%):
passed this type of treatment (recovery) x 100 / needed this type of treatment (recovery).
The main criteria for the effectiveness of clinical examination are shifts in the state of health of patients (improvement, deterioration, no change), the presence or absence of relapses, indicators of disability, a decrease in morbidity and mortality in the dispensary group, as well as access to disability and the results of rehabilitation and re-examination of people with disabilities. "D" - accounting. To assess these changes, a so-called milestone epicrisis is drawn up for each patient once a year, which is recorded in the “Medical card of an outpatient patient”.
The period of adulthood has a considerable length of time, and the activity of a nurse may be somewhat different at different intervals of this period, however, the general focus on preserving the health of an adult remains. In this age period, the basic needs are satisfied by a person independently, without the intervention of the environment, but many people need qualified advice on maintaining the optimal functioning of the body (table).
Table 1. The main directions of nursing activities
| Need | Way of satisfaction | Directions of nursing |
| 1. Breathing | Provided naturally; NPV 16-18 in 1 min | Tips for outdoor walks |
| 2. Fluid intake | Independently, up to 1.5-2 liters per day | Tips for ensuring adequate fluid intake, monitoring fluid intake |
| 3. Nutrition | On one's own | Recommendations for a rational and adequate diet |
| 4. Physiological functions | On one's own | Recommendations for monitoring the regularity of bowel movements, in this regard, advice on nutrition |
| 5. Personal hygiene | On one's own | Recommendations for daily showering, more often if necessary |
| 6. Active activity (movement) and rest | On one's own | Recommendations for the regimen of the day and physical activity. Drawing up a physical exercise program together with the patient (walking in the fresh air, cycling, swimming, exercise on a stationary bike, aerobics) |
| 7. Sleep | Sleep for at least 8-9 hours, daytime sleep is possible | Recommendations for the regime of the day |
| 8. Sexual activity | It persists, in women it slightly increases | Safer Sex Tips, Family Planning Tips |
| 9. Maintaining a safe environment | Supported independently | Training in measures of safe behavior on the street, at home. Quitting bad habits (smoking, substance abuse, alcohol consumption) |
| 10. Social needs: a) communication; b) social contacts; c) striving for self-affirmation | Many expand social contacts, achieve a high level of self-realization; some people may be dissatisfied with what they have achieved, looking for reasons for failure in their family or career | Recommendations for maintaining and maintaining social contacts; showing interest in various events |
"Disease is easier to prevent than to cure."
Hygiene training and education of the population is an obligatory section of the work of any health facility and every medical worker. It is aimed at improving the sanitary culture of the population, preventing diseases and spreading knowledge about a healthy lifestyle.
Hygiene education and upbringing is included in the health worker's work schedule at the rate of 4 hours per month.
Hygienic education and upbringing is based on the concept of healthy lifestyle formation, the main tasks are formulated:
Reducing the prevalence of smoking;
Improving the quality of food;
Increased physical activity;
Mitigating the influence of damaging psychosocial factors and improving the quality of life;
Compliance by the population with personal and public hygiene measures;
Decreased alcohol consumption;
Prevention of drug use;
Improving the quality of the environment.
The promotion of medical and hygienic knowledge among the population helps to reduce morbidity and mortality, helps to educate a healthy, physically strong generation.
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