Utilização da caderneta da criança na Rede de Saúde e suas interfaces na atenção primária

Abstract

Introduction: The Child’s Notebook (CN) is essential for monitoring child development, empowering families, and facilitating communication among healthcare professionals. Since 2018, there has been a shortage of this document in several Brazilian municipalities. Recently, a digital version of the CN was launched; however, structural challenges in Primary Health Care (PHC)—such as the lack of technological resources—reinforce the importance of understanding the limitations and potential of the physical version in the local context. Objective: To analyze the use of the CN in the municipality of Lavras, Minas Gerais, Brazil. Methods: This is a cross-sectional, mixed-methods study linked to the project “Child Health Notebook: implications for food and nutrition security in early childhood.” In the quantitative phase, 324 caregivers of children assisted in the municipality were interviewed. The database was double-entered and validated using Epi-Info and Microsoft Excel. Descriptive analyses were conducted in Jamovi 2.3, and Fisher’s exact test was used to identify statistical associations. The qualitative phase consisted of semi-structured interviews with health professionals from Lavras, interpreted using Bardin’s Content Analysis approach. Results: Most caregivers (94.8%) were female. Although 86.4% were familiar with the CN, only 68.4% understood its content. Pediatricians were the only professional category with a majority of affirmative responses regarding CN completion (88.5%). Fisher’s exact test revealed significant associations between CN awareness and kinship, as well as between understanding of CN content and marital status, ethnicity, and education level. The qualitative analysis revealed challenges such as work overload, fragmented care, replacement of the CN with the Simplified Card, and lack of municipal protocols. Professionals also reported the devaluation of PHC in the municipality, characterized by the prioritization of specialized care, low adherence to routine child care (puericulture), and limited multiprofessional integration. Conclusion: The findings reveal challenges in the use of the CN within PHC, which should be the main setting for puericulture. Public policies that strengthen PHC and promote strategies to increase CN adherence are essential to ensure its effective use as a child care tool. Expanding access to the digital version and implementing local protocols are important steps, but the limited infrastructure of Basic Health Units—such as lack of internet and computers—indicates that the physical CN remains fundamental for monitoring and promoting child health.