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Chapter 1: Perspectives of Pediatric Nursing
Health Care for Children
●Healthy People 2020
●Framework for identifying essential components for child health promotion programs ●Designed to prevent future health problems in children
●Don't want children to have unhealthy lifestyle that will shorten life expectancy Health Promotion: 6 Categories (WHO 2007)
o1. Tobacco use
●Smoking or dipping
o2. Behavior that results in injury and violence ●Gangs, etc
o3. Alcohol and substance use ●Synthetic marijuana on the rise
●Some substances legal, may not be wise to use
▪Legalized marijuana can cause problems (shrinking of the brain)
o4. Dietary and hygienic practices that cause disease o5. Sedentary lifestyle ●Advancement of technology, TV , cars cause people to be more sedentary (can lead to obesity and chronic conditions like DM (type 2))
o6. Sexual behavior that causes unintended pregnancy and disease
●Early parenthood in adolescents
●STDs Child Health Promotion
●Provides opportunities to reduce differences in current health status among members of different groups and ensure equal opportunities and resources to enable all children to achieve their fullest health potential
●Health equality across all groups Nutrition in Infancy
oBreast feeding is the BEST!
●Human milk is preferred form of nutrition for all infants
●Provides
▪Micronutrients
▪Immunologic properties (Be careful not to destroy it by overheating)
▪Enzymes that enhance digestion and absorption
oCommercial infant formula is another good option (until 1 y/o) Nutrition in Childhood
●Life-long eating habits est. by age 3
●Habits pretty much set, can be hard to change them
●Parent teaching: look at parent's attitude and what to teach them
●Role of Culture with food: will influence your habits ●Dental Care
oDental caries the single most common chronic disease of childhood. 2
oDental caries are preventable
●Dental hygiene beginning with first tooth eruption
▪@ 6-8 months first primary teeth erupt in infants
▪Start getting them to practice cleaning teeth when they come in
oRole of fluoridated water
oEarly dental preventive care
●Promote healthy dental hygiene habits
●Brush teeth 2x a day and floss x1
oIntroduction to dentist early
Immunizations: Role of Nurse
oReview individual immunization records at every clinic visit
oAvoid missing opportunities to vaccinate
oEncourage parents to keep immunizations current (US Department of Health and Human Services, 2009) oKeep up with changes in immunization schedules, recommendations, and research related to childhood vaccines
oWhen should we give flu shots?
oShould not give immunizations if child is immunocompromised , on chemo, etc
●Don’t want to introduce live viruses to susceptible pts
oKnow contraindications of immunization
oCDC recommended immunizations for children from birth to 6 years
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●Hep B: birth, 2 mos, 6 mos
●DTaP: 5 doses; Tdap (11-18 years vaccine)
●Influenza start at 6 months and get yearly
●Meningococcal: 11-12 years and booster before 16 years
●HPV: minimum 9 years (girls); 9-18 years (male)
Age:Birth 2 months4 months6 months1-1.5 years4-6 years11-12 years
Vaccin
eHep BHep B
DTaP
RV
Hib
IPV
PCVHep B
DTaP
RV
Hib
IPV
PCVHep B
DTap
RV
Hib
IPV
PCV Influenza (YEARLY)MMR
Hep A
DTaP
Hib
PCV
VaricellaVaricella
DTaP
IPV
MMRTDaP
HPV
Meningococcal
Childhood Health Problems (TEXTBOOK*) 3
●Obesity and Type 2 Diabetes, p. 3
●Obesity- BMI > 95th percentile
●Prevalence of overweight children x2, adolescents x3 (1980-2000)
●Advancements in entertainment and technology contribute to obesity problem
●Lack of physical activity r/t limited resources, unsafe environment, inconvenient play and exercise facilities, easy access to TV and video games
oIncrease incidence of obesity among low-income, minority children
●Overweight: Increase risk for metabolic syndrome (HTN, altered glucose metabolism, dyslipidemia, abd obesity)
●Goal to reduce incidence of overweight children from 20% to <6%
Childhood Injuries, p. 3
●Most common cause of death and disability
●Death rate increase (suicide, poisoning, falls)
●Suicide > MV A as leading cause of injury mortality
●Other nonintentional injuries
oHead injuries
oDrowning
oBurns
oFirearm accidents
●Small infants: falls
●Crawling infant: risk for aspiration or poisoning
oPutting things in mouth
●Mobile toddler: falls, burns, collisions
oExploring and investigate, can run and climb
●Older children: oblivious to environmental hazards (street traffic/water)
oAbsorption with play
●Need for acceptance: older children and adolescents accept dares and challenges
●Rate of injury high in children <9 years
oMost fatal injuries occur in later childhood and adolescence
●Drowning and burns are among top 5 leading cause of deaths for males and females throughout childhood
oImproper use of firearms: major cause of death among males
o95% medication related emergency room visits in children <5 years are d/t ingesting medications while unsupervised Violence, p. 5
●Higher homicide rates: minority populations esp AA
●Violence permeates and desensitizes the child towards violence
▪TV , commercials, video games, movies
●Nurses need to be especially aware of children that:
▪Harm animals or start fires
▪Depressed
▪Repeatedly in trouble w/ criminal justice system Substance Abuse Mental Health Problems, p. 6
o1/5 adolescents have mental health problems
o1/10 serious emotional problem that affects daily functioning 4
●Children and adolescents w/ mental health problems:
▪Likely to engage in risk and thrill seeking behavior and drop out of school
●50-75%: anxiety disorders and impulse control disorders (conduct disorder or ADHD): common in adolescence
●Suicide: 3rd leading COD in ages 10-19 ●Mortality oInfant Mortality ●Death in first year of life ●Recorded per 1000 live births
▪Neonatal mortality (<28 days of life)
▪Postneonatal mortality (28 days to 11 months) oChildhood Mortality ●usually presented per 100,000 population ●Leading causes:
▪Accidental injuries: 35.6%
▪Homicide: 11.4%
▪Suicide
●Morbidity
oChildhood morbidity oStatistics generally rates per 1000 population oDifficult to define ●May denote acute illness, chronic disease, or disability ●Childhood Morbidity
oAcute illness: symptoms severe enough to limit activity or require medical attention ●Respiratory illness = approximately 50% of all acute conditions
●Infections and parasitic disease = 11%
●Injuries = 15%
oMost common chief illness is the common cold.
oURI and diarrhea decrease in frequency w/ age
oAcne and HA increase
oChildren w/ increased Morbidity
●Homeless children
●Children living in poverty
●LBW children
●Children w/ chronic illnesses
●Foreign-born adopted children
●Child in Day care centers ●The "New Morbidity"
oAKA Pediatric Social Illness
●Behavior, social, and educational problems ●Psychosocial factors
▪Poverty, violence, aggression, noncompliance, school failure, and adjustment to parental separation and divorce
oMental health issues
