Health is a complex phenomenon.

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Health is a complex phenomenon. It is a state of
physical, mental social well being and not
merely the absence of disease
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HISTORY OF THE CARE OF CHILDREN Influenced
by their importance in society OFTEN VIEWED AS
PROPERTY Primitive times Ancient
Greece Industrial Revolution 1700s Father of
Pediatrics Abraham Jacobi milkstations for
pure milk pasteurization not required until much
later Late 1800s first childrens hospital in
Philadelphia Prevention of Cruelty to Children
Society based on the Society of Prevention of
Cruelty to Animals 1909 First Pediatric White
House Conference still meet q 10 yrs.
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1912 The Childrens Bureau was established under
the jurisdiction of the Dept. of Labor then
Dept. of Health, Education Welfare NOW
called Dept. of Health Human Services. This
federal dept. it to 1. Assist states in care of
children 2. Support child welfare 3. Inform
public of problems (unsafe toys, car seats,
etc. In 1920s World Health Organization
(WHO) major concern being women childrens
health Now are many childrens advocate
groups 1900s isolate sick children 1940s
studies by Spitz Robertson on the detrimental
effects of isolation maternal deprivation Even
though knew the effect change was slow!
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Still changing our attitudes about care of
children Immunizations 1955 Salk polio
vaccine Nutritional advances Antibiotics
(improving with not only types but not abusing
them Control of infectious disease Patient/Parent
education 20th century focus shifts to
prevention of illness health social problems
prevention of problems Healthy People 2000 now
2010 increase the span of healthy life for
Americans reduce health disparities among
Americans achieve access to preventive services
for ALL Americans HEALTH PROMOTION, HEALTH
PROTECTION, PREVENTIVE SEVICES
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TRENDS IN MATERNAL CHILD HEALTH NURSES ROLE
MULTIFACETED
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MORTALITY VS. MORBIDITY Prevalence of illness
disease over a period of time infections
most common childhood illnesses with respiratory
infections as 1 Morbidity denotes 3
things 1. Acute illness 2. Chronic illness(a
condition that persist for more than 30 days) 3.
Disability (often measured in day off from school
or days confined to bed. Can be result of
acute or chronic illness. children under 17 over
95 are not disabled, 2 have mild, 2
have moderately and only 0.2 are severely
(account for most spent) Morbidity much more
difficult to define measure than mortality
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NEW MORBIDITY Problems besides disease or
injury which affect childs health Behavioral,
social (family), educational problems
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Cigarette UseLifetime use (ever
tried).70.4Daily use ..25.3
White students.29.3
Hispanic .19.6 Black
..11.2Current cigarette, cigar, or
smokeless tobacco use..32.8
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Births to 1990
1998 teen moms
13 13 ?
single moms 28
33 receiving late or no prenatal care
6 4 moms who
smoked in pregnancy 18
13 low birth weight
7 8
preterm birth
11 12 mom less than
12th grade education 24
22 teens already mother
24 22 source
The Right Start Report
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Alcohol Lifetime Use.81.Current Use of
Alcohol..50Episodic Heavy Use
(gt5drinks on gt1day in last 30 days).32
Male.34.9 Female.28.1
White..35.8 Hispanic32.1
Black.16...
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1999 Youth Risk Behavior Survey9.9 students
overweight (BMI gt 95th percentile) Males
11.9 Females 7.930 students thought they
were overweight Males 23.7 Females
36.442 students trying to lose weight(in last
month) Males 26.1 Females 59.4
7.6 had taken diet pills or liquids4.8 had
vomited or taken laxatives Males 2.2
Females 7.5
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Infant Mortality1900 200 per 10001940
47 .. ..1960 26 ..
..1982 11.2 .. .. (Black infants -
25.7 per 1000)1998 7.2 .. ..1999
(Illinois).. 8.3 .. .. Blacks
in IL.. 17.4 ..Whites in IL. 6.2 Leading
Causes Infant Mortality1 Congenital Anomalies
2 R/T Prematurity and LBW3 SIDS
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In 1998 7.2 For whites 6.0 For blacks
13.8 For native Americans 9.3
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Leading Causes Death Ages 1-4(per 100,000 live
births) Injuries . 1 Motor
Vehicle Accident 2 Drowning 3
Fires and Burns 4 FirearmsCongenital
anomaliesCancer Homicide
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Leading Causes of Death Ages 10-24
per 100,000)Motor Vehicle Accidents.31Homi
cide..18Suicide..12Leading
Causes of Death Ages gt24Cardiovascular disease
.42 Cancer24related to
tobacco and drug use, unhealthy diet and physical
inactivity, behaviors often established in
adolescence
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Mortality from injuries per 100,000 live
birth TYPES OF INJURIES under 1 1-4
5-14 15-24 MALES of
deaths 2.4 42 52
51 Motor vehicle 5.2 6.8
9.1 55.5 Drowning
3.2 6.1
2.7 5.1 Fire burns 3.1
5.9 1.3
1.2 Firearms 0.1 0.2
1.0 2.3 Ingestion of food/object 5
2 Mechanical suffocation
6.2 -- --
-- Falls -- 0.6 0.3
--- Poisoning -- --
-- 1.6 Females of
deaths 2.6 35 41
45 Motor vehicle 5.6 6.1 4.8
19.7 Drowning 2.3 3.5
0.7 0.6 Fire Burns 3.1 3.9
1.0 0.6 WHY DO WE CARE
ABOUT STATISTICS????
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Immunization (vaccination) is a means of
triggering acquired immunity. This is a
specialized form of immunity that provides
long-lasting protection against specific
antigens, such as certain diseases. Small doses
of an antigen (such as dead or weakened live
viruses) are given to activate immune system
"memory" (specialized white blood cells that are
capable of "recognizing" the antigen and quickly
responding to its presence).

• Four different types of vaccines are currently
  available.
• Attenuated (weakened) live virus is used in the
  measles, mumps, rubella(MMR) vaccine and the
  varicella (chicken pox) vaccine. These vaccines
  last longer than other vaccines, but can cause
  serious infections in people with compromised
  immune systems.
• Killed (inactivated) viruses or bacteria used in
  some vaccines. For example, the pertussis vaccine
  uses killed virus. These vaccines are safe even
  in people with compromised immune systems.
• Toxoid vaccines contain a toxin produced by the
  bacterium or virus. For example, the diphtheria
  and tetanus vaccines are actually toxoids.
• Biosynthetic vaccines contain synthetic
  "man-made" substances. For example, the Hib
  (Haemophilus influenza type B) conjugate vaccine
  is a biosynthetic vaccine containing two antigens
  that are combined to form a "conjugate" molecule
  that triggers the immune system to produce
  antibodies that are effective against this
  disorder.

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• A recommended immunization schedule for
  children includes
• Birth HBV
• 2 months Polio, DTaP, Hib, HBV, Pneumococcus
• 4 months Polio, DTaP, Hib, Pneumococcus
• 6 months Polio, DTaP, Hib, HBV, Pneumococcus
• 12 to 15 months Hib, Pneumococcus, MMR,
  Varicella. The child may also be tested for TB.
  TEST at same time OR wait for 4-12 weeks before
  do skin test for TB because maybe chance for a
  false positive
• 15 to 18 months DTaP
• 4 to 6 years Polio, DPT, MMR (Note MMR may be
  delayed to age 11 to 12)
• 14 to 16 years Td (repeat as a booster every 10
  years)
• A recommended immunization schedule for adults
  includes
• Tetanus/diphtheria A primary immunization series
  should be given once (if not received as a
  child), then routine booster doses of
  tetanus-diphtheria (Td) should be given every 10
  years.

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Know normal schedule How given Contraindication Wh
at to teach
HepB IM
DTaP, Td IM
Hib IM
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MMR sub Q IF PG? If need TB skin test Wait 2
months after MMR If allergic to gelatin, Neomycin
cant get
Varicella sub Q IF PG? If allergic to
gelatin, Neomycin cant get
PCV IM
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IM
PO ?
IM now choice
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Sub Q
Sub Q
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Sub Q
IM
Sub Q
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VACCINE INFORMATIONThe MMR vaccine is a "3-in-1"
vaccine that protects against measles, mumps, and
rubella. Although single antigen (individual)
vaccines have been developed for each component
of the MMR, they are not readily available and
usually used only for very specific situations.
An example of such a situation would be if an
outbreak of either measles, mumps, or rubella was
occurring in a specific community and public
health officials deemed it necessary to immunize
infants 6 to 12 months old. Single antigen
vaccines might be used because they pose less
risk to children younger than the recommended age
of 12 months for the MMR. For children 12 months
or older and adults, the risks of giving the
single antigen vaccine are presumed to be the
same as giving the MMR.
The first shot is recommended at 12-15 months.
Because the first shot may not provide adequate
lifetime immunity to some individuals, a second
MMR is recommended prior to school entry at 4-6
years or prior to entry into junior high at 11-13
years. Some states require a second MMR at
kindergarten entry
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Varicella vaccine is recommended between the ages
of 12 and 18 months. (see immunization schedule)
If a teenager is not known to have had Chicken
pox, then blood can be drawn to see if he or she
is susceptable to the disease, and if so the
vaccine should be administered. Varicella
vaccine has become a recommended childhood
vaccine and now required in many states including
Illinois.
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NURSES'CAN FACILITATE ADJUSTMENT TO
HOSPITALIZATION POSTHOSPITALIZATION BY
Introducing self, explain role in appropriate
terms length to child/parents Allow child to
adjust to you, dont rush in and start
procedures. Possibly include doll, bear,
toy. Observe child Compliment child on
something, utilize home items ie. blankets,
pacifers, toys,ete. Get on their level
physically (eye level) Give choices you can live
with Be honest, explain prepare child for what
will happen, what is exppcted. Do NOT lie if
something is going to hurt. State things
positively, ie. I need you to Watch words, ie.
"It will be just a little stick in the arm."
Especially with toddlers preschoolers (even
some young school age children). Remember
toddlers have magical thinking and pre-schoolers
have vivid imaginations. Let child see handle
equipment when possible, ie. BP cuffs,
stethoscopes. Take BP on dous, stuffed animals,,
etc.,, let them listen to their hearts, etc. or
mos. Dont forget privacy, Include Parent's,
they are usually child's best advocate. Find out
child!s vocab Rooming in for parents. Primary
nursmg.
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SOME SPECIFIC TECHNIQUES Sometimes when
________ some people feel ______. Do you ever
feel that way? OR before procedure prepare child
in open way. Sometimes this feels like a pinch
and sometimes it doesn't bother people. You tell
me what it feels like to you. Choice of shot
(GUN) or injection on R or L hip, thigh, etc.
"Medication given through the needle into the
body to make you feel better. Drawing, crayons
and paper very important Use power of
suggestion, ie. if for pain, "this medicine will
take the hurt away." "I need you to ........ "It
is OK to cry but I need you to hold very still
and not move." Avoid giving NEGATIVE suggestion.
PRAISE!!!! Use band aids, stickers, rewards,
What if T_ , paper dolls to illustrate where
something hurts, where procedure is going to take
place, etc. Writings, Have child keep diary or
daily log. Play Provides diversion, relaxation,
security. allows expression of feelings allows
creative expression and often increases coping
ability Stay with child during and after
procedures! Praise! Comfort! Involve
parent/significant person in procedure ?? At
least in the comfort afterwards. KEEP PARENT
INFORMED! INCLUDE PARENT! UTILIZE PARENT THEY
ARE THE EXPERT IN TIHEIR CHILDS ACTIONS AND
COPING ABILITY
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NURSES'HAVE THE DUTY TO ALSO MAXIMIZE THE
POTENTIAL BENEFITS OF HOSPITALIZATION.
NURSES'HAVE A WONDERFUL OPPORTUNITY TO
FACILITATE POSITIVE CHANGE WITHIN THE CHILD AND
AMONG THE FAMILY MEMBERS. THESE MAY
INCLUDE -Fostering or possibly improving
parent-child relationship -Providing educational
opportunities to learn more about their bodies,
each other and even what health professionals
do, immunization schedules, proper nutrition,
exercise, general health maintenance, preventing
problems. -Promote self mastery ---- emphasize
child's competence and avoid paying attention to
the negative behavior. Although hospitalization
is usually stressftd, point out how well
child/parent are coping. -- PRAISE! -Provide
increase socialization, self help groups when
appropriate, ie. new diabetic, asthmatic,
etc -Provide opportunity to master new
procedures, ie. home meds, new procedures such
as postural draining, inhalers, etc.
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NURSES'HAVE THE DUTY TO ALSO MAXIMIZE THE
POTENTIAL BENEFITS OF HOSPITALIZATION.
NURSES'HAVE A WONDERFUL OPPORTUNITY TO
FACILITATE POSITIVE CHANGE WITHIN THE CHILD AND
AMONG THE FAMILY MEMBERS. THESE MAY
INCLUDE -Fostering or possibly improving
parent-child relationship -Providing educational
opportunities to learn more about their bodies,
each other and even what health professionals
do, immunization schedules, proper nutrition,
exercise, general health maintenance, preventing
problems. -Promote self mastery ---- emphasize
child's competence and avoid paying attention to
the negative behavior. Although hospitalization
is usually stressftd, point out how well
child/parent are coping. -- PRAISE! -Provide
increase socialization, self help groups when
appropriate, ie. new diabetic, asthmatic,
etc -Provide opportunity to master new
procedures, ie. home meds, new procedures such
as postural draining, inhalers, etc.
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SIBLINGS OF HOSPITALIZED OR ILL CHILD FEAR
(maybe me next!, or is my brother/sister going to
die) GUILT ( why not me?, or I did or caused this
to happen!) JEALOUSY (IR child is getting all
the attention, new toys, is loved more) CONFUSION
IMAGINATION (may make things worse in their own
minds) ANGER - RESENTMENT THEIR BEHAVIOR MAY
BE WUMRAWN ACTING OUT DEPRESSION
REGRESSION TEARFUL, CLINGS TO PARENT OR
COMBINATION OF ANY OR ALL PARENTS MAY ALSO
EXPERIENCE FEAR GUILT ANGER (MAY BE DISPLACED
ONTO HOSPITAL STAFF
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Separation anxiety
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POST HOSPITAL BE14AVIOR MAY INCLUDE Aloofness
from parents Dependant, clingy, demanding Sleep
disturbances Hyperactivity Eating disturbances
Regression Anger Jealous of siblings. Fighting
with siblings. These are due to a nwnber of
reasons, some include separation from
significant people, familiar surroundings lack
of opportunity to form new attachments or to
keep existing ones strange environment fear of
having to return to the hospital/doctor Other
influences are length and type of hospitalization
Encourage parent to try to ignore
negative/regressive behavior. Stress the
positive behavior. THIS TOO SHALL PASS!!
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Some hospitals use a form similar to
this one. Most also add meaning to the
childs vocabulary Forms that I have
cover from newborn to 24 months, covering
each months what to expect or
milestones.
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ASSESSMENT ON ADMISSION IS VIP Discover
norm routine bath, naps, play norm comfort
measures pacifiers, blanket, favorite
toys Childs vocabulary words for drink,
bathroom, ect. Vaccinations New milestones
general growth developmental. Is it
nomal? If possible pre-admission classes
benefit both parents child Utilize minimal
contact initially WHY ? Observe What?
Why? Incorporate parents WHY ? Utilize common
tools such as?
Vital signs
Color posture interaction with parents
Developmentally is he where he should be
Growth charts, Immunization charts, snellen
E or picture charts Denver Developmental
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Snellen E or Blackbird Chart for kids who
do not read or know letters
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Under the age of 2 years
Head circumferences above eyebrows pinna
around occipital prominence Each visit until
2yrs, then yearly until school age, then PRN
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After age 2 plot on graph
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Plot each visit regardless if hospital
of doctors visit
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Look at plotted Growth curve Look at
parents size
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• DENVER DEVELOPMENT SCREENING TOOL
• looks at
• Personal social
• Fine motor adaptive
• Language
• 4. Gross motor skills

Brazeleton Neonatal Behavorial Assesment
Scale (BNBSS) access the infants interactional
behavior which can help parents focus on their
infants individuality ie. some infants
cannot comfort themselves can be overstressed
by too much stimulation therefore, need
intervention to decrease stimulation or to
increase comfort action
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Approximate timing of developmental changes in
girls
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Approximate timing of developmental changes
in boys
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Size of cuff VIP Cuff width approx 40 of
the circumference of arm bladder covers 80-100
0f circumference of arm
BP often number/P NB 65/41 1
mo95/58 2-5mos 101/57
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Breast milk or formula for 1st yr solids
when extrusion reflex disappear 4-6 mos
Double birth wt at 6 mos. Triple birth wt at
12 mos Food intro one at a time for 5-7 days
before next food introduced
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Remember sequence for exam for infants,
toddlers, preschoolers Always invasive part last
maybe ears, eyes, temp Observe motor skills
gait throughout history exam Auscultate while
quiet Heart rate, respiratory rate count for
full minute Perform traumatic parts of exam last
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Changes in body portions from before birth to
adulthood
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GUIDELINES FOR REVIEW OF SYSTEMS
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Written informed consent of the parent or
legal guardian is required. One blanket consent
is NOT sufficient. Separate informed permission
must be obtained for each surgical or diagnostic
procedure
In Wong book, p. 740, talks about informed
consent involving children with a mental age of
7 yrs or older. Following vary from state to
state Mature minor permits minor to give
consent even though they are not technically an
adult as long as they understand consequences
of their decisions. ie. Treatment for STDs,
contraceptive services, pregnancy, or
drug/alcohol abuse Emancipated minor
legally underage but recognized as having legal
capacity of an adult. ie. Pregnancy, marriage,
high school graduation living independently, or
in the military service Treatment without
parental consent in emergency that include
danger to life or permanent injury it is
applied according to the law Conflicts with
religious beliefs most have procedures by which
custody can be transferred to governmental or
private agency
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TEMPORARY CAREGIVER CONSENT FORM SHOULD
BE WITNESSES BY 2 UNRELATED PEOPLE
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Pain 4 basic means to assess pain 1.
Objective physiological change ? 2.
Behavioral change ? 3. Subjective data from
child ? 4. Pain producing pathological
findings from the chart ?
1. Increase pulse, respirations, BP pupils
dilate, older children like adults become
diaphretic
2. Cry, kick, scream, increase activity, rub or
pull at painful spots
3.-description, by 3 some even as young as
2, can verbalize or use doll or model to
point or draw where it hurts-duration, type,
location, severity-use pain scales, smiley
faces, colors, etc.
4.What is wrong with child What was done to
child
ALWAYS include parents because they are
childs advocate, they know their child
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DEVELOPMENTAL CHARACTERISTICS OF CHILDRENS
RESPONSES TO PAIN
Pain tolerance actually increases with age as
coping skills improve
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Even babies show pain
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CHILDRENS DEVELOPMENTAL CONCEPTS OF
ILLNESS PAIN
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Medicate freely. If pain is continuous dont use
PRN meds BUT around clock or use PCA with
parents involvement Two principles to
remember 1. Schedule med for pain
prevention 2. Dose for maximum comfort Its OK
to cry, be aware of nonverbal pain Some ER use a
combination injection, DPT Demerol, Phenegran
Thorazine Watch for med errors - immunization
ACRONYM FOR ASSESSMENT FOR PAIN Q question
the child U use pain rating scales before
after TX E evaluate actual behavior S secure
parents patients involvement children may
tell parent but some times not nurse T
take action whether med or no pharmacological
means such as distraction, guided imagery,
etc Make sure you document what you did the
reaction to. If no relief find some other
means or notify physician