This book is dedicated to all the nursing students I have encountered over the years. We would also like to thank all the pediatric nurses who contributed their wealth of knowledge and expertise to develop chapters for this book.
Preface
The objectives also provide the student with a method to evaluate understanding of the material presented. Chapter worksheets at the end of each chapter help students review essential concepts.
Contents
Brief Table of Contents
Foundations of Pediatric Nursing
Introduction to Child Health and Pediatric
The definition of nursing, “the diagnosis and treatment of human responses to actual or potential health problems,” also applies to the practice of pediatric nursing (American Nurses Association, 2004). The nurse analyzes the data to make an assessment of the child's health and developmental status. In pediatric health care, the term consent refers to the child's participation in the health care decision-making process (McCullough & Stein, 2009).
Finally, ascertain the child's willingness to participate in treatment or research (American Academy of Pediatrics, 2007a; McCullough & Stein, 2009).
Factors Influencing Child Health
It is important to consider the continuing role of the previous biological parent and the role of the stepparent in the child's life. A child's community consists of family, school, neighborhood, youth organizations and other peer groups. Thus, the socialization process begins earlier and involves a greater percentage of the child's waking time (Figure 2.6).
To be accepted, the child must conform to the specific values and beliefs of the group.
Questions for the Parent
Questions for the Child
Retrieved February 25, 2011, from http://www.aacap.org/cs/root/facts_for_families/grandparents_raising_grandchildren American Academy of Child and Adolescent Psychiatry. Retrieved February 22, 2011, from http://www.healthychildren.org/English/ages-stages/gradeschool/pages/Gender-Identity-and-Gender-Confusion-InChildren.aspx. Retrieved February 25, 2011, from http://www.childrensdefense.org/child-research-data-publications/number-of-children-in-foster-care-decline.pdf.
Retrieved February 6, 2009, from http://www.globalissues.org/article/715/today-over-26500-children-died-around-the-world.
Health Promotion of the Growing Child and Family
Growth and Development of the Newborn and Infant
Heredity influences growth and development by determining the child's potential, while the environment contributes to the level of achievement. Nurses should be familiar with normal developmental milestones so that they can accurately assess the child's development and provide age-appropriate anticipatory guidance to parents. When assessing the growth and development of a premature infant, use the child's adjusted age to determine expected outcomes.
To determine the adjusted age, subtract the number of weeks the child was premature from the child's chronological age.
Physical Growth
Infants also exhibit enormous amounts of learning in the psychosocial and cognitive domains, in language and communication, and in the social/emotional domains. When obtaining the health history, the nurse may ask the parent or caregiver if the skill is present and when it was achieved. The child can also demonstrate the skill during the interview or examination, or the nurse can elicit the skill from the child.
This baby would show healthy growth if he were the size of a 3-month-old and should be expected to reach the developmental milestones of a 3-month-old, not a 6-month-old.
Organ System Maturation
Blood pressure rises steadily during the first 12 months of life, from an average of 60/40 in newborns to 100/50 at 12 months. The small intestine is about 270 cm long and grows to adult length during the first few years of life (Wyllie, 2007). Acrocyanosis (blueness of the hands and feet) is normal in newborns; it decreases during the first days of life (Fig. 3.3).
As the high hemoglobin concentration of the newborn decreases over the first 2 to 3 months, iron is recycled and stored.
Psychosocial Development
This provides immunity during the first 3 to 6 months of life to antigens previously exposed to the mother. Infants then synthesize their own IgG, reaching approximately 60% of adult levels by 12 months of age (Feigin, Cherry, Kaplan, & Demmler-Harrison, 2009). IgM is produced in significant amounts after birth and reaches adult levels by 9 months of age.
Cognitive Development
Motor Skill Development
Warning signs that may indicate problems with motor development include the following: arms and legs are stiff or limp; child cannot support head at 3 to 4 months of age; child reaches with only one hand; child cannot sit with assistance at 6 months of age; child does not crawl by 12 months of age; child cannot be supported until 12 months of age. Fine motor skills develop in a proximodistal manner (from the center to the periphery) (see Fig. 3.4). In other words, the infant first bats with the whole hand, eventually progressing to coarse grasping, before being able to grasp fine fingertip grasp (Goldson & Reynolds, 2011) (Fig. 3.8).
The newborn's hand movements are involuntary in nature, while the twelve-month-old baby is able to feed himself with a cup and a spoon.
Sensory Development
The sense of smell develops quickly: the seven-day-old infant can distinguish the smell of his or her mother's breast milk from that of another woman and will preferentially focus on the mother's smell. The sense of touch is perhaps the most important of all the senses for newborn communication. Holding, stroking, rocking or cuddling calms babies when they are upset and makes them more alert when they are sleepy.
Warning signs that may indicate problems with sensory development include the following: young baby does not respond to loud noises; child does not focus on a near object; baby does not start making noises or babbling by 4 months; baby does not turn to detect sound at age 4 months; baby crosses eyes most of the time at the age of 6 months.
Communication and Language Development
It is very important that the parent or caregiver talks to the child so that the child learns communication skills. The child moves past furniture or (E) takes steps with help at 10 to 11 months of age. The child stands independently from a squatting position and walks around 12 months of age (plus or minus 3 months).
Warning signs that may indicate problems in language development are as follows: the baby does not make sounds at the age of 4 months; the baby does not laugh or cry at the age of 6 months; the baby does not talk at the age of 8 months; the baby does not use single words with meaning at the age of 12 months (mama, dad).
Social and Emotional Development
As parents consider their baby's usual activity level, how intensely he or she reacts with others and the environment, and how stimulated he or she becomes with interactions, they begin to learn about their baby's temperament. The parent should notice how adaptable and flexible the baby is, as well as how predictable and persistent the baby is. Nurses can help parents interpret observations about their baby's temperament and recommend ways to support the baby's individual behavior.
Becoming familiar with the infant's temperament also helps parents describe the best approach to the infant to others (eg, child care providers or health professionals).
Cultural Influences on Growth and Development
Growth and development are sequential and orderly, although some children develop more quickly than others. After assessing the child's current growth and development status, problems related to growth and development can be identified. Nursing care planning for the child with growth and development problems should be individualized based on the needs of the child and the family.
Nursing Plan 3.1 (p. 82) can be used as a guide in planning the nursing care of an infant with growth and development problems.
Promoting Healthy Growth and Development
Encourage parents to meet the infant's needs quickly and with affection to promote feelings of trust in the infant. Parents should always keep an eye on the infant (no amount of child restraint can replace the watchful eye of a caring parent). Avoid the risk of suffocation by keeping window shades and draperies out of the infant's reach (AAP, 2010b, 2010c).
Breast milk or formula supplies all of the infant's daily nutritional needs until 4-6 months of age, at which point solid foods can be introduced (Shelov & Altmann, 2009).
Infant
Watching and listening to the infant feed can assess the adequacy of the baby's latching technique. Most infants will not require specific amounts per feeding; the infant should be fed until full. One ounce of breast milk or formula should be placed in the cup while the infant learns.
It is important to establish a bedtime routine around 4 months of age due to the child's increased alertness and activity.
Addressing Common Developmental Concerns
The baby's activities are based on the basic needs for food, safety, warmth, love and comfort. In a child-proofed home, fewer restrictions should be placed on the baby's behavior and he or she can explore. Solid foods should be delayed until the age of 6 months, when the baby can hold a spoon on its own.
What is the best instruction by the nurse regarding the infant's oral health.
Growth and Development of the Toddler
The toddler period covers the second 2 years of life, from age 1 to age 3. Both physical growth and the acquisition of new motor skills slow down somewhat during the childhood years. The color of the stool can change (yellow, orange, brown or green) depending on the baby's diet.
Thus, mastering the development of motor skills contributes to the toddler's growing sense of self-esteem.
Emotional and Social Development
Feces can be seen as part of the child, and the toddler may become angry if he sees them disappear into the toilet. The slow-warming toddler's behavior is more passive; the toddler may be very alert and withdrawn and may take longer to mature. Changes in routine usually do not cause as much upset, because the toddler's natural response is one of passivity (Feigelman, 2007).
Based on the toddler's temperament, give parents suggestions for interacting with the toddler in different situations.
Moral and Spiritual Development
The toddler's growth and development influence both his or her daily life and that of the family. The safest place for the toddler to ride is in the backseat of the car. A full back seat in the truck is the preferred placement for the toddler car seat.
Remove firearms from the home, or keep them in a locked cabinet out of reach of the toddler.
