Pediatric Nursing: Healthcare for Children

• Pediatric nursing aims to improve health care quality for children and their families.

Health Care for Children

• In 2014, approximately 75 million children aged 0-17 lived in the U.S., comprising 24% of the population.
• The health status of children improved with increased immunization rates, decreased adolescent birth rates, and improved child health.
• Preterm births have declined for seven consecutive years, and the adolescent birth rate hit a record low.
• Average math scores for 4th and 8th graders rose, while youth violent crime victimization rates declined.
• In 2013, the rate of children living in poverty was 22%.

National Children's Study

• The National Children's Study is a long-term study in the U.S., following 100,000 children and their families from birth to age 21.

• The study aims to link children's environments with their physical and emotional health and development.

• Goals of the study include information for intervention in unhealthy diets, dental problems, obesity, violence, injury, substance abuse and mental health disorders.

• The study supports Healthy primary goals to increase quality and years of healthy life, and to eliminate health disparities related to race, ethnicity, and socioeconomic status

• Millions of children and their families lack health insurance, hindering access to care and promotion services.

• Disparities in pediatric care are related to race, ethnicity, socioeconomic status, and geography.

• Medical progress and societal trends shape child health patterns, needing new policy priorities.

• Urgent priorities for children's health include concerns like poverty, hunger, insurance, abuse/neglect, obesity, firearm injuries and mental health.

Health Promotion

• Child health promotion reduces health status differences among groups, ensuring equal opportunities and enabling optimal health potential.
• Health indicators offer a framework for essential components in child health promotion, preventing future health issues.
• Bright Futures aims to improve the health of the nation's children.
• Bright Futures themes includes family support, child development, mental health, healthy nutrition-weight, physical activity, oral health, sexual development sexuality, safety-injury prevention, and community relationships.
• Health promotion strategies appropriate per childhood development stage
• Child health promotion includes promoting development, nutrition, and oral health as key themes for all ages.
• Preventative healthcare recommendations from Bright Futures can be found in chapters to 9, 11, 14 and 15.

Development

• Health promotion integrates surveillance of physical, mental, and emotional changes from birth to adolescence.
• Developmental processes are different per stage, and therefore continuous screening and assessment are essential for early intervention.
• Infancy sees the most dramatic development, parent-infant interactions are central to promoting development and assessment.
• Early childhood requires early identification of development of delays to establish early interventions
• Anticipatory guidance strategies keeps parents aware of specific developmental stage requirements.
• Middle childhood requires surveillance to strengthen cognition, emotion, communication, self-esteem, and independence.
• Adolescents have difference in physical, social and emotional maturity, which is important for surveillance.

Nutrition

• Nutrition is essential for growth and development.
• Human milk is still the preferred nutrition for infants and contains beneficial micronutrients.
• The surge in breastfeeding is due education to increase knowledge of the benefits for both parents.
• By the age of 3, children establish lifelong eating habits, where nurses play a part in parent education of nutrition.
• Eating preferences and attitudes toward food are derived from culture and family.
• During adolescence food choices are related to sociability and peer's behaviors.
• Detrimental eating habits are occasionally found in adolescents whom struggle with illnesses such as diabetes, renal and lung diseases, hypertension, and cardiovascular issues.
• Homelessness, low incomes and migrant families typically don't have the capacity to provide sufficient food, nutritious vegetables, fruits and protein.
• Subsequently this can can cause deficiencies, depression, and developmental delays.

Oral Health

• Oral health is a component of health promotion throughout childhood.
• Preventing dental cavities and developing good oral hygiene habits starts in childhood.
• Caries are the most common chronic child illness, and minority children face the most challenges.
• Dental disease is called Early Childhood Caries, can start before the first birthday, causes infections within 2 years of development.
• Low income families are twice as likely to develop such dental disease, and are also half as likely to visit the dentist regularly compared to other children.
• Childhood caries can be prevented through oral health practices, fluoride.
• Nurses play a huge role in the education of children regarding dental hygiene, fluoridated water and early dental preventive care.
• When oral health practices are established early in development it will prevent periodontal disease and dental decay.

Childhood Health Problems

• Significant medical problems affect child health due to society changes, medical knowledge, struggling with insurance, economic troubles, and disruptive family influences.
• New morbidity refers to social or behavior problems faces by patients such as poverty, noncompliance, aggression, school failure, violence, or family separation.
• Mental health also causes struggles in adolescence.
• Highest risk children includes those born early, of low or very low birth weight, children whom are homeless, attend daycare, face long-term problems such as psychiatric conditions, or any disabilities

Obesity and Type 2 Diabetes

• Childhood obesity which is the most common nutritrional problem among American children is growing
• BMI is used to define if a child is the right weight (body mass index)
• It is greater or at the 95th percentile for teens with overweight
• BMI for "Overweight" is the 85th and 95th percentile.
• 30% of all American teens are overweight - and 17 % are obese.
• Entertainment-technology also contributes to growing childhood obesity factors
• Low minority teens have the highest risk for obesity due to lack of convenient play, lack of physical activity and easy media access.
• Nurses should focus on prevention efforts to decrease 20% of overweight teens to the average of 6% for ethnicity
• Prenatal periods will need to be a focus point for reducing the incidence
• If between ages 6-12 interventions can show promise in the patients life

Childhood Injuries

• In the US, injuries is the primary factor in disability + mortality for children

• Suicides were also a cause of mortality and injury in children

• Drowning and other accidents still take lives of children every day

• Normal growth of a child determines the type of injury and the circumstances surrounding it.

• Children whom are curious will try to mimic behavior of others, making them more prone to danger.

Childhood Injuries Risk Factors

• Sex - Male difference mainly the result of behavioral characteristics, especially aggression

• Temperament - Children with difficult temperament profile, especially persistence, high activity level, and negative reactions to new situations

• Stress - Predisposes children to increased risk taking and self-destructive behavior; general lack of self-protection

• Alcohol and drug use - Associated with higher incidence of motor vehicle injuries, drownings, homicides, and suicides

• History of previous injury - Associated with increased likelihood of another injury, especially if initial injury required hospitalization

• Developmental characteristics

• Mismatch between child's developmental level and skill required for activity (e.g., all-terrain vehicles)

• Natural curiosity to explore environment

• Desire to assert self and challenge rules

• In older child, desire for peer approval and acceptance

• Cognitive characteristics (age specific)

• Infant - Sensorimotor: explores environment through taste and touch

• Young child - Object permanence: actively searches for attractive object; cause and effect: lacks awareness of consequential dangers; transductive reasoning: may fail to learn from experiences (e.g., perceives falling from a step as a different type of danger from climbing a tree); magical and egocentric thinking: is unable to comprehend danger to self or others

• School-age child-Transitional cognitive processes: is unable to fully comprehend causal relationships; attempts dangerous acts without detailed planning regarding consequences

• Adolescent-Formal operations: is preoccupied with abstract thinking and loses sight of reality; may lead to feeling of invulnerability

• Anatomic characteristics (especially in young children)

• Large head-Predisposes to cranial injury

• Large spleen and liver with wide costal arch-Predisposes to direct trauma to these organs

• Small and light body-May be thrown easily, especially inside a moving vehicle

• Other factors-Poverty, family stress (e.g., maternal illness, recent environmental change), substandard alternative child care, young maternal age, low maternal education, multiple siblings

• Different injuries are common in different stages of development.

• Older boys are exposed to environmental hazards on roads and bodies of water when they spend time playing outside

• Injuries tend to be more fatal in the later stages of and child development

• Preventative strategies and interventions in child fatalities have decreased due to increase use in car restraints and helmets.

• Causes remain to be motor accidents, bicycle and motorcycle deaths.

• For major vehicle accidents involving kids: The most common involved at midblock or at intersections, or in parking lots, where small children are typically hit by vehicles backing up.

• Injuries while riding bicycles can cause fatalities - specifically when the child is somewhere between 5 and 14 years of age - from traumatic issues around the head. Most of these fatalities can be reduced by helmets greatly.

• A lot of kids still do not wear helmets for being uncool.

• Suicide rates can be caused from drowning or burning - firearms can also be cause of death

• Annually more than 500,000 also suffer from a issue related to medications.

Violence

• Youth violence is a widespread and high-priority issue in every sector of American society

• Causes are not entirely known

• The media can also desensitize the population in America

• Violence is common at schools in America by using illicit drugs, guns, and gangs

• High rates of homicide and suicide involves complex issues involving social and economic influences

• Prevention lies in understanding psychology that leads to suicide and homicide.

• There should be rapid qualified interventions in the process.

• Nurses can see these red flags and educate the adolescents that own or encounter firearms

• Firearms dramatically effect the chances of homicide or suicide as a whole.

• Violence in children leads to critical and emotional stress

• Homicide can be a huge critical issue for 15-19 age year old children due to firearms, drugs, poverty and family conflict.

• Early and chronic exposure can affect a childs negative outlook, leading to long and lasting trauma.

Domestic Violence Hotline

• PO Box 161810
• Austin, TX 78716
• 800-799-SAFE
• www.ndvh.org

Child Trends

• Child Trends Databank. Teen homicide, suicide, and firearm deaths. http://www.childtrends.org/?indicators=teen-homicide-suicide-and-firearm-deaths; 2015.

Mental Health Problems

• 1 in 5 children face mental health problems, or face an emotional issue that can affect how functioning daily
• Psychosocial probelms are common in children, and there are many disorder during adolescence such as attention deficits, depression and anxiety that develop in kids
• Should be aware of mental states and of potential medical ideation
• Should be aware of high quality resources.

Infant Mortality

• Infant mortality deaths during the first year of life divided into neonatal or post neonatal

• Infant mortality has decreased greatly in the United States

• US lacks from other nations reducing infant mortality

• Many underdeveloped countries have been lacking, a major death for neonatal is birth weight.

• Access to prenatal care is a very important factor in mortality and preventing the rate as much as possible.

• Most of the causes of death in infant mortality continue to remain to occur during the prenatal care.

• LBW(low birth weight) is associated with reducing incidence in birth defects will then in turn prevent other anomalies.

• Infant mortality because of hiv has drastically decreased in the year 1990s

• Infant mortality among Native Americans is much lower than other minority races

• LBW occurs more in African American children.

Childhood Morbidity-Mortality

• Children ages 5-14 display the lowest rate of death

• In later stages of adolescents rises due to injury, suicide and injuries

• In 201, accidental injuries made up 34% of deaths

• In different minority groups the most that has been steadily going up has been in African American males

• Homicide is increasing more frequently in these groups mostly caused form firearms within children.

• Acute deaths in children are defined as severe enough to limit activity.

• Leading to respiratory which accounts for 50% of cases.

The Art of Pediatric Nursing

• Pediatric nursing aligns with the American Nurse Association's definition of nursing, including promotion and protection, alleviation of suffering, diagnosis treatment and advocacy

Family Centered Plan

• Recognizes a child in its constant life.

• Planning is for the care of a health practice.

• Making decisions and the nursing role lies to support families and decisions, where nurse factors in all the needs of care.

• Philosophy and acknowledges family structures, and families need support, and information.

• Family as the constant in Childs life fluctuation depending on personnel within that system

• Collaboration from professional to family at all hospitals.

• How implementation and program goes.

• All family members are to complete unbiased information with professional help.

Enabling and Empowerment

• Enable by creating ways for member to display skills, create new means
• Empowerment of families so they acquire new knowledge, strengths, and abilities
• Highlighted through features.

Atraumatic Care

• Eliminate psychological physical distress from the heath care system
• Setting location, and personnel provide prevention palliation and treatment.
• Anxiety Fear Anger Disappointment, these are a form distress that can occur.
• Who what where and why regarding a procedure to prevent or minimize the stress is concerned.
• Main goal is do no harm.
• To minimize separation, by protecting minimizing physical or emotional.

Role of Pediatric Nurse

• Promote well being of child
• Functions vary.
• Nurses primary role is to care for child.
• Boundaries that promote caring.
• Nurse should be separate.
• By exploring patients area's more can be identified in nurses and problems.

Family Advocacy Caring

• Responsibly to consumer of nursing like the child.

• Team must identify goals and best address defined problems

• Making informed choices.

• Must demonstrate compassion and caring as a caregiver.

• By offering compassion, the child can have positive experience

• Every nurse is to understand promoting education.

• Prevention and promotion of health

• Need to assess childs growth including nutrition.

• Education and guidance is best in the approach

• Preventing mental issues and promote well being.

• Prevention happens when providing procedure.

• Provide guidance.

• Health teaching is an approach

• Support emotional needs and counseling

• Can assist as a nurse

• Collaboration coordinate activities within a health team to bring children in to their best interest