PEDIATRIC NURSING I. NURSING CONSIDERATIONS TO A PEDIATRIC CLIENTS: A. COMMUNICATING WITH CHILDREN 1. Speak in quiet, pleasant tones. 2.

Always explain what you are going to do. 3. Be honest. 4. Do not make promise you cannot keep. 5. Observe nonverbal behavior for clues to level of understanding. 6. Do not threaten; and when necessary, punish the act not the child. 7. Never shame a child by using terms like baby or sissy. 8. Allow child to show feelings. 9. Encourage time to talk. 10. Provide support to child and parents and family. 11 .If teaching with a child is interrupted, start over from the beginning. 12. Promote independence. 13. Do not compare child progress to that of anyone else. 14. Allow choices if possible. 15. Involve parents in childs care. 16. Provide praise at every opportunity. 17. Keep routines as much like home as possible. 18. Allow parents time and opportunities to ask questions and express themselves. 19. If parents cannot stay with child, encourage them to bring in a favorite toy, pictures of family members ,or to make a tape to be played for the child.

B. PLAY 1. Make play appropriate for mental age and physical or disease state. 2. Use multi-sensory stimulation. 3. Provide toys safe for mental age. 4. Offer play specific to age group. C. PREPARATION FOR PROCEDURES 1. Allow child to play with equipment to be used. 2. Demonstrate procedure first on a doll. 3. Teach child skills that will be needed after the procedure and provide time to practice. 5. Describe sensations the child may experience during or after the procedure. 6. Listen carefully to child. 7. Parents can often be helpful in preparing child for procedures, but need to be prepared as well. 8. School-age children and adolescents may not wish parents to be present during procedure.
Age Neon ate Physical and Neurological Maintains eye contact Gross Motor Turns head from side to side(to avoid suffocation ) Fine Motor Language

1 mont h 2mon ths 3 mont hs 4 mont hs 5 mont hs 6 mont hs

Dance/startle reflex disappears Closure of posterior fontanel Grasp and tonic neck reflex disappears Rolls over the place

Lifts head from prone

Cries

Social smile

No eye and hand coordinatio n Lifts head and chest on prone Rolls over

No eye and hand coordinatio n Picks object to mouth

Bobbies and coos

Luagh and makes consonant sounds

Moro reflex disappears

7 mont hs

Double birth Sits with weight;dentition support;loo begins(lower) ks for dropped objects Turns,spins,unde Plays with rstands feet easily Change in cries but texture,spit up not long the food

Raking grasp;cup can be introduced Thumb finger Grasp from one hand to another mmmmwh en crying;says Dada and Mama; coughs to get attention; begins to fear strangers Cries when scolded Follow simple

8 mont hs 9 mont

Sits alone

Pulling self up;Crawls

Crawls

Holds bottle to

hs

backward

mouth

10 mont hs

Crawls forward(one hand to another)respond s to own name

11 mont hs 12 mont hs

Moves prone to sitting;walk s holding on to furniture Cooperates with Stands with dressing support Triple birthweight;Babi nski reflex dsappears Attemps to climb;Walk s with support

gestures and requests(bye -bye and pick-aboo)looks for hidden objects Picks up Responds to tiny objects own name

15 mont hs 18 mont hs

Walks alone Closure of anterior fontanel;smears stool,starts bowel training

Shakes head to indicate NO Drinks from Uses two cup,attemp words s to tower blocks;use of spoon;poin ts with one finger;pulls off with socks Names familiar objects 3 blocks Uses phrases

2 years

5 Uses short blocks;undr sentences esses

2 years

20 temporary teeth,start teaching tooth brushing,daytim e control bladder

3 years

4 years

Grasp,walk and sphincter control;jum ps from chair;stand s on one foot briefly Nighime Walks bladder;ritualisti backward;p c behavior at edals a bedtime tricycle;cli mb stairs;turns doorknob Has a color Jumps,alter recognition;catc nates steps hes ball when climbing stairs

himself;cop ies vertical lines 7-8 blocks Parallel play

Copies 500-900 circle;uses vocabulary scissors;but words ton and unbuttons

5 years

Balances with eyes closed

6 years 7

Counts Reads

Copies square;ties shoe laces;brush es teeth;write s his first name Runs,jumps Copies rope;skips triangle;pri on one foot nts letters,dra ws picture of a man;dresse s alone Recognizes all shapes Copies

1500 vocabulary words

Imaginary friends;coop erative play

Competitive play

years 8 years

10-11 permanent teeth

diamond Collects objects NUTRITION IN CHILDHOOD Breastmilk or infant formula Breastmilk or formula with iron Begins to use fingers to feed Soft foods;teething crackers and fruits Limit formula to 30 oz per day Holds own bottle Begins to drink from cup Chopped foods into small pieces Enjoys self-feeding with finger foods Develops food jag Increase mastery of spoons and forks Tendency to eat fastfood and junk foods Food preference may be influenced by peers My use food for emotional security Struggle for ideal body weight.

0 3 months 4 6 months 6- 12 months

1-2 years

3-5 years 6-12 years 13-18 years

SLEEP PATTERNS (vary among infants) 1.Most infants sleep when not eating during the first month 2.Most infants sleep 9 to 11 hours at night between ages 3 to 4 months. 3. Most infants take morning and afternoon naps by 12 months of age.

4 Bedtime rituals should begin in nfancy to prevent future sleep problems. ELIMINTION PATTERNS 1. Elimination patterns usually develop by the second week of life and are typically associatedwith the frequency and amount of feedings. 2. Stool color and consistency depend on what the infant eats. For all infants,these qualities change with the introduction of solid foods. 3. Urinary output averages 200 to 300 ml by the end of the first week of life with about 20 voiding per day. Average urinary output is 350 to 550ml/day during infancy.

GROWTH AND DEVELOPMENT 1.Definition: GROWTH refers to an increase in body size(height and weight) DEVELOPMENT refers to an increasing capacity to function at more advanced levels. 2. Stages(approximate age ranges) a. The prenatal stage extends from conception to birth.

b. The infancy stage extends from birth to about 12 months(neonatal-birth to 28 days,infancy-29 days to about 12months.0 c. The early childhood stage extends from 1 to 16 years(toddlerhood,1-3 yrs.,preschool,3-6 yrs d. The middle childhood (school-age) stage extends from 612 years e. The adolescent stage extends from 12 to 18 years ROLES OF PEDIATRIC NURSES 1. Family advocate. Nurses assist in identifying the needs and goals of children and their families and in developing appropriate nursing interventions. 2. Health promoter. Nurses assist in promoting health and preventing diseases by forstering growth and development, proper nutrition, immunization and early identification of health problems. 3. Health teachers. Nurses provide families with information on topics such as anticipatory guidance. 4. Counselor. Nurses support families through active listening. A therapeutic relationship between a nurse and the child and family includes caring as well as carefully defined boundaries. 5. Collaborator. As a key member of the interdependent health care professionals. 6. Researcher. Nurses use and contribute to use and contribute to research that enhances the nursing care of children and adolescents and their families.

RELATED SAFETY CONCERNS 1. Accidental injuries are major cause of death during infancy: a. Falling off beds and downstairs b. Aspiration of small objects. c. Poisoning from overdose of medication of ingestion of toxic household substances d. Suffocation cause by inadvertently covered nosew and mouth,pressure on the throat or chest,prolonged lack of air(possibly in a closed,parked car),or strangulation(from crib rails or household cords) e. Burns from hot liquid,foods,scalding bath water,excessive sun exposure,or electrical injury. f. Motor vehicle accidents,most commonly linked to improper use,or nonuse,of infant car seat.