Nursing Ethics in the Care

of Infants and Children

Lycia L. Harris
Jacksonville State University

The issue of ethics in nursing is already a

somewhat difficult subject. This subject
becomes even more complex when
ethical decisions involving the care of
infants and children is involved. Often
times families are frightened when
deciding issues related to the care of their
children. Many often look to the nurse as
an expert who is there to assist them
when making potentially life altering
choices.

Children are
Vulnerable
Human children are the only species
that are born into the world helpless
and totally dependent upon another
person for survival.
Some feminist philosophers have used
the principle of human dependence for
their personal views on ethics as
related to the care of infants and
children.

Feminist Philosophers said that the type of care

that happens between a mother and her
vulnerable, dependent child should be used as
the model for all moral relationships.

 The feminist views of ethics is especially

important for nurses in the care of infants
and children. Nurses must use the carefocused feminist approach. In this type of
care, the nurse must use certain feminist
values:
compassion
empathy
sympathy
kindness and
nurturing.
These are also said to be the attributes of a
good mother.

Some philosophers feel that the term mother

should not be assigned to a specific sex. Any
person taking responsibility for a childs life and
well-being should be considered a mother.

Infancy: Trust vs.

Mistrust
Due to the vulnerability of
children, a sense of trust must be
established between them and their
caregiver. In Ericksons stages of
development, infants start out in the
trust vs mistrust stage. A child
developing trust is dependent on the
mothering person being nurturing
and protective.

Trust is compromised when the

mothering person can not choose the
people who provide care to their
children, including the nurse. The
nurse, usually in a more intimate
relationship than other caregivers,
must establish a relationship of trust
with the caregiver. The caregiver trusts
the nurse to educate them about the
childs illness. The caregiver often looks
to the nurse for advice.

The professional nurse must

provide ethically appropriate care
and not allow personal feelings to
get involved.

The March of Dimes recommends

newborn screening for 29
preventable, treatable disorders.

Newborn Screening
The screening recommended by the
March of Dimes is grouped into five
categories:
Amino acid metabolism disorders
Organic acid metabolism disorders
Fatty acid oxidation disorders
Hemoglobinopathies
Others
The March of Dimes also recommends
screening for hearing loss.

Statistics
By 2006, only six states had mandatory
testing of newborns for all of the 29
conditions . 31 states made mandatory
testing for more than 20 disorders. Twelve
states screen for 10-20 of those disorders
and 8 states screen for fewer than 10 of the
conditions.
One million of the four million babies born
each year will get the appropriate
screenings. Many will die from preventable
diseases.

Nurses must become active locally

and politically to educate the public
about discrepancies in newborn
screening from state to state and
become more politically involved to
make sure that all patients receive
the same care and testing.

Vaccination
The effectiveness of public
vaccination campaigns in the 20th and
21 century as assured that most
people living in the United States will
never come in to contact with
diseases that were eradicated years
ago via vaccination. For this reason,
many do not take the importance of
childhood vaccination seriously. Just
like newborn screening, vaccination
regulations vary from state to state.

 Every state allows some children not

to be vaccinated due to medical
reasons which must be documented
by their doctors.
Some states also allow exclusions in
vaccination for religious and
philosophical reasons. Those states
with exemptions allow the
unvaccinated children to attend
school, but the parents can be sued is
another student gets sick with a
vaccine preventable disease.

The CDC makes unvaccinated

children stay at home during
preventable outbreaks.

Resurgence of Preventable
disease Small pox

Measles

Whooping Cough

In 1997, the American Nurses

Association would publish its
position statement about childhood
immunization programs and the
role of the public health nurse.
Nurses must educate about the
importance of immunizations and
encourage caregivers to consider
following the recommended
guidelines.

Underserved Children
in the U.S.
The vulnerability of children is made
even worse due to conditions such as
poverty and poor social and family
situations. People in health care do
not usually meet the needs of the
children that are not medical. Nurses,
as patient advocates should always
assess all the needs of the children
they care for. Questions should be
asked about living conditions, social
problems, drug abuse and poverty.

Health care professionals should assess the

familys available resources and put them in
touch with services within the community.
This intervention will help prevent the risk of
developmental delays, drug and physical
abuse and emotional problems. According to
research by the Robert Wood foundation in
2006, 8.4 million children in the United States
are deprived of needed care. Most of the 8.4
million can receive Medicaid or other state
funding but the parents are unaware of this.

Nurses must be willing to deal with social

problems that are hard to solve. These issues
include:
Immigrant children
Homelessness
Poverty.
One if five children in the United States is
from an immigrant family. Welfare laws say
that these families cannot get assistance from
programs like Medicaid for at least 5 years
after arriving in the U.S.

Anchor Babies

Anchor babies are those children

born to non U.S. citizens in the
United States which automatically
gives the babies U.S. citizenship.
Anchor babies are immediately
able to receive assistance, but
parents fear deportation so they
do not utilize available services
which makes health disparities
greater.

Surrogate Decision
Making

Children are legallay not able to make

decisions about their health care. In this
case, a surrogate, usually the parent
makes decisions for them. Most ethical
standards related to surrogates is based
on the standard of best interest. The
surrogate decision makers make their
decisions best on the best results for
the child. The nurse must be careful not
to influence that decision with personal
feelings.

Child Abuse

Another issue the professional

nurse faces is child abuse. Many
cases of child abuse goes
unreported. Nurses must observe
closely and report any suspicion of
abuse. If known abuse is present
and not reported, the nurse or
health professional could face
consequences.

Conclusion

When providing health care to infants and

children, the nurse plays a very important role
ethically. The nurse must be sure to provide
accurate information, yet, somehow not let
personal feelings get involved. If nurses follow
the ethical guideline out line by the ANA an
the code of ethics, Care of infants and children
should be stress free and appropriate. Many
issues are involved, but quality care and
patient advocacy and parent education are the
most important roles the nurse faces.

Refrences
Butts, Janie and Rich, Karen.
(2008). Nursing Ethics Across the
Curriculum and into Practice.
(2nded)Subury, Massachuttes. Jones
and Bartlett.
WWW.CDC.Com
American Nurses Association.
(2011) 1997 Position Statement:
childhood
Immunization.http://www.nursingw