Chapter 1: Perspectives of Pediatric Nursing
Goals for Pediatric Nursing
Improve the quality of life!
◦ Promote development
• Most dramatic occurs during infancy
• Early identification of delays improves outcomes
◦ Improve childhood nutrition
• Poor food choices at restaurants
• Kids learn behaviors
They will continue to follow the examples we set for them
Parents set kids up with healthy behaviors. Educate the parents!!
Eating habits develop within first 3 years of life and are impacted
by culture and family
◦ Improve oral health
• 1 in 3 kids under age 5y/o kids have dental carries
• Unhealthy habits early on indicates a higher risk for adults with poor oral
health
• Linked to respiratory diseases
Health of the family = health of the pediatric pateint
Issues Affecting Childhood Health
Obesity
◦ BMI >95th percentile
◦ Nutritional
◦ T2DM, HTN,DLD
◦ Maternal obesity is a large indicator of childhood obesity
◦ Limited resources
◦ use of video games and TV
Injuries
◦ Developmental Stages play a role in injuries
• Toddlers- Walking
• Adolescent- risk taking behaviors
Violence
◦ Exposure on TV, video games and news
◦ Violence in the home
Vaping
◦ respiratory diseases
Mental Health
◦ Suicides
• Social media
◦ 1 in 5 have MH diagnosis
◦ All ages (including infants)
Infant Mortality
Definition: Number of deaths per 1000 live births during the first year of life (error on
page 6) **stillborns and abortions do not count in this number**
◦ Neonatal period: Day 1 to day 27 of life
, ◦ Postnatal period: Day 28 to 1 year of life
◦ 5/6 deaths per 1000 live births
• Access disparities in the US
Risk Factors
o Birth Weight
Major determinant of neonatal death in the United States
Low birth weight (LBW): Less than 2500 g (5 ½ lbs)
Lower birth weight = Higher mortality rate
Earliest gestation survival: 23 weeks
o African American race
o Male gender
o Short or long gestation
Short: <36 weeks
Normal: 40 weeks
Long: >41/42 weeks
o Maternal age (younger or older)
Younger: teen
Older: >35 y/o
o Maternal education
Causes of Infant Death
o #1: Congenital anomalies
Genetic issues, brain abnormalities
o #2: Low birth weight and early term
o #3: Sudden infant death syndrome (SIDS)
o #4: Unintentional injury
#1 cause in infants: Suffocation
Childhood Mortality
Definition: Injuries are the leading cause of death in children older than 1 year
o #1: Motor vehicle crashes
Worldwide
o #2: Drowning
Toddlers: 1-3 y/o
o #3: Burns
Toddlers: 1-3 y/o
School aged: 6-12 y/o (use of matches and lighters)
o #4: Firearms
Teaching children about firearm safety
Ask children if they have access
Locked up and ammunition kept separate
Educate parents to ask parents of friends at sleepovers if they have
firearms
o #5: Poisoning
Suicide:
o >10 years old
Childhood Morbidity
, Quality of life: Individualized to the patient
o Parents/child perceptions
May denote acute illness, chronic disease, or disability
Difficult to define and measure
Groups with increased morbidity
o Children who are homeless, poor, or chronically ill; foreign-born adopted
children; and children in daycare
Family-Centered Care
Recognizes the family as the constant in a child’s life, p 7
◦ Enabling: Giving the family the resources to continue to provide the care that they
have been giving to the child
◦ Empowerment: Improving education, giving access to specialist to improve care
Educating/including: siblings, grandparents, anyone apart of the child’s life
Systems must support, respect, encourage, and enhance the family’s strength and
competence
Needs of all family members
Atraumatic Care
Goal: First, do no harm!
Eliminate or minimize
◦ Physiological distress
Anxiety, fear, anger, disappointment, sadness, shame, guilt
◦ Physical distress
Pain, immobilization, loud noises, darkness/lights
Where
◦ Where on the body?
Do they use that hand to write? Do they suck their thumb?
Ask parents with younger pateints
◦ Where is the procedure being done?
Do the procedure in a different room from the one they are staying in
because the child will associate the room with fear/pain.
Room stays safe space
Who
◦ Who is in the room at the time?
Mom/Dad should be at bedside
Send out Students/Residents
Siblings can leave
Why
◦ Is there a different way to get the same impact?
How
◦ Use distraction
◦ Reducing pain
◦ Preparing the child
Pediatric Nurse’s Role
Therapeutic relationship building
◦ Negotiating a meaningful relationship with the child and family within well-
defined boundaries (p8)
Goals for Pediatric Nursing
Improve the quality of life!
◦ Promote development
• Most dramatic occurs during infancy
• Early identification of delays improves outcomes
◦ Improve childhood nutrition
• Poor food choices at restaurants
• Kids learn behaviors
They will continue to follow the examples we set for them
Parents set kids up with healthy behaviors. Educate the parents!!
Eating habits develop within first 3 years of life and are impacted
by culture and family
◦ Improve oral health
• 1 in 3 kids under age 5y/o kids have dental carries
• Unhealthy habits early on indicates a higher risk for adults with poor oral
health
• Linked to respiratory diseases
Health of the family = health of the pediatric pateint
Issues Affecting Childhood Health
Obesity
◦ BMI >95th percentile
◦ Nutritional
◦ T2DM, HTN,DLD
◦ Maternal obesity is a large indicator of childhood obesity
◦ Limited resources
◦ use of video games and TV
Injuries
◦ Developmental Stages play a role in injuries
• Toddlers- Walking
• Adolescent- risk taking behaviors
Violence
◦ Exposure on TV, video games and news
◦ Violence in the home
Vaping
◦ respiratory diseases
Mental Health
◦ Suicides
• Social media
◦ 1 in 5 have MH diagnosis
◦ All ages (including infants)
Infant Mortality
Definition: Number of deaths per 1000 live births during the first year of life (error on
page 6) **stillborns and abortions do not count in this number**
◦ Neonatal period: Day 1 to day 27 of life
, ◦ Postnatal period: Day 28 to 1 year of life
◦ 5/6 deaths per 1000 live births
• Access disparities in the US
Risk Factors
o Birth Weight
Major determinant of neonatal death in the United States
Low birth weight (LBW): Less than 2500 g (5 ½ lbs)
Lower birth weight = Higher mortality rate
Earliest gestation survival: 23 weeks
o African American race
o Male gender
o Short or long gestation
Short: <36 weeks
Normal: 40 weeks
Long: >41/42 weeks
o Maternal age (younger or older)
Younger: teen
Older: >35 y/o
o Maternal education
Causes of Infant Death
o #1: Congenital anomalies
Genetic issues, brain abnormalities
o #2: Low birth weight and early term
o #3: Sudden infant death syndrome (SIDS)
o #4: Unintentional injury
#1 cause in infants: Suffocation
Childhood Mortality
Definition: Injuries are the leading cause of death in children older than 1 year
o #1: Motor vehicle crashes
Worldwide
o #2: Drowning
Toddlers: 1-3 y/o
o #3: Burns
Toddlers: 1-3 y/o
School aged: 6-12 y/o (use of matches and lighters)
o #4: Firearms
Teaching children about firearm safety
Ask children if they have access
Locked up and ammunition kept separate
Educate parents to ask parents of friends at sleepovers if they have
firearms
o #5: Poisoning
Suicide:
o >10 years old
Childhood Morbidity
, Quality of life: Individualized to the patient
o Parents/child perceptions
May denote acute illness, chronic disease, or disability
Difficult to define and measure
Groups with increased morbidity
o Children who are homeless, poor, or chronically ill; foreign-born adopted
children; and children in daycare
Family-Centered Care
Recognizes the family as the constant in a child’s life, p 7
◦ Enabling: Giving the family the resources to continue to provide the care that they
have been giving to the child
◦ Empowerment: Improving education, giving access to specialist to improve care
Educating/including: siblings, grandparents, anyone apart of the child’s life
Systems must support, respect, encourage, and enhance the family’s strength and
competence
Needs of all family members
Atraumatic Care
Goal: First, do no harm!
Eliminate or minimize
◦ Physiological distress
Anxiety, fear, anger, disappointment, sadness, shame, guilt
◦ Physical distress
Pain, immobilization, loud noises, darkness/lights
Where
◦ Where on the body?
Do they use that hand to write? Do they suck their thumb?
Ask parents with younger pateints
◦ Where is the procedure being done?
Do the procedure in a different room from the one they are staying in
because the child will associate the room with fear/pain.
Room stays safe space
Who
◦ Who is in the room at the time?
Mom/Dad should be at bedside
Send out Students/Residents
Siblings can leave
Why
◦ Is there a different way to get the same impact?
How
◦ Use distraction
◦ Reducing pain
◦ Preparing the child
Pediatric Nurse’s Role
Therapeutic relationship building
◦ Negotiating a meaningful relationship with the child and family within well-
defined boundaries (p8)
