#nursing It includes the common health problems and nursing management of a child. It contain excessive cry, allergy, abdominal distension, omitting, etc.

1. Mr. Abhijit Bhoyar
COMMONHEALTHPROBEMS DURING CHILDHOOD

2. EXCESSIVE CRY
• Excessive cry can be defined as persistent
crying of the child instead of fulfilling all
biological needs and bodily comforts.
• When cry is present for a long period and
beyond normal limit then it is termed as
excessive cry, because to a particular
extent cry is normal.

3. Non-
pathological
Conditions
Pathological
Conditions
Emotional
Conditions

4. • Non-pathological Conditions
• The common causes of excessive cry are mainly non-pathological. Mother or primary caregiver or
nurse should be good observer to find out the cause. These causes are hunger, thirst, wet nappy,
chilling, high or low environmental temperature or excessive heat or cold, discomfort position,
tight or over clothing, open safety pin, insect bites, over stimulation, sudden loud noise, etc.
• Pathological Conditions
• Serious causes of excessive cry are mainly related to pathological conditions. They include
abdominal colic or distension, high fever, constipation, infections or inflammations (meningitis,
otitis media, and oral thrush), any accidental injury or surgical conditions.

5. • Emotional Conditions
• Emotional deprivation makes the child to cry excessively. Infants cry due to fear and helplessness
when parents leave them or favourite toys are taken away.
• The child can cry due to unanticipated events like change in food or routine activity, separation
from parent, stranger approach, etc.
• Excessive cry can be found in anger and frustration due to lack of mothering, disturbed play, lack
of sleep and inappropriate parent-child relationship.

6. Quality of cry in infant is very
important for assessing the
problems and cerebral
functions.
Low, angry, lusty cry indicates
normal infant
Persistent or continuous cry
indicates hunger
Weak and whining cry indicates
ill infant
High-pitched, penetrating cry
indicates cerebral irritation Cat
like screeching cry indicates
chromosomal defect.
Types

7. Management of Excessive Cry
• Assessment of cause and types of cry by close observation, physical examination and details
history help in appropriate interventions.
• Non-pathological causes can be managed by the parents and family members by identifying the
cause and removing it. Nurse should provide necessary guidance to detect the cause, whenever
needed and when the child is brought to the health care setting for excessive cry.
• Emotional conditions need interventions by the nurses or professional persons to remove the
cause of emotional deprivations. Parents usually need counselling and guidance on child rearing.

8. • Pathological conditions need to be diagnosed by necessary investigations and early interventions
to be arranged.
• These children may require hospitalization, medications, surgical procedures and supportive
measures to prevent complications.
• Nurse should assist and participate in the management by necessary assessment, planning,
interventions and evaluation.
• Parental support and necessary explanation about the condition of the child are also important
nursing responsibilities.

9. VOMITING
• Vomiting is the most common symptom found
during infancy and childhood.
• It is a reflex process governed by the vomiting
center of the medulla oblongata.
• It can be defined as forceful expulsion of
stomach content through the mouth.
• During vomiting, duodenum contracts in
spasm, its content reflux into the stomach and
then through vigorous contractions of
abdominal muscles, the stomach is emptied
forcefully.
• Usually glottis and soft palate close the air
passage to prevent aspiration of stomach
content.

10. • Occasional vomiting needs little attention. But frequent and persistent vomiting
may be serious and requires further evaluation.
• It can lead to dehydration, electrolyte imbalance, metabolic alkalosis and
aspiration of vomitus resulting asphyxia, pneumonia or atelectasis.
• Vomiting can be accompanied by other features like excessive salivation,
tachypnea, tachycardia, sweating, dilated pupil, pallor, etc.

11. Nonorganic Causes
• Swallowed amniotic fluid or blood,
• faulty feeding techniques
• Excessive cry,
• faulty feeding
Organic Causes
• Infections
• Mechanical conditions
• Emotions
• Toxins
• Neurological

12. Nonorganic Causes
• In Neonates: Swallowed amniotic fluid or blood, faulty feeding techniques, swallowed air due to
erratic feeding, posseting and side effects of drugs.
• Early infancy: Excessive cry, faulty feeding, overfeeding, rumination, introduction of solid,
loneliness, etc.
• Late infancy and childhood: Forced feeding, emotional disorders as attention seeking behavior in
poor parent-child relationship, motion sickness, repetitive swinging movement, sudden
excitement, fear, anxiety, unpleasant sight or odour and cyclic vomiting.

13. Organic Causes
• Infections: Intrauterine infections, septicemia, meningitis, encephalitis, acute gastroenteritis,
acute respiratory infections, pertussis, viral hepatitis, tonsillitis, otitis media, urinary tract
infections, acute appendicitis, pancreatitis, necrotizing enterocolitis, etc.
• Mechanical conditions: Congenital hypertrophic pyloric stenosis, esophageal atresia, malrotation
of gut, duodenal atresia, volvulus, intussusceptions, hiatus hernia, esophageal diverticulum,
pylorospasm, gastroesophageal reflux, etc.

14. • Neurological: Birth asphyxia, birth defect of central nervous system, birth injuries, intracranial
SOL, hydrocephalus, intracranial hemorrhage, increased intracranial pressure, subdural
hematoma, etc.
• Metabolic: Diabetes mellitus, uremia, galactosemia, hypoglycemia, cholemia, hypercalcemia and
inborn error of metabolism.
• Toxic: Ingestion of irritant food or drug, food poisoning, allergic food intake, postnasal discharge
or dripping.
• Emotional: Anorexia nervosa, migraine, psychogenic habit vomiting, etc.

15. Assessment
• The cause of vomiting is assessed by details history about the condition, complete physical
examination and necessary investigations.
• Thorough history to be collected about the vomiting episodes including duration, frequency and
amount of vomiting, appearance of vomitus with or without presence of bile, blood, or fecal
material, type and amount of oral intake and timing of vomiting in relation to oral feeding, etc.
• History of associated symptoms like fever, headache, earache, abdominal pain, weight loss,
drowsiness, confusion, etc. should be excluded.

16. • History of exposure to any infected persons like diarrhoea, mumps or any other infections are also
essential.
• A complete physical examination to be done including careful abdominal examination,
auscultation of bowel sound and palpation for tenderness.
• Assessment of general condition, vital signs, blood pressure, urine output, hydration status, body
weight are also important.
• Laboratory and radiological investigations should be planned according to the probable cause of
vomiting to confirm the diagnosis.

17. Treatment
• No treatment is required for the children having vomiting due to nonorganic causes.
• Only sips of water to be given after vomiting.
• Parents need explanation and reassurance for the correct feeding technique and necessary
modifications in child care practices.
• The organic causes should be diagnosed early and medical or surgical management should be
performed according to the particular condition and cause

18. Nursing Interventions
• Continuous observation should be done to assess child's
condition and recording of findings.
• Administration of IV fluid therapy to prevent fluid
electrolyte imbalance and maintenance of intake and
output chart.
• Administration of prescribed medications, especially anti-
emetics.
• Arrangement of planned investigations of blood, X-ray,
ultrasonography of abdomen, scanning, etc.

19. Nursing Interventions
• If not contraindicated, feeding should be given in small
amount frequently with clear fluids, ice chips, milk,
breastfeeding, diluted fruit juices, then gradually transfer
to semisolid and solid food. High fat in diet must be
avoided. Slight head up position should be maintained
during feeding.
• Care to be taken to prevent aspiration of vomitus by
turning head to one side.

20. Nursing Interventions
• General cleanliness and hygienic measures to be
maintained. Especially after vomiting, neck folds, face,
back of the ear to be cleaned. Mouthwash must be given.
Involving parent in child care and providing emotional
support to the parents.
• Following aseptic measures and universal precautions for
prevention of cross infection.
• Participating in medical and surgical management.
• Teaching the parents about care during vomiting, feeding
technique, hygienic measures, emotional care by love and
affection, avoiding over protection, etc.

21. CONSTIPATION
• Constipation is a common problem found in
children.
• It is infrequent passage of dry and hard stool often
with difficulty and pain.
• The most common form of constipation is
functional or nonorganic which is often familial.
• Chronic constipation is common but acute
constipation may occur due to organic causes.

22. Nonorganic
Causes
Organic
Causes
Lack of muscle tone in chronic illness,
malnutrition, rickets, intestinal
parasitosis, cystic fibrosis, prolonged
vomiting, hypertrophic pyloric
stenosis, duodenal atresia, meconium
ileus, intestinal obstruction,
Hirschsprung's disease, etc
Insufficient intake of food and
starvation or undernutrition, lack of
fluid intake, dehydration, artificial
feeding, delay introduction of solid
food, poor toilet training, faulty bowel
habits, etc

23. The children with chronic constipation may have
symptoms like
• Abdominal discomfort,
• Flatulence,
• Anorexia,
• Nausea,
• Vomiting,
• Headache,
• Disturbed sleep,
• Abdominal pain,
• Rectal pain, etc.

24. • Management of constipation depends upon the specific cause.
• Diagnostic measures include details history of bowel pattern, through physical examination,
laboratory tests (stool, urine, blood), radiological investigations (barium enema) and abdominal
ultrasonography.
• Organic causes are managed by medical or surgical interventions as needed for the particular
condition.

25. The management of nonorganic causes includes the
following interventions
• Explanation and reassurance to the parents about the nature and cause of constipation.
• Increasing intake of fluid and water.
• Allowing balanced diet with high residual foods including roughage, more carbohydrate
(adding sugar), leafy vegetables, fruits, etc.
• Encouraging the older child for regular bowel habit at a particular time everyday and
without hurry and distractions. Arranging suitable toilets and toilet seat.
• Improving hygienic measures and motivating the older child to solve own problem.

26. • If required, stool softener or mild laxative, or suppositories or enemas
can be used.
• Suppository or medications should not be used frequently.
• If the condition worsen, medical help to be taken for detection of any
organic cause and management.
• Informing the parents about the prevention of constipation by simple
measures.
• Managing the nonorganic causes and appropriate toilet training are
important aspect of prevention of constipation.
• Nurse should explain the preventive measures and answer the
questions as asked by the parents and children.

27. ABDOMINAL PAIN
• Abdominal pain is a common complaint and most children experience it at some
time.
• Acute abdominal pain may be a serious problem requiring hospitalization and
immediate interventions.
• Chronic and recurrent abdominal pain is common in school-aged children who
require thorough investigations and specific management.

28. • Assessment of abdominal pain begins with collection of history regarding onset, duration,
precipitating factors, location, severity, presence of other symptoms, etc.
• Abdominal examination in a relaxed and quiet approach helps to identify the cause which can be
confirmed by other necessary investigations like examination of stool, urine and blood, X-ray
abdomen, abdominal ultrasonography and endoscopy, etc.

29. Causes of Abdominal Pain
• Acute abdominal pain are commonly caused by acute gastroenteritis, hepatitis, peritonitis,
intestinal obstruction, appendicitis, necrotizing enterocolitis, pancreatitis, urinary tract infections,
lower lobe pneumonia, abdominal trauma, etc.
• Chronic and recurrent abdominal pain may be due to functional pain, milk allergy, chronic
constipation, malabsorption, abdominal infections, dysentery, amebiasis, giardiasis, worm
infestations, abdominal tuberculosis, irritable bowel syndrome, hydronephrosis, lead poisoning,
abdominal epilepsy, Hirshsprung's disease, etc.

30. • Abdominal pain may present with associated features like high-grade fever, anorexia, nausea,
vomiting, reduced activity level, jaundice, weight loss, abdominal mass, tenderness, distension,
etc.
• Organic causes of abdominal pain may present with sudden onset of severe pain which may
awakens the child from sleep or as referred pain or localized pain in non-periumbilical region.
• Inconsistent and nonspecific pain in periumbilical region indicates functional pain.

31. Management
• Pain assessment is an important responsibility of nursing personnel. Exact cause of abdominal
pain can be detected with good observation, history and physical examination.
• Management of abdominal pain depends upon its nature and cause. Minor pain that resolve
spontaneously does not require further attention. Persistent pain, which is severe enough to
effect the activities, needs complete investigations.
• Parents and older children should be explained and reassured about the nature of abdominal
pain, possible management and prognosis. Psychogenic abdominal pain of the child requires
relief of parental tension and conflict in the child. Development of trusting relationship with
parents, child, and health care providers are essential.

32. • Hospitalization may be required for symptomatic management of pain and treatment of
particular cause.
• Acute abdominal pain may be due to surgical conditions and requires surgical intervention.
• Pain may be relieved by anticholinergic drugs.
• Oral intake of fluid and food may be allowed or restricted according to child's tolerance and
associated features.
• Chronic abdominal pain may be treated at out patient department (OPD) or hospital admission
may require to treat the exact cause.

33. ABDOMINAL DISTENSION
• Abdominal distension is a common problem
usually associated with intestinal obstruction
and infections.
• It occurs when abdomen stretched out or
inflated with air, gas and secretion and needs
immediate attention.

34. Causes
• Acute gastroenteritis,
• Intestinal obstruction,
• Congenital malformation of
gastrointestinal tract (GIT),
• Peritonitis,
• Pneumonia,
• Septicemia,
• Electrolyte imbalance, etc.

35. Clinical features
• Abdominal pain,
• Nausea,
• Vomiting,
• Absence of stool,
• Respiratory distress,
• Increased pulse rate,
• Increased abdominal girth,
• Loss of appetite,
• Malaise, etc.

36. Management
• Early detection of problem and prompt management of the condition help in prevention of
complications.
• Assessment of the child's condition and detection of cause are the important aspects of
management.
• Gastric intubation to aspirate the GI secretions and to relief from distension. It also helps to
reduce respiratory distress related to distension and to prevent possibility of aspiration of GI
secretions to lungs.

37. • Administration of IV fluid to maintain fluid-electrolyte balance.
• Maintenance of intake and output chart is very important.
• Keeping the child in nothing per mouth till the distension is relieved.
• Monitoring vital signs and other problems and recording the findings.
• Protection from cross infection and maintenance of hygienic measures and elimination patterns.
• Explanation and reassurance to the parent and giving necessary instruction to participate in child
care.
• Specific management of the cause by medical and surgical measures.

38. ALLERGIES
• Allergy is an abnormal acquired immune response to a foreign substance.
• It is a state of changed reactivity in a host as a result of contact with an allergen.
• It is an adverse consequences resulting from the interaction of an allergen with humeral
antibody and/or cellular immune response.
• Sensitization or an initial exposure to the allergen is required. Subsequent contact with
the allergen results in a broad range of reactions.
• Allergy is a problem of great importance in children.
• It is difficult to avoid allergy but early detection and prompt management are essential to
prevent complications and recurrence.

39. The common allergens are
• Various food items,
• Drugs,
• Animal hair,
• Feathers,
• Dust,
• Pollens,
• Insect bites,
• Infections,
• Cosmetics,
• Oils, etc.
These allergens are introduced by
skin contact (e.g. cosmetics) or by
inhalation (pollen) or by ingestion
(food items) or injection (drugs).

40. Factors responsible for the condition include the followings:
• Hereditary predisposition: Positive family history of allergy is found in about 60% of
cases.
• Exposure to sensitizing factors: Previous exposure of allergen is responsible for this
immune response.
• Psychological factors: Release of histamine in psychological disturbance may precipitate
the allergic symptoms. Asthma and eczema may develop due to emotional disturbances.
• Infections are common allergens and allergic children are more liable to upper
respiratory infections.
• Other conditions like acute nephritis, rheumatic fever, scabies, etc. have been associated
with allergic reaction.
• Drugs may produce allergic symptoms mainly antibiotics, aspirins, etc.

41. Types of Allergic Reactions
Type I
(immediate)
Type III
(immune
complex)
Type IV (cell-
mediated)
Type II
(cytotoxic)

42. Type I (immediate)
• It is rapid and immediate reactions of local or systemic anaphylaxis and mediated by IgE.
• The local response includes urticaria, asthma, angioedema and systemic reaction as life-
threatening anaphylaxis.
• Allergen reaches the bloodstream and triggering massive release of chemical mediators that
produce laryngeal and pulmonary edema with severe bronchial obstruction and vasodilation
which can cause shock due to increased vascular permeability.

43. Type II (cytotoxic)
• It is initiated by allergen as antigenantibody reaction and mediated by IgG and IgM that causes
cell damage.
• Transfusion reaction and drug reaction are type II allergic reaction which is produced due to lysis
of blood cells and other cells.

44. Type III (immune complex)
• It occurs in sensitized people, when antibody (IgG and IgM) attached to antigen (allergen) creating
a complex and damage the walls of blood vessels or the basement membrane.
• It causes local inflammation and massive complement activations.
• Serum sickness is a type III reaction characterized by fever, joint pain, muscle pain, urticaria and
lymphadenopathy.
• It develops in sensitized people who receive penicillin or sulfonamides or antitoxins.

45. Type IV (cell-mediated)
• This reaction is mediated by T-lymphocytes.
• Contact dermatitis is one of the type IV reactions.
• It occurs in many common allergens like rubber, leather, nickel, etc. Contact dermatitis is
manifested by acute erythema, edema, itching and scaling.
• Delayed hypersensitivity reaction in skin test is another form of type IV reaction.

46. Clinical Manifestations
Type I allergic reactions
• Allergic rhinitis,
• Asthma,
• Acute urticaria,
• Angioedema,
• Atopic dermatitis
• Anaphylactic shock
Type II allergic reactions
• Hemolysis in mismatched blood
transfusion,
• Hemolytic anemia,
• Purpura,
• Agranulocytosis due to drug
hypersensitivity

47. Clinical Manifestations
Type III allergic reactions
• Serum sickness,
• Vasculitis,
• Glomerulonephritis,
• Allergic alveolitis,
• Rheumatic arthritis,
• SLE,
• Farmer's lung
Type IV allergic reactions
• Contact dermatitis,
• Homograft rejection,
• Areas of necrosis,
• Cessation in tuberculosis
Local or systemic inflammatory response is
manifested by redness, edema, heat, respiratory
symptoms including wheezing, coughing, sneezing
and nasal congestion with increased blood eosinophil
level.

48. Management of Allergies
• Avoidance of allergens after identification by careful history and skin test.
• Elimination of allergens and environmental control are the initial steps.
• Drug therapy used for symptomatic relief of allergic manifestations and interruption of tissue damage
as consequence of antigen-antibody reactions are very important.
• The used drugs are antihistamines, corticosteroids, adrenergics (epinephrine, salbutamol) and
methylxanthines (theophylline) groups.
• Immunotherapy or desensitization of allergens done by repeated injections of increasing amounts of
allergic extract till the patient reaches an optimal tolerance level. This procedure is done in a well-
equipped health care facility.

49. Nursing Interventions
In hospital and community, nurse can play an important role for the management of this condition
by the following activities:
• Careful history-taking to detect the allergens.
• Providing information to the people and given health education about avoidance of common
allergens, allergic reactions and its effects.
• Following preventive measures of allergic reactions like skin test for specific drugs, prevention of
mismatched blood transfusion, etc.
• Keeping all emergency drugs ready in hands to manage life-threatening anaphylactic reactions
promptly.
• Administering drug therapy and other management during hospitalization and providing routine
need based care.
• Referring for desensitization therapy.
• Providing support to the child and parents including family members.