Genetics, family dynamics, socioeconomic status, culture, environment, and growth and development influence pediatric health. Chromosomal abnormalities, single-gene mutations, and other factors can cause congenital defects. Family reactions to illness vary and may impair coping. Low socioeconomic status adversely impacts health through limited access to healthcare and nutrition. Culture influences health beliefs and practices. Environmental hazards like pollution and media influences also impact pediatric health. Growth involves increasing size while development refers to functional and physiological maturation. Temperament describes a child's behavioral style. Pediatric nurses promote health, teach, counsel, advocate, and collaborate to care for children and families. A thorough pediatric health assessment considers the child's needs and involves the family.

1. PEDIATRIC NURSING
DR. REGIE P. DE JESUS

2. INFLUENCESON
PEDIATRICHEALTH
• Genetics – study of heredity
• Congenital (present at birth) defects result from chromosomal abnormalities,
monogenic (single-gene) mutations, or other intrauterine factors.
• Alterations in a chromosome, part of a chromosome, or gene can cause a
genetic disorder.
A. HEREDITY AND GENETICS

3. INFLUENCESON
PEDIATRICHEALTH
• Chromosome disorders - Deviations in numbers
of chromosomes (ie, gain or loss of a
chromosome) are designated with the suffix -
somy.
• Monosomy - loss of one chromosome from a
pair., rare, and the fetus is usually nonviable.
• Turner syndrome (45, XO) is basically the
only viable monosomy; however, 99% of these
fetuses are spontaneously aborted.
A. HEREDITY AND GENETICS

4. TURNER SYNDROME

5. INFLUENCESON
PEDIATRICHEALTH
• Trisomy refers to an addition to a pair of
chromosomes.
• most common include trisomy 13 (Patau
syndrome), trisomy 18 (Edwards
syndrome), and trisomy 21 Down
syndrome).
A. HEREDITY AND GENETICS

6. TRISOMY 13
PATAU SYNDROME

7. TRISOMY 18

8. TRISOMY 21

9. INFLUENCESON
PEDIATRICHEALTH
• Alterations in the number of sex
chromosomes typically do not cause
serious effects. Klinefelter syndrome
(47, XXY) is the most common sex
chromosome abnormality syndrome).
A. HEREDITY AND GENETICS

10. INFLUENCESON
PEDIATRICHEALTH
• classic deletions syndromes, such as
cri-du-chat
A. HEREDITY AND GENETICS

11. Types of inheritance patterns
• Autosomal dominant inheritance.
• Autosomal recessive inheritance.
• X-linked dominant inheritance.
• X-linked recessive inheritance.
Monogenic (single-gene) disorder

16. Types of inheritance patterns
• Autosomal dominant inheritance.
Children of a heterozygous parent have
a 50% chance of possessing the
defective gene. Children who do not
inherit the defective gene will
themselves have unaffected offspring.
• E.g. osteogenesis imperfecta
Monogenic (single-gene) disorder

17. Types of inheritance patterns
• Autosomal recessive inheritance.
Children of two heterozygous parents
have a 25% chance of being affected.
Unaffected children have a 66% chance
of carrying the gene and possibly
passing it to their offspring.
• E.g. Cystic fibrosis,
Monogenic (single-gene) disorder

18. Types of inheritance patterns
• X-linked dominant
inheritance. Daughters of
an affected father will
probably be affected; sons
will not. Half the daughters
and half the sons of
affected mothers will be
affected. There are no
carriers, and normal
children will themselves
have normal offspring.
• E.g. Rett Syndrome
Monogenic (single-gene) disorder

19. Types of inheritance patterns
• X-linked recessive
inheritance. Males are usually
affected; half the female
children of affected fathers will
be carriers and may pass the
gene to their offspring.
• E.g. hemophilia, red-green color
blindness
Monogenic (single-gene) disorder

20. PEDIGREE CHART

21. INFLUENCESON
PEDIATRICHEALTH
Family functions include the following:
• Childbearing and child-rearing
• Providing basic needs (ie, food, safety, clothing, shelter, and health care)
• Providing communication and emotional support
• Enabling enculturation and socialization
• Preparing children to become citizens
B. FAMILY

22. INFLUENCESONPEDIATRICHEALTH
Family reactions to a child's illness or hospitalization vary and may
include:
• Possible impaired coping. Fears and anxieties about a child's illness or
hospitalization may increase, compromising the family's ability to cope
and their ability to help the child cope.
• Loss of control. A sense of helplessness may result from stressors such
as seriousness of the illness, previous hospitalizations, medical
procedures, lack of information, support systems, ego strengths, other
family problems, cultural and religious beliefs, family communications,
and previous coping abilities.
• Possible parental displays of stress. Examples include anxiety, denial,
guilt, anger, fear, frustration, depression, and such defense
mechanisms as displacement and projection.
B. FAMILY

23. INFLUENCESONPEDIATRICHEALTH
Social class probably has the greatest influence due to differences in child-rearing
practices and attitudes toward health. Children are raised differently by parents who
vary in education, communication skills, occupation, and income.
a. Low socioeconomic status has the greatest adverse influence on health. This is
due to several factors:
1. Escalating health care costs and unaffordable health insurance premiums
2. Eating unbalanced meals and insufficient food
3. Forgoing health care related to lack of funds or lack of value in the importance
of health, especially health promotion and disease prevention measures
4. Inadequate housing that may result in overcrowding, poor sanitation, and thus
greater exposure to communicable diseases.
C. SOCIOECONOMIC FACTORS

24. INFLUENCESONPEDIATRICHEALTH
• Humans acquire culture early in life, and cultural understanding is usually
established by 5 years of age.
• Culture and religious beliefs influence choice of mate, post-marital residence,
family kinships, household rules, household structure, family obligations, family-
community interactions, dietary customs, communication patterns, interpersonal
relationships, and health beliefs and practices.
• Some groups consider folk healers as powerful.
• Many cultures use home remedies.
D. CULTURAL, & RELIGIOUS FACTORS

25. INFLUENCESONPEDIATRICHEALTH
• Safety hazards in the home and community contribute to falls, burns, drownings,
and motor vehicle and other accidents.
• Passive smoking is a recognized health hazard for children and adolescents. Other
pollution (eg, from radiation, chemicals, and water, air, or food contamination)
poses significant health hazards as well.
• Media influences include the following;
• Children may identify with and mimic characters or criminals portrayed in the
media (TV, videos, movies, magazines, newspapers), which may lead to violence and
harm to self and others.
• Excessive TV viewing has been linked to obesity and high blood cholesterol levels in
children.
E. ENVIRONMENT

26. It is the process of physical maturation
resulting an increase in size of the body
and various organs. It occurs by
multiplication of cells and an increase
in in intracellular substance. It is
quantitative changes of the body.
It is the process of functional and
physiological maturation of the individual. It
is progressive increase in skill and capacity
to function. It is related to maturation and
myelination of the nervous system. It
includes psychological, emotional and social
changes. It is qualitative aspects.
GROWTH DEVELOPMENT
INFLUENCESONPEDIATRICHEALTH
F. GROWTH AND DEVELOPMENT

27. GROWTH vs DEVELOPMENT

28. GROWTH
vs
DEVELOPMENT

29. INFLUENCESONPEDIATRICHEALTH
Infancy
Neonate
• Birth to 28 days
Infancy
• 29 days to 1 year
Early Childhood
Toddler
• 1-3 years
Preschool
• 3-6 years
f. Growth and development
Middle Childhood
School age
• 6 to 12 years
Late Childhood
Adolescent
• – 13 years to approximately 18
years

30. PRINCIPLES OF
GROWTH and
DEVELOPMENT
• Cephalocaudal direction
• Proximodistal direction
• General to Specific

31. CEPHALOCAUDAL
DIRECTION
The process of cephalocaudal direction from head
down to tail.
This means that improvement in structure and
function come first in the head region, then in the
trunk, and last in the leg region.
e.g. gaining control of head and arms, torso, and
finally legs
Head larger relative to the rest of the body, lower
parts of body must do more growing to reach adult
size

32. CEPHALOCAUDAL DIRECTION

33. PROXIMODISTAL
DIRECTION
The process in proximodistal from center
or midline to periphery direction.
development proceeds from near to far -
outward from central axis of the body
toward the extremities
e.g.
Brain/spinal cord (central nervous system)
and organ systems in trunk develop before
arms & legs, finger, toes
Motor control of trunk and head before
arms and legs

34. PROXIMODISTAL DIRECTION

35. GENERAL TO
SPECIFIC
Children use their cognitive and language
skills to reason and solve problems.
• Children at first are able to hold the big
things by using both arms, In the next part
able to hold things in a single hand, then
only able to pick small objects like peas,
cereals etc.
• Children when able to hold pencil, first
starts draw circles then squares then only
letters after that the words.

36. GENERAL TO
SPECIFIC

37. TEMPERAMENT
involves the child's style of emotional and behavioral
responses across situations.
Types of temperament child.
1. Easy children are even tempered, regular, and
predictable; they approach new stimuli
positively.
2. Difficult children are irritable, highly active, and
intense; they react to new stimuli with negative
withdrawal.
3. Slow-to-warm-up children are moody, inactive,
and moderately irregular; they react with mild
but passive resistance to new stimuli.

38. A t t r i b u t e s o f
T e m p e r a m e n t
1. Activity refers to the level of motor movement and energy
expenditure, such as sleeping, eating, playing, dressing, and
bathing.
2. Rhythmicity is the regularity or predictability in the timing of
physiologic functions such as hunger, sleep, and bowel movements.
3. Approach-withdrawal is the nature of initial responses to new
stimuli, such as people, situations, places, foods, toys, and
procedures. Approach responses are positive, displayed by activity
or expression; withdrawal responses are negative expressions.
4. Adaptability is the ease or difficulty with which the child adapts or
adjusts to a new situation.
5. Threshold of responsiveness is the amount of stimulation, such as
sound or light, required to generate a response

39. A t t r i b u t e s o f
T e m p e r a m e n t
6. Intensity of reaction is the energy level of reactions, regardless of
quality or direction; degree to which the child expresses himself or
herself.
7. Mood is the amount of friendly, happy, pleasant behavior versus
unfriendly, unhappy, behavior in various situations.
8. Distractibility is the ease with which external stimuli can divert
attention or behavior.
9. Attention span and persistence is the length of time a child pursues
a given activity (attention) and continues the activity despite
obstacles (persistence).

40. ROLES OF PEDIATRIC
NURSES
• Family advocate. Nurses assist in identifying
the needs and goals of children and their
families and in developing appropriate nursing
interventions.
• Health promoter. Nurses assist in promoting
health and preventing disease by fostering
growth and development, proper nutrition,
immunizations, and early identification of
health problems.
• Health teacher. Nurses provide families with
information on topics such as anticipatory
guidance, parenting, and disease processes.

41. ROLES OF PEDIATRIC
NURSES
• Counselor. Nurses support families through
active listening. A therapeutic relationship
between a nurse and the child and family
includes caring as well as carefully defned
boundaries.
• Collaborator. As a key member of the
interdependent health care team, nurses collab.
rate and coordinate nursing services with other
health care professionals.
• Researcher. Nurses use and contribute to
research that enhances the nursing care of
children and adolescents and their families.

42. P E D I A T R I C H E A L T H
A S S E S S M E N T
Child considerations
• Maintain eye contact (if culturally appropriate), bending to the child's
level as needed.
• Use language appropriate for the child's cognitive level; involve the child
in the assessment interview by asking appropriate questions.
• Remember that a child is aware of the caregiver's nonverbal
communication and body language.
• Allow the child some "warm-up" time to become acquainted with the
caregivers and the environment; introduce yourself and explain your
purposes.
• Respect the child's responses and need for privacy as appropriate for age.
• Incorporate play into the assessment as appropriate.

43. P E D I A T R I C H E A L T H
A S S E S S M E N T
Family considerations
• Develop a family-oriented approach that encourages parents to
participate.
• Choose a quiet environment for the assessment and for any teaching
sessions.
• Ask open-ended questions to elicit responses other than "yes" or "no."
• Focus on the information needed or problem to be solved.
• Communicate the importance of parental roles with the health care team
in planning and providing care for the child.
• Listen attentively, respect responses, and provide appropriate feedback.
Use silence judiciously.
• Encourage parents to express concerns and ask questions.