principles of paediatrics

1. CURRENT PRINCIPLES, PRACTICES
AND TRENDS IN PEDIATRIC NURSIG
Mr.MANPREET SINGH
MSC (N) II YEAR

2. PEDIATRICS
“Pediatrics is the speciality of medical science
concerned with physical, mental and social health of
children from birth to young adulthood”

3. Pediatrics – derived from Greek word
pais / paisons -child
iatreia -cure
ics -subject of science

4. Pediatric nursing
“ Pediatric nursing is the practice of nursing
involved in the health care of children from
infancy through adolescence”.
-Terrikyle & Susan

5. EVOLUTION OF PEDIATIRCS

6. Ancient and medieval medical writings
• Hippocrates wrote a small treatise on
On “dentition” on the subject of
teeth & noted how children
differ from adults in various ways in
his “Aphorisms”

7. Soranus of Ephesus
• detailed history of childhood diseases
• explanations include feed, Bathe, swaddle an
infant
• described finger nail test for breast milk
quality

8. • Galen (200 A.D) wrote of ear discharge,
pneumonia, and intestinal prolapse and
described a disorder that corresponds to
rickets.

9. 787 AD, Arch Bishop Dathers --one of th first
foundling asylums at Milan

10. Avicenna (990 AD)–Arabian physician
discussed tetanus, worms, convulsions,
meningitis & umbilical abscess.

11. Rhazes (Baghdad) –wrote an entire treatise on
children.

12. RENAISSANCE MEDICAL WRITINGS
First medical book –printed
Pediatric treatise by italian
Paolo Bagellardo

13. Thomas Phaer (1594) – first english language
work on pediatrics called – “the book of
children”
-dentition, teething, crying, fever, cramps,
palsies
-advocated
washing the
child in
camomolie(TEA)

14. Hieronymus ( 1583) wrote-
“de morbus pusorium “

15. Thomas sydenham (1624-1689)-english
hippocrates wrote on
-scarlet fever
-measles
-small pox
-epilepsy
-rickets
-teething fever
-scorbutus(scurvy)
-chorea(st.vitus dance)

16. Edward Jenner (1749-1823)-
Invented small pox vaccine

17. Dr . Eli Ives (1813-1852) – gave lectures to
medical students at Yale – about diseases in
children.

18. British physician – William buchan
noted that one half of the human race dies in
infancy

19. Theophile Rouseel (1816-1903) –French
physician and politician
set laws that protected infants , abused and
abandoned children.

20. Two of the first text books in pediatrics were
published in 1825.
“Treatise on the physical & medical treatment”
-Dr, William Potts Dewees
“Practical observations on diseases of children”
-Dr.George Logan

21. First pediatric hospital – 1802
“Hospital de enfants malades” ( French)
called “Hospital for sick children”
• Opened in Paris

22. Dr. Elizabeth Blackwell –first woman
To graduate –US medical school

23. America’s first children hospital-
“Children’s Hospital Of
Philadelphia” (1854)

24. Louis Pasteur (1862) –Pasteurization

25. New York Medical College starts a regular
professorship for the diseases of children in
1860.

26. Dr. Abraham Jacobi – Starts
“American Journal Of Obstetrics And Diseases”

27. Dr.Mary Putnam Jacobi –first women member of
the “Academy Of Medicine”

28. The first issue of the “Archives Of Pediatrics”
was published in 1884

29. American Pediatric Society (1888) –
Dr.Job Lewis Smith With Dr.Abraham Jacobi

30. Dr. Thomas Morgan Rotch –
Americas first professor of
pediatrics at Harvard
Medical School in 1893

31. Dr. Dorothy Reed Mendenhall –first to recognize
Hodgkins disease was a blood cell disorder and
not a form of tuberculosis

32. Sir Alexander Flemming - Pencillin
Jonas Salk (1914-1995)
& Albert Sabin(1906 -1993) -Polio

33. Sir Edward Mellanby –Discovers Cod Liver Oil
Can Treat Rickets

34. Dr. Emily Patridge Bacon – first pediatric
specialist in Philadelphia.
-introduced “well baby clinics”

35. Dr. J.P.Crozier – publishes
“The Diseases of Infants& Children”
which later became
“The Nelson’s Pediatric’s Text book”

36. June 23, 1930 –American Academy of Pediatrics
was formed at Detroit (Michigan)

37. Dr. Charles Bradley – described the use of
benzedrine in children with behavioral
problems(1937)

38. Dr.Dorothy Hansine Anderson (1938)- first to
recognize Cystic Fibrosis

39. Hattie Elizabeth Alexander , M.D- developed a
treatment for Hib Meningitis.

40. Dr. William E.Ladd & Robert E.Gross (1941)
published pediatric surgery textbook
“Abdominal Surgery Of Infancy & Childhood”

41. Dr.Norman M.Gregg(1941) reports on
congenital rubella

42. Dr. Helen Taussig And Dr. Alfred Blalock (1943)
developed a palliative surgical treatments for
babies with Tetrology Of Fallot

43. Dr.R.L. Jackson & Mrs. H.G. Kelly (1994)
published growth charts

44. First military pediatrics residency program –
Boston’s Chelsa Naval Base (1946)

45. First issue of pediatrics :
“JOURNAL OF AMERICAN ACADEMY
OF PEDIATRICS” (1948)

46. PEDIATRICS IN INDIA

47. Ayurveda – description of maternal and child
health.

48. Sushrutha – “Sushrutha Samhita”
Atharva Veda – Childrens Diseases
Kashyapa &Jeevaka :Pediatricians –Ancient
India
Charaka – Case Management Of New Born
Kaumarabritya & Panchatantra- Prenatal Care

49. The history can be studied as :
 Academics
 Pediatric – Indian Pioneers
 Indian Academy Of Pediatrics
 Change Of Spectrum Of Illness
 Demographic Trends
 National Programs

50. Evolution Of Pediatric Nursing In
Relationship To Child Health

51. Past centuries –
• health was poorer
• Crowded living conditions
• Inadequate unsanitary food
• Harsh working conditions
• Increased mortality & morbidity rates

52. Over the years……
• Focused attention on the health of the children
• 1900s- Lilian Wald (NY)-public health nursing
• Pediatric nursing-teachers college of columbia
university
• Improved nutrition, sanitation, medicine
• Changes in the health care delivery system
• 1980-division of maternal-child health (N) practice

53. HISTORICAL BACKGROUND ON
THE CARE OF CHILD

54. Child in primitive societies
-NOMADS

55. Child in ancient civilizations
EGYPT
• Settled in the valley of Nile
• Dressed infants in loose clothes
• Breast feeding

56. Greece & Rome
Physical Beauty –Greece
Strong Sons (Good Warriors)- Rome

57. • Ancient jews- hygienic measures
• Hebrews –cleanliness & circumcision
- large family – a sign of Gods
blessing

58. Impact of Christianity on child care:
• Value of child as a son and daughter
• Protection of the weak by the strong and care
of the ill by the well.

59. The Child In Europe
• Great epidemics
• Young men died in war
• Women married early- large
families
• Maternal death rate was high
• Orphaned children
• Infants- boarding homes or baby
farms
• Asylums -787 AD
• No Principles of sanitation,
housing, nutrition
• Accidents were common

60. The child in the United States
• Early 20th century – children
lived on farms
• Lack of medical care
• 19th century - large slums (NY)
• Over –crowded, unsanitary
conditions
• Accidents were common
• Contaminated milk- intestinal
disorders
• Dairies, stores- not inspected
• Milk from tuberculous cows
• Mortality & morbidity rates –
increased

61. The child in developing countries
International activities
• WHO
• UNICEF

62. WHO (1948):
Geneva, switzerland
Objectives:
• Directs & co-ordinates health work
• Collaboration with governments
• Evaluates a country’s health
problems
• Eradicate diseases & prevent
injuries
• Promotes nutrition, housing,
sanitation, env. Hygiene
• MCH welfare
• Promotes mental health

63. UNICEF (1946):
• Meet the emergency needs of
children
• is financed by voluntary
contributions from govts, groups, &
individuals
• In USA, children volunteer –
by“halloween”
• Sales of calenders, christmas
cards,fund medicines & food

64. FACTORS INFLUENCING THE CARE
OF CHILD

65. It includes :
 Societal factors
 Professional factors

66. Societal factors
• Attitude towards children
• Poor & deprived families
• Consumerism
• The women’s movement
• Health care : changes & advances

67. Attitude towards
children:
Infanticide, neglect,
abuse -persist

68. Poor & deprived families:
Insufficient financial resources
Misconception – govt provides –minority
groups- metros
Bread winner unemployed

69. Consumerism ;
Consumers are vocal
Assertive in making decisions

70. Women’s movement:
Mother’s work on a part-time basis or full time
Mother’s take the responsibility
Family – centered care

71. Health care : changes& advances:
• Concept of health & illness –changing
• Holistic view of health
• High – level wellness
• Self care movement
• Advances and changes in medical care

72. Professional factors
• The process of professionalization
• Expansion of the nurses role
• Nurse practice acts
• Professional organizations

73. Principles Of Pediatrics

74. 1.Respect the child’s need to regress & help him
to accept dependence on others if he resists
this

75. 2.Have an awareness of the child’s need for help
in reconquering the negative counterpart of
the core problem in the stages of
development to which he has regressed.

76. 3.Protect the child-family inter -relationships

77. 4.Awareness of the feelings of others and
readiness to respond to them so as to
strengthen their resources to cope up with
stress is the major principle underlying
effective emotional support

78. 5.Children can tolerate discomfort if they are
prepared for it, comprehend its real purpose
and are adequately prepared.

79. 6.To child, play is not time out from daily living,
but rather an essential part of it that enables
him grow & mature through the various stages
of the development.

80. HEALTH CARE
DELIVERY SETTINGS

81. It includes
Clinics & offices
Home care
Parish nursing
Other setting

82. CLINICS
• Well organized out patient facilities
• Information is distributed & education is
offered on childhood immunizations
• Specialty clinics
• School based health centers

83. HOME CARE
• Lower cost & patient satisfaction
• IV therapy , phototherapy

84. PARISH NURSING
• Health promotion
• Health maintenance
• Illness prevention
• Community services
• Support groups

85. OTHER SETTING
Local and national groups
camps

86. CURRENT PRACTICE

87. It involves
Educational requirements
Research and roles
Critical thinking & nursing process
Documentation
Confidentiality & informed consent

88. Educational requirements
• Update the knowledge
• Accountability – important
• Responsibility to community

89. Research & roles
Research
– Evidence – based practice
Roles
– Health promotion & anticipatory guidance
– Advocating
– Holistic attitude
– Ethical decision making

90. Critical Thinking & Nursing Process
Critical thinking – systemic, expanded way of
thinking
Nursing process –

91. Documentation
• Data collection
• Assessment findings
• Patient care needs
• Interventions
• Specific time ( legally important)
• Discharge needs
• Law- “ if something was not charted – not
done”

92. Confidentiality & Informed Consent
• HIPAA ( Health Insurance Portability &
Accountability Act) regulations
• Should not share information
• Patient records – carefully monitored
• Should not give private information –
telephone callers

93. TRENDS IN PEDIATRIC
NURSING

94. It includes
• Family centered care
• High technology care
• EBP
• Primary nursing
• Case management
• Child oriented environment
• Atraumatic care
• Cost- containment
• Nursing process application
• Ethics
• Rights of children
• others

95. Family centered care
• Positive environment for family members
• Guide in unknown new experiences
• Enhance the strength & competence
• Basic components
-enabling ( opportunities)
-empowerment ( interaction)
• Incorporate into policies & practice- cultural div.
• Recognize & respect diff. methods of coping
• Family- family networking

96. High technology care
• Advancement in medical field
• Diagnostic technology

97. High technology includes
• Controversial fetal surgeries
• Fetal blood transfusions
• MTP
• Cloning
• IVF
• Female feticide

98. Emerging technologies
1. Genetics & genomics
Diseases could be treated by genetic
element

99. • 2.less invasive & more accurate tools for diag.
Home phototherapy

100. Influenza A&B detecting device

101. Wart cryotweezers

102. Shot blocker

103. Cerumen remover

104. Sensicardiac

105. Da vinci robotic surgery

106. 3D printing

107. Others
-robotics
-biometrics
-EHR

108. Evidence based practice
• CPG’S & patient centered multidmensional
multidisciplinary plans of care

109. Primary nursing
• 24 hour responsibility & accountability-one
nurse
• When primary nurse is not working, an
associate nurse will maintain

110. Case management
• Extension of primary
nursing
• Out – patient setting
• A case manager – a
patient or a group of
patients

111. Child oriented environment
• Child- friendly env. – hospital
• Hospitalization – disrupts routines
• Skilled staff
• Liberal visiting hours
• Families – receive information

112. Atraumatic care
• Provision of therapeutic care- minimize
physical & psychological distress
• Therapeutic care
-PREVENTION
-DIAGNOSIS
-TREATMENT
-PALLIATION

113. SUGGESTED INTERVENTIONS
• Parent –child relationship
(hosp.)
• Prepare the child before
any procedure
• Control pain
• Child privacy
• Play
• Minimize loss of control
• Respect cultural & religious
differences

114. Cost containment
• It is a management technique utilized to
reduce the cost of hospitalization
• Multi- disciplinary approach
• Enabling & empowerment

115. Nursing Process Application

116. Ethics In Pediatric Nursing
• In nursing practice
Non-maleficence-do no harm
Beneficence – do good
Justice
Respect for autonomy
Truth telling

117. • Related to research
1.Informed consent
Legal age -18 yrs
2.Conceptual issues
e.g., reusing life saving care for religious
practices
3.Beneficience
4.Truth telling
5.Confidentiality
6.Conflicts of interest

118. Children’s rights
• History of children’s human rights
Natural rights
FOUNDLING HOSP (1741)LONDON – education
& maintenance of exposed & deserted young
children
THOMAS SPENCE (Political radical) – rights of
children -1796

119. Social reform
Industrial revolution – children worked in factories,
coal mines
Charles Dickens (Oliver Twist)- wrote of the terrible
conditions
Factories act -19th century (< 9yrs not allowed)
Mary carpenter - neglected children

120. USA -----children rights movement ---orphan train
National child labor committee---abolition of
child labor
National child labor law(1924)----- congress
constitutional amendment
Franklin D Roosevelt (1938)---signed Fair Lbor
standards.

121. Janusz korczak (polish educationalist): ----”How
to love a child”---- later entitled---THE CHILD’S
RIGHTS TO RESPECT.

122. DECLARATION OF THE RIGHTS OF THE
CHILD.
1959---United Nations General Assembly
adopted an expanded version as…whose
provisions are,
• Protection rights
• Provision rights
• Participation rights

123. DECLARATION OF THE RIGHTS OF THE
CHILD.
• Protection rights: against maltreatment
neglect & all forms of exploitation.

124. DECLARATION OF THE RIGHTS OF THE
CHILD.
• Provision rights: right to food, health care,
education and benefit from social security.

125. DECLARATION OF THE RIGHTS OF THE
CHILD.
• Participation rights: right to act in certain
circumstances and the right to be involved in
decision making.

126. INDIAN CONSTITUTION
• Article 24---prohibits employment of
children in factories under age 14.
• Article 39---prevents abuse of children of
tender age.
• Article 45---provides for free and
compulsory education ---till they complete
age 14 yrs.

127. UNITED NATIONS DECLARATION OF
THE RIGHTS OF THE CHILD
• Right to develop in an
atmosphere of affection and
security, and wherever possible,
in the care and under the
responsibility of his/her parents.

128. UNITED NATIONS DECLARATION OF
THE RIGHTS OF THE CHILD
• Right to enjoy the benefits of
social security, including
nutrition, housing and medical
care.

129. UNITED NATIONS DECLARATION OF
THE RIGHTS OF THE CHILD
• Right to free education

130. UNITED NATIONS DECLARATION OF
THE RIGHTS OF THE CHILD
• Right to full opportunity for play
and recreation.

131. UNITED NATIONS DECLARATION OF
THE RIGHTS OF THE CHILD
• Right to a name and nationality.

132. UNITED NATIONS DECLARATION OF
THE RIGHTS OF THE CHILD
• Right to special care, if
handicapped.

133. UNITED NATIONS DECLARATION OF
THE RIGHTS OF THE CHILD
• Right to special care, if
handicapped.

134. UNITED NATIONS DECLARATION OF
THE RIGHTS OF THE CHILD
• Right to be among the first to
service protection and relief in
times of disaster.

135. UNITED NATIONS DECLARATION OF
THE RIGHTS OF THE CHILD
• Right to learn to be a useful
member of society and to
develop in a healthy and normal
manner and in conditions of
freedom and dignity.

136. UNITED NATIONS DECLARATION OF
THE RIGHTS OF THE CHILD
• Right to be brought up in spirit of
understanding, tolerance,
friendship among the people,
peace and universal brotherhood.

137. UNITED NATIONS DECLARATION OF
THE RIGHTS OF THE CHILD
• Right to enjoy these rights,
regardless of race, colour, sex,
religion, national or social origin.

138. Other trends
• KMC
• Rooming- in concept
• Child – to –child
program
•

139. 1.Kangaroo mother care
• First presented by Rey & Martinez in Bogota,
Columbia.
• Care of preterm infants carried skin-to-skin
with the mother.
• Promote health and well-being of infants born
preterm as well as full term.

140. Kangaroo mother care
Key features:
• Early, continuous and prolonged skin-to-skin
contact
• Exclusive breast feeding
• initiated in hospital and continued at home

141. 2.Rooming-in-concept
• Placing of the newborn in the same room as
the mother - early post-partum period, to
foster maternal-fetal bonding and facilitate
breast feeding.

142. 2.Rooming-in-concept
Benefits of rooming-in:
• Cry less and remain calm
• Mothers get rest
• Ability to respond to baby’s feeding cues

143. 3.Child-to-Child Program
• David Morley & Dr. Hugh Hawes ----conceived
the idea ----children working with other
children to bring change(1978).
• First major child-to-child project---”Little
Teacher Program” ---Botswana.

144. EVOLUTION OF CHILD HEALTH
• Government programs
• Change in mortality and morbidity.
• Insurance
• Health promotion
• Emergency preparedness
• Current practice
• Cultural and religious considerations
• Complementary and alternative medicine.