Children differ from adults both physically and mentally in several key ways important for nurses to understand. Physically, children have proportionately larger body surfaces, thinner skin, smaller airways, less developed organs and excretory systems. Mentally, children's brains develop rapidly, their cognition and behaviors change with age, and they rely more on social bonding and are prone to separation anxiety. Understanding these anatomical, physiological, cognitive and social differences is necessary for nurses to appropriately care for children of all ages.

1. PRESENTED BY:
Manisha praharaj
M.Sc(N) 1st year.

2.  Children and adults differ physically and
mentally.
 As a nurses it is necessary to learn the
differences to deliver the care accordingly.

3.  Anatomical differences
 Physiological differences
 Cognitive differences
 Social differences
 Emotional differences

4.  SIZE- different sized children according to age.
Thus the usage of various sized cots in pediatric
wards.
 Greater size and weight of the newborn’s head as
compared to the body length and weight.
 Immaturity and inadequate ossification- prone for
injuries
 Sutures and skulls are not united.

5.  Fontanels are not closed
 Shape of the head and chest can be altered
by constant pressure from lying in one
position.
 Muscles are 25% of weight in infants and it is
40% in adult.

6.  Children have a proportionately larger
body surface area (BSA) than adults do.
The smaller the patient, the greater the
ratio of surface area (skin) to size.
 As a result, children are at greater risk
of excessive loss of heat and fluids;
children are affected by more quickly
and easily toxins that are absorbed
through the skin.

7.  Thinner skin-
Children have thinner skin than adults.
Their epidermis is thinner and under-
keratinized, compared with adults.
As a result, children are at risk for
increased absorption of agents that can
be absorbed through the skin.

8.  Excessive IV fluids and medications easily
causes pedal edema.
 Hence rate of flow should be adjusted.
 Dosage calculation of drug is also necessary.

9.  Infants tongue is large.
 Nasal and oral airway passages are relatively
small making the baby more prone to airway
obstruction.
 Nose breathers till 6 months of age. (breathing
difficulty in respiratory infections).

10.  No tears in early infancy- due to poor
functional development of lacrimal gland.

11.  It is short and straight in children (10 degree in
children and 40 degree in adults).
 Air sinuses are not fully developed
 Sore throat extends to otitis media because of
the closeness of it to throat.

12.  Short and narrow trachea under 5 years-
susceptible to foreign body aspiration.

13.  In children cardiac sphincter of the stomach
is relaxed.
 Vomiting is so frequent, hence proper
positioning of the child during feed is so
important.
 Poor protection of the liver and spleen –
prone for trauma.
 Stomach capacity is 90ml. And gastric
emptying time is very short.
 So baby should feed frequently.

14.  By utilizing energy substrate for the process
of growth, the load presented to the
excretory pathway is decreased.
 Kidney function is reduced.
 Urinary bladder capacity is 15ml. So baby
urinate 15-20 times/day.

15.  ABSOLUTE MEASUREMENTS:
 Rapid loss of 35 ml of blood by a newborn
baby represents 10% of blood volume.
 This much loss can lead to circulatory
failure.

16.  BMR rate is high in newborn.
 In neonate 6-8ml of oxygen/ kg/ min is
normal whereas 2-4 ml of oxygen/kg/min is
normal in adults.
 Increased CO2 due to more metabolic rate.

17.  Children's cells divide more rapidly than
adults to assist in their rapid rate of growth
As a result, children are more susceptible to
the effects of radiation than adults

18.  Poor thermo regulation is attributed to
immaturity of the hypothalamus.
 Shivering and sweating mechanisms are
absent in newborn.

19.  Reserve of brown fat from which heat can be
liberated by non shivering thermogenesis.
 Once used brown fat cannot be replaced.

20.  No voluntary control over the environment or
activity.
 (Eg.) On cold day adult used to wear socks, woolen
clothes etc. but the child depends on the care
takers.

21.  ICF- Less
 ECF- More (double than the adults)
 Easily fluctuates during the GI infections.

22.  Neonate- 85 ml/kg of BW.
 Adult- 60-70 ml/kg of BW.

23.  Concentration of urine in newborn is 800
mOsmol/L whereas in adults it is 1400 mOsmol/L.
 GFR and tubular functions are lower in neonates
than adult because low blood supply to kidney,
smaller pore size and less filtration power across
nephron.
 GFR- 38 ml/ min (neonate)
 GFR- 125 ml/min (adult)

24.  Water absorption is poor – faeces of the child
is watery.
 Dehydration leads to circulatory failure
within 24 hours if treatment is inadequate.

25.  Change from fetal to normal circulation.
 Heart rate is more in children.
 Newborn – 110-160 beats/ min.

26. Stoppage of placental circulation
Rt atrial pressure suddenly falls
Decreased pulmonary pressure

27. Increased left side pressure
Increased left ventricular output
Cessation and reduction of flow via PDA

28.  Functional closure- within few hours after
delivery
 Structural closure- within 6 weeks

29.  Foramen ovale- fossa ovalis
 Ductus arteriosus- ligamentum arteriosum
 Ductus venosus- ligamentum venosum
 Umbilical veins- ligamentum teres

30.  Respiratory rate is 35-40 breaths/ min.
 Infants prefer to breathe through the nose.
 Small children are dependent on contraction
of the diaphragm to breathe.

31.  Immature- physiological jaundice.
 Production of albumin, clotting factors and vitamin
K are less.
 Iron reserve is less.
 Liver cannot convert glucose though liver is
immature so children are more prone to have
hypoglycemia.

32.  90% of brain growth takes place by 2 years of
age.
 Nerve endings in the retina (rods and cones)
are not fully developed. Thus the images are
blurred and colourless for few weeks.

33.  Fear , escape and avoid strangers till 5 years of
age.
 Explore the environment.
 INFANCY- more bonding with parents.
Seperation anxiety is very common.
 TODDLERS – Negativistic behaviours

34.  PRE SCHOOLER- short attention span, easily
distractable.
 ADOLESCENTS- Identity of peer, confusion.

35.  Unlike adult, children and adolescents are
still in a period of social development which
involves
1. learning the values,
2. knowledge and skills that enable them to
relate to others.

36.  The goal is for children and adolescents to
build a positive sense of their own identity
and their role in relationships with people
around them.

38. THANK YOU