pediatrics

1. Chapter 1
Perspectives of Pediatric Nursing
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2. Health During Childhood
• Health is a state of complete physical,
mental, and social well-being and not
merely the absence of disease.
—The World Health Organization
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3. Child health problems
Issues Affecting Childhood Health
Obesity and Type 2 diabetes: http://www.who.int/dietphysicalactivity/childhood/en/
• Both problems are connected to each other
• Is among the most common problem affecting childhood nowadays
• Is increasing in an epidemic level especially Obesity
• In 2020, an estimated 39 million children under the age of 5 years were
overweight or obese.
• Once considered a high-income country problem, overweight and obesity
are now on the rise in low- and middle-income countries, particularly in
urban settings.
• In Africa, the number of overweight children under 5 has increased by
nearly 50 per cent since 2000.
• Nearly half of the children under 5 who were overweight or obese in 2016
lived in Asia.
• Over 340 million children and adolescents aged 5-19 were overweight or
obese in 2016. 3
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4. • The prevalence of overweight and obesity among children and
adolescents aged 5-19 has risen dramatically from just 4% in 1975 to just
over 18% in 2016. The rise has occurred similarly among both boys and
girls: in 2016 18% of girls and 19% of boys were overweight.
• While just under 1% of children and adolescents aged 5-19 were obese in
1975, more 124 million children and adolescents (6% of girls and 8% of
boys) were obese in 2016.
• Overweight and obesity are linked to more deaths worldwide than
underweight. Globally there are more people who are obese than
underweight – this occurs in every region except parts of sub-Saharan
Africa and Asia.
• Advancements in technology, entertainment, contributed to this situation.
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5. Related injuries and causes of death
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6. Related injuries and causes of death
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7. Child health problems
Developmental stage– related injuries
– Are the most common cause of death and injury/disability to children,
especially motor vehicles accidents
– Examples: are head injuries, burns, drowning,
– As children develop, their curiosity develop and push them to explore the
environment and injuries then can happen.
– The child developmental stage partially determine what type of injuries
might take place and hence can help in planning service
• E.g. Small infant roll themselves, then they are exposed to
falls from unprotected surfaces.
• E.g. crawling infants, usually place foreign objects in their
mouths, and thus exposed to aspirations, poisoning, blocked
airway, etc.
• Mobile toddler with their curiosity are more prone to burns,
falls (they climb and jump), collisions.
(Important Table in page 4)
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8. 8
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9. Child health problems
• Substance abuse/Experimenting:
– Tend to start earlier in males than females
– May start as early as age 10 years and continue into
adolescence stage
– Cigarettes, speedy driving, drug abuse etc.,, are common
behaviors that adolescents usually like to experiment
– Community interventions targeting these behaviors are the main
method of treatment.
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10. Child health problems
• Between 500 million and 1.5 billion children experience violence annually
• About 20 % of women and 5-10 % of men suffered sexual abuse as children
• 3 out of every 4 children experience violent discipline at home
• 85 million children -55 million boys and 30 million girls - are involved in
hazardous work
• Just over 1 billion children live in countries or territories affected by armed
conflict ex: gaza
• Almost half of all forcibly displaced persons globally are children – over 12
million girls and boys
• Only 52 out of 197 countries have prohibited physical punishment of
children in institutional care
• Nurses role would be to be aware of the problem and in early identification
of those who might be at risk, or might be exposed to such risk.
Source: Save the Children Sweden organization [online]
http://resourcecentre.savethechildren.se/start/child-protection-post-
2015/violence-against-children-numbers
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Violence

11. Child health problems
• Mental health problems:
Fact 1 (WHO 10 facts about mental Health)
• Around 20% of the world's children and adolescents have mental
disorders or problems
• About half of mental disorders begin before the age of 14. Similar types of
disorders are being reported across cultures. Neuropsychiatric disorders
are among the leading causes of worldwide disability in young people. Yet,
regions of the world with the highest percentage of population under the
age of 19 have the poorest level of mental health resources. Most low-
and middle-income countries have only one child psychiatrist for every 1
to 4 million people.
Fact 5
• Mental disorders are important risk factors for other diseases, as well as
unintentional and intentional injury, cardiovascular disease, diabetes, and
vice-versa
Fact 6
• Stigma and discrimination against patients and families prevent people
from seeking mental health care
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12. Child health problems
• Children and adolescents with Mental health problems are more likely to
drop school or perform less well in schools (less educated when they grow
older)
• Attention Deficit Hyperactivity Disorder (ADHD) is the most common mental
health problem in children.
• Read More about ADHD here:
http://www.webmd.com/add-adhd/childhood-adhd/ss/slideshow-adhd-in-
children
• Suicide: is self chosen death, and is the third leading cause of death for
children in USA (very different in our region)
• Nurses should be alert to the symptoms of mental illness and potential
suicidal thoughts sand be aware of potential resources for mental health
care services for referral purposes.
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14. Infant Mortality
• Definition: Number of deaths per 100,000 live births during the
first year of life
– Neonatal period: Day 1 to day 27 ,Postnatal period: Day 28
to 1 year of life
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Infant Mortality Estimates
ISO Code Country Name 2013.5
AUS Australia 2.4
BHR Bahrain 2.3
CAN Canada 3.4
DNK Denmark 2.4
IRL Ireland 2.3
JOR Jordan 11.2
QAT Qatar 4.3
CHE Switzerland 3.0
ARE United Arab Emirates 4.8
GBR United Kingdom 2.8
USA United States 4.4

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Child Mortality Estimates
Country-specific under-five mortality rate
Estimates generated by the UN Inter-agency Group for Child Mortality
Estimation (IGME) in 2014
Downloaded from http://data.unicef.org
Last update: 16 September 2014
ISO Code Country Name 2013.5
FRA France 4.2
IRL Ireland 3.8
JOR Jordan 18.7
SAU Saudi Arabia 15.5
ARE United Arab Emirates 8.2
GBR United Kingdom 4.6
USA United States of America 6.9

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17. Birth Weight
• Major determinant of neonatal death, there is a relationship
between Low Birth Weight (LBW) and infant morbidity and
mortality.
• The lower the birth weight the higher the risk of mortality.
• Low birth weight (LBW): Less than 2500 g
• Lower birth weight = Higher mortality rate
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Last update: October 2014
ISO Code Countries and areas Reference year(s)
2009-2013
Total Footnote
ISL Iceland 2012 4
IRL Ireland 2011 5
JOR Jordan 2007 13x
QAT Qatar 2010 8
SAU Saudi Arabia 2012 9
TUR Turkey 2008 11x
ARE United Arab Emirates 2009 6
GBR United Kingdom 2011 7
USA United States 2010 8

18. Causes of Infant Death
• Congenital anomalies ‫الخلقية‬ ‫التشوهات‬
• Sudden infant death syndrome (SIDS)
• Unintentional injury
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MAIN CAUSES OF INFANT DEATH FULL
REPORT

19. Causes of Infant Death (cont’d)
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20. Childhood Mortality
• Injuries are the leading cause of death in
children older than 1 year
– Motor vehicle crashes
– Drowning
– Burns
– Firearms
– Poisoning
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21. Causes of Childhood Death
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22. Causes of Childhood Death (cont’d)
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23. Causes of Childhood Death
(cont’d)
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24. Causes of Childhood Death (cont’d)
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25.  Family-centered care
• Recognizes the family as the constant in a child’s life
• Systems must support, respect, encourage, and enhance the
family’s strength and competence
• Families are the natural care-givers and decision makers for the
child, nurses needs to acknowledge that and support/facilitate its
implementation
• Nurses role is to support their family and help them fulfil their caring
role
• Needs of all family members must be addressed
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PHILOSOPHY OF PEDIATRIC CARE

26. Family-Centered Care (cont’d)
• Two main concepts to achieve the family
centered care
1. Concept of ENABLING: creating opportunities and means for
all family members to display their current abilities and
competence and to acquire new ones to meet the needs of the
child and family. ‫تمكين‬
2. Concept of EMPOWERMENT: the interaction of professionals
with families in such away that families maintain or acquire a
sense of control over their family lives and acknowledge a
positive changes that result from helping behavior that foster
their own strengths, abilities and actions.
Extra Readings on Blackboard.
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27.  Atraumatic care
• Is the provision of therapeutic care in settings, by personnel, and through
the use of interventions, that eliminate or minimize the psychological and
physical distress experienced by children and their families in the health
care system
• Interventions to provide atraumatic care include for examples:
• E.g. 1 Preparing children for the procedure
• E.g. 2 providing space for parents in room to stay with their child
• E.g. 3. modifying environment to enhance comfort play, toys,
drawings, lightening, noise control, etc,
• E.g. 4 modifying policies and guidelines to accommodate such care
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PHILOSOPHY OF PEDIATRIC CARE

28.  Adhere to the United Nations
Declaration of the Rights of the Child
• All children need
– To be free from discrimination
– To develop physically and mentally in freedom
and dignity
– To have a name and nationality
– To have adequate nutrition, housing, recreation,
and medical services
– To receive special treatment if handicapped
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PHILOSOPHY OF PEDIATRIC CARE

29.  Adhere to the United Nations
Declaration of the Rights of the Child
• All children need (cont’d)
– To receive love, understanding, and maternal
security
– To receive an education and develop his or her
abilities
– To be the first to receive protection in disaster
– To be protected from neglect, cruelty, and
exploitation
– To be brought up in a spirit of friendship among
people
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30. Pediatric Nurse’s Role
1. Therapeutic relationship building
– Negotiating a meaningful relationship with the child and family
within well-defined boundaries
– Pediatric nurses needs to establish meaningful relationships with
children and families but remain separate enough to distinguish
their own feelings and needs, IF NOT, pediatric nursing can be
emotionally exhausting.
2. Family advocacy and caring
– Advocate the provision of atraumatic care
– The nurse assist child and family make an informed decisions
– Ensuring that family is aware of all the healthcare
resources/services available for their child.
– Demonstrate caring, empathy, and good listening skills when
dealing with parents and children
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31. Pediatric Nurse’s Role
3. Disease prevention and health promotion
– Educate about health promotion and injury prevention using
anticipatory guidance
4. Health Teaching
5. Support by providing or referring to counseling
6. Coordination and collaboration of care:
• This role is especially importance in pediatric nursing as the
whole family members requirements needs to be taken into
consideration, this can make it challenging as well.
7. Ethical decision making
– Who make the final decision about treatment, child, parent, or
healthcare professional.
– Participation of children in research
– Create an environment that embraces discussion of ethical
dilemmas and employs mechanisms for dispute resolution
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