Pediatrics 150 150 Tony Guo



21st Century Pediatric Nursing

Pediatric Health Promotion

  • 24% of the US population is made up of children
  • Healthy People 2020
    • Goals:
      • Increase quality and length of healthy life
      • Eliminate health disparities
    • Leading Health Indicators
      • Physical activity
      • Overweight and obesity
      • Tobacco use
      • Substance abuse
      • Responsible sexual behavior
      • Mental health
      • Injury and violence
      • Environmental quality
      • Injury and violence
      • Access to health care
  • Bright Futures
    • National Health Promotion Initiative with the goal to improve the health of our nation’s children
    • Major themes are:
      • Promoting family support, child development, mental health, healthy nutrition that leads to healthy weight, physical activity, oral health, healthy sexual development and sexuality, safety and injury prevention, and the importance of community relationships and resources.
  • Development
    • Unique to each stage of development- continuous screening and assessment are needed for early intervention.
    • AAP policy statement on screen viewing time – shift of importance from what is on the screen to who is viewing the information with the child.
  • Childhood Health Problems
    • Oral health- dental caries is the most common chronic disease in childhood
      • Early childhood caries is a preventable disease, and nurses play an essential role in educating children and parents about practicing dental hygiene, beginning with the first tooth eruption; drinking fluoridated water, including bottled water; and instituting early dental preventive care.
    • Obesity & Type 2 DM
      • The most common nutritional problem among children in the United States
      • Overweight is defined as a BMI at or above the 85th percentile and below the 95th percentile for children and teens of the same age and sex.
      • Lack of physical activity related to limited resources, unsafe environments, and inconvenient play and exercise facilities, combined with easy access to television and video games, increases the incidence of obesity among low-income minority children.
    • Childhood injuries
      • Most common cause of death & disability in children
      • Risk factors
        • Sex
          • Preponderance of males; difference mainly the result of behavioral characteristics, especially aggression
        • Temperament
          • Children with difficult temperament profile, especially persistence, high activity level, and negative reactions to new situations
        • Stress
          • Predisposes children to increased risk-taking and self-destructive behavior; general lack of self-protection
        • Alcohol and drug use
          • Associated with higher incidence of motor vehicle injuries, drownings, homicides, and suicides
        • History of previous injury
          • Associated with increased likelihood of another injury, especially if initial injury required hospitalization
        • Developmental characteristics
        • Mismatch between child’s developmental level and skill required for activity (e.g., all-terrain vehicles)
        • Natural curiosity to explore environment
        • Desire to assert self and challenge rules
        • In older child, desire for peer approval and acceptance
        • Cognitive characteristics (age-specific)
        • Infant
          • Sensorimotor: explores environment through taste and touch
        • Young child
          • Object permanence: actively searches for attractive object; cause and effect: lacks awareness of consequential dangers; transductive reasoning: may fail to learn from experiences (e.g., perceives falling from a step as a different type of danger from climbing a tree); magical and egocentric thinking: is unable to comprehend danger to self or others
        • School-age child
          • Transitional cognitive processes: is unable to fully comprehend causal relationships; attempts dangerous acts without detailed planning regarding consequences
        • Adolescent
          • Formal operations: is preoccupied with abstract thinking and loses sight of reality; may lead to feeling of invulnerability
        • Anatomic characteristics (especially in young children)
        • Large head
          • Predisposes to cranial injury
        • Large spleen and liver with wide costal arch—
        • Predisposes to direct trauma to these organs
        • Small and light body
          • May be thrown easily, especially inside a moving vehicle
        • Other factors
          • Poverty, family stress (e.g., maternal illness, recent environmental change), substandard alternative child care, young maternal age, low maternal education, multiple siblings
      • Drowning is one of the leading causes of death; Children left unattended are unsafe even in shallow water
      • Burns are among the top three leading causes of death from injury in children 1 to 14 years of age
      • Improper use of firearms is the fourth leading cause of death from injury in children 5 to 14 years of age
    • Violence
      • Strikingly higher homicide rates are found among minority populations, especially African-American children.
      • Violence seems to permeate US households through television programs, commercials, video games, and movies, all of which tend to desensitize the child toward violence.
      • Families that own firearms must be educated about their safe use and storage.
    • Bullying
      • This is a serious problem and can involve emotional, physical, verbal, and cyber-related abuse
      • When youth are not well accepted by their peers, they are vulnerable to bullying; physical disabilities, obesity, and sexual orientation can be risk factors creating vulnerability.
    • Mental health problems
      • Nurses should be alert to the symptoms of mental illness and potential suicidal ideation and be aware of potential resources for high-quality integrated mental health services.

Infant Mortality

  • Number of deaths per 1000 live births during first of life
    • 5.9 per 1000 in the U.S.
  • Leading causes of death in the U.S.:
  • Birth defects
  • Preterm birth & low birth weight
  • Sudden Infant Death Syndrome (SIDS)
  • Maternal pregnancy complications
  • Texas has a rate of 5.9 per 1000


Child Mortality

  • Death rates for children older than 1 year of age have always been lower than those for infants.
  • A sharp rise occurs during later adolescence, primarily from injuries, homicide, and suicide
  • Five leading causes of Death in Children in the United States: Selected Age intervals by Rate per 100,000 population
Rank 1-4 years of age 5-9 years of age 10-14 years of age 15-19 years of age
Causes Rate Causes Rate Causes Rate Causes Rate
1 Injuries  7.6 Injuries  3.6 Injuries  3.6 Injuries  17.7
2 Congenital anomalies  2.5 Cancer  2.1 Suicide  2.1 Suicide  8.7
3 Homicide  2.3 Congenital anomalies  0.9 Cancer  2.0 Homicide  6.7
4 Cancer  2.0 Homicide  0.6 Congenital anomalies  0.8 Cancer  2.9
5 Heart disease  0.9 Heart disease  0.3 Homicide  0.8 Heart disease  1.4


Childhood Morbidity

  • Illnesses severe enough to limit activity or require medical attention
    • Most common childhood illness is the cold
    • Respiratory illness accounts for 50% of all acute conditions
    • 11% are caused by infections and parasitic disease
    • 15% are caused by injuries


Pediatric Nursing Care

  • Family-centered care:
    • Recognize the family as a constant in the child’s life
    • Support the competence of the family
    • Address the needs of all family members
    • Enable and empower families
  • Key elements of Family-Centered Care
    • Incorporating into policy and practice the recognition that the family is the constant in a child’s life, whereas the service systems and support personnel within those systems fluctuate
    • Facilitating family-professional collaboration at all levels of hospital, home, and community care:
      • Care of an individual child
      • Program development, implementation, and evaluation
      • Policy formation
    • Exchanging complete and unbiased information between family members and professionals in a supportive manner at all times
    • Incorporating into policy and practice the recognition and honoring of cultural diversity, strengths, and individuality within and across all families, including ethnic, racial, spiritual, social, economic, educational, and geographic diversity
    • Recognizing and respecting different methods of coping and implementing comprehensive policies and programs that provide developmental, educational, emotional, environmental, and financial support to meet the diverse needs of families
    • Encouraging and facilitating family-to-family support and networking
    • Ensuring that home, hospital, and community service and support systems for children needing specialized health and developmental care and their families are flexible, accessible, and comprehensive in responding to diverse family-identified needs
    • Appreciating families as families and children as children, recognizing that they possess a wide range of strengths, concerns, emotions, and aspirations beyond their need for specialized health and developmental services and support


  • Empowerment describes the interaction of professionals with families in such a way that families maintain or acquire a sense of control over their family lives and acknowledge positive changes that result from helping behaviors that foster their own strengths, abilities, and actions.


Family, Social, Cultural, and Religious Influences on Child Health Promotion

  • Family Systems Theory
    • A change in any part of a family system affects all other parts of the family
  • Family Stress Theory
    • Stress is an inevitable part of family life and any event can be stressful on the family
  • Developmental Theory 
    • Families develop and change over time in similar and consistent ways


Assumptions Strengths Limitations Applications
Family Systems Theory
A change in any one part of a family system affects all other parts of the family system (circular causality).

Family systems are characterized by periods of rapid growth and change and periods of relative stability.

Both too little change and too much change are dysfunctional for the family system; therefore, a balance between morphogenesis (change) and morphostasis (no change) is necessary.

Family systems can initiate change, as well as react to it.

Applicable for family in normal everyday life, as well as for family dysfunction and pathology.

Useful for families of varying structure and various stages of life cycle.

More difficult to determine cause-and-effect relationships because of circular causality. Mate selection, courtship processes, family communication, boundary maintenance, power and control within family, parent-child relationships, adolescent pregnancy and parenthood.


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