Medical Science related to diagnosis and tx of childhood ilness.

Have to adapt care based on age, size, and growth, as well as level of development

Often not just focusing on pt, but also on family as well.

It's not individulized.

Use parents as resources. Look at them for input.

In most cases parents have authority to make healthcare decisions.

Exceptions: actual/suscepted child abuse/neglect, parents incapcitated and if parents aren't permitting life.

Apples confidentiality.

Exception is hazardous to community. Can impact others then you do need to share.

Suspected child abuse have to be reported and child threatening to hurt/injure themselves.

1 Trust vs mistrust - 1 yr (need to be held fed)

2 Autonomy vs Shame & Doubt - 1-3yrs (indepedent)

3 Initiative vs guilt - 3-6yrs preschool (trying to please)

4 Industry vs inferiority - 6-12yrs (desire to learn, can act out)

5 identity vs role confusion - 12-18yrs adolescence (develop own identity, trying to fit in, thinks their infallible)

Directed towards parents.

Hold child to interact.

Encourage parent to be with child as much as possible to help with care.

Keep it simple & brief. No medical terminology.

Talk to them right before procedure.

They have no sense of time. Relate it to meal times.

Be honest.

They use cause and effect, but not correct associations.

Use therapeutic play to get their feelings out.

They can begin to take an active role in their care.

They understand instructions.

They'll ask questions.

They can be responsible for certain aspects for their care.

Their responsive to 1:1 care.

Want to know, but may be embarrassed.

They're modest.

1:1 is helpful.

Build trust and ask open ended questions.

Might be bitter/frustrated/angry/noncooperative.

Do not judge them.

Separation anxiety.

They want their mom.

longer separation goes they find another caregiver to attach to. It can become an issue.

Regression typically happens. (bedwetting)

Also nightmares/neg behavior.

Mutilation and bodily harm.

They have an active imagination.

Tend to misinterpret words. Keep it simple.

They'll see illness as a punishment.

Regression sometimes occurs.

Therapeutic play very helpful.

Pain and bodily injury.

Fear of loss of control.

Fears related to what they're missing in school and peers.

Ask questions.

Separation isn't a big issue.

Start first when doing vitals.

Infants and young children (2-3) are abdominal breathers so watch bellies.

Watch for flaring and retractions. Chest looks like it's caving in. Ribcage almost sucking in. Distressed.

Infants and young children count for a full minute b/c they're irregular and almost like cheynes stokes.

Route depends on age.

4 and under axillary/temporal.

Never leave a child while taking a temp.

Usually do apical.

Radial is too hard to find.

5 & under apical for full minute.

**kids change very quickly!

Don't routinely do on little ones unless surgery/illness.

Cover 2/3 of upper arm.

Most younger kids done electronically.

Always explain that it's going to squeeze.

Introduced 3-6months.

Give solids first, make sure they swallow.

7-8 months.

Encourage older children to pick their own foods.

Don't force child to eat if they don't really want to.

1,000ml/day todders and up

Children dehydrate more quickly.

careful monitoring

Sites checked every 30-60min

 Overload can be fatal

Children IV in foot/scalp b/c IVS can be dislodged.

Scalp veins close to surface.

Apply to children

Explain to child what they're taking

And if it's going to hurt and that it's okay to cry

Watch them take med

P.O  liquid for smaller child/infant

Don't mix med unless you absolutely have to.

If you have to mix use very little liquid. Don't put it in bottle.

IM if baby is 1yr/younger. Gluteal muscles are not developed. Give in vastus lateralis.

Takes in account the child's weight

Two nurses do the calculation

Newborns sleep on bakcs.

Resting big for healing.

try not to use, but sometimes have to

Mummy/elbow restraints

Have to order!

Check reflexes. Moro (startle) Rooting (stroke cheek, turn)

Check fontanels anterior & posterior. Anterior closes in 18 months. If dehydrated they sink in.

Fear of improper care, lack of confidence, fear that child will suffer, fear of unknown.

Even newborns get pain meds.

Mental, emotional, social, and spirtual stability.

Effected by genetics, physical health, family, culture, where they live, economic status, as well as self concept.

Physical, emotional, neglect, or sexual

Abuse can occur in any household, any race, age, socioeconomic, group, religion, sex.

Legally bound to identify and report abusive or potentially abusive situations ASAP!

Look at symptoms and what you're being told. If they don't match you need to report.

Watch parent & child interaction.

1 history of abuse, tends to repeat

2 use of alcohol/drugs

3 stressful situations

4 lack of knowledge about normal growth and development

Be reassuring.

Assign same nurse to build comfort.

Don't be judgmental.

Emotional abuse is harder to pick up. 

can't please parents.

Say things like everything they do is wrong.

Link to physical cause such as cleft palate/cardiac problems/malabsorption.

Kids tend to be irritable, can starve to death, even if caught early can have developmental issues.

Often from abuse. No physical cause

No bond between parent & child. No interaction.

Kids tend to be irritable, can starve to death. Even if caught early can have developmental issues.

Complex developmental disability.

result of a neurological disorder that affects normla funcitioning of brain.

Mild-severe effects.

Impaired/difficult social interactions

Diff in verbal and nonverbal communication

Restricted and repetitive behavior (headbanging/twirling)

Stereotyped interests/activites (focused)

Some have intellectual disabilities, motor defects, ADHD

Some are intellectually gifted and excel in certain areas.

Effects males more.

NOT caused by thimerosal in vaccines

NOT caused by MMR vaccine

Research bio-chemical problem involving neurotransmitters or

Due to abnormalities in CNS and brain metabolism

Increased occurances in paternal age over 50 and under 25

S/SX begin before age 3. Sometimes within the first month.

Infant-shows little or no response to human interaction

Avoids eye contact

Difficulty feeding and sleeping

Shows lack of response to sounds.

Some babies are perfectly fine in infancy than regress.

no babbling or responding to name by 12 months

Not speaking by 16 months

Toddler may suddenly be unable to communicate verbally

May exhibit echolalia (repeating words over and over again)

Possible self destructive acts

May have some sx but have obsessive interest in single subject

have high level of vocab and formal speech patterns

Might be clumsy

high end intellectually (single subject)

Rule out other conditions

3 categories of characteristics

-inability to relate to others

-inability to communicate well with others

-obviously limited activities and intersts

No cure

Behavior modification/highly structured environment

Increasing social awareness

Teach verbal communication skills

Decrease unacceptable behavior

Meds-SSRI, antipsychotic, Ritalin