Mammary gland enlargement, non-purulent vaginal discharge (leukorrhea), and mild uterine withdrawal bleeding (pseudomenstruation) are benign transient findings commonly seen in newborns; they are physiologic responses to transplacental maternal estrogen exposure. Reassurance should be provided.
Shaken baby syndrome is a form of child physical abuse resulting from violent shaking of an infant by the extremities or shoulder that causes bleeding within the brain and/or eyes. The clinical findings of shaken baby syndrome are nonspecific and include lethargy, vomiting, seizures, irritability, inability to eat, and inconsolable crying. Multiple and severe shaking episodes can result in breathing difficulty and lifelessness. Caregivers typically do not report a history of trauma.
Pediatric hospitalization
Toddlers react to the experience of hospitalization with a display of intense emotions, regressive behaviors, and manifestations of separation anxiety. Nursing care centers on integrating home routines into planned activities.
Before initiating a treatment program that requires a client and family to make major lifestyle and behavior changes, the nurse needs to assess readiness for change. Motivation and a desire for change are the keys to successful weight loss.
Lead poisoning can lead to many severe complications of the neurological system (eg, developmental delays, cognitive impairment, seizures). Elevated blood lead levels are particularly dangerous in young children due to immature development of the brain and nervous system.
Coping mechanisms used by hospitalized toddlers include following homes rituals and routines, having parents stay with the child (including overnight), and using the playroom for relief of anxiety and fear.
The nurse's role with a dying client is to aid communication. When a dying child asks about death, the parents should know about the child's concerns.
When assessing an infant, the nurse should observe, auscultate, palpate, and then perform traumatic procedures (eg, examine eyes, ears, mouth). Elicitation of the Moro reflex should be performed last.
Toddlers and pre school age experience anxiety, key nursing interventions to alleviate separation anxiety include encouraging:
- the presence of favorite items
-establishing a daily routine
-proving opportunities for play
-facilitating phone calls
with the parents
-proving support when the child is upset.
*infants should doble in birth weight by age 6 months and triple in birth weight by age 12 months. At birth, head circumference is slightly more than chest circumstances, but these equalized by age 12 months. The posterior fontanelle fuses by age 2 months, and anterior fontanelle fuses by age 18 months.
Development milestone of Toddler
Development milestone of Infant
Preschool-age
children (3-6 years)
Preschool-age children (3-6 years) are in Piaget's preoperational stage of cognitive development. They become increasingly verbal but are unable to understand cause and effect, often ascribing inappropriate causes to phenomena; therefore, the adopted child may feel responsible for being adopted.
Magical thinking is common during the preschool period. It is not unusual for a child to have an imaginary friend, and parents should be taught that this is a normal part of development. Magical thinking satisfies children's questions about the world they live in.
*A 3-year-old should be able to eat with a spoon.
*When a parent tells the nurse that an infant cries "all the time," the priority nursing action is to assess the pattern, quality, and frequency of the child's crying. This will help the nurse determine if the crying is normal infant behavior or a sign of a more serious condition that requires further evaluation and treatment.
*Fine motor skills of infants develop around the ability to grasp objects. Voluntary grasping with the palm begins around 5 months, followed by the ability to transfer an object between hands by 7 months and the development of a crude pincer grasp (using the thumb, index, and other fingers) around 8-10 months.
*Separation anxiety is common during infancy and toddlerhood and may be very stressful for the child.
After age 6 months, infants should not exhibit head lag when raised from a supine to a sitting position. Infants usually engage in interactive play (eg, peek-a-boo) between 10 and 12 months. Infants' weight gain decreases after age 6 months from 5-7 oz (140-196 g) to 3-5 oz (84-140 g) a week
*Infants should double in birth weight by age 6 months and triple in birth weight by age 12 months. At birth, head circumference is slightly more than chest circumference, but these equalize by age 12 months. The posterior fontanelle fuses by age 2 months, and the anterior fontanelle fuses by age 18 months.
*Toddlers typically exhibit parallel play, during which they participate in various activities alongside one another but remain primarily independent. Parallel play is without group organization or common goals.
*If toddlers are not expressing themselves verbally and do not enjoy being talked to or read to, speech and hearing deficits should be explored.
*Separation anxiety is common during infancy and toddlerhood and may be very stressful for the child. Allowing the child to remain with the caregiver when appropriate will promote calmness and decrease the child's stress.
Developmental assessment findings in 2-year-old clients include the ability to build block towers, say their own name, and walk without assistance. The nurse should notify the HCP if a child is not meeting age-appropriate developmental milestones so the child can be referred for further testing.
*Readiness for toilet training is dependent on the child's ability to voluntarily control the anal and urethral sphincters, which usually occurs at age 18-24 months. Other developmental and behavioral indicators of toilet training readiness include the child's ability to express the urge to defecate or urinate, understand simple commands, pull clothing up and down, and walk to and sit on the toilet.
*Toddlers display behaviors associated with negativism and ritualism as they seek autonomy. When teaching about toddler health promotion, the nurse should tell parents to avoid giving options that allow toddlers to say "no", refrain from forcing toddlers to eat, allow toddlers a 15- to 30-minute period to calm down before meals, and use time-outs for management of temper tantrums.
*An 18-month-old should have a vocabulary of at least 10 words and be able to use a spoon.
Toddlers and preschool-age children experience separation anxiety in response to the stress of illness and hospitalization. Key nursing interventions to alleviate separation anxiety include encouraging the presence of favorite items, establishing a daily routine, providing opportunities for play, facilitating phone calls with the parents, and providing support when the child is upset.
*An 18-month-old is developing both fine and gross motor skills, which include going up stairs while holding a hand and turning 2 or 3 pages in a book.
*Friends play a significant role in the adolescent's quest for identity and provide a source of support, belonging, and understanding. Interacting with friends during recuperation after surgery is important to help counteract feelings of loneliness and isolation.
*Nursing care for the hospitalized adolescent client needs to be developmentally appropriate and promote the elimination of stressors. The nurse should encourage adolescent clients to interact with peers, discuss emotions or fears about treatments, and involve the client in decision-making regarding the plan of care.
*Sexual maturation in boys begins with an increase in testicular size, followed by changes in the scrotum, appearance of pubic, axillary, facial, and body hair, and voice changes.
Play serves as an important part of children's emotional, social, and physical development. It is important that they be provided with toys that can help them achieve developmental tasks. Appropriate toys for preschoolers are those that encourage imitation of adults, such as dolls, puppets, imaginative toys, dress-up clothing, medical kits, cars, and planes.
Preschoolers (age 3-6) enjoy associative play, in which children engage in the same type of activity, but the play is unorganized without specific goals or rules. Infants play alone (solitary), toddlers play next to each other (parallel), and school-age children play with others with a common goal (cooperative).
*A child age 3-5 believes death is reversible. A child age 6-9 understands that death is permanent but has difficulty in perceiving one's own death. By age 10-12, a child will be aware that death affects everyone.
FTT is a state of undernutrition and inadequate growth found in infants and young children. Physiologic risk factors for FTT include preterm birth, breastfeeding difficulties, gastroesophageal reflux, and cleft palate. Socioeconomic risk factors include poverty, social or emotional isolation, caregivers with cognitive disabilities or mental health disorders, and lack of nutritional education.
*FTT is generally defined as weight less than 80% of ideal for age and/or depressed weight for length, correcting for gestational age, sex, and special medical conditions. Observation of the child while being fed may provide information related to the cause of inadequate dietary intake, including disturbances in feeding behavior and psychosocial factors.
Nurses performing painful procedures (eg, capillary heel stick) should implement pain management techniques to promote client comfort and stability. Appropriate nonpharmacological pain management interventions for infants include nonnutritive sucking, concentrated sucrose solutions, skin-to-skin contact, and swaddling.
The 2 core symptoms of autism spectrum disorder are abnormalities in social interactions and communication (verbal and nonverbal), and patterns of behavior, interests, or activities that can be restricted and repetitive. Social skills, especially communication, are delayed more significantly than other developmental functioning.
Therapeutic communication
It is important for the nurse to develop a rapport with the child and the caregiver based on mutual trust and respect. Strategies for building this relationship include actively including the child in the interview, using age-appropriate explanations, maintaining an eye level position, and asking open-ended questions.
Separation anxiety disorder
Separation anxiety starts around age 6 months, peaks at age 10-18 months, and can last until age 3 years. It produces more stress than any other factor (eg, pain, injury, change in surroundings) for children in this age range. However, separation anxiety is normal and resolves by age 3 years.
*Hospitalization can be very stressful for a child. Regressive behaviors during hospitalization are a normal response to changes in routine. The nurse should inform the caregivers that this behavior is temporary and that the child will regain lost milestones rapidly after discharge.
*Pharmacological
interventions such as desmopressin and tricyclic antidepressants are often used for nocturnal enuresis treatment in children age >5 years when there has been little or no response to behavioral approaches and/or when short-term improvement of enuresis is desired for attending sleepovers or overnight camp.
*Nocturnal enuresis, or involuntary bed-wetting at night, is managed with a variety of interventions. Initial strategies for addressing nocturnal enuresis include the use of positive
reinforcement, awakening the child at a specified time to void, and having the child assist with wet linen changes
According to Erikson's stages of psychosocial development, school-age children deal with the conflict of industry versus inferiority. During this stage, unlike other developmental stages, learning is a priority and completing school work provides a sense of accomplishment and satisfaction. It is therefore important that parents provide hospitalized school-age children with missed school work on a regular basis.
Hormone replacement therapy
Growth hormone replacement is an option for children who are not growing according to accepted standards. The treatment should begin as soon as delays are noted and continue until bone growth begins to cease despite replacement therapy. Replacement is administered via subcutaneous injections.
Risk factors for FTT include poverty, lack of structured meal times, negative attitudes toward food, domestic violence, and substance abuse.
Poverty-Most common
Social or Emotional isolation: parents may lack the support system needed to assist them with the problems of child rearing.
Cognitive disability or mental health disorder.
Lack of nutritional education.
Regular visits to the dentist, starting within 6 months of first tooth eruption or by the first birthday, are recommended by pediatric professional organizations. Early assessment, dental care, anticipatory guidance, and education about periodontal disease prevention facilitate good oral health for children.
Mobile baby walkers are associated with injuries such as falls and drowning as they can easily tip over. Children can also reach higher places while in a baby walker, enabling them to pull hot objects and dangerous substances off counters and tables
Positional plagiocephaly, or flattening of the skull, can develop when infants spend a lot of time in the same position. Positioning techniques (eg, "tummy time," alternating the head position) can prevent or correct plagiocephaly. Infants should always be placed in the supine position to sleep.
The pincer grasp should be present by age 10 months. Offering small finger foods allows the infant to develop fine motor skills. The child will also enjoy the ability to self-feed and explore a variety of nutritious foods.
The nurse should allow a parent to interact with the toddler and assist with the examination process to encourage client cooperation. Examination of a toddler should proceed from least to most invasive, allowing the client to inspect pieces of equipment before use. Use minimal physical contact initially.
Maintaining psychosocial integrity is a priority when a child is hospitalized. This is achieved by integrating age-appropriate diversions (eg, medical play for a preschooler) in the nursing care.
School-age children possess concrete thinking and fear loss of control. When administering an injection to a school-age child, the nurse should offer a specific, task-based coping technique (eg, instruct the child to count aloud or breathe deeply) to increase the child's sense of control and thereby reduce anxiety.
A child's expression of pain varies based on developmental stage and past experiences with pain. The nurse should use age-appropriate pain scales. A child who is asleep or playing may be experiencing pain.
Hearing impairment in infants delays development of intelligible speech. As these infants become toddlers, they often have a loud voice and monotone speech that is difficult to understand. They appear shy, timid, and inattentive.
Sleep needs of school-age children are dependent on health status, activity level, and age. Required sleep averages 11 hours (for 5-year-olds) to 9 hours (for 12-year-olds). It is important to establish bedtime hours and bedtime rituals. These children usually do not need daytime naps if they have slept well at night.
Aortic root disease (ie, aneurysm, dissection) is the major cause of morbidity and mortality in Marfan syndrome. Therefore, competitive or contact sports are discouraged due to the risk of cardiac injury and sudden death.
Play serves as an important part of children's emotional, social, and physical development. It is important that they be provided with toys that can help them achieve developmental tasks. Appropriate toys for preschoolers are those that encourage imitation of adults, such as dolls, puppets, imaginative toys, dress-up clothing, medical kits, cars, and planes.
Thumb Sucking- Malocclusion- Parent teaching
The risk of teeth misalignment and malocclusion occurs when a child uses a pacifier or sucks the thumb after the eruption of the permanent teeth.
Consumption of any amount of alcohol during pregnancy places a fetus at risk for fetal alcohol syndrome. Clinical manifestations include intellectual disability, developmental delay, and distinct facial characteristics (indistinct philtrum, thin upper lip, epicanthal folds, flat midface, and short palpebral fissures).
Bullying is not a part of normal childhood growth and development. It is abusive behavior that can have lasting and harmful physical and psychological effects on its victims.
Performing a physical assessment in a toddler can be challenging. The nurse should establish a rapport with the parent and then attempt to gain the child's trust. Playing with the child can make the experience easier on the nurse, parents, and child. The nurse should always perform the least invasive procedures first, explain them in simple terms, and praise the child throughout the assessment.