Unit 1

PEDIATRICS INTRODUCTION &

OVERVIEW

By Selemaye Z. (MSc in PCHN)

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objectives
At the end of this session the
students will be able to:-
 Define pediatrics
 Define pediatrics nursing
 Describe goals and principle of
pediatrics nursing
 Differentiate between child and
adult
 Explain approach for pediatric Hx
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Con….
 PEDIATRICS derived from Greek words.
PEDIA means CHILD
IATRIC means TREATMENT
ICS means BRANCH OF SCIENCE
 So, Pediatrics can be defined as the
branch of medical science that deals
with the care of the children, from
conception to adolescence, in health
and illness.
 It is concerned with preventive, curative,
& rehabilitative care of children
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Introduction
Pediatricsis the discipline
dedicated to all aspects of the
well-being of infants, children,
and adolescents including their
health;
◦ Their physical, mental, and
psychologic growth and
development; and their opportunity
to achieve full potential as adults.

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Con…..
The life of the child may be divided into the
following periods:-
1. The prenatal period = before birth
2. Neonatal = first 4 weeks of birth
3. Infancy = first year of life
4. Toddler = 1-3 years of life
5. Preschool = 3 - 5 years of age (early
childhood)
6. School age = 6-12 years of age (late
childhood)
7. Puberty = starts 10-12 years of age in girls
and one to two yrs. later in boys
8. Adolescence of youth = 12 - 18 yrs.
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Con…
Children cannot advocate for themselves
As the professionals whose entire
purpose is to advance the well-being of
children, we all must be advocates for
the individual child and for all children,
irrespective of backgrounds &
boundaries
The more politically, economically, or
socially privileged a population or a
nation is, the greater the need for
advocacy for children

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Con……
The young are often among the
most vulnerable or disadvantaged
-require special attention.
As world is through modernization
positively and negatively, a global,
rather than a national, perspective
for the field of pediatrics becomes
both a reality and a necessity.

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Scope and History

More than a century ago,

pediatrics emerged as a medical
specialty in response
In 1959, the UN -Declaration of
the Rights of the child,
articulating the universal
presumption that
◦ children everywhere have
fundamental needs and rights

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Scope and History Pediatrics

 Early primitive people were used to

destroy those who were sick or
weak
 In Egypt, as early as 1500 BC,
children received treatment, which
differed from that given to adults
 Egyptian children were cared for by
dressing infants in loose clothes and
breast-feeding was encouraged

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Con…
Due to the speed of modern
transport and exploding world
population brought people of the
world closer.
Thus, health problems that were
the concern only a small segment
of population became threatening
to the whole world.

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Goals of pediatrics
To provide skillful, intelligent ,need
based comprehensive care to
children in health and sickness
To interpret the basic needs of
children to their parents and family
members to guide them in child care
To promote growth and development
of children towards optimum state of
functions and the peak of their
capacity in future
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Principle of pediatrics nursing
Build a working relationship with the
parents and their children from the
time of first contact
Should be aware that all behaviors
should be meaningful
Should accept parents and their
children exactly as they are
Allow them to know that their
problems are important and
professionals are there to help for
solutions
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Principle of pediatrics nursing

Have an empathy for parents and children.

Willing to acknowledge the parents right to
their own decisions concerning their
accident.
Allows the parents and the children to
express their emotions
Ask questions limited to a single idea or
reference.
Speak a language understandable to
parent and children and help parents to
feel that there is unity between health
team
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Pediatrics practice
Pediatrics practice is concerned with
Well being of children towards optimal
functioning
Integration of developmental needs of
children in to nursing care with holistic
approach
Integration of scientific principles and theory
related to child heath in to nursing practice
Delivering care to the family
Interdisciplinary team approach
Focusing on the ethical moral and legal
problems regarding child care
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Aspects of pediatrics
Nursing
Pediatric
nursing practice
depends on the 3 aspects;
1. Family centered
2. A traumatic care
3. Case management

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Family centered care
Family is constant
Family/professional collaboration
Exchanging complete and
unbiased information
Honoring of cultural diversity
Different methods of coping
Family-family support
Appreciating families as family

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Traumatic care
The overriding goal in providing a
traumatic care is first do no
harm.
Three principles provide the
frame work for achieving this
goal:
Prevent or minimize child separation
from the family
Promote a sense of control
Prevent or minimize bodily injury
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Case management

Itis an approach to coordinate

care controlled costs and
improved patient/family
satisfaction.
Case managers are responsible
and accountable for particular
groups of patients.

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Differences between adult and
pediatric
CHILDREN ARE NOT LITTLE ADULTS
 Different and unique exposures
 Dynamic developmental
physiology
 Longer life expectancy
 Politically powerless

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1.DIFFERENT AND UNIQUE EXPOSURES

 Unique exposure pathways

Trans placental
Breastfeeding
 Exploratory behaviors leading to exposures
Hand-to-mouth, object-to-mouth
Non-nutritive ingestion
 Stature and living zones, microenvironments
Location – lower to the ground
High surface area to volume ratio
 Children do not understand danger
Pre-ambulatory
Adolescence – “high risk” behaviours

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DYNAMIC DEVELOPMENTAL PHYSIOLOGY

More vulnerable
Increased energy, water and
oxygen
Consumption of anabolic state
◦ Absorption
◦ Biotransformation
◦ Distribution
◦ Elimination
◦ Critical windows of development

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3. LONGER LIFE EXPECTANCY

Exposures early in life permit

Manifestation of environmental
illnesses with long latency
periods
◦ More disease
◦ Longer morbidity
„‟Children inherit the world WE
make!‟‟

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4. POLITICALLY POWERLESS

No political voice

Advocacy by health sector
Environmental laws and
regulations
◦ Local
◦ National
◦ International

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Anatomy and Physiology:
Pediatric

Less body fat, increased elasticity

of connective tissue, and close
proximity of organs to the body
surface impair dissipation of
energy applied
Incomplete calcification of bones
and active growth centers
limit absorption of energy and
can increase potential for injury
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Con….
Larger head and tongue
◦ Special attention to positioning
◦ Potential for airway obstruction
Conical-shaped trachea
Shorter trachea
Danger of main stem intubation

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Con…..
Respiratory concerns
Hypoventilation and hypoxia are
more likely than hypovolemia and
hypotension
Injured children can rapidly
deteriorate from labored
breathing to tachypnea and
progress to apnea from
exhaustion
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Con….
Shock
Most pediatric injuries do not
cause immediate blood loss
Bp is a poor indicator of blood
loss and peripheral perfusion
Children remain in compensated
shock longer than adults, but
decline very rapidly

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PEDIATRIC HISTORY TAKING AND PHYSICAL EXAMINATION

Differences of a pediatric history

compared to an adult history:
Content Differences
◦ Prenatal and birth history
◦ Developmental history
◦ Social history of family -
environmental risks
◦ Immunization history

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Parent as Historian

A. Parent's interpretation of signs, symptoms

1. Children > 4yrs age may be able to provide
some of their own
2. Reliability of parents‟ observations varies
3. Adjust wording of questions
B. Observation of parent-child interactions
1. Distractions to parents may interfere with
history taking
2. Quality of relationship
C. Parental behaviors/emotions are important
1. Parental guilt - nonjudgmental/reassurance
2. The irate parent: causes

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Outline of the Pediatric
History
I. C/C
◦ problem/duration) family to seek
medical attention
II. History of Present Illness
◦ historian, r/nship to patient and
their reliability
◦ Age, sex, race, information about
patient
◦ chronological account of the illness,
including any previous treatment
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Pediatric Hx taking and PE out
line
◦ It belongs here if it is relates to the
differential diagnosis for the chief
complaint
◦ duration, aggravation and relieving
factors, associated symptoms, pertinent
positive and pertinent negative findings
History of past illness( any history
of medical or surgical problem, and
any measure/treatment, pregnancy
and birth history

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Con…
Developmental history (contains
different developmental mile stone
and their specific time of
occurrence,
Immunization history
Nutritional history
Family history
Social history
Systemic inquiry (systemic
review) & physical examination
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PHYSICAL EXAMINATION
Differences in Performing A Pediatric
Physical Examination Compared to an
Adult:
I. General Approach
Gather as much data as possible by
observation first
Position of child: parent‟s lap vs. exam
table
Stay at the child‟s level as much as
possible. Do not tower!!
Order of exam: least distressing to most
distressing
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Con…
Rapport with child
◦ Include child - explain to the child‟s
level
◦ Distraction is a valuable tool
Examine painful area last - get
general impression of overall
attitude
Be honest. If something is going
to hurt, tell them that in a calm
fashion.
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Con….
Understand developmental
stages‟ impact on child‟s
response.
For example, stranger anxiety is
a normal stage of development,
which tends to make examining a
previously cooperative child more
difficult.

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Con….
II. Vital signs
Normals differ from adults, and
vary according to age
Temperature
Heart rate
◦ Auscultate or palpate apical pulse or
palpate femoral pulse in infant
◦ Palpate antecubital or radial pulse in
older child

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Con….
D. Respiratory rate -Observe for a
minute.
Infants normally have periodic
breathing so that observing for only
15 seconds will result in a skewed
number
E. Blood pressure
a. Appropriate size cuff - 2/3 width of
upper arm b. Site

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Con….
F. Growth parameters - must plot
on appropriate growth curve
a. Weight
b. Height/length
c. OFC: Across frontal-occipital
prominence so greatest diameter
d. (Occipital Frontal Circumference)
III. Unique findings in pediatric
patients

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Con….
I. General Appearance
A. Statement about striking and/or
important features. Nutritional
status, level of consciousness,
toxic or distressed, cyanosis,
cooperation, hydration,
dysmorphology, mental state
B. Obtain accurate weight, height
and OFC
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 Con…
II. Head
Size and shape
Fontanelle(s) • Size • Tension - calm
and in the sitting up position
Sutures - overriding
Scalp and hair
Signs of rickets (depending on age

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Con….
III. Eyes
A. General • Strabismus • Slant of
palpebral fissures • Hypertelorism
or telecanthus
B. Conjunctiva, sclera, cornea
C. Plugging of nasolacrimal ducts
D. Epicanthal folds

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Con….
III. Ears
Position of ears Observe from
front and draw line from inner
canthi to occiput
Tympanic membranes
Hearing - Gross assessment only
usually
IV. Nose
A. Nasal septum B. Mucosa (color,
polyps) C. Sinus tenderness D.
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Con….
V. Mouth and Throat A. Lips (colors,
fissures) B. Buccal mucosa (color, vesicles,
moist or dry)
C. Tongue (color, papillae, position,
tremors)
D. Teeth and gums (number, condition)
E. Palate (intact, arch)
F. Tonsils (size, color, exudates)
G. Posterior pharyngeal wall (color, lymph
hyperplasia, bulging)
H. Gag reflex
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Con….
VI. Neck
A. Thyroid B. Trachea position C.
Masses (cysts, nodes) D. Presence
or absence of nuchal rigidity
VII. Lungs/Thorax
A. Inspection • Pattern of breathing

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Con….
Abdominal breathing is normal in
infants Period breathing is
normal in infants (pause < 15
seconds)
Respiratory rate
Use of accessory muscles:
retraction location, degree/flaring
Chest wall configuration

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Con….
Auscultation
Equality of breath sounds, Rales,
wheezes, rhochi , Upper airway noise
Percussion and palpation often not
possible and rarely helpful
VIII. Cardiovascular
A. Auscultation •
Rhythm • Murmurs • Quality of heart
sounds
B. Pulses • Quality in upper and lower
extremities
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Con…
IX. Abdomen
A. Inspection
◦ Shape
◦ Infants usually have protuberant abdomens
◦ Becomes more scaphoid as child matures
◦ Umbilicus (infection, hernias)
◦ Muscular integrity (diasthasis recti
B. Auscultation
C. Palpation
 Tenderness - avoid tender area until end of exam
 Liver, spleen, kidneys
 May be palpable in normal newborn
 Rebound, guarding
 Have child blow up belly to touch your hand

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Con…..
X. Musculoskeletal
A. Back • Sacral dimple • Kyphosis, lordosis
or scoliosis
B. Joints (motion, stability, swelling,
tenderness)
C. Muscles
D. Extremities ;- Deformity , Symmetry ,
Edema and Clubbing
E. Gait
◦ In-toeing, out-toeing
◦ Bow legs, knock knee
◦ Limp, Hips
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Con…..
XI. Neurologic –
most accomplished through
observation alone A. Cranial
nerves B. Sensation C.
Cerebellum D. Muscle tone and
strength
E. Reflexes - DTR • Superficial
(abdominal and cremasteric),
Neonatal primitive
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Con….
XII. GU
A. External genitalia
B. Hernias and Hydroceles
◦ Almost all hernias are indirect
◦ Can gently palpate; do not poke finger into the
inguinal canal
C. Cryptorchidism
• Distinguish from hyper-retractile testis
• Most will spontaneously descend by several
months of life
D. Rectal and pelvic exam not done routinely -
special
indications may exist
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References

Approaches and principles of ped Hx

& PE.
Children's Health and the
Environment, WHO Training Package
for the Health Sector
www.who.int/ceh, 2008.
Nelson Text Book of Pediatrics 20th
ed.
Bates' Guide to Physical Examination
and History Taking, 10th Edition
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