Child Health CHAPTER 19. 2 Child Health Overview Well-child visit –Health professionals assess...

Child Health

CHAPTER 19

2

Child Health Overview

• Well-child visit– Health professionals assess child for:

• Current health status• Progression of growth and development• Need for immunizations

– Health professionals have opportunity to teach parents about child’s growth and development

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Growth and Development• Growth

– Physical increase in whole or any of its part– Parameters of a child’s growth can be

easily measured with accuracy through the following:

• Weight• Head circumference• Length or height• Dentition

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Growth and Development

• Weight– Important indicator of child’s nutritional

status and general growth– Used to calculate medication dosages for

children– Should be measured at every visit

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• Head circumference– Related to intracranial volume– Normal brain growth = expected rate of

increase in head circumference– Abnormal lags or surges may indicate

serious problems

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Growth and Development• Length or height

– Compared with head circumference and weight measurement for overall indicator of physical growth

– Measure infant from crown of head to heel • Place child in recumbent position

– Standing height measurement for children three years or older

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Growth and Development• Dentition

– Refers to eruption of teeth and follows sequential pattern

– Eruption of primary teeth – 6-30 months• Twenty primary teeth

– Eruption of permanent teeth - around 6 years of age

• Normally 32 permanent teeth

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• Development– Increase in function and complexity that

results through learning, maturation, and growth

– Development screening tests used as assessment tools

• Brazelton Neonatal Behavior Assessment Scale for Newborns

• Dubowitz for newborns• Ages and Stages Questionnaires (ASQ)


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• Stages of childhood growth and development – Newborn – birth to one month– Infancy – One month to one year– Toddlerhood – One to three years– Preschool Age – Three to six years– School Age – Six to twelve years– Adolescents – Twelve to eighteen or twenty-

one years


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• Cephalocaudal– Growth and development proceeds from

head to toe• Muscular control follows the spine downward

• Proximodistal– Growth and development proceeds from

center outward or from midline to periphery

Growth and Development Principles

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• General to specific– Activities move from being generalized

toward being more focused

• Simple to complex– Language develops from simple to complex

• Growth spurts– Occur throughout childhood

• Alternate with periods of slow growth

Growth and Development Principles

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Immunizations• Immunization

– Process of creating immunity to a specific disease in an individual

– Medication administered is a vaccine• Suspension of infectious agents or some part of

them• Given to establish resistance to an infectious

disease

• Immunity– State of being immune to or protected from a

disease, especially an infectious disease

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• Childhood immunizations– Administered to well child according to specific

schedule– Recommended childhood immunizations

• Hepatitis B• DTaP• Hib• Polio (IPV)• MMR• Varicella• PCV

Immunizations

COMMUNICABLE DISEASES

Child Health

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• Chicken Pox (Varicella)– Viral disease of sudden onset with slight

fever, successive eruptions of macules, papules, and vesicles on the skin, followed by crusting over of lesions with a granular scab

• Itching may be severe

– Infectious agent: Varicella-Zoster virus– Immunization: varicella vaccine

Communicable Diseases

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• Diphtheria– Serious infectious disease affecting nose,

pharynx, or larynx, usually resulting in sore throat, dysphonia, and fever

– Infectious agent: • Corynebacterium diphtheriae

– Immunization: • One of the components of the DPT vaccine


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• Erythema infectiosum (fifth disease)– Viral disease characterized by a face that

appears as “slapped cheeks,” a fiery red rash on the cheeks

– Infectious agent: • Human Parvovirus


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• Impetigo– Contagious superficial skin infection

characterized by serous vesicles and pustules filled with millions of staphylococcus or streptococcus bacteria, usually forming on the face

• Progresses to pruritic erosions and crusts with a honey-colored appearance

• Highly contagious lesions


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• Mumps (Infectious Parotitis)– Acute viral disease characterized by fever,

swelling, and tenderness of one or more salivary glands, usually the parotid glands

– Infectious agent: • Mumps virus

– Immunization:• One of the components of the MMR vaccine


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• Pertussis (Whooping Cough)– An acute upper respiratory infectious disease

that occurs mainly in children and infants• Characterized by violent cough that consists of

series of several short coughs, followed by a long drawn inspiration during which the typical whoop is heard

– Infectious agent: • Bordetella pertussis

– Immunization: • One of the components of the DPT vaccine


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• Roseola infantum– Viral disease with a sudden onset of a high

fever for 3 to 4 days during which time the child may experience mild coldlike symptoms and slight irritability

• Fever falls rapidly on the 3rd or 4th day and a maculopapular rash appears on the trunk

• Rash expands to rest of body – Fades in 24 hours

– Infectious agent: • Herpes virus 6


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• Rubella (German Measles, Three-day Measles)– Mild febrile infectious disease resembling

both scarlet fever and measles• Characterized by a rash of both macules and

papules that fades and disappears in 3 days• Koplik’s spots and photophobia are not present

with Rubella


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• Rubella (German Measles, Three-day Measles)– Infectious agent:

• Rubella virus



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• Rubeola (“Red Measles,” Seven-day Measles)– Acute, highly communicable viral disease– Begins as an upper respiratory disorder– Fever, sore throat, cough, runny nose,

sensitivity to light, and possible conjunctivitis• Typical red, blotchy rash appears 4 to 5 days after

onset of symptoms• Behind ears, on forehead or cheeks, progressing

to extremities and trunk – lasts about 5 days


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• Rubeola (“Red Measles,” Seven-day Measles)– Infectious agent:

• Measles virus



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• Scarlet Fever (Scarlatina)– Acute, contagious disease characterized by

sore throat, abrupt high fever, increased pulse, strawberry tongue, and pointlike bright red rash on the body

– Infectious agent: • Group A beta-hemolytic streptococci


PATHOLOGICAL CONDITIONS

Child Health

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Asthma• Pronounced

– (AZ-mah)

• Defined– Paroxysmal dyspnea

• Severe attack of difficulty breathing

– Accompanied by wheezing caused by a spasm of bronchial tubes or by swelling of their mucous membrane

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• Asthmatic attack– Starts suddenly with coughing and a sensation

of tightness in the chest– Followed by slow, laborious, wheezy breathing

• Expiration is more strenuous and prolonged than inspiration

• Patient may assume a “hunched forward” position in an attempt to get more air

– Status Asthmaticus• Severe asthma that is unresponsive to conventional

therapy and lasts longer than 24 hours

Asthma

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• Pronounced– (CLEFT LIP and PAL-at)

• Defined– Cleft Lip is a congenital defect in which there

is an open space between nasal cavity and lip

• Due to failure of soft tissue and bones in this area to fuse properly during embryonic development

Cleft Lip and Palate

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Cleft Lip and Palate• Defined

– Cleft Palate is failure of the hard palate to fuse, resulting in a fissure in the middle of the palate

• Newborn has difficulty with feeding and breathing as result of the abnormalities

• Medical management and surgical intervention are necessary

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• Pronounced– (koh-ark-TAY-shun of the ay-OR-tah)

• Defined– Congenital heart defect characterized by a

localized narrowing of the aorta• Results in increased blood pressure in upper

extremities and decreased blood pressure in lower extremities

Coarctation of the Aorta

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Croup• Pronounced

– (CROOP)

• Defined– Childhood disease characterized by a barking

cough, stridor and laryngeal spasm• Stridor = high-pitched musical sound when

breathing in

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Cryptorchidism

• Pronounced– (kript-OR-kid-izm)

• Defined– Condition of undescended testicle(s)– Absence of one or both testicles from the

scrotum

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Down Syndrome

• Pronounced– (DOWN SIN-drohm)

• Defined– Congenital condition characterized by

multiple defects and varying degrees of mental retardation

– Trisomy 21

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• Clinical manifestations– Evident at birth

• Low set ears• Short broad appearance to the head• Protruding tongue• Short thick neck• Simian line• Transverse crease on palm• Broad short feet and hands• Poor or diminished muscle tone• Hyperflexible joints

Down Syndrome

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Dwarfism

• Pronounced– (DWARF-izm)

• Defined– Generalized growth retardation of the body

due to the deficiency of the human growth hormone

– Also known as congenital hypopituitarism or hypopituitarism

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Epispadias

• Pronounced– (ep-ih-SPAY-dee-as)

• Defined– Congenital defect in which the urethra opens

on the upper side of the penis at some point near the glans

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Epispadias

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• Pronounced– (eh-rith-roh-blass-TOH-sis fee-TAL-iss)

• Defined– Hemolytic anemia that occurs in neonates due

to a maternal-fetal blood group incompatibility, involving ABO grouping or Rh factors

– Also known as hemolytic disease of newborn (HDN)

Erythroblastosis Fetalis

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Esophageal Atresia• Pronounced

– (ee-soff-ah-JEE-al ah-TREE-zee-ah)

• Defined– Congenital abnormality of esophagus due to

its ending before it reaches the stomach either as a blind pouch or as a fistula connected to the trachea

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Gigantism

• Pronounced– (JYE-gan-tizm)

• Defined– Proportional overgrowth of body’s tissue due

to hypersecretion of human growth hormone before puberty

• Child experiences accelerated abnormal growth chiefly in long bones

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Hyaline Membrane Disease

• Pronounced– (HIGH-ah-lign MEM-brayn dih-ZEEZ)

• Defined– Severe impairment of respiration in premature

newborn – Also known as respiratory distress syndrome

of the premature infant (RDS)

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Hydrocele

• Pronounced– (HIGH-droh-seel)

• Defined– Accumulation of fluid in any saclike cavity or

duct, particularly scrotal sac or along spermatic cord

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Hydrocephalus

• Pronounced– (high-droh-SEFF-ah-lus)

• Defined– Congenital disorder in which there is an

abnormal increase of cerebrospinal fluid in the brain that causes the ventricles of the brain to dilate

• Results in increased head circumference in the infant with open fontanels

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Hypospadias

• Pronounced– (high-poh-SPAY-dee-as)

• Defined– Congenital defect in which the urethra opens

on the underside of the penis instead of at the end

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Hypospadias

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Intussusception

• Pronounced– (in-tuh-suh-SEP-shun)

• Defined– Telescoping of a portion of proximal intestine

into distal intestine usually in the ileocecal region causing an obstruction

• Typically occurs in infants and young children

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Patent Ductus Arteriosus

• Pronounced– (PAY-tent DUK-tus ar-tee-ree-OH-suss)

• Defined– Abnormal opening between pulmonary artery

and aorta caused by failure of fetal ductus arteriosus to close after birth

• Defect seen primarily in premature infants

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Phimosis

• Pronounced– (fih-MOH-sis)

• Defined– Tightness of foreskin (prepuce) of penis of

male infant that prevents it from being pulled back

• Opening of foreskin narrows due to tightness and may cause some difficulty with urination

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• Pronounced– (RISE SIN-drohm)

• Defined– Syndrome marked by severe edema of the

brain and increased intracranial pressure, hypoglycemia, and fatty infiltration and dysfunction of the liver

• Symptoms may follow an acute viral infection, occurring in children below the age of 18, often with fatal results

Reye’s Syndrome

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Shaken Baby Syndrome• Pronounced

– (Shaken Baby SIN-drom)

• Defined– Serious form of child abuse that describes a

group of unique symptoms resulting from repetitive, violent shaking

– Violent shaking (forward and backward shaking) produces acceleration

– Deceleration forces within the head of the child that can cause brain injury

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Spina Bifida Occulta

• Pronounced– (SPY-nah BIH-fih-dah oh-KULL-tah)

• Defined– A congenital defect of central nervous system

in which back portion of one or more vertebrae is not closed

• Dimpling over area may occur

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Sudden Infant Death Syndrome (SIDS)

• Pronounced– (Sudden Infant Death SIN-drohm)

• Defined– Completely unexpected and unexplained

death of an apparently well, or virtually well, infant

– “Crib death”

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Tay-Sachs Disease

• Pronounced– (TAY-SACKS dih-ZEEZ)

• Defined– Congenital disorder caused by altered lipid

metabolism due to an enzyme deficiency

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Tay-Sachs Disease

• Symptoms of neurological deterioration – Occur around age of six months– Progressive - due to accumulation of a

specific type of lipid in the brain• Physical and mental retardation also occur

– Deafness, blindness with a cherry red spot on each retina, convulsions, and paralysis

• Death occurs around the age of two to four years

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• Pronounced– (teh-TRALL-oh-jee of fal-OH)

• Defined– Congenital heart anomaly that consists of four

defects: – Pulmonary stenosis; – Interventricular septal defect– Dextroposition of the aorta so it receives blood from

both ventricles– Hypertrophy of the right ventricle

• Babies are termed “blue babies”

Tetralogy of Fallot

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• Defects of tetralogy of Fallot (1) Pulmonary stenosis

• Restricts flow of blood from heart to lungs

(2) Interventricular septal defect• Creates right-to-left shunt between ventricles• Allows deoxygenated blood to communicate with

oxygenated blood

Tetralogy of Fallot

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• Defects of tetralogy of Fallot (3) Shifting of aorta to the right

• Aorta overrides right ventricle• Aorta communicates with interventricular septal

defect• Oxygen-poor blood passes more easily into aorta

(4) Hypertrophy of right ventricle• Occurs because of increased work required to

pump blood through obstructed pulmonary artery

Tetralogy of Fallot

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Transposition of the Great Vessels

• Pronounced– (trans-poh-SIH-shun of the great vessels)

• Defined– Condition in which two major arteries of the

heart are reversed in position, resulting in two non-communicating circulatory systems

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Umbilical Hernia

• Pronounced– (um-BILL-ih-kahl HER-nee-ah)

• Defined– Outward protrusion of intestine through a

weakness in abdominal wall around the umbilicus

• Umbilicus = navel or “belly button”

DIAGNOSTIC TECHNIQUES, TREATMENTS

AND PROCEDURES

Child Health

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Diagnostic Techniques, Treatments, and Procedures

• Heel puncture– Method of obtaining a blood sample from a

newborn or premature infant by making a shallow puncture of the lateral or medial area of the plantar surface of the heel

– “Heel stick”

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• Pediatric urine collection– Pediatric urine collection bag is applied to the

perineal area of the infant so urine can collect in the bag for a specimen

• Skin must be completely dry for the bag to adhere

Diagnostic Techniques, Treatments, and Procedures

Child Health CHAPTER 19. 2 Child Health Overview Well-child visit –Health professionals assess...

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