Pediatrics &

Child Health
Nursing
By: Milion R. (BSc, MScN)
For Nursing
 UNIT ONE
OVERVIEW OF CHILD HEALTH CARE

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Learning Objectives:

After completion of this unit, the you will be able to

describe:

 Definition of pediatrics/child health

 Origin and history of pediatrics

 Pediatrics history taking and physical examination

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Introduction
Definition:
 Child Health is the purview of pediatrics.

 I.e. Pediatrics ↔ Child Health.

 Pediatrics: the term pediatrics is derived from

Greek words:
 •“pedia” meaning a child •“iatrike” meaning
treatment (Rx.) •“ics” meaning a branch of science.
 Thus, pediatrics is a study of the child from

conception; their growth and development, as well

as their opportunity to achieve full potential as
adults.
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Origin and history of pediatrics:

 Pediatrics became a medical specialty in the mid

–19th century.
 Before that time the care and treatment of
childhood diseases was included with in general
medicine and obstetrics.
 Virtually all nations have been practicing
departments of pediatrics or child health.
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 Cont’d
 With some reasons, pediatrics became an
independent medical specialty:
 The health problems of children differ from those

of adults.
 Children response to an illness is influenced by

age.
 Management of childhood illness is significantly

d/t with that of adults.

 Worldwide, children represent a higher
proportion of total population.

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Definitions of some Terms (Age
Classifications)
 Definition
 Neonate
 Birth to 28 day
 Infancy
 >28 day to 1 year

 Early Childhood
 Toddler
 1-3 years
 Preschool
 3-6 years

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Terms from child health
indicators:
 IUFD - the death of the fetus after 28 weeks of
gestation before the onset of labor.
 Neonatal death - is death of live born up to
28 days
 Early neonatal death - is death of infant
during first seven completed days
 Late neonatal death - is the death of live born
infant after 1 w/k but up to 28 completed days
of life.

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UN Convention on the Rights of
the Child
 The Right
 to Life
 to have a name & identity
 to be raised by his/her parents within a family
 to have a relationship with both parents
 to be protected from abuse

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Promotive, Preventive and Curative
aspects of Child Health:
 Promotive: refers to increases healthiness
through health education.
 Curative: refers to treatment of diseases
through medication.
 Preventive: refers to prevention of diseases
through: Health education, Immunization, and
Environmental sanitation.

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Cont’d
 Prevention is the best measure for maintaining
health.
 There are three levels of prevention:
 Primary
 Secondary and
 Tertiary prevention

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Primary prevention
 The aim is to avoid disease before its onset.
 Growth monitoring: a strategy to monitor the nutritional
status of the children.
 Oral re-hydration: prevent dehydration
 Promotion of breast feeding
 Immunization: developing immunity against infection
through vaccination
 Health education on sanitation:

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Secondary prevention
 Aim: early detection and treatment of the disease.

 Screening methods such as tuberculin surveys

 Treating the respective health problem

Tertiary prevention
 Aim: - rehabilitation, to prevent deformities.

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Pediatric History And Physical
Examination
Pediatric history
• Key elements in the history taking process include.
• Greet in a friendly manner and introduce your self .
• Establishing a warm, caring atmosphere and asking
questions in, unhurried manner
• Use simple language
• Good eye contact and a sense of undivided attention
should be maintained.
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Cont’d…key elements
• sit opposite the caregiver and/or patient at a
comfortable distance
• Outside interruption should be kept to a minimum.
• write notes, and refer to written data as little as
possible.
• Ascertain who is with the child, It may not be the
mother but another family member

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History… components
• Identification
• Name, age, sex, name of parents (informant),date
of examination, date of admission, source of referral
• Chief complaint
• What is the reason for the health visit
• Must be in informants own word and must include
the duration.
• History of present illness
• Chronology, elaboration, associated symptoms
• History of past illness

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 Perinatal history
 ANC contact of the mother
 Any illness during pregnancy like hypertension
 Immunization for tetanus and diphtheria
 The onset, duration of labor or ROM, the mode of delivery,
place of delivery, who conducted the delivery, the birth
weight, APGAR score or did the new born cried immediately
after birth, any procedure immediately after birth.
 Any problems during neonatal period like jaundice, cyanosis

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 Nutritional(dietary)history
 Type of feeding
 Duration of exclusive breast feeding, time of initiation, frequency,
total duration of BF.

 Formula feeding,
 Animal milk, commercial infant formula

 Complementary feeding
 Current diet

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History... Schedule of
immunization
At birth OPV0,BCG
Immunization history
6wks OPV1,DPT+1Hep1+Hib1, PCV 1,
 Is the Rota 1
child/infant OPV2,DPT2+Hep2+Hib2
10wks
PCV 2, Rota 2
being
immunized 14wks OPV3,DPT3+Hep3+Hib3,
PCV 3, IPV
 When was the
last vaccination 9 month Measles, vitamin A (1st)
 Route of
vaccine 15 month Measles, vitamin A (2nd)

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Hitory...
Developmental history
 Growth and development follows a predictable pattern
 Always is cephal to caudal and proximal to distal

• Personal history:
• Child relation with the sibs, other family member and
children in the school

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History...

• Family history:
 health status of siblings, parents and grand
parents.

• Socioeconomic history:
• Family income, occupation of the parents,
housing, school and play facilities available for the
child.
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History...

• Review of systems
• Check list of symptoms
• Almost similar with adults

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Pediatrics physical
examination
IMPORTANT HINTS
 Avoid irritating the child and prevent him from crying (if
possible).
 Examine the child in the most comfortable way according
to his age (exam table, mother’s hands, mother’s lap,
while playing with a toy…).
 Postpone the painful and/or irritating examination
(throat/ears).

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Cont’d
 Specific techniques similar to adult

1. Inspection

2. Palpation

3. Percussion

4. Auscultation

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Cont’d
General appearance
 State of alertness/ level of consciousness.
 Facial expression
 State of nutrition
 hygiene, body posture and movements.

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 Vital signs
 Temperature.
 Heart Rate
 Respiratory Rate.
 Blood Pressure.
 Vital signs vary based on the age of the patient .
 For newborns and infants take apical heart rate
 Take respiratory rate for full minute
 Take rectal temperature for infants
 For measuring BP use the appropriate cuff

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 Vital signs vary based on the age
of the patient:

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 Anthropometric Measurements
(Wt., Ht, HC)
 Use appropriate scale for age to measure the weight.
 Measure recumbent length till 2 years of age and then
standing length (height) after that.
 Head Circumference is the occipitofrontal
circumference and measures the circumference
passing through the most distal points on the occiput
and the frontal area.

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 Stadiometers for Measuring Children

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 Head circumference

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Skin, Hair, and nails
 Skin: - Color, elasticity, rash

 Examine the skin for color, lesions, scars.

 Hair: - Texture, color, distribution, areas of hair loss.

 Nails: - Color, shape.

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Head and neck

Head: - size, shape, fontanelles
 Face: - shape, complexion (pallor, cyanosis, jaundice),
Edema.
 Eyes: - sclera, eyelids, spacing, eyelashes, sunken

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Cont’d
 Ears: - size, position, deformity, discharge

 Mouth: - mandible, size, lips, tongue, gum, teeth,

palate, Throat and uvula.

 Neck: - Length, pulsations, webbing, Lymph Nodes.

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LUNGS
 Inspiration and Expiration
 Chest size and symmetry
 Breath sounds
 Abnormalities - decreased BS, crackles, wheeze, stridor

CARDIOVASCULAR
 Pulses
 Apical pulse - varies with age
 rhythm

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ABDOMEN
 Warm hands, follow steps of examination
 Look at Face not hands
 If abdomen tense, try flexing legs at hip
Look For:
 Masses, lesions,
 Distention, fluid
 Liver, spleen, kidneys
 Abdominal aorta
 Bladder
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 MUSCULOSKELETAL
• Gait
• Symmetry
• Strength
• Range of motion
• Dyskinetic movements impairment of voluntary
movement
• Joint swellings and noise

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NEUROLOGIC

 Extent of neurologic  Level of consciousness

exam dictated by history  Seizures, loss of
consciousness
 Much of the usual
 Mental status
neurologic examination is
done by observation
 Cranial nerve examination

with respect to age

 Sensory examination
 Motor examination
 Deep tendon reflexes

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 Thank you

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