CHILD HEALTH



CHILD HEALTH

Child Health Overview

Well-Child Visit

Health professionals assess the 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

Growth and Development

Growth

Physical increase in the whole or any of its part

Parameters of a child’s growth can be easily measured with accuracy through acquiring the following:

Weight

Head circumference

Length or height

Dentition

Growth and Development (continued)

Weight

Important indicator of child’s nutritional status and general growth

Used to calculate medication dosages for children

Should be measured at every visit

Growth and Development (continued)

Head Circumference

Related to intracranial volume

Normal brain growth = expected rate of increase in head circumference

Abnormal lags or surges may indicate serious problems

Growth and Development (continued)

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 3 years or older

Growth and Development (continued)

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

Growth and Development (continued)

Development

Increase in function and complexity that results through learning, maturation, and growth

Development screening tests are used as assessment tools

Brazelton Neonatal Behavior Assessment Scale for Newborns

Dubowitz for Newborns

Denver II Developmental Screening Test for Infants and Young Children

Growth and Development (continued)

Stages of Childhood Growth and Development

Newborn – birth to 1 month

Infancy – 1 month to 1 year

Toddlerhood – 1 to 3 years

Preschool Age – 3 to 6 years

School Age – 6 to 12 years

Adolescents – 12 to 18 years or 21 years

Growth and Development Principles

Cephalocaudal

Growth and development proceeds from head to toe

Muscular control follows the spine downward

Proximodistal

Growth and development proceeds from the center outward or from the midline to the periphery

Growth and Development Principles (continued)

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

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

Immunizations (continued)

Childhood Immunizations

Administered to the well child according to specific schedule

Recommended Childhood Immunizations

Hepatitis B

DTaP

Hib

Polio (IPV)

MMR

Varicella

PCV

COMMUNICABLE DISEASES

CHILD HEALTH

Communicable Diseases (continued)

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 the lesions with a granular scab

Itching may be severe

Infectious agent: Varicella-Zoster virus

Immunization: varicella vaccine

Communicable Diseases (continued)

Diphtheria

Serious infectious disease affecting the 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

Communicable Diseases (continued)

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

Communicable Diseases (continued)

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

Communicable Diseases (continued)

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

Communicable Diseases (continued)

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: bacteria, Bordetella pertussis

Immunization: one of the components of the DPT vaccine

Communicable Diseases (continued)

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

Communicable Diseases (continued)

Rubella (German Measles, 3-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

Infectious agent: Rubella virus

Immunization: One of the components of the MMR vaccine

Communicable Diseases (continued)

Rubeola (“Red Measles”, 7-Day Measles)

Acute, highly communicable viral disease that begins as an upper respiratory disorder, which is characterized by 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

Infectious agent: Measles virus

Immunization: one of the components of the MMR vaccine

Communicable Diseases (continued)

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

Asthma

Pronounced

(AZ-mah)

Defined

Paroxysmal dyspnea (severe attack of difficulty breathing) accompanied by wheezing caused by a spasm of the bronchial tubes or by swelling of their mucous membrane

Asthma (continued)

Asthmatic Attack

Starts suddenly with coughing and a sensation of tightness in the chest

Followed by slow, laborious, wheezy breathing

Expiration is much 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

Cleft Lip and Palate

Pronounced

(CLEFT LIP and PAL-at)

Defined

Cleft Lip is a congenital defect in which there is an open space between the nasal cavity and the lip

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

Cleft Lip and Palate (continued)

Defined (continued)

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

Coarctation of the Aorta

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 the upper extremities and decreased blood pressure in the lower extremities

Croup

Pronounced

(CROOP)

Defined

Childhood disease characterized by a barking cough, suffocative and difficult breathing, stridor and laryngeal spasm

Stridor = high-pitched musical sound when breathing in

Cryptorchidism

Pronounced

(kript-OR-kid-izm)

Defined

Condition of undescended testicle(s); the absence of one or both testicles from the scrotum

Down Syndrome

Pronounced

(DOWN SIN-drohm)

Defined

Congenital condition characterized by multiple defects and varying degrees of mental retardation

Also called trisomy 21

Down Syndrome (continued)

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

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

Epispadias

Pronounced

(ep-ih-SPAY-dee-as)

Defined

Congenital defect in which the urethra opens on the upper side of the penis at some pint near the glans

Epispadias (continued)

Erythroblastosis Fetalis

Pronounced

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

Defined

Form of hemolytic anemia that occurs in neonates due to a maternal-fetal blood group incompatibility, involving the ABO grouping or the Rh factors

Also known as hemolytic disease of the newborn (HDN)

Esophageal Atresia

Pronounced

(ee-soff-ah-JEE-al ah-TREE-zee-ah)

Defined

Congenital abnormality of the esophagus due to its ending before it reaches the stomach either as a blind pouch or as a fistula connected to the trachea

Gigantism

Pronounced

(JYE-gan-tizm)

Defined

Proportional overgrowth of the body’s tissue due to the hypersecretion of the human growth hormone before puberty

Child experiences accelerated abnormal growth chiefly in the long bones

Hyaline Membrane Disease

Pronounced

(HIGH-ah-lign MEM-brayn dih-ZEEZ)

Defined

Severe impairment of the function of respiration in the premature newborn

Also known as respiratory distress syndrome of the premature infant (RDS)

Hydrocele

Pronounced

(HIGH-droh-seel)

Defined

Accumulation of fluid in any saclike cavity or duct, particularly the scrotal sac or along the spermatic cord

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

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

Hypospadias (continued)

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

Patent Ductus Arteriosus

Pronounced

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

Defined

Abnormal opening between the pulmonary artery and the aorta caused by failure of the fetal ductus arteriosus to close after birth

Defect seen primarily in premature infants

Phimosis

Pronounced

(fih-MOH-sis)

Defined

Tightness of the foreskin (prepuce) of the penis of the male infant that prevents it from being pulled back

The opening of the foreskin narrows due to the tightness and may cause some difficulty with urination

Reye’s Syndrome

Pronounced

(RISE SIN-drohm)

Defined

A 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

Spina Bifida Occulta

Pronounced

(SPY-nah BIH-fih-dah oh-KULL-tah)

Defined

A congenital defect of the central nervous system in which the back portion of one or more vertebrae is not closed

A dimpling over the area may occur

Sudden Infant Death Syndrome (SIDS)

Pronounced

(Sudden Infant Death SIN-drohm)

Defined

The completely unexpected and unexplained death of an apparently well, or virtually well, infant

Also known as “crib death”

Most common cause of death between the second week and first year of life

Tay-sachs Disease

Pronounced

(TAY-SACKS dih-ZEEZ)

Defined

Congenital disorder caused by altered lipid metabolism due to an enzyme deficiency

Tay-sachs Disease (continued)

Symptoms of Neurological Deterioration

Occur around age of 6 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 2 to 4 years

Tetralogy Of Fallot

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 (continued)

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 (continued)

Defects of Tetralogy of Fallot (continued)

(3) Shifting of aorta to the right

Aorta overrides the 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

Transposition of the Great Vessels

Pronounced

(trans-poh-SIH-shun of the great vessels)

Defined

Condition in which the two major arteries of the heart are reversed in position, resulting in two non-communicating circulatory systems

Umbilical Hernia

Pronounced

(um-BILL-ih-kahl HER-nee-ah)

Defined

An outward protrusion of the intestine through a weakness in the abdominal wall around the umbilicus

Umbilicus = navel or “belly button”

DIAGNOSTIC TECHNIQUES AND PROCEDURES

CHILD HEALTH

Diagnostic Techniques and Procedures

Heel Puncture

A 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

Also called a “heel stick”

Diagnostic Techniques and Procedures (continued)

Pediatric Urine Collection

A 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

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