Care of the Family and Child
MIKE PYORALA
RCP, P.A.L.S, A.C.L.S., B.L.S., 12-LEAD ECG
A.H.A. INSTRUCTOR
Care of the Family and Child
Objectives
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Psychological aspects

Developmental issues
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Approach

Assessment
Care of the Family and Child
Why are psychological and emotional
needs difficult to manage?
Care of the Family and Child
Psychological Aspects
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Child’s viewpoint
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Parent’s viewpoint

Health Care Provider’s viewpoint
Care of the Family and Child
Crisis
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CHALLENGES
 Individual
 Unit
Care of the Family and Child
Child’s Viewpoint

Pain

Fear
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Guilt
Care of the Family and Child
Parent’s Viewpoint

Frightened
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Guilty

Exhausted
Care of the Family and Child
Health Care Provider’s Viewpoint

Scared

Inexperienced

Empathetic
Care of the Family and Child
Child’s Responses
Care of the Family and Child
Care of the Family and Child
Care of the Family and Child
Care of the Family and Child
Key Points
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Be honest

Give real choices
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Support family relationship

Maintain self-control

Respect right to privacy
Care of the Family and Child
Key Points

Assume the child can hear you.
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Do not introduce fear/anxiety.

Praise children.
Care of the Family and Child
Parental Responses

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Decreased ability to:
 accept and understand incoming information
 think clearly and to solve problems
Helplessness
Anxiety
Hysteria
Anger
Guilt
Care of the Family and Child
Assessment

Perception of the event

Previous experience

Family relationships

Culture/religion

Support systems
Care of the Family and Child
Strategies

Include the parents and child

Ask for the parent’s assistance

Acknowledge feelings

Be honest

Stay calm

Familiarize family with the environment

Give control

Prepare the family
Care of the Family and Child
Developmental Issues
The child’s chronological age may not
always match the developmental age.
Care of the Family and Child
Care of the Family and Child
Care of the Family and Child
Care of the Family and Child
Care of the Family and Child
Care of the Family and Child
Care of the Family and Child
Care of the Family and Child
Physical Examination

Does the child look sick?

Does the child sound sick?
Care of the Family and Child
Primary Survey

Appearance

Airway and C-spine

Breathing
Care of the Family and Child
Remember:
Many problems, especially respiratory
distress, are made worse by agitation.
Care of the Family and Child
Approach
Varies with age
Care of the Family and Child
Less than 1 month of age


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Respond to
 Soothing voice
 Gentle hands
 Pacifier
Keep warm
Exam chest and abdomen first
Care of the Family and Child
Infant (1-6 Months)

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Unafraid of strangers
Responds to cooing and tickling
Keep warm
Exam chest and abdomen first
Care of the Family and Child
Infant (6-12 Months)

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Afraid of strangers
Separation anxiety
Examine in parent’s lap
Examine trunk then proceed to head
Care of the Family and Child
Toddler (1-3 Years)
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Independent
Strong distrust of strangers
Patient but firm approach
Keep parents nearby
Limit exam to bare essentials
Care of the Family and Child
Preschooler (3-5 Years)
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Frightened of bodily injury
Need explanations and reassurance
May be more cooperative
Modest
Examine in presence of parents
Examine chest and abdomen first
Care of the Family and Child
School-Age Child (6-12 Years)
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Cooperative
More aware of death
Need reassurance
Modest
Examine with parents present
Examine in an adult fashion
Care of the Family and Child
Adolescent (12-18 Years)
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Expect to be treated as an
adult
Many of the same fears as
younger children
Body image
Excessively modest
Examine as an adult
Care of the Family and Child
The approach to the unconscious child of any
age is the same as for the unconscious
adult, with rapid performance of the
primary survey and institution of priority
treatments.
Care of the Family and Child
Tips on Treatment

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Talk to all patients of all ages
Give explanations in simple language
Be honest
Be sympathetic
Offer reassurance
Carefully document
Care of the Family and Child
Vital Signs
Vary with age
Care of the Family and Child
Broselow® Resuscitation Tape
Care of the Family and Child
Weight


Critical measurement
(Age in years x 2) + 8 = weight in kilograms
Care of the Family and Child
Respirations


Count respirations before touching the child.
Count for 1 full minute to assess:
 quantity
 quality
 effort
Care of the Family and Child
Heart Rate



Newborn
Infant/young child
Older child
Umbilical Cord
Brachial artery
Carotid artery
Care of the Family and Child
Remember :
In Shock,
Heart rate rises long before blood pressure
falls!!!!!!
Care of the Family and Child
Remember:
Bradycardia in an ill child indicates extreme
distress, requiring URGENT intervention.
Care of the Family and Child
Blood Pressure



Wide range of normals
May see up to 25% decrease in blood volume before BP
decreases.
Over one year may estimate minimum systolic:
(Age in years x 2 ) + 70 = minimum systolic blood
pressure
Care of the Family and Child
Remember:
Never wait until the child is hypotensive to
initiate volume resuscitation!!!!!!
Care of the Family and Child
Temperature


Children cool quickly
Exposure and low cardiac output lower core temperature
Care of the Family and Child
Neurological

Anterior Fontanel
 Bulging or tense
 Sunken
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LOC

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Alertness
Eye contact
Recognition of parents
Playing
Withdrawal to pain
Care of the Family and Child
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Talk
Reassure
Be Honest
Carefully document
Care of the Family and Child
Care for Yourself


Discuss and review difficult pediatric cases
Critical Stress Debriefings