pediatric
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Njood Abdullah Ali
Your baby may have very mild symptoms of premature birth, or may have moreobvious complications :
Some signs of prematurity include the following
:
Small size, with a disproportionately large head
 Sharper looking, less rounded features than a full-term baby's features, due to
a lack of fat stores
 Fine hair (lanugo) covering much of the body
 Low body temperature, especially immediately after birth in the delivery
room, due to a lack of stored body fat
 Labored breathing or respiratory distress
 Lack of reflexes for sucking and swallowing, leading to feeding difficulties

The following tables show the median birth weight, length and head circumference of
.premature babies at different gestational ages for each sex
Weight, length and head
circumference by gestational
age for boys
Gestational age
Weight
Length
Head
circumference
40 weeks
7 lbs., 15 20 in. (51 13.8 in. (35 cm)
oz.
cm)
(3.6 kg)
35 weeks
5 lbs., 8 18.1
12.6 in. (32 cm)
oz.
in. (46 cm)
(2.5 kg)
32 weeks
3 lbs.,
16.5
11.6 in. (29.5
15.5 oz. in. (42 cm) cm)
(1.8 kg)
28 weeks
2 lbs., 6.8 14.4
10.2 in. (26 cm)
oz.
in. (36.5
(1.1 kg)
cm)
24 weeks
1 lb., 6.9 12.2
8.7 in. (22 cm)
oz.
in. (31 cm)
(0.65 kg)
Weight, length and head
circumference by gestational
age for girls
Gestational age
Weight
Length
Head
circumference
40 weeks
7 lbs.,
20 in. (51 13.8 in. (35 cm)
7.9 oz.
cm)
35 weeks
32 weeks
28 weeks
24 weeks
(3.4 kg)
5 lbs.,
4.7 oz.
(2.4 kg)
3 lbs., 12
oz.
(1.7 kg)
2 lbs.,
3.3 oz.
(1.0 kg)
1 lb., 5.2
oz.
(0.60 kg)
17.7
in. (45
cm)
16.5
in. (42
cm)
14.1
in. (36
cm)
12.6
in. (32
cm)
12.4 in. (31.5
cm)
11.4 in. (29 cm)
9.8 in. (25 cm)
8.3 in. (21 cm)
Special care
If you deliver a preterm baby, your baby will likely need a longer hospital stay in a
special nursery unit at the hospital. Depending on how much care your baby requires,
he or she may be admitted to an intermediate care nursery or the neonatal intensive
Doctors and a specialized team with training in taking care of .)NICU( care unit
preterm babies will be available to help care for your baby. Don't hesitate to ask
.questions
Your baby may need extra help feeding, and adapting immediately after delivery.
Your health care team can help you understand what is needed and what your baby's
.care plan will be
Often, the specific cause of premature birth isn't clear. However, there are known risk
factors of premature delivery, including:
 Having a previous premature birth
 Pregnancy with twins, triplets or other multiples
 An interval of less than six months between pregnancies
 Conceiving through in vitro fertilization
 Problems with the uterus, cervix or placenta
 Smoking cigarettes or using illicit drugs
 Some infections, particularly of the amniotic fluid and lower genital tract
 Some chronic conditions, such as high blood pressure and diabetes
 Being underweight or overweight before pregnancy
 Stressful life events, such as the death of a loved one or domestic violence
 Multiple miscarriages or abortions
 Physical injury or trauma
For unknown reasons, black women are more likely to experience premature birth
than are women of other races. But premature birth can happen to anyone. In fact,
many women who have a premature birth have no known risk factors.
While not all premature babies experience complications, being born too early can
cause short-term and long-term health problems. Generally, the earlier a baby is born,
the higher the risk of complications. Birth weight plays an important role, too.
Some problems may be apparent at birth, while others may not develop until later.
Short-term complications
In the first weeks, the complications of premature birth may include:
 Breathing problems. A premature baby may have trouble breathing due to an
immature respiratory system. If the baby's lungs lack surfactant — a substance
that allows the lungs to expand — he or she may develop respiratory distress
syndrome because the lungs can't expand and contract normally.
Premature babies may also develop a lung disorder known as
bronchopulmonary dysplasia. In addition, some preterm babies may
experience prolonged pauses in their breathing, known as apnea.
 Heart problems. The most common heart problems premature babies
experience are patent ductus arteriosus (PDA) and low blood
pressure (hypotension). PDA is a persistent opening between the aorta and
pulmonary artery. While this heart defect often closes on its own, left
untreated it can lead to a heart murmur, heart failure as well as other
complications. Low blood pressure may require adjustments in intravenous
fluids, medicines and sometimes blood transfusions.
 Brain problems. The earlier a baby is born, the greater the risk of bleeding in
the brain, known as an intraventricular hemorrhage. Most hemorrhages are
mild and resolve with little short-term impact. But some babies may have
larger brain bleeding that causes permanent brain injury.
 Temperature control problems. Premature babies can lose body heat
rapidly. They don't have the stored body fat of a full-term infant, and they
can't generate enough heat to counteract what's lost through the surface of
their bodies. If body temperature dips too low, an abnormally low core body
temperature (hypothermia) can result.
Hypothermia in a premature baby can lead to breathing problems and low
blood sugar levels. In addition, a premature infant may use up all of the energy
gained from feedings just to stay warm. That's why smaller premature infants
require additional heat from a warmer or an incubator until they're larger and
able to maintain body temperature without assistance.
 Gastrointestinal problems. Premature infants are more likely to have
immature gastrointestinal systems, resulting in complications such as
necrotizing enterocolitis (NEC). This potentially serious condition, in which
the cells lining the bowel wall are injured, can occur in premature babies after
they start feeding. Premature babies who receive only breast milk have a much
lower risk of developing NEC.
 Blood problems. Premature babies are at risk of blood problems such as
anemia and newborn jaundice. Anemia is a common condition in which the
body doesn't have enough red blood cells. While all newborns experience a
slow drop in red blood cell count during the first months of life, the decrease
may be greater in premature babies.
Newborn jaundice is a yellow discoloration in a baby's skin and eyes that
occurs because the baby's blood contains excess bilirubin, a yellow-colored
substance, from the liver or red blood cells. While there are many causes of
jaundice, it is more common in preterm babies.
 Metabolism problems. Premature babies often have problems with their
metabolism. Some premature babies may develop an abnormally low level of
blood sugar (hypoglycemia). This can happen because premature infants
typically have smaller stores of stored glucose than do full-term babies.
Premature babies also have more difficulty converting their stored glucose into
more-usable, active forms of glucose.

Immune system problems. An underdeveloped immune system, common in
premature babies, can lead to a higher risk of infection. Infection in a
premature baby can quickly spread to the bloodstream, causing sepsis, an
infection that spreads to the bloodstream.
Long-term complications
In the long term, premature birth may lead to the following complications:
 Cerebral palsy. Cerebral palsy is a disorder of movement, muscle tone or
posture that can be caused by infection, inadequate blood flow or injury to a
newborn's developing brain either early during pregnancy or while the baby is
still young and immature.
 Impaired learning. Premature babies are more likely to lag behind their fullterm counterparts on various developmental milestones. Upon school age, a
child who was born prematurely might be more likely to have learning
disabilities.
 Vision problems. Premature infants may develop retinopathy of prematurity,
a disease that occurs when blood vessels swell and overgrow in the lightsensitive layer of nerves at the back of the eye (retina). Sometimes the
abnormal retinal vessels gradually scar the retina, pulling it out of position.
When the retina is pulled away from the back of the eye, it's called retinal
detachment, a condition that, if undetected, can impair vision and cause
blindness.
 Hearing problems. Premature babies are at increased risk of some degree of
hearing loss. All babies will have their hearing checked before going home.
 Dental problems. Premature infants who have been critically ill are at
increased risk of developing dental problems, such as delayed tooth eruption,
tooth discoloration and improperly aligned teeth.
 Behavioral and psychological problems. Children who experienced
premature birth may be more likely than full-term infants to have certain
behavioral or psychological problems, as well as developmental delays.
 Chronic health issues. Premature babies are more likely to have chronic
health issues — some of which may require hospital care — than are full-term
infants. Infections, asthma and feeding problems are more likely to develop or
persist. Premature infants are also at increased risk of sudden infant death
syndrome (SIDS).
Although the exact cause of preterm birth is often unknown, there are some things
that can be done to help women — especially those who have an increased risk — to
reduce their risk of preterm birth, including:
 Progesterone supplements. Women who have a history of preterm birth, a
short cervix or both factors may be able to reduce the risk of preterm birth
with progesterone supplementation.
 Cervical cerclage. This is a surgical procedure performed during pregnancy
in women with a short cervix, or a history of cervical shortening that resulted
in a preterm birth.
 During this procedure, the cervix is stitched closed with strong sutures that
may provide extra support to the uterus. The sutures are removed when it's
time to deliver the baby. Ask your doctor if you need to avoid vigorous
activity during the remainder of your pregnancy.
Bringing home a new baby can be exciting and overwhelming at first. You are still in
the process of getting to know your baby and understanding the different types of
behavior they exhibit. This information will help you develop realistic expectations
and feel confident about caring for your new baby.
Normal during early infancy
 Pimples, dry skin and mild rashes
 Lumps under a baby’s nipple
 Mucous or mildly bloody vaginal discharge
 Rusty red discoloration in the urine
 Regurgitating (spitting up) after feedings
 Hiccups
 Occasional coughing to clear the throat
 Sleeping up to 18 hours per day
 Brief episodes of rapid, non-labored breathing
 Day/night confusion (cluster feeding late at night)
 Sneezing and noisy nasal congestion without breathing difficulty
 Sucking blister at the center of the upper lip
 Crying for diaper change, feeding or warmth
 Not calming unless being held or cuddled
Crying
Babies cry as a way to communicate hunger, soiled diaper, overstimulation, pain,
frustration and even loneliness, and in time you will learn to tell the difference in
cries. When your baby continues to cry, try the following:
 First take care of hunger, the need to feed or burp and diaper change
 Rock your baby in a gentle, rhythmic motion
 Pat or rub the back to help calm and relax
 Try swaddling your baby
 Go for a walk with your baby in a sling or stroller
 Go for a ride in the car
 Do not worry about spoiling your baby by holding him/her too much—it helps
them to trust and love you and feel secure
Stool quality and gas
 Thick, sticky and dark stool is normal until formula is given or breast milk
arrives
 Breast milk stools are loose and seedy
 Formula stool can be mushy
 As long as the stools are not firm or hard, are not bloody and come out
regularly, they are normal no matter what the color
 Gas is common in newborns
 If gas seems excessive, try burping more frequently and using over-thecounter infant gas drops
Sleep
Newborns may sleep 16 or more hours per day, typically in 3-4 hour periods. Don’t
expect your baby to sleep through the night until about three months of age. If your
baby is not sleeping through the night by three months, there is no reason for worry.
Babies must develop their own sleep patterns and cycles by learning from a
consistent, organized parenting style.
 Initially, newborns sleep most of the day with brief periods of wakefulness
lasting one to two hours each, and wake up at night for one or two feedings
 Babies may wake at night if they are cold or need a diaper change
 Most babies will sleep through normal household noises
 Never put babies to sleep with bottles in their mouths. Fluids from the bottle
can cause ear infections and tooth decay
 The American Academy of Pediatrics recommends placing babies on their
backs in their cribs to reduce and prevent Sudden Infant Death
Syndrome (SIDS)
To reduce the risk of SIDS:
 Don't let your baby get overheated. Room temperature should be comfortable
for an adult
 Don't smoke or let others smoke around your baby
 Remove all fluffy and loose bedding, stuffed animals and pillows from the
sleep area. Avoid blankets and top sheets
 Place your baby on a firm mattress in a safety-approved crib
 Make sure your baby's face is uncovered during sleep
 Teach all caregivers to place your baby on his/her back during nap and sleep
time
Pacifiers
 Non-nutritive sucking is a reflex and calms young infants
 There is no objection to using pacifiers whether you are bottle or breast
feeding
Baby's reflexes
 The rooting reflex: This occurs when babies are touched on their cheeks. They
turn their faces toward the touch and open their mouths. It helps babies locate
food
 Rely on the rooting reflex when feeding your baby: Gently touch the baby's
cheek with the bottle nipple or your own nipple, and the baby will turn to you.
When something touches babies' lips, they begin to suck
 The Moro reflex: This startling reflex occurs when babies hear a loud noise or
experience a sudden change in their pose. They throw their arms out, away
from the body, and appear startled
 The grasp reflex: This occurs when you place your finger into a baby's hand
and the baby grasps your finger
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Phallic stage
Main article: Phallic stage
The third stage of psychosexual development is the phallic stage,
spanning the ages of three to six years, wherein the child's genitalia are
his or her primary erogenous zone. It is in this third infantile development
stage that children become aware of their bodies, the bodies of other
children, and the bodies of their parents; they gratify physical curiosity by
undressing and exploring each other and their genitals, and so learn
the physical (sexual) differences between "male" and "female" and
the gender differences between "boy" and "girl". In the phallic stage, a
boy's decisive psychosexual experience is the Oedipus complex, his son–
father competition for possession of mother. This psychological
complex derives from the 5th-century BC Greek
mythologic character Oedipus, who unwittingly killed his father, Laius,
and sexually possessed his mother, Jocasta. Analogously, in the phallic
stage, a girl's decisive psychosexual experience is the Electra complex,
her daughter–mother competition for psychosexual possession of father.
This psychological complex derives from the 5th-century BC Greek
mythologic character Electra, who plotted matricidal revenge
with Orestes, her brother, against Clytemnestra, their mother,
and Aegisthus, their stepfather, for their murder of Agamemnon, their
father, (cf. Electra, by Sophocles).
Social and Emotional
Development
A child’s later social and emotional behaviour can only be
recognized and accepted when the early roots of such behaviour have been dug out. For this reason, the developmental
psychologists have been specially interested in the infant’s first
social and emotional attachments. It has been observed that
each child does appear to take on a “unique” self during the
early years. An individual’s reacting to them may be utterly
confusing without exploration of psychological roots in
infancy.
Another important issue is to know the influence of nature and
nurture on the development of social behaviour. It will be
relevant to know which aspect of the child’s personality has an
inherent component existing from birth and which aspects are
shaped largely or entirely by the social experiences and the
interacting environment. A careful examination of the child’s
early social responses might provide some answers.
Initiative vs. Guilt
Once children reach the preschool stage (ages 3–6 years), they are
capable of initiating activities and asserting control over their world
through social interactions and play. According to Erikson, preschool
children must resolve the task of initiative vs. guilt.By learning to plan
and achieve goals while interacting with others, preschool children can
master this task. Initiative, a sense of ambition and responsibility, occurs
when parents allow a child to explore within limits and then support the
child’s choice. These children will develop self-confidence and feel a
sense of purpose. Those who are unsuccessful at this stage—with their
initiative misfiring or stifled by over-controlling parents—may develop
feelings of guilt.
Stage 3:
Preschoolers are increasingly focused on doing things themselves and
establishing their own goals.
 Initiative: When caregivers nurture these tendencies, children learn
how to make decisions and plan for the future. They can grow into
adults who are able to follow their ambitions.
 Guilt: If children are criticized for being assertive, they may
feel guilt for pursuing their desires. Controlling caregivers may
teach children to follow another’s lead rather than starting their
own plans.
Emotional Development:
The educational psychologists nowadays do not study
emotional development independent of the development of
social behaviour. In fact, both social and emotional
developments are integral parts of personality adjustment.
Psychologists of early days, however, in their search for
different fields of psychology considered emotional development as an independent growth process.
Development of Social Behaviour:
The development of social behaviour ensues along with the
personality development. Any evaluation of personality is
based largely on observations of social behaviour—that is,
child’s interaction with others revealing the inter-personal
relationship. This relationship starts in the family and then
carried into other communications outside home, especially
with peers and other later associates throughout the life span.
piaget
Piaget Theory- Preoperational Stage (2-7 years-old)
 This the second stage of Piaget Theory. Schooling generally starts
at about 3 years-old, which brings about an important social change
and causes significant social development.
 The child will start relating to other children and people,
especially peers. Before this age, the interaction was generally
with family.
 How do children aged 2-7 communicate? While between the
ages 3-7 the child will largely expand their vocabulary, they are
still guided by an “egocentric thinking”, meaning that the child
will think according to their individual

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experiences, which makes their thinking and thoughts starts,
intuitive, and lacking logic. This is why children until the age of
about 6 will misunderstand events and will have trouble expressing
them.

Talking in the third person is very common in this
stage because children still don’t fully understand the concept of
“I” or “me” that separates them from the rest of the world.
 Children between 2-7 will be curious and want to learn, which is
why they so often as “why”.
 Children of this stage often give human characteristics or
feelings to objects. This is called personification.
“Egocentric” thinking, according to Piaget Theory: Why do children
in this stage have such a hard time putting themselves in other people’s
position? This may be related to the “Theory of the Mind”, which refers
to the ability to put yourself in someone else’s mind or in “someone
else’s shoes”. Children won’t be able to do this until about 4-5 years old,
which is why until they reach this age, children will think that others
think how they do. This theory helps explain why children don’t know
how to lie or use irony until about 5 years-old.
Each of these limitations of the pre-logical stage will be overcome at
about 6 or 7 years-old, in the next cognitive developmental stage, and will
consolidate until about 14 or 15 years-old.
Piaget Theory What can we do to help the cognitive development of
the child in the pre-operational stage (from 2 to 7 years old)?
1. Adjust to your child’s cognitive development: Keep in mind
your child’s development stage and adapt to their thinking.
2. 2. Put symbolic play into practice: Through this activity, many of
your children’s skills are developed and they allow them to form an
inner picture of the world. Through play you can learn the roles
and situations of the world around you: pretend to eat or drink,
pretend to drive, pretend to be a doctor and help someone else, etc.
You can practice any activity that helps your child expand his or
her language, develop empathy, and strengthen his or her mental
representations of the world around you.
3. 3. Encourage exploration and experimentation: Let him
discover colors and their classification, tell him how some things
happen, plants or animals, convey curiosity to learn.
Age 4
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Enjoys doing new things
Is more and more creative with make-believe play
Would rather play with other children than alone
Cooperates with other children
Plays “Mom” or “Dad”
Often can’t tell what’s real and what’s make-believe
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Talks about what he or she likes and is interested in
Plaget's contribution to a theory of emotional development is
discussed in this chapter. Although he has frequently been
criticized for neglecting the emotional aspects of children's
development, it can be demonstrated that Piaget has
contributed substantially to a discussion of infants' and
children's emotions. An extensive, descriptive presentation of
Piaget's database of infants' emotions is provided here. Based
on this descriptive account, a classification of the contexts in
which infants' emotional expressions occur in Piaget's work is
derived
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Emotional ,social and cngnitive in preschool
age
PreSchool‐age children with movement problems such as Developmental
Coordination Disorder (DCD) are known to have social and emotional
difficulties. However, little research has investigated younger children to
determine whether these problems emerge at school age or are present
earlier. The aim of the current study was to investigate the relationship
between motor coordination, emotional recognition and internalising
behaviours in young preschool children. Forty‐one kindergarten
children (M = 4 years, 4 months), 22 boys and 19 girls, were assessed on
the McCarron Assessment of Neuromuscular Development, the
Emotional Recognition Scales, the Wechsler Preschool and Primary Scale
of Intelligence, and the Child Behavior Checklist. Motor ability was
positively related to a child's emotion comprehension. However, once
age, sex, Performance IQ and Verbal IQ were controlled for, it was no
longer a significant predictor, which contrasts with previous findings in
school‐age children. However, the expected correlation between motor
ability and anxiety/depression was significant with a moderate effect size.
The results indicate that further investigation is required on the
relationship between motor ability and social–emotional development in
preschool‐age children.
Jane and Jenny, her 10-year old daughter, was walking out of the
school when Jenny collapsed in a series of fits. Scared and unsure
what to do, Jane held Jenny’s head on her lap as her convulsed.
The ambulance arrived as contacted by a bystander, and they
were brought to the emergency department where Jenny
underwent MRI. Jenny was diagnosed with seizure disorder, and
the physician already educated Jane on what to anticipate with this
disorder to avoid panic and confusion during seizures.
Epilepsy is defined as a brain disorder characterized by an
enduring predisposition to generate epileptic seizures and by
the neurobiological, cognitive, psychological, and social
consequences of this condition.
Nursing care for a child with seizure disorder include the following:
Nursing Assessment
Nursing assessment includes:
 History. The diagnosis of epileptic seizures is made by
analyzing the patient’s detailed clinical history and by
performing ancillary tests for confirmation; someone who has
observed the patient’s repeated events is usually the best
person to provide an accurate history; however, the patient
also provides invaluable details about auras, preservation of
consciousness, and postictal states.
 Physical exam. A physical examination helps in the
diagnosis of specific epileptic syndromes that cause
abnormal findings, such as dermatologic abnormalities (e.g.,
neurocutaneous syndromes such as Sturge-Weber, tuberous
sclerosis, and others); also, patients who for years have had
intractable generalized tonic-clonic seizures are likely to
have suffered injuries requiring stitches.
Based on the assessment data, the major nursing diagnoses are:
 Risk for trauma or suffocation related to loss of large or
small muscle coordination.
 Risk for ineffective airway clearance related to
neuromuscular impairment.
 Situational low self-esteem related to stigma associated
with the condition.
 Deficient knowledge related to information misinterpretation.
 Risk for injury related to weakness, balancing difficulties,
cognitive limitations or altered consciousness.
Nursing Care Planning and Goals
The major nursing goals for a child with seizure disorder are:
 The patient or caregiver will verbalize understanding of
factors that contribute to the possibility of trauma and or
suffocation and take steps to correct the situation.
 The patient or caregiver will identify actions or measures to
take when seizure activity occurs.
 The patient or caregiver will identify and correct potential risk
factors in the environment.
 The patient or caregiver will demonstrate behaviors, lifestyle
changes to reduce risk factors and protect self from injury.
 The patient or caregiver will modify the environment as
indicated to enhance safety.
 The patient or caregiver will maintain treatment regimen to
control or eliminate seizure activity
 The patient or caregiver will recognize the need for
assistance to prevent accidents or injuries.
 The patient will maintain effective respiratory pattern with
airway patent or aspiration prevented.
 The patient or caregiver will demonstrate behaviors to
restore positive self-esteem.
 The patient or caregiver will participate in treatment regimen
or activities to correct factors that precipitated a crisis.
 The patient or caregiver will verbalize understanding of the
disorder and various stimuli that may increase potentiate
seizure activity.
Nursing Interventions
Nursing interventions for a child with seizure disorder include the
following:
 Prevent trauma/injury. Teach SO to determine and
familiarize warning signs and how to care for patient during
and after seizure attack; avoid using thermometers that can
cause breakage; use tympanic thermometer when necessary
to take temperature; uphold strict bedrest if prodromal signs
or aura experienced; turn head to side and suction airway as
indicated; support head, place on soft area, or assist to floor if
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out of bed; do not attempt to restrain; monitor and document
AED drug levels, corresponding side effects, and frequency
of seizure activity.
Promote airway clearance. Maintain in lying position, flat
surface; turn head to side during seizure activity; loosen
clothing from neck or chest and abdominal areas; suction as
needed; supervise supplemental oxygen or bag ventilation as
needed postictally.
Improve self-esteem. Determine individual situation related
to low self-esteem in the present circumstances; refrain from
over protecting the patient; encourage activities, providing
supervision and monitoring when indicated; know the
attitudes or capabilities of SO; help an individual realize that
his or her feelings are normal; however, guilt and blame are
not helpful.
Enforce education about the disease. Review pathology
and prognosis of condition and lifelong need for treatments as
indicated; discuss patient’s particular trigger factors (flashing
lights, hyperventilation, loud noises,video games, TV
viewing); know and instill the importance of good oral hygiene
and regular dental care; review medication regimen,
necessity of taking drugs as ordered, and not discontinuing
therapy without physician supervision; include directions for
missed dose.
The patient or caregiver verbalized understanding of factors
that contribute to the possibility of trauma and or suffocation
and take steps to correct the situation.
The patient or caregiver identified actions or measures to
take when seizure activity occurs.
The patient or caregiver identified and corrected potential risk
factors in the environment.
The patient or caregiver demonstrated behaviors, lifestyle
changes to reduce risk factors and protect self from injury.
The patient or caregiver modified environment as indicated to
enhance safety.
The patient or caregiver maintained treatment regimen to
control or eliminate seizure activity
The patient or caregiver recognized the need for assistance
to prevent accidents or injuries.
The patient maintained effective respiratory pattern with
airway patent or aspiration prevented.
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The patient or caregiver demonstrated behaviors to restore
positive self-esteem.
The patient or caregiver participated in treatment regimen or
activities to correct factors that precipitated a crisis.
The patient or caregiver verbalized understanding of the
disorder and various stimuli that may increase potentiate
seizure activity.