CHAPTER 19
Child Health
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
2
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
3
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
4
Growth and Development
• Head circumference
– Related to intracranial volume
– Normal brain growth = expected rate of
increase in head circumference
– Abnormal lags or surges may indicate
serious problems
5
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
6
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
7
Growth and Development
• 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)
8
Growth and Development
• 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 twentyone years
9
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
center outward or from midline to periphery
10
Growth and
Development Principles
• 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
11
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
12
Immunizations
• Childhood immunizations
– Administered to well child according to specific
schedule
– Recommended childhood immunizations
•
•
•
•
•
•
•
Hepatitis B
DTaP
Hib
Polio (IPV)
MMR
Varicella
PCV
13
COMMUNICABLE DISEASES
Child Health
Communicable Diseases
• 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
15
Communicable Diseases
• 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
16
Communicable Diseases
• 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
17
Communicable Diseases
• 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
18
Communicable Diseases
• 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
19
Communicable Diseases
• 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
20
Communicable Diseases
• 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
21
Communicable Diseases
• 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
22
Communicable Diseases
• Rubella (German Measles, Three-day
Measles)
– Infectious agent:
• Rubella virus
– Immunization:
• One of the components of the MMR vaccine
23
Communicable Diseases
• 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
24
Communicable Diseases
• Rubeola (“Red Measles,” Seven-day
Measles)
– Infectious agent:
• Measles virus
– Immunization:
• One of the components of the MMR vaccine
25
Communicable Diseases
• 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
26
PATHOLOGICAL
CONDITIONS
Child Health
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
28
Asthma
• 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
29
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 nasal cavity and
lip
• Due to failure of soft tissue and bones in this area
to fuse properly during embryonic development
30
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
31
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 upper
extremities and decreased blood pressure in lower
extremities
32
Croup
• Pronounced
– (CROOP)
• Defined
– Childhood disease characterized by a barking
cough, stridor and laryngeal spasm
• Stridor = high-pitched musical sound when
breathing in
33
Cryptorchidism
• Pronounced
– (kript-OR-kid-izm)
• Defined
– Condition of undescended testicle(s)
– Absence of one or both testicles from the
scrotum
34
Down Syndrome
• Pronounced
– (DOWN SIN-drohm)
• Defined
– Congenital condition characterized by
multiple defects and varying degrees of
mental retardation
– Trisomy 21
35
Down Syndrome
• 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
36
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
37
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
38
Epispadias
39
Erythroblastosis Fetalis
• 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)
40
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
41
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
42
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)
43
Hydrocele
• Pronounced
– (HIGH-droh-seel)
• Defined
– Accumulation of fluid in any saclike cavity or
duct, particularly scrotal sac or along
spermatic cord
44
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
45
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
46
Hypospadias
47
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
48
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
49
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
50
Reye’s Syndrome
• 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
51
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
52
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
53
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”
54
Tay-Sachs Disease
• Pronounced
– (TAY-SACKS dih-ZEEZ)
• Defined
– Congenital disorder caused by altered lipid
metabolism due to an enzyme deficiency
55
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
56
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”
57
Tetralogy of Fallot
• 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
58
Tetralogy of Fallot
• 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
59
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
60
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”
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DIAGNOSTIC
TECHNIQUES, TREATMENTS
AND PROCEDURES
Child Health
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”
63
Diagnostic Techniques,
Treatments, and Procedures
• 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
64