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AL BALDA APPLIED UNIVERSITY Nursing C a r e OF Children PREPAREO BY: MAI HAMSONEH 3 2 0 2 ??????To d d l e r s a n d Preschool Has definite likes and dislikes Growth slows and appetite diminishes Meal time can become a battle for control School age "6-12" years Usually has a good appetite. Likes variety Still prefers plain foods TV and friends influence food choices Breast milk benefits 1- Complete diet. Sterile milk 2- Easily digested. 3- Have greater immunity. 4- Breast fed infants are less likely to have G.I disorders and food allergies Principle of child care

1. Informed consent) / Parents should be understood the purpose of medical treatment and the risk o f the treatment. / Consent should be signed by parent. (Children non-eligible.)
2. Preparation for procedure / Clean and shave skin before surgery. Administer analgesic before stressful procedure. Psychological preparation. Establish trust and provide support. / Involve the child in the performance of some procedures. o Let child to express his feeling. 3. Preparation for surgery. 4. Bathing (never leave children alone in the bath tub). 5. Oral hygiene. 6. Skin hygiene. 7. Prevent cross infection. Wear gioves. Hand washing. Gowning. Mask. 8. Treat fever > 38.5 Antipyretic, Never give aspirin to children o Remove clothes. Decrease room temperature Apply cold compresses. Tub bath
3. Assist in infant's position far medical procedure. 10. Collection of specimens. Urine specimen: / For infant use a special urine collector. Clean plastic bag that adhere to the urinary opening before using this bag, clear and dry the area. J. If a urine specimen needed to be sterile use a sterile container. 11. Blood specimen. / Venous blood sample/can be obtained by venipuncture Capillary blood sample can be obtained by finger on ear lobe stick method. o The best blood sample (Capillary) from infant is by heel-stick figure (1). Before procedure warm the heel by moist compresses for 5-10 minutes. o Then clean by alcohol o The puncture should be not deeper than 2.4mm o To avoid complication Arterial blood sample through radial, brachial, femoral artery. Administration o f medication : Before administer check the five rights. Routes of administering medications a) Oral Easiest, less pain use a standard medicine spoon / cups or use syringes crush tablet if prescribed for child during administration place the dropper or the syringe a long the side of the infants tongue to avoid aspiration b) I.M injection Use small syringes (1ml). Small infant muscle may not tolerate more than (0.5 ml ) The preferred site for infant is the vastus lateralis Using the gluteal site is recommended after a child has been walking Don't use the same site of I.vi injection c) intravenous administration Before I.V administration check site for potency . Never administer medication with blood products . Microdropper for some medication to be given in a specific time d) rectal administration Suppositories. use gloves, lubricant, hold the buttocks for 5 minutes e) optic drops Pull the lower lid downward apply the solution to the conjunctiva but not directly to the eyeball, close the eye gently . ) ear drops. for children under 3 years. the external auditory canal is straightened by pulling the pinna downward and straight back. For children over 3 years the pinna is pulled upward and back. g) nose drops. as in adults Maintain fluid balance Intake 1) IV - accurate recording

2. PO - prolonged periods of NPO require IV fluids Out put: - urine - adequate urine out put is (1 ml /kg/ hour ). Evaluate, amount, color, concentration , weigh diapers before and after voiding ( 1g = 1ml) Maintain fluid balance :

• Measure intake and output in certain cases as major surgeries, some medications as diuretics, but, renal diseases, beat failupe, de raration sialete apelitus. - Measure and record all intake (oral, parentral ) and all output (urine, stool, vomiting, drainage tube, wounds) Play therapy Play is the work of the child. 1- Social- effective play :children take pleasure in relationship with people as adult talk, touch... 2- Sense pleasure play : light, color, taste, odor. 3- Skill play as ride bicycle. 4- Dramatic or pretended play, stories, toys, they practice new role using telephone, playing policeman ,teacher role or nurse, 5- Game : example puzzles, computer games, competitive games. Function of the play 1- Sensorimotor development: for muscle development child can explore the nature of the physical world by touching, heating, explore space, coordinate activity. 2- Intellectual activities : learn colors, shape ,size, other objects, numbers, words, solve problems. 3- Socialization: child learn to establish social contact . 4- Creativity : blocks, drawing o 5- Self awareness : explore their bodies, know their abilities . 6- Therapeutic purpose: decrease tension and stress, express emotions Criteria for judging the suitability of toys : 1- Safety 2- Compatibility : childs age, level of development, experienc 3_Usefulness: challenge the development of the child, enhance social and personality development , increase motor and sensory skills, express emotions, implement therapeutic procedure. Toy Safety Selection Select-toys that suit the skills, abilities, and interests of children. Select toys that are safe for the specific child; look for a label that indicates the intended age- group. Toys that are safe for one age may not be safe for another. For infants, toddlers, and all children who still mouth objects, avoid toys with small parts that may pose a fatal choking or aspiration. Hazard. Toys in this category are usually labeled, "Not recommended for children under 3 years."Check for safety labels such as "flame retardant"' or "flame resistant." Select toys durable enough to survive sough play, look for sturdy construction such as tightly secured eyes, nose, or any small parts. Select toys light enough that they will not cause harm if one falls on a child. Look for toys with smooth, rounded edges. Avoid toys with sharp edges that can cut or that have sharp points. Points on the inside of the toy can puncture if the toy is broken. Avoid toys with any shooting or throwing objects that can injure eyes this includes toys with which other missiles such as sticks or pebbles might be used as substitutes for the intended projectiles. Arrows and darts used by children should have blunt tips and be manufactured from resilient materials; make certain the tips are securely attached. Make certain that materials in toys are nontoxic Avoid toys that make loud noises that might be damaging to child's hearing even some speaking toys are too loud when held close to the ear. Supervision Maintain a safe play environment. Remove and discard plastic wrappings on toys immediately; they could suffocate a child. Remove large toys, bumper pads, and boxes from playpens; an adventuresome child can use such items as a means of climbing or falling out. Set "ground rules" for play Supervise young children closely during play.(warm relationship with parents. Learning skills such as toilet training and reading. Biological Growth and Physical Development External proportions Growth of different tissues and organ systems produce changes in body proportions During fetal development the head is the faster growing body head constitutes 50% of total body length during infancy the legs are the most rapidly growing part during childhood; i n adolescence the trunk elongates. in the newborn infant the lower limbs are one third the total length but only 15% of the total body weight; in the adult the lower limbs constitute one half of the total body height and 30% or more of the total body weight. Biologic determinants of G&D. 1- Height: occurs as a result of )skeletal growth growth in height stops when )maturation of the Skeleton is complete 2- Weight the average.Development: It is an increase in the complexity of function and skills progression and it is the behavioral aspect of the growth Health Assessment Of Growth And Development Of Children Patterns of growth and development: 1-Directional trends later
• Cephalocaudal: from head to feet ,the head develops first whereas the feet develops Example: infants control head before they control the trunk and extremities.Table (1) Caloric requirements Age Daily High risk neonate requirements 120-150 cal/kg Normal neonate 100-120 cal/kg 1-2 year 90-100 cal/kg 2-6 years 80-90 cal/kg 7-9 years 70-80 cal/kg 10-12 years 50-60 cal/kg Nutrition considerations Newborn infants Initially infants are usually breast-fed many mothers begin early supplement with formula, Infants should remain on breastfeeding or formula until one year of age.There is a fixed, order to development it does not progress at the same rate pace.(There is periods of accelerated growth and periods of decelerated growth) hiddle chi chood and marked y incrdases al the beginning ol adolescence ,and hecreases in early adulthood. 5- Lymphoid tissues: lymphoid tissues contained in the lymph nodes, thymus, spleen, tonsils, adenoids and blood lymphocytes) o Small in size o Well developed at birth o Increase rapidly to reach adults by 6 years of age and continue to grow.Example: Infant shoulder control precedes the hands ,the whole hand is used as a unit before the fingers
• Differentiation: development from simple to complex, from general to specific Example: baby uses palmer grasp(grasp object by hand)before use of pincer grasp(thumb and finger) 2-Sequential trends
• Growth and development passing through sequence stages
• Example: children crawl before they creep, creep before they stand and stand before they walk.The slow-to-warm-up child: react negatively and with mild intensity to new stimuli, adapt slowly, quite inactive and moodily, Development During Infancy One month
• Weight gain 150-210 gm/week for first 6 months.3- Bone age: both bone age and dentition are used as indicators of development) Bone age is determined by comparing the mineralization of ossification centers and advancing bony form to age related standards.Teach children to be aware of electrical appliances and even electrically operated play things; often children are unfamiliar with the hazards of electricity in association with water.Psychological development may influenced by primary socialization occurs during the first year when the infant makes social attachments and trust in the world.4- Neurologic maturation (nervous system grows more rapidly after birth than before birth) It is believed that no now nerve cells appear after the sixth month of fetal life (Neurophysiologic changes provide the foundation for language, learning, and behavioral development).M e t a b o l i s m : the BMR highest in the newborn infant, the proportion decreases progressively to maturity.The bas al energy requirement of infants is about 108 kcal / kg and decrease s to 40 to 45 kcal / kg at maturity.Temperature
• Thermoregulation is one of the most important adaptation responses of the infant during the transition from intrauterine to extra uterine life.The difficult child: highly active, irritable and irregular in their habits, negative withdrawal responses, adapt slowly to new situations., intense mood, frequent period of crying, 3.Immunization of children against communicable diseases Primary Nursing Care of Children Growth and development of children
• Growth: An increase in number and size of cells, results in increased size and weight of the whole or any of its parts.Bone formation begins during the second month of fetal life when the first center of ossification appears, at birth the number of centers approximately 400, about half the number at maturity.The lymphoid tissues are: At 10-12 years they reach maximum development that is twice their adult size followed by rapid decline to stable adult by the end of adolescence. I n f a n t C a r e Teething: Some discomfort is common when )eruption, drooling, finger sucking, biting objects, difficult sleeping, low- grade fever.Care Of Toddler Voluntary control of anal and urethral sphincters is achieved after the child is walking 18-24 m o n t h s .Consequently a careful assessment of caloric requirements and daily caloric intake is essential.Teach children the safe use of utensils that under certain circumstances can cause injury scissors, knives, needles, heating elements, or loops, long string, or cord.Maintain toys in good repair, without signs of possible hazards such as sharp edges, splinters, weak seams, or rust.Example maturation of the central nervous system is influenced by adequacy of stimulation and nutrition. newborn weighs from) 2500 g to 3500 (g.
• The birth weight doubles by 6 months of age
• The birth weight triples by the end of the first year
• The birth weight quadruples by the end of the second year.- Body temperature increase with active exercise, crying, emotional upset, and infection Sleep and Rest o Sleep is a protective function in all organisms, allows for repair and recovery of tissues following activity.o Newborn infants sleep most of the time, as infants grows the sleep time gradually decreases.- Weaning: Process of giving up on method of feeding for another or relinquish the breast or bottle for cup
• There is no time for weaning for every child but most infant shows sign of readiness for weaning during the second half of the first year.Insist that children wear gloves and wrist, elbow, and knee pads when using skateboards or in- line skates.Maintenance Inspect old and new toys regularly for breakage, loose parts, and other potential hazards.Look for jagged or sharp edges or broken parts that might constitute a choking hazard.Approximately 2 to 2.75 kg per year until the adolescent growth spurt.The BMR determines the caloric requirement of the child.Temperament (manner of thinking, behaving of an individual) From the time of delivery, children differ in the way of response to the environment and others 1 .- Height gain 2.5cm monthly for first 6 months
• Head circumference 1.5cm monthly for first 6 month.- Vague, indirect regard of faces and bright objects.6 months - Body wt doubled
• Teeth eruption, 2 lower central incisors (6-8 months).- Apply anesthetic ointment & oral analgesics.- Mother (need Iron supplement when child 4-6 months), when fetal Iron stores are depleted
• Mother needs Vitamin D supplement.- Employed mothers are encouraged to express milk and stored in the refrigerator & given every 3 hours.- Addition of solid food to the infants diet, because the gastrointestinal tract developed well, teeth eruption.Nutritional needs of children N u t r i t i o n a l Assessment Most of the pediatric patients admitted to hospital have significant health problem which influence their nutritional status.For infants avoid toys with strings or cords that are 7 inches or longer because they may cause strangulation.Insist that children wear helmets when using bicycles, skateboards, in-line skates.Examine all outdoor toys regularly for rust and weak or sharp parts that could become a danger to a child.o Check electrical cords and plugs for cracked or fraying parts.- Proximodistal or(near-to-far),midline to peripheral.Physiological changes There are some changes in the basic functions such as Metabolism, Temperature, and pattern of sleep and rest.- Infants and young children are highly susceptible to temperature fluctuations.2 months - Close posterior fontanel
• Less flexed position.3 months - Grasp reflex absent.- Recognize family members
• No head lag, hold head erect & steady
• Sit erect if supported (4-5 months).- Begin to show regular pattern in bladder, bowel elimination.- Know stranger, quiet, enjoy sitting, looking and exploring 9 months - Ability to use thumb & index fingers to grasp.- Coo & babbles.2.3.4.5.2..

AL BALDA APPLIED UNIVERSITY
Nursing
C a r e
OF Children
PREPAREO BY: MAI HAMSONEH
3 2 0 2
ﻣﻦﺗﻄﻠﺐ
U n i t 1
Primary Nursing Care of children Growth and development of children

1. Health assessment of Growth and development of children.


2. Nutritional needs of children.


3. Principles of child care.


4. play.


5. Immunization of children against communicable diseases
   Primary Nursing Care of Children
   Growth and development of children

• Growth: An increase in number and size of cells, results in increased size
  and weight of the whole or any of its parts.
  Development: It is an increase in the complexity of function and skills
  progression and it is the behavioral aspect of the growth
  Health Assessment Of Growth And Development Of Children
  Patterns of growth and development:
  1-Directional trends
  later


• Cephalocaudal: from head to feet ,the head develops first whereas the feet develops
  Example: infants control head before they control the trunk and extremities. Use
  their eyes before their hands.


• Proximodistal or(near-to-far),midline to peripheral.
  Example: Infant shoulder control precedes the hands ,the whole hand is used as a
  unit before the fingers


• Differentiation: development from simple to complex, from general to specific
  Example: baby uses palmer grasp(grasp object by hand)before use of pincer
  grasp(thumb and finger)
  2-Sequential trends


• Growth and development passing through sequence stages


• Example: children crawl before they creep, creep before they stand and stand before
  they walk.
  3-Developmental pace.
  There is a fixed, order to development it does not progress at the
  same rate pace.(There is periods of accelerated growth and periods of
  decelerated growth)
  hiddle chi chood and marked y incrdases al the beginning ol adolescence ,and hecreases in
  early adulthood.
  4-Sensitive periods:
  The process of growth will be affected by a particular environment either Positive or negative
  influence.
  Example maturation of the central nervous system is influenced by adequacy of
  stimulation and nutrition.
  Psychological development may influenced by primary socialization occurs during the
  first year when the infant makes social attachments and trust in the world.
  (warm relationship with parents. Learning skills such as toilet training and reading.
  Biological Growth and Physical Development
  External proportions
  Growth of different tissues and organ systems produce changes in body proportions
  During fetal development the head is the faster growing body head constitutes 50% of total body
  length during infancy the legs are the most rapidly growing part during childhood; i n
  adolescence the trunk elongates.
  in the newborn infant the lower limbs are one third the total length but only 15% of the total
  body weight; in the adult the lower limbs constitute one half of the total body height and 30% or
  more of the total body weight.
  Biologic determinants of G&D.
  1- Height: occurs as a result of )skeletal growth growth in height stops when )maturation of the
  Skeleton is complete
  2- Weight the average. newborn weighs from) 2500 g to 3500 (g.


• The birth weight doubles by 6 months of age


• The birth weight triples by the end of the first year


• The birth weight quadruples by the end of the second year.


• after 2 years the normal rate of weight gain. Approximately 2 to 2.75 kg per year until the
  adolescent growth spurt.
  3- Bone age: both bone age and dentition are used as indicators of development)
  Bone age is determined by comparing the mineralization of ossification centers and advancing
  bony form to age related standards.
  Bone formation begins during the second month of fetal life when the first center of ossification
  appears, at birth the number of centers approximately 400, about half the number at maturity.
  4- Neurologic maturation (nervous system grows more rapidly after birth than before birth)
  It is believed that no now nerve cells appear after the sixth month of fetal life (Neurophysiologic
  changes provide the foundation for language, learning, and behavioral development).
  5- Lymphoid tissues: lymphoid tissues contained in the lymph nodes, thymus, spleen, tonsils,
  adenoids and blood lymphocytes) • Small in size
  • Well developed at birth
  • Increase rapidly to reach adults by 6 years of age and continue to grow.
  Growth of lymph tissues follow a special pattern unlike other body tissues.
  The lymphoid tissues are:
  At 10-12 years they reach maximum development that is twice their adult size followed by rapid
  decline to stable adult by the end of adolescence.
  6- Development of organ and systems.
  Physiological changes
  There are some changes in the basic functions such as Metabolism, Temperature, and pattern of
  sleep and rest.
  M e t a b o l i s m :
  the BMR highest in the newborn infant, the proportion decreases progressively to maturity.
  The BMR determines the caloric requirement of the child.
  The bas al energy requirement of infants is about 108 kcal / kg and decrease s to 40 to 45 kcal /
  kg at maturity.
  Temperature


• Thermoregulation is one of the most important adaptation responses of the infant during the
  transition from intrauterine to extra uterine life.


• Infants and young children are highly susceptible to temperature fluctuations.


• Body temperature increase with active exercise, crying, emotional upset, and infection
  Sleep and Rest
  • Sleep is a protective function in all organisms, allows for repair and recovery of tissues
  following activity.
  • Newborn infants sleep most of the time, as infants grows the sleep time gradually decreases.
  Temperament (manner of thinking, behaving of an individual)
  From the time of delivery, children differ in the way of response to the environment and others
  1 . T h e c a s y o b i d : r e g u e i n t h e r h a b t s , h a v e p o s t v p r o a c h t o n e w s t i n u l , a d a p r a b l e t o
  change.

2. The difficult child: highly active, irritable and irregular in their habits, negative withdrawal
   responses, adapt slowly to new situations., intense mood, frequent period of crying,


3. The slow-to-warm-up child: react negatively and with mild intensity to new stimuli, adapt
   slowly, quite inactive and moodily,
   Development During Infancy
   One month

• Weight gain 150-210 gm/week for first 6 months.


• Height gain 2.5cm monthly for first 6 months


• Head circumference 1.5cm monthly for first 6 month.


• Flexed position.


• Turn head from side to side when prone (abdomen) position.


• Head lag.


• Hand closed & strong grasp reflex


• Follow light, fix eyes on moving object.


• Cries to express discomfort. No tears.


• Vague, indirect regard of faces and bright objects.
  2 months - Close posterior fontanel


• Less flexed position.


• Hand open.


• Turn head to side when sound is made, at level of ear.


• Smiling, (social smile).
  3 months - Grasp reflex absent.


• Follow object (by eyes) to periphery (180°).


• Coo & babbles.


• Recognize familiar faces & object as bottles, (laugh loud).
  4 months - Drooling begin.


• Recognize family members


• No head lag, hold head erect & steady


• Sit erect if supported (4-5 months).


• Can carry objects to mouth (4-5 month).


• Laugh loud (3-4 month).
  5 months - Growth rate begin to decline (.


• No head lag, supported well.


• Can turn from back to abdomen.


• Play with toys.


• Cary object directly to the mouth.
  6 months - Body wt doubled


• Teeth eruption, 2 lower central incisors (6-8 months).


• Chewing and biting.


• Sits with back straight with out help.


• Hold bottles.


• Grasp feet & pulls to mouth.


• Has taste preference.


• Produce sounds baba.
  7 months - Tooth eruption upper central incisors.


• Transfer object from one hand to another.


• Response to own name.


• Fear of strangers.
  8 months - Sit steadily unsupported. Sit without support.


• Begin to show regular pattern in bladder, bowel elimination.


• Know stranger, quiet, enjoy sitting, looking and exploring
  9 months - Ability to use thumb & index fingers to grasp.


• Respond to simple commands


• Understand (NO).


• C r a w l b a c k w a r d .


• Play by him self, likes people around.
  10 months - Stand wile holding on the furniture.


• Crawl forward with hands.


• Can change from prone (Abdomen) to sitting position.


• Say dada & mama with meaning.


• Comprehend bye bye -simple game. (Imitative)
  1 months - Walking holding on to furniture.


• Imitation of sounds.
  12 months - Triple birth weight.


• Close of anterior fontanel (12-18 months).


• Recognize objects by name.


• Walk with support, (12-15 months).


• Give child a frozen teething ring to relieve inflammation.


• Apply anesthetic ointment & oral analgesics. - Human milk (breast feeding) is most preferable.


• Mother (need Iron supplement when child 4-6 months), when fetal Iron stores are depleted


• Mother needs Vitamin D supplement.


• If baby on bottle-feeding he needs iron fortified formula. .


• Employed mothers are encouraged to express milk and stored in the refrigerator & given every
  3 hours.


• Number of feeding 6 at the first months decrease to (4-5 at 6 months.)


• Addition of solid food before 4-6 months is not recom mended.


• Continue breast-feeding or bottle milk.


• Addition of solid food to the infants diet, because the gastrointestinal tract developed well,
  teeth eruption. Head control is developed.


• Weaning: Process of giving up on method of feeding for another or relinquish the breast or
  bottle for cup


• There is no time for weaning for every child but most infant shows sign of readiness for
  weaning during the second half of the first year. Weaning should be gradual by replacing one
  bottle or breast-feeding at a time.
  I n f a n t C a r e
  Teething: Some discomfort is common when )eruption, drooling, finger sucking, biting objects,
  difficult sleeping, low- grade fever.
  Nutrition: 1st - 6 months:
  Growth & Development For Toddler
  12 months - Walk without help (12-15 months), walk alone.
  15 months - Creeps up stairs


• Says 4-6 words, name, pictures, and object.
  18 m o n t h s .
  Anterior fontanel closed.
  Able to control sphincters.
  Able to run.
  Jump in place.
  Manage spoon without rotation.
  24 m o n t h s
  • Head circumference exceed chest circumference.
  • Control bowel & bladder, steady gate.
  • Go up & down stairs alone
  • Use I, Me & you
  • Comprehend & use 300 words, (16 Temporary teeth)
  3 0 m o n t h s
  Birth wt quadrupled.
  Jump from step.
  Care Of Toddler
  Voluntary control of anal and urethral sphincters is achieved after the child is walking 18-24
  m o n t h s .
  Bowel training is usually accomplished before bladder training.
  Night time bladder training may not be completed until 4-5 years
  Permanent teeth are 32 and begin to erupt at about 6 years.
  Nutritional needs of children
  N u t r i t i o n a l Assessment
  Most of the pediatric patients admitted to hospital have significant health problem which
  influence their nutritional status.
  Consequently a careful assessment of caloric requirements and daily caloric intake is essential.
  Acutely ill children max - require more the maintenance daily calories.
  Table (1) Caloric requirements
  Age
  Daily
  High risk neonate
  requirements 120-150 cal/kg
  Normal neonate
  100-120 cal/kg
  1-2 year
  90-100 cal/kg
  2-6 years
  80-90 cal/kg
  7-9 years
  70-80 cal/kg
  10-12 years
  50-60 cal/kg
  Nutrition considerations
  Newborn infants
  Initially infants are usually breast-fed
  many mothers begin early supplement with formula, Infants should remain on breastfeeding or
  formula until one year of age.
  Mothers who are breast-feeding should be encouraged continue prenatal vitamins. Solid foods
  should be discouraged prior to 5-6 months.
  To d d l e r s a n d Preschool
  Has definite likes and dislikes
  Growth slows and appetite diminishes
  Meal time can become a battle for control
  School age "6-12" years
  Usually has a good appetite. Likes variety
  Still prefers plain foods
  TV and friends influence food choices
  Breast milk benefits
  1- Complete diet. Sterile milk 2- Easily digested.
  3- Have greater immunity.
  4- Breast fed infants are less likely to have G.I disorders and food allergies
  Principle of child care

1. Informed consent) / Parents should be understood the purpose of medical treatment and the
   risk o f the treatment.
   / Consent should be signed by parent. (Children non-eligible.)


2. Preparation for procedure / Clean and shave skin before surgery.
   Administer analgesic before stressful procedure.
   Psychological preparation.
   Establish trust and provide support.
   / Involve the child in the performance of some procedures.
   • Let child to express his feeling.


3. Preparation for surgery.


4. Bathing (never leave children alone in the bath tub).


5. Oral hygiene.


6. Skin hygiene.


7. Prevent cross infection. Wear gioves. Hand washing. Gowning. Mask.


8. Treat fever > 38.5 Antipyretic, Never give aspirin to children
   • Remove clothes. Decrease room temperature
   Apply cold compresses. Tub bath


9. Assist in infant's position far medical procedure. 10. Collection of specimens. Urine
   specimen: / For infant use a special urine collector. Clean plastic bag that adhere to the urinary
   opening before using this bag, clear and dry the area.
   J. If a urine specimen needed to be sterile use a sterile container.


10. Blood specimen. / Venous blood sample/can be obtained by venipuncture
    Capillary blood sample can be obtained by finger on ear lobe stick method.
    • The best blood sample (Capillary) from infant is by heel-stick figure (1). Before procedure
    warm the heel by moist compresses for 5-10 minutes.
    • Then clean by alcohol
    • The puncture should be not deeper than 2.4mm
    • To avoid complication
    Arterial blood sample through radial, brachial, femoral artery.
    Administration o f medication :
    Before administer check the five rights.
    Routes of administering medications
    a) Oral Easiest, less pain
    use a standard medicine spoon / cups or use syringes
    crush tablet if prescribed for child
    during administration place the dropper or the syringe a long the side of the infants
    tongue to avoid aspiration
    b) I.M injection Use small syringes (1ml).
    Small infant muscle may not tolerate more than (0.5 ml )
    The preferred site for infant is the vastus lateralis
    Using the gluteal site is recommended after a child has been walking
    Don't use the same site of I.vi injection
    c) intravenous administration Before I.V administration check site for potency .
    Never administer medication with blood products .
    Microdropper for some medication to be given in a specific time
    d) rectal administration Suppositories. use gloves, lubricant, hold the buttocks for 5
    minutes
    e) optic drops Pull the lower lid downward apply the solution to the conjunctiva but not
    directly to the eyeball, close the eye gently .
    ) ear drops. for children under 3 years. the external auditory canal is straightened by
    pulling the pinna downward and straight back.
    For children over 3 years the pinna is pulled upward and back.
    g) nose drops. as in adults
    Maintain fluid balance
    Intake 1) IV - accurate recording

2. PO - prolonged periods of NPO require IV fluids
   Out put: - urine - adequate urine out put is (1 ml /kg/ hour ). Evaluate, amount, color,
   concentration
   , weigh diapers before and after voiding ( 1g = 1ml)
   Maintain fluid balance :

• Measure intake and output in certain cases as major surgeries, some medications as diuretics,
  but, renal diseases, beat failupe, de raration sialete apelitus.


• Measure and record all intake (oral, parentral ) and all output (urine, stool, vomiting,
  drainage tube, wounds)
  Play therapy
  Play is the work of the child.
  1- Social- effective play :children take pleasure in relationship with people as adult talk, touch...
  2- Sense pleasure play : light, color, taste, odor.
  3- Skill play as ride bicycle.
  4- Dramatic or pretended play, stories, toys, they practice new role using telephone, playing
  policeman ,teacher role or nurse,
  5- Game : example puzzles, computer games, competitive games.
  Function of the play
  1- Sensorimotor development: for muscle development child can explore the nature of the
  physical world by touching, heating, explore space, coordinate activity.
  2- Intellectual activities : learn colors, shape ,size, other objects, numbers, words, solve
  problems.
  3- Socialization: child learn to establish social contact .
  4- Creativity : blocks, drawing •
  5- Self awareness : explore their bodies, know their abilities .
  6- Therapeutic purpose: decrease tension and stress, express emotions
  Criteria for judging the suitability of toys :
  1- Safety
  2- Compatibility : childs age, level of development, experienc
  3_Usefulness: challenge the development of the child, enhance social and personality
  development
  , increase motor and sensory skills, express emotions, implement therapeutic procedure.
  Toy Safety Selection Select-toys that suit the skills, abilities, and interests of children.
  Select toys that are safe for the specific child; look for a label that indicates the intended age-
  group. Toys that are safe for one age may not be safe for another.
  For infants, toddlers, and all children who still mouth objects, avoid toys with small parts that
  may pose a fatal choking or aspiration. Hazard. Toys in this category are usually labeled, "Not
  recommended for children under 3 years."
  For infants avoid toys with strings or cords that are 7 inches or longer because they may cause
  strangulation. Lupi
  For all children under 8 years avoid electric toys with heating elements.
  For children under 5 years avoid arrows or darts. Check for safety labels such as "flame
  retardant"' or "flame resistant."
  Select toys durable enough to survive sough play, look for sturdy construction such as tightly
  secured eyes, nose, or any small parts.
  Select toys light enough that they will not cause harm if one falls on a child.
  Look for toys with smooth, rounded edges. Avoid toys with sharp edges that can cut or that have
  sharp points. Points on the inside of the toy can puncture if the toy is broken.
  Avoid toys with any shooting or throwing objects that can injure eyes this includes toys with
  which other missiles such as sticks or pebbles might be used as substitutes for the intended
  projectiles.
  Arrows and darts used by children should have blunt tips and be manufactured from resilient
  materials; make certain the tips are securely attached.
  Make certain that materials in toys are nontoxic Avoid toys that make loud noises that might be
  damaging to child's hearing even some speaking toys are too loud when held close to the ear.
  Supervision Maintain a safe play environment.
  Remove and discard plastic wrappings on toys immediately; they could suffocate a child.
  Remove large toys, bumper pads, and boxes from playpens; an adventuresome child can use such
  items as a means of climbing or falling out.
  Set "ground rules" for play Supervise young children closely during play.
  Teach children how to use toys properly and safely. Instruct older children to keep their toys
  away from younger brothers, sisters, and friends. Keep children who are playing with riding toys
  away from stairs, hills, traffic, and swimming pools. Establish and enforce rules regarding
  protective gear.
  Insist that children wear helmets when using bicycles, skateboards, in-line skates.
  Insist that children wear gloves and wrist, elbow, and knee pads when using skateboards or in-
  line skates.
  Instruct children on electrical safety.
  Teach children the proper way to unplug an electric toy-pull on the plug, not the cord.
  Teach children to be aware of electrical appliances and even electrically operated play things;
  often children are unfamiliar with the hazards of electricity in association with water. Teach
  children the safe use of utensils that under certain circumstances can cause injury scissors, knives,
  needles, heating elements, or loops, long string, or cord.
  Maintenance
  Inspect old and new toys regularly for breakage, loose parts, and other potential hazards.
  Look for jagged or sharp edges or broken parts that might constitute a choking hazard.
  Check movable parts to make certain they are attached securely to the toys; sometimes pieces
  that are safe when attached to the toy become a danger when detached. Examine all outdoor toys
  regularly for rust and weak or sharp parts that could become a danger to a child.
  • Check electrical cords and plugs for cracked or fraying parts. Maintain toys in good repair,
  without signs of possible hazards such as sharp
  edges, splinters, weak seams, or rust. Make repairs immediately, or discard out of reach of
  children. Sand sharp wooden toys or splintered surfaces so they are smooth.
  Use only paint labeled "nontoxic" to repaint toys, toy boxes, children's furniture.
  Storage Provide a safe place for children to store toys.
  Select a toy chest or toy box that is ventilated, is free of self locking devices that could trap a
  child inside, and has a lid designed not to pinch a child's fingers or fall on a child's head. To
  avoid entrapment and
  suffocation, containers other than toy chests used for storage. purposes should be fitted with
  spring- loaded support devices if they have a hinged lid.
  Teach children to store toys safely to prevent accidental injury from stepping, tripping, or falling
  on a toy. Play things meant for older children and adults should be safely stored away on high
  shelves, in locked closets, or in other areas unavailable to younger children.
  Immunity and vaccination
  Immunity : is the resistance that an individual has against disease specific immunity to a
  particular organism implies that an individual has either generated the appropriate antibody in his
  or her own body or received a readymade antibodies from another source
  SPECIFIC RESISTANCE (IMMUNITY)
  Responds to threats on an
  individualized basis
  ACQUIRED IMMUNITY
  Produced by prior
  exposure or antibody
  production
  INNATE IMMUNITY
  Genetically determined-
  no prior exposure or
  antibody production
  involved
  ACTIVE IMMUNITY
  Produced by antibodies
  that develop in response
  to antigens
  (Immune response)
  PASSIVE IMMUNITY
  Produced by transfer
  of antibodies from
  another person
  Naturally
  acquired immunity
  Develops after
  exposure to antigens
  in environment
  Induced
  active immunity
  Develops after
  administration of
  antigen to
  prevent disease
  Induced passive immunity
  Conferred by
  administration of
  antibodies to
  combat infection
  Natural
  passive immunity
  Conferred by transfer
  of maternal antibodies
  across placenta
  or in breast milk
  Communicable diseases
  1- Measles): Acute highly communicable viral disease caused by the measles virus with fatality
  rate of 5% in malnourished population.
  Transmission: Droplet spread
  Clinical features: Coryza, Conjunctivitis, Cough, skin rasldast 4-6 days.
  Incubation period: 10 days
  Complications: Pneumonia, diarrhea, otitis media, mal nutrition, encephalitis.
  Prevention:
  • Natural immunity after having the disease.
  • Passive immunity from mother.
  • Immunization 90-95 efficacy.
  2- Pertusis
  Acute disease Involving the trachiobronchial tract, caused by bacterium bordeatella pertusis.
  Transmission: Spread through droplets.
  Incubation period: 6-12 days.
  Clinical features: Coryza, sneezing, fever, persistent cough, sudden inspiratory whope
  Complication: Pneumonia, Malnutrition, Mortality rate.
  P r e v e n t i o n :
  • Natural by having the disease.
  • Immunization by Killed brodeatella. Efficacy: 60-90% after 3 doses.
  Side effects for the vaccine: Local swelling, tenderness, convulsion Screaming attacks, collapse,
  brain damage.
  3 - T e t a n u s :
  Acute neurological disease caused by the toxin of tetanus bacillus, more common in agricultural
  regions.
  Transmission:
  Contact with soil, dust contaminated with clostridium tetani spores Cutting umbilical cord by
  contaminated instrument.
  Incubation period: 4-21 days.
  Clinical features:
  • Inability to suck (due to Jaw muscle spasm).
  • Rigidity and convulsions.
  • Tenderness, painful muscle spasm.
  • Difficulty in swallowing.
  Complications
  • Secondary infection (Respiratory)
  • Breathing difficulty.
  • Cerebral edema.
  • Phlebitis.
  • Embolism. 100% fatality if not treated.
  Prevention: matermal antibodies (temporary toxiod immunization).
  4- poliomyelitis:
  Acute viral infection caused by three antigenic types of poliovirus I, II, III. Type I is the most
  paralytogenic.
  Transmission: oral entry through contaminated food or water with infected feces.
  Incubation period: 7-12 days.
  Clinical features: Non paralytic cases, Fever, sore throat, headache, nausea, vomiting, diarrhea,
  stiffness of neck or back lasting 2-10 days.
  In paralytic Cases: same symptoms and sudden onset of paralysis of muscles and limbs, face,
  chest, respiration muscles.
  Prevention: Temporary protection by Maternal Antibodies Immunization efficacy is about 95%
  for full immunized.
  5 - D i p h t h e r i a :
  Acute bacterial disease caused by coryne bacterium diphtheria affect tonsils pharynx, nose, and
  occasionally other mucous membranes and skin which may lead to muscular and sensory nerve
  paralysis and myocarditis, fatality rate is 5-25%.
  Transmission: Contact with patient or carrier.
  ncubation period: 2-5 days.
  Clinical Features:
  • URT lesions marked by patches of grayish membrane surrounded by red inflammatory zone
  which may cause pharyngeal obstruction.
  • Swelling and edema of neck.
  In laryngeal case: Neurological complication, myocaraditis.
  P r e v e n t i o n : Matemal Antibodies
  I n f e c t i o n
  Immunization (Diphtheria. Toxoid) Effecacy: Highly effective after 3 doses.
  6- Tuberculosis
  A mycobacterial disease caused by mycobacterium tuburculosis primerly from human and
  human and bovis from cattle.
  Transmission; Air borne droplets. Incubation.Period: 4-12 weeks. Clinical features:
  • Initial infection un noticed
  • T.B. sensitivity appear within few weeks.
  • Pulmonary T.B. spread to other parts (Milliary and meningeal).
  Prevention: appropriate immunization
  Drug therapy prevent progressive latent infection
  Vaccine: attenuated bacteria
  Efficacy: protection for 20 years.
  7-Rota virus infection
  Rotavirus Infection
  Rotavirus is very contagious, it spreads when intail;
  es young children come into contact with an infested
  person's lody fluids or teces. or iteras that have come
  in contuct with the fever of an infected person.
  *Mist cases of rotavirus occur in children Lees 3 .
  m o n t h s t o 3 5 m o n t h s o l d .
  *The primary mode of transmission ot rotasirus la the
  Paisage of the virus in stool to the mouth ot anether
  • c h i l d . k n e w n a s a t e c e l e r a l roule of t a r m i s s i o n .
  • The v i r u s con live ter h o u r s on h e n d s a n d e x e n longer
  son h a r l s u r t e c e s .
  The Jordanian national Immunization program/2020
  Recommended vaccines
  First month BEG
  61 days (HEXA « DAPT1 PV1 • HW1+HepB1|= RV1
  91 days DaPTR +PV2 + HiB2 +HapB2 + RV2 + OPV
  121 days DaFTS +|PV3 + HIB3 *HepB3 + RN3÷ OPY
  271 days Measks + OPY +Vitamin A 100,0000
  12 months MMR I + Hepritis A
  18 months MIARZ HOPY + OPT Hepatals A +Vitamin 4
  1 3 0 , 0 0 0 m l
  6 years T& +OFV
  15 years Td
  C o n t r a i n d i c a t i o n t o c h i l d i m m u n i z a t i o n :
  T h e r e are almost no contraindications to vaccination
  • Children with a mild illness should be immunized as usual
  • Children with malnutrition can develop good immunity, so
  immunize them as usual because they are more likely than
  other children to die from some diseases, especially measles
  C o n t r a i n d i c a t i o n s a r e :
  • Very severely ill children who need to be hospitalized, or
  children who have very high fever, should be delay vaccination.
  • If a child has had severe reaction from DPT injection
  (convulsions or shock) (DPT is a combined vaccine for
  Diphtheria, Pertussis and Tetanus) do not give that child any
  more doses of DPT. Give him DT vaccine.
  • BCG is the only vaccine which not be administered to children
  with clinically apparent AIDS or Immune deficiency diseases,
  premature babies, malnutrition, and infection skin disease.
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