1. CHAPTER 19
Child Health

2. 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

3. Growth and Development
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

4. 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

5. 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

6. 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

7. 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

8. Growth and 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)

9. 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 twenty-one years

10. 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

11. 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

12. Immunizations Immunization Immunity
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

13. Immunizations Childhood immunizations
Administered to well child according to specific schedule
Recommended childhood immunizations
Hepatitis B
DTaP
Hib
Polio (IPV)
MMR
Varicella
PCV

14. COMMUNICABLE DISEASES
Child Health

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Communicable Diseases
Rubella (German Measles, Three-day Measles)
Infectious agent:
Rubella virus
Immunization:
One of the components of the MMR vaccine

24. 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

25. Communicable Diseases
Rubeola (“Red Measles,” Seven-day Measles)
Infectious agent:
Measles virus
Immunization:
One of the components of the MMR vaccine

26. 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

27. PATHOLOGICAL CONDITIONS
Child Health

28. Asthma Pronounced Defined (AZ-mah) Paroxysmal dyspnea
Severe attack of difficulty breathing
Accompanied by wheezing caused by a spasm of bronchial tubes or by swelling of their mucous membrane

29. 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

30. Cleft Lip and Palate Pronounced Defined (CLEFT LIP and PAL-at)
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

31. 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

32. 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

33. Croup Pronounced Defined (CROOP)
Childhood disease characterized by a barking cough, stridor and laryngeal spasm
Stridor = high-pitched musical sound when breathing in

34. Cryptorchidism Pronounced Defined (kript-OR-kid-izm)
Condition of undescended testicle(s)
Absence of one or both testicles from the scrotum

35. Down Syndrome Pronounced Defined (DOWN SIN-drohm)
Congenital condition characterized by multiple defects and varying degrees of mental retardation
Trisomy 21

36. 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

37. Dwarfism Pronounced Defined (DWARF-izm)
Generalized growth retardation of the body due to the deficiency of the human growth hormone
Also known as congenital hypopituitarism or hypopituitarism

38. Epispadias Pronounced Defined (ep-ih-SPAY-dee-as)
Congenital defect in which the urethra opens on the upper side of the penis at some point near the glans

39. Epispadias

40. 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)

41. Esophageal Atresia Pronounced Defined
(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

42. Gigantism Pronounced Defined (JYE-gan-tizm)
Proportional overgrowth of body’s tissue due to hypersecretion of human growth hormone before puberty
Child experiences accelerated abnormal growth chiefly in long bones

43. 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)

44. Hydrocele Pronounced Defined (HIGH-droh-seel)
Accumulation of fluid in any saclike cavity or duct, particularly scrotal sac or along spermatic cord

45. Hydrocephalus Pronounced Defined (high-droh-SEFF-ah-lus)
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

46. Hypospadias Pronounced Defined (high-poh-SPAY-dee-as)
Congenital defect in which the urethra opens on the underside of the penis instead of at the end

47. Hypospadias

48. Intussusception Pronounced Defined (in-tuh-suh-SEP-shun)
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

49. 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

50. Phimosis Pronounced Defined (fih-MOH-sis)
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

51. Reye’s Syndrome Pronounced Defined (RISE SIN-drohm)
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

52. Shaken Baby Syndrome Pronounced Defined (Shaken Baby SIN-drom)
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

53. Spina Bifida Occulta Pronounced Defined
(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

54. 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”

55. Tay-Sachs Disease Pronounced Defined (TAY-SACKS dih-ZEEZ)
Congenital disorder caused by altered lipid metabolism due to an enzyme deficiency

56. 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

57. Tetralogy of Fallot Pronounced Defined (teh-TRALL-oh-jee of fal-OH)
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”

58. 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

59. 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

60. 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

61. Umbilical Hernia Pronounced Defined (um-BILL-ih-kahl HER-nee-ah)
Outward protrusion of intestine through a weakness in abdominal wall around the umbilicus
Umbilicus = navel or “belly button”

62. DIAGNOSTIC TECHNIQUES, TREATMENTS AND PROCEDURES
Child Health

63. 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”

64. 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