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

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

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

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

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

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

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)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

PATHOLOGICAL CONDITIONS Child Health

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

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

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

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

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

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

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

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

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

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

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

Epispadias

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)

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

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

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)

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

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

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

Hypospadias

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

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

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

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

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

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

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”

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

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

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”

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

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

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

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”

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”

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