Basic Pediatric Nursing Care

Basic Pediatric Nursing Care
Chapter 30 Basic Pediatric Nursing Care

History of Child CareThen and Now
For centuries children were considered miniature adult. In colonial America children were expected to assume adult responsibilities as soon as they could. Infant and childhood mortality rate were high. Epidemic diseases were common, with no control or treatment for smallpox, diphtheria, measles, dysentery, mumps, chickenpox, yellow fever, cholera, or whooping cough.

History of child care-then and now
Industrializion in America Population shifted from rural to urban settings. People lived in overcrowded and unsanitary conditions. Children were looked at as little adults and worked in factories 12 to 14 hours a day. They had no legal rights and there were no work laws.

1860: Dr. Abraham Jacobi, a New York physician referred to as the “father of pediatrics,” first lectured to medical students on the special diseases and health problems of children. At “milk stations,” infants were weighed and mothers were taught how to prepare milk before giving it to their babies. Late 1800s: Increasing concern developed for the social welfare of children, especially those who were homeless or employed as factory laborers.

Lillian Wald: founder of public health or community nursing Early 1900s: Children with contagious diseases were isolated from adult patients; parents were prohibited form visiting. 1940s: Famous works of Spite and Robertson on institutionalized children; the effects of isolation and maternal deprivation were recognized. 1909: White House Conference on Children focused on issues of child labor, dependent children, and infant care. 1912: U.S Children’s Bureau was established.

1919: First funded program for mothers and children 1929: Depression caused conditions for children to decline, once again 1987: National Commission on Children formed; served as a forum on behalf of the children of the nation Children are the focus of many reform initiatives in the twenty-first century, and solutions will emphasize collaboration among various disciplines.

Pediatric Nursing Nursing of infants and children is consistent with the revised definition of nursing proposed by the Social Policy Task Force of the American Nurses Association (ANA) in 2003. This definition incorporates the four essential features of nursing practice: Attention to the full range of human experiences and responses to health and illness without restriction to a problem-focused orientation Integration of objective data with knowledge gained from an understanding of the patient or group’s subjective experience

Application of scientific knowledge to the processes of diagnosis and treatment
Provision of a caring relationship that facilitates health and healing (ANA,2003)

Characteristics of a pediatric nurse
Pediatric nursing is different from other clinical specialties in nursing. Pediatric nursing is family-centered nursing in its truest sense. The pediatric nurse must have keen observation skills, especially when caring for infants and toddlers or children who are critically or cannot communicate in the traditional sense. Supporting a children a through difficult procedures or illnesses is an activity in which a pediatric nurse commonly becomes involved.

Teaching is ongoing in pediatrics.
Nurses also need to be aware of the indirect teaching that occurs through example. A pediatric nurse also functions as a child and family advocate, whether those activities involve an ethical decision or the quality of care given. Being able to communicate effectively with a child is essential.

Pediatric Nursing Children with Special Needs
Medical advances over the past two decades have resulted in significant changes in the pediatric population. Fragile or premature infants and children with severe injuries or disabilities who never would have survived in the past are now being saved. Children with special needs make up approximately 35% of the youngsters hospitalized today.

Pediatric Nursing Family-centered care
-the term family-centered care, although part of nursing literature for many year, has been redefined and clarified. (box 30-1) -three key components of family-centered care are respect, collaboration, and support. -two basic concepts in family-centered care are enabling and empowerment. -the parent-professional partnership is a powerful mechanism for enabling and empowering families..

Family-centered care con’t
-partnerships imply the belief that partners are capable individuals who become more competent by sharing knowledge, skills, and resources in a manner that benefits all participants. -often illness and hospitalization are the first crises children must face: 1.stress represents a change from the usual state of health and environment routine 2. children have a limited number of coping mechanisms to resolve stressors.

Pediatric Nursing Partnerships with Parents
Concept of partnerships with parents Parental involvement in their children’s care has evolved from that of relinquishing their role to institutions to today’s role of planners, in addition to recipients, of services. Parents are treated as equals and have a rightful role in deciding what is important for themselves and their family. Parents of special needs children often become experts on their child’s condition.

Pediatric Nursing Future Challenges for the Pediatric Nurse
The present shift from treatment of disease to promotion of health is likely to further expand nurses’ roles in ambulatory care, with prevention and health teaching receiving a major emphasis. Technological advances will influence the pediatric nurse to increase technical skills related to patient care. Nurses will need to keep abreast of developments in adolescent medicine and continually adapt their care to the cultural environment in which they practice.

Pediatric Nursing Nursing Implications of Growth and Development
The stage of growth and development are complex processes that occur as the body grows and the mind and personality unfold. One of the nurse’s primary responsibilities is to identify an infant or child who is demonstrating cognitive impairment. Knowledge of child development allows the nurse to use a developmental rather than a chronologic approach to pediatric nursing care. Understanding normal growth and development enables a nurse to select age-appropriate toys for the infant or young toddler and to devise activities that appeal to the school-aged child or adolescent.

Pediatric Nursing Nursing Implications of Growth and Development (continued) Age and developmental level influence the ways in which children perceive and understand experiences such as illness or disability and therefore their ability to cope. A knowledge of growth and development also is the basis for anticipatory guidance with parents. Psychological preparation of a patient for an event expected to be stressful.

Physical Assessment of the Pediatric Patient
The rate of growth, level of understanding, and means of communicating differ with a child from the adults. Growth Measurements Measurement of physical growth is a key element in evaluation of the health status of children. Measurements are plotted by percentiles on growth carts and compared with those of the general pediatric population to determine deviation from the norm.

Growth Measurements (continued) Child whose growth may be questioned include the following: -children whose height and weight percentiles are widely disparate. Length Measurements are taken when children are supine; recumbent length is usually measured until 2 years of age. Height Measurement is of a child standing upright.

Table30-2 Expected growth rate at various ages Age expected growth rate per year 1-6 mon 18-22cm 6-12 mon 14-18cm Second yr 11cm Third yr 8cm Fourth yr 7 cm 5-10 yr 5-6cm

Growth Measurements (continued) Weight Fluid loss and inadequate calories are reflected in a child’s weight, especially that of infants and toddlers. Same scale should be used, and the child should be weighed at the same time every day. Skinfold Thickness Skinfold thickness should be determined at one site with at least two measurements. Arm circumference measures muscle mass.

Vital Signs Key elements in evaluating physical status are vital signs-temperature, pulse, respiration, and blood pressure. Temperature Reflects metabolism, is fairly stable from infancy through adulthood Despite the ability to regulate their temperatures, infants and toddlers are prone to wide variations, especially after crying for extended periods or after active play. Female maintain a temperature slightly above that of males throughout life.

Primary purpose of measuring body temperature to detect abnormally high or low values
Routes: oral, rectal, axillary, and tympanic Normal findings approximately 97° F to 99° F Age temperature 3 mon 6 mon 1 yr 3 yr 5 yr 7 yr 9 yr

Vital Signs (continued) Heart Rate/Pulse Great variations also exist in the heart rates of children Infection and physical activity increase heart rate. Note any irregularities in volume, rate, and rhythm. Apical pulse is taken on infants and young children; a radial pulse is often taken on children 5 years of age and older. Pulse rate should be counted for 1 full minute. Apical beat of a newborn may be 152 beats per minute and gradually slows to 72 to 75 beats by adolescence.

Vital Signs (continued) Respirations Infants’ respirations are mainly diaphragmatic; observe abdominal movement for 1 full minute. In older children, respirations are chiefly thoracic. Respiratory rate slows as a child progresses from infancy to adolescence. Newborns are obligate nasal breathers. Rate, depth, and quality should be assessed. Rate may be as rapid as 40 to 50 breaths per minute, gradually slowing to 25 to 32 per minute.

Vital Signs (continued) Blood Pressure Blood pressure should be measured in children 3 years of age and older. Blood pressure is low in a newborn and gradually rises; at the end of adolescence, it is about 120/78. It is important to use the correct size cuff to ensure accuracy. Measure blood pressure before any anxiety-producing procedures.

Box 30-6 Calculating BP Use the following quick formula for normal systolic bp: -1to 7 yrs: age in yrs to 18 yrs: ( 2by age in yrs) +83 normal diastolic bp: -1to 5 yrs: to 8 yrs: age in year+52

Head-to-Toe Assessment Skin Genetic and physiologic factors affect assessment of color. Pallor may be a sign of anemia, chronic disease, edema, or shock. Erythema may be the result of increased temperature, local inflammation, or infection. Skin texture should be smooth, soft, and slightly dry to the touch.

Head-to-Toe Assessment (continued) Accessory Structures Hair should be lustrous, silky, and elastic Nails should be pink, convex, smooth, and hard but flexible, not brittle Handprints and footprints Palm normally shows three flexion creases

Head-to-Toe Assessment (continued) Eyes At birth, visual acuity is 20/400; when holding a baby, assume an en face position. Clear vision by the baby only at very close range. By the second week of life, tear glands begin to function. Newborns can follow bright, colorful objects by the second or third week of life. Vision improves to 20/30 by age 2 to 3 years. Accommodation and refraction are present by school age.

Head-to-Toe Assessment (continued) Ears Inspect for general hygiene. If the ear canal appears free of cerumen, ask how ears are cleaned. Advise parents and children to clean the ears with a washcloth; wipe only the outer portion of the canal with a swab. Mineral oil may be used to soften cerumen.

Head-to-Toe Assessment (continued) Nose, Mouth, and Throat Nose should lie from the center point between the eyes to the notch of the upper lip. Normally there is no discharge from the nose. Infants and toddlers, however, usually resist and will not open their mouth. It is also important to check the number of teeth. Good dental hygiene begins as soon as the primary teeth erupt. Permanent teeth begin to appear at about 6 years, and most are present by 12 years.

Head-to-Toe Assessment (continued) Lungs Make sure the child is not crying. Have them “blow out.” Listen systematically. Chest Chest is almost circular. As the child grows, the chest normally increases in a transverse direction. Asymmetry may indicate serious underlying problems.

Head-to-Toe Assessment (continued) Back Newborn is C-shaped. Older child typically has S-shaped curve. Marked curvature in posture is abnormal. Abdomen Inspection: done while the child is erect and supine. Abdomen is cylindrical and position is flat Auscultation: unlike listening to heart or lung sounds The most important sound to listen for is peristalsis, which may be heard every 10 to 30 seconds, depending on when the child last ate.

Head-to-Toe Assessment (continued) Extremities Examine for symmetry, range of motion, and signs of malformation. Fingers and toes should be counted. Toddler begins to walk, the legs are usually bowlegged until lower body and leg muscles develop. Observe for arch development and correct gait. School-aged walking posture is more graceful and balanced. During puberty, adolescents may experience awkward posture from rapid growth of extremities.

Head-to-Toe Assessment (continued) Renal Function There is a functional deficiency in the kidney’s ability to concentrate urine and to cope with conditions of fluid and electrolyte fluctuation, such as dehydration or fluid overload. Urine output varies and depends on the size of the infant or child. Many tests done in adults are not done in young children because of immature kidney function.

Head-to-Toe Assessment (continued) Anus Check the anal sphincter. History of bowel movements should be noted. Assess for perianal itching; test for pinworms. Genitalia This is an excellent time to elicit questions concerning body functions or sexual activity. The examination is an excellent time for eliciting question concerning body function or sexual activity.

Factors Influencing Growth and Development
Nutrition Nutrition is probably the single most important influence on growth. A child’s appetite fluctuates in response to growth spurts. Infants begin life outside the womb, nursing at the breast or ingesting formula or breast milk via bottle or tube. Most infants are given solid foods at 4 to 6 months of age, when they begin to need more iron in the diet and their teeth begin to erupt.

Nutrition (continued) It is important for each new food to be introduced at weekly intervals so that food allergies can be identified. By 9 months, several teeth have erupted and junior foods, which are a more coarse texture, can be offered. By 12 to 15 months, toddlers should be eating table food prepared for the family. Weaning is a major accomplishment of toddlerhood. The pediatric nurse should help parents plan meals and snacks including foods less damaging to teeth.

As the child moves through toddler and preschool stages, fads with strong preferences develop; encourage a balanced diet. frequent snacking on food high in fat and sugar and low in essential nutrients cause special concerns during the teen years. Nutritional assessment should focus on the dietary adequacy of iron, calcium, and multivitamins with folic acid.

Metabolism Metabolic needs vary among individuals. Rate of metabolism is highest in the newborn infant because of ratio of total body surface to body weight is much greater than it is in the adult. The body uses energy provided by foods. Because metabolism is so high in infants and children, their ability to recover from surgery or a fractured bone is swift compared with that of an adult.

Sleep and Rest Children spend less total time sleeping as they mature. Most babies are sleeping through the night by the latter part of their first year and take one or two naps a day; the 3-year-old has usually given up daytime naps. The best way to prevent sleep problems with the infant/child is to establish bedtime rituals that do not foster problematic patterns.

Speech and Communication Crying at birth is the earliest evidence of speech, followed by other sounds -cooing, laughing, or babbling. By 9 months, infants practice and painstakingly repeat the noises they can make. A 1-year-old has a three- to four-word vocabulary; by 18 months, they usually know 25 to 50 words; by 2 years, they may know more than 250 words. Children learn the complex symbol system of language with astonishing speed.

The nurse should know what typifies speech at certain stages of childhood.
A nurse uses verbal communication in variety of ways. General strategies to consider when talking with children include: -use a calm, unhurried, and confident voice. -speak clearly, be specific, and use as few words. -state direction and suggestions in a positive way. -listen to and observe the child at play. -be honest with children.

Nonverbal Communication Young children become very adept at understanding nonverbal communication. They sense anxiety or fear by the rise in pitch of the parent’s voice. Nonverbal symbols include nodding of the head, using direct eye contact; tapping finger or foot; avoiding eye contact; and sign language.

HOSPITALIZATION OF A CHILD
Hospitalization is an anxiety-producing experience for children and their families, primarily because of a basic fear of not knowing what will occur. Such as experience can be made less traumatic by anticipatory guidance, explanations, and preparation to help relieve fear and anxiety. Adequate preparation makes the transition from the security of a home to the unfamiliar atmosphere of a hospital less difficult.

Hospitalization of a Child
Preadmission Programs Many hospitals have orientation programs for children who are to be admitted. Programs are based on the child’s level of understanding and stage of development. It is helpful for children to handle some of the items they will see while hospitalized, such as masks and gowns, stethoscopes, anesthesia masks, and syringes. Timing is important. Adolescents should be told as far in advance as possible to allow them time to inform peers and solicit their support.

Children should be allowed to prepare for this new experience in their own way.
Parents can benefit from such orientation programs too. An emergency admission thrusts the child into an unknown environment surrounded by strange equipment, frightening sounds, and unfamiliar adults.

Admission Child may be assigned to a nursing unit according to their age group. Confidentiality is of great importance when interviewing the hospitalized pediatric partient. Characteristics of providers should include compassion, warmth, understanding, and an ability to communicate with the child. Pediatric units are usually bright, colorful, and cheery areas with cartoon figures on the walls. First impression are important and may influence the child’s entire hospital stay.

-two important locations to be pointed out are the area in which snacks or liquid refreshments are available and the play room where they will spend time when allow out of bed. -many hospitals have developed a system of family-centered care. -the family is considered to be partner in the care of the child.

Hospital Policies Sometimes anxiety levels about a hospital admission are high. Parents who are involved in care have a sense of contribution to the child’s recovery. Certain hospitals allow children to wear their own clothes. After a child is admitted, a nursing history is obtained; an identification bracelet is usually worn on the wrist. Vital signs and weight are measured and recorded. All newly admitted infants and children have routine blood samples drawn by a laboratory technician.

Developmental Support for the Child Hospitalization interrupts children’s normal routines and threatens their normal developmental process. It is not unusual for children to regress when hospitalized; this often persists for several months after discharge. Nurses should be especially concerned with meeting the psychosocial needs of children with special needs who are hospitalized.

Pain Management Health care professionals tend to underestimate pain in children. Anything that is painful to adults should be assumed to be painful to infants and children. Pain is now considered the fifth V/S and must be recorded during each shift assessment. Knowing when a child is in pain and how intense the pain is can sometimes be difficult; the nurse must rely on physiologic variables and behavioral variable. Wong-Baker Faces Scale may be helpful in assessing pain level.

Surgery Preparing a child for surgery entails providing information to parents and the child about what will happen and what the child will experience. Six Common Stress Points 1.Admission, 2.blood tests, 3.the afternoon of the day before surgery, 4.injection of preoperative medication before and during transport to the operating room, 5. and 6.return to the postanesthesia care unit. Age influences the types of fears and concerns child may experience regarding surgery.

Parent Participation It is essential to establish an effective working relationship with parents as soon as possible. Parents are the most significant individuals to a child; they know their child better than anyone else. In obtaining a nursing history, it is important for the nurse to select a quite place on the unit to listen to parent’s responses. Patents experience a series of reactions when a child is hospitalizd. On admission parents need specific information on routines, hospital policies that affect them, any limitations that exist, and what is expected of them.

Parent participation con’t
Later, diagnostic test, medications, or procedures that are planned by the physician should be explained to the parents. As the parents’ comfort increases, they become more involved in meeting their child’s physical needs. The equipment that surrounds a child can be overwhelming, with the strange-sounding alarms or with electrodes placed on different parts of the child’s body. Initially a parent may watch the nurse suction the child, perform chest physical therapy, or change a dressing.

Parent participation con’t
Parents must be confident in their ability to perform given tasks in their child’s care and should be encouraged to participate only in as many activities as they feel comfortable performing. The pediatric nurse must gain the trust of the parents by : 1. Reviewing and interpreting information 2. asking the parents whether have any question 3. conveying concern of the parents’ well-being 4. listening and being available 5. respecting them as experts on their child and soliciting their input.

COMMON PEDIATRIC PROCEDURES
Some of the following procedures are for general care of children, procedures healthy children experience in the home. Using a sensation-based approach is believed to be the most effective method of preparation. Timing of preparation is important. It is usually best to prepare young children close to the time of the procedure.

Common Pediatric Procedures
Bathing This provides an opportunity for skin assessment. Check temperature of water. Water only is used to clean areas around the eyes. Protect child from drafts. Bathe from the trunk down. If umbilical cord is still present, give sponge bath and clean around cord with alcohol. Be careful to remove soap, rinse, and dry creases. Cotton-tipped applicators are never used inside the ear canal.

Bathing (continued) Infants enjoy being placed in basins for baths. Use dry hands to pick up the infant. Allow this child to play and splash. Most toddlers love to be placed in a tub for their bath. Toys should be provided. The child should never be left in a tub without supervision. School-aged children may be reluctant to bathe; encourage them to participate in their care. Adolescents bathe or shower daily; privacy is important.

Feedings Breastfeeding The mother may wish to continue breastfeeding her baby who is ill or hospitalized. Provide a quiet environment and a comfortable chair for nursing. If the mother is unable to be present for every feeding, encourage her to use a breast pump; bottles of breast milk can be frozen and given later by bottle or tube feeding.

Feedings (continued) Formula Positioning should be comfortable for the adult and the infant; infant should be held securely. If a burp is not elicited in one position, try another. Formula or juice should fill the nipple entirely to decrease the amount of air swallowed in the course of the feeding. After feeding, the infant is positioned on the right side.

Feedings (continued) Solids Infant should be fed in an infant seat. Older infants can be placed in a high chair with a safety strap. Toddlers may resist high chairs; nurse may need to try an alternative to prevent injury. Parents should provide three regular meals and planned snacks each day so that the child eats about every 2 to 3 hours. Children should sit down to eat; choking is more likely if children eat on the run.

Feedings (continued) Gavage Some infants and children require the passing of a feeding tube through the nose or mouth, down the esophagus, and into the stomach. To measure for placement: measure from the nose to the bottom of the earlobe and then to the end of the xiphoid process or go by height. Restraint may be needed to pass the tube. Because infants are nose breathers, the mouth is preferred.

Feedings (continued) Gavage Older children can be asked to swallow as the tube is placed. Once the tube is in place, secure with tape. Before feeding, check placement. Infants are given a pacifier to associate sucking with satisfying hunger. Allow to flow into the stomach via gravity. At the completion of feeding, flush the tube with sterile water.

Feedings (continued) Gastrostomy This is often used in children when passing a gastric tube is contraindicated or in children who require tube feeding over an extended period. A tube is inserted into the abdominal wall and into the stomach and secured with a purse-string suture. Feedings are carried out in the same manner and rate as in gavage feeding. After feedings, the child is placed on the right side or in Fowler’s position.

Feedings (continued) Total Parenteral Nutrition A highly concentrated solution of protein, glucose, and other nutrients is infused intravenously through conventional tubing with a special filter attached to remove particulate matter and microorganisms. Wide-diameter vessels, such as the subclavian vein, are the usual sites of infusion. Nursing responsibilities include control of sepsis, monitoring infusion rate, and continuous observation.

Safety Reminder Devices At times, for safety, children should be restrained after surgery or during a procedure or examination. This is used only as a last resort. The device should be applied correctly, and circulation and skin integrity must be monitored closely. The device should be removed every 2 hours so that the body area can be exercised. Release extremities one at a time so that the child cannot pull out an IV or NG tube.

Safety Reminder Devices (continued) Types Elbow safety reminder Mummy safety reminder Clove-Hitch safety reminder Jacket safety reminder

Urine Collection Collecting a urine specimen can be a major problem in pediatrics when the child is not toilet trained. Methods of Collection Suprapubic bladder tap Plastic urine collection bags Catheterizations

Venipunctures to Obtain Blood Specimens In infants and young children, a jugular or femoral vein may be used to obtain a blood specimen. The nurse’s responsibility is to prepare, position, and restrain the child. Holding the head or lower extremities absolutely immobile is critical. Pressure should be applied to the site to prevent the formation of a hematoma. Sometimes the veins of the extremities, especially the arm and the hand, are used.

Lumbar Puncture Explain the procedure and answer any questions. EMLA, a local anesthetic cream, may be applied to the lumbar area; it should be applied at least 1 hour before procedure. Position the child at the edge of the exam bed, on the side, facing nurse with neck and legs gently flexed. Observe for any signs of difficulty. A toddler may need to have the legs wrapped in a blanket The child should be held securely until the spinal tap is completed.

Oxygen Therapy This is used to improve the child’s respiratory status by increasing the amount of oxygen in the blood; it is also used in children who have cardiac or neurologic disorders. Infants and young children receiving oxygen are monitored on an oximeter. Methods Hood and incubator Mist tents Nasal cannula

Suctioning Suctioning should be used when secretions are audible in the airway or when signs of airway obstruction or oxygen deficit are present. Various devices are used to suction children such as a bulb syringe or a straight suction catheter. Depth: approximately 1/4 to 1/2 inch Timing: not more than 5 seconds Frequency: allow 30 seconds between attempts

Intake and Output Many health disorders require accurate monitoring of the amount of solids and liquids taken in and the amount excreted. All fluids given to a child are documented on a record kept at the bedside. All urine voided is measured before it is discarded; weigh diapers if appropriate.

Medication Administration The nurse must know how to compute the dose correctly and administer it properly. All computed dosages must be checked by a second nurse for safety. The right amount of the right medication must be given to the right child at the right time and via the right route. Nurses must also observe and document a child’s response to the drug. Methods of calculating dosages for children consider age, body weight, and body surface area.

Medication Administration (continued) Oral medications -when administration liquid, care must be observed to prevent aspiration. -to encourage the child’s acceptance of oral medication: -give the child an ice pop or small ice cube to suck to numb the tongue before giving the drug. -mix the drug with small amount such as sweet thing. -many pediatric medications are given by drops pr dropper.

Common pediatric procedures
Medication administration con’t -intradermal, subcutaneous, and intramuscular medications -injection are a source of pain and fear for children, so drugs are usually given by injection only when other routes cannot be used. -injection administered with care seldom produce trauma to the child.

-intradermal, subcutanceous, and intramuscular medication con’t -factors that are considered when selecting a site for IM injection on an infant or child include: 1. the amount and character of the medication to be injected. 2. the amount and general condition of the muscle mass. 3.the type of medication being given.

Intravenous (IV) medication
-the IV route of administering a medication is often selected for the following reasons: -medication is almost immediately distributed to tissues and prompt physiologic action occurs. -with consecutive doses, predictable drug levels can be achieved to maintain therapeutic effects.

Optic, otic, and nasal administration
-there are few differences in administering eye, ear, and nose medication to chridren or adult. -instilling eyedrops in infants can be difficult because they often clench their lids together. -eardrops are instilled with the child restrained. -for nasal administration, position the child with the head hyperextended to prevent strangling sensations cause by medication tricking into the pharynx rather than up into the nasal passages.

Rectal admistration The rectal route is less reliable but sometimes is used when the oral route is difficult or contraindicated. Enema -the procedure for an enema does not differ essentially from that of an adult. -proper insertion of the catheter tip, especially in infant, is essential to prevent rectal damage and perforation.

Safety Protecting a child from harm is a major issue in pediatrics.
Anticipatory guidance for parents of infants and toddlers and health teaching for school-age children and adolescents are two methods of preventing accidents. Injuries cause more deaths and disabilities in children than do all causes of disease combined. Parents and children should talk and listen to each other to prevent many accidents. The adult who is a role model can influence a child immensely.

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