1. Chapter 27
Pediatrics

2. What Is Pediatrics?
Branch of medicine that cares for newborns, infants, children, adolescents
Patient population has special needs
MAs knowledgeable about growth and development phases
[FIGURE 27-1]

3. What Is Pediatrics? Medical assistant responsibilities:
Taking history of child
Assessing child
Measuring vital signs, height, weight, vision, hearing
Laboratory work
Administration of injections
Observing parent–child interactions
Noting child’s development level

4. What Is Pediatrics? First physical examination of newborn
Performed immediately after delivery
Newborn APGAR scoring
PKU and other testing
“Well-child” versus “sick-child” visits
Prevention of health problems and diseases
Immunizations given
17 vaccine-preventable diseases

5. What Is Pediatrics? Preparation of vaccines for administration
Most recommended vaccines administered first 15 to 18 months of life
Vaccine storage follows manufacturer’s guidelines
Essential to know what allergies child has
Symptoms of side effects, contraindications, allergies
(See Table 27-1: Vaccine Administration Guidelines)
(See Procedure 27-1: Administration of a Vaccine)

6. What Is Pediatrics? Preparation of vaccines for administration
MA responsible for documentation
Immunization recordkeeping mandated by state and federal laws
TPMS includes immunization recordkeeping
Vaccines stimulate immune system to produce antibodies against pathogens
(See Procedure 27-2: Maintaining Immunization Records)

7. What Is Pediatrics? Giving multiple vaccines at the same time
[FIGURE 27-6A and FIGURE 27-6B]
Giving multiple vaccines at the same time

8. What Is Pediatrics? Recommended vaccination schedule
Repeated doses of several vaccines required
Administer only compatible vaccines at any one visit
Administered according to schedule to ensure complete vaccination by 15 to 18 months
Booster vaccines on school entry

9. What Is Pediatrics? Considerations for vaccine administration
Infection control (Standard Precautions)
Hand washing
Gloving
Syringe selection
Needle selection
Needle-free injection
(See Table 27-2: Injection Guide for Infants and Children)

10. What Is Pediatrics? Considerations for vaccine administration
Inspecting vaccine
Reconstitution
Prefilling syringes
Labeling
Multiple vaccinations
Nonstandard administration
(See Table 27-2: Injection Guide for Infants and Children)

11. What Is Pediatrics? Considerations for vaccine administration
Needle gauge
Needle length
Infants (younger than 12 months)
Injection technique
Toddlers and older children (12 months to 10 years)
Adolescents and adults (11 years and older)
(See Table 27-2: Injection Guide for Infants and Children)

12. What Is Pediatrics? Giving injections to pediatric patients
Infants and toddlers held in such a way that they cannot move
Parents informed of procedure for administering injections
Birth to about 2 years of age, vastus lateralis muscle preferred site
2 to about 4 years old, deltoid preferred site

13. What Is Pediatrics? Giving injections to pediatric patients
Keep syringe and needle out of child’s sight
Do not tell child injection will not hurt; explain it will sting for short while
Vastus lateralis preferred site for intramuscular injections
Deltoid used for subcutaneous pediatric injections

14. What Is Pediatrics? Giving injections to pediatric patients
Clinical responsibilities for MA same or similar procedures as adult examination
Preservatives used in vaccines for 70 years
No relationship between thimerosol and neurotoxicity from vaccine administration

15. Theories of Growth and Development
Newborns
Infants
Toddlers
Preschoolers
School-aged children
Adolescents
[FIGURE 27-9]

16. Growth Patterns Length and weight measurements
Used to calculate pediatric doses of medication
Measurements plotted on physical growth percentile chart
Growth charts aid in diagnosis of growth abnormalities and nutritional disorders and disease
Hereditary factors influence growth patterns

17. Growth Patterns Infant holds and positions
Lifting and carrying done safely
Be especially careful of infant’s neck
Primary positions:
Upright
Cradle
“Football” carry

18. Growth Patterns Primary positions: Upright Cradle “Football” carry
[FIGURE 27-13, FIGURE 27-14, FIGURE 27-15]

19. Growth Patterns Height and weight measuring devices
Infant platform scale
Infant measuring board
Tape measure on a pad
Stature-measuring device

20. Growth Patterns Height and weight measuring devices
[FIGURE and FIGURE 27-16]

21. Growth Patterns Measuring head circumference
Alerts provider to abnormal development
Flexible paper or metal measuring tape
Head and chest circumference equal at age 1 to 2 years
Rapid growth may indicate hydrocephalus
Slow growth may indicate microencephaly

22. Growth Patterns Measuring chest circumference
Suspicion of overdevelopment or underdevelopment of heart or lungs or calcification of rib cartilage
Snugly wrap measuring tape around chest at nipple level
(See Procedure 27-3: Measuring the Infant: Weight, Length, and Head and Chest Circumference)

23. Growth Patterns Infant/child failure to thrive
May have organic and inorganic causes
May be social and emotional causes
Many causes may be treated if found in time

24. Pediatric Vital Signs Temperature Oral Aural (tympanic) Rectal
Axillary
Temporal artery
(See Procedure 27-4: Taking an Infant’s Rectal Temperature with a Digital Thermometer)

25. Pediatric Vital Signs Pulse Apical pulse Use of stethoscope
Normal heart rate ranges for children
Heart rhythm and rate
Normal, bounding, or thready
(See Table 27-3: Normal Heart Rate Ranges for Children)
(See Procedure 27-5: Taking an Apical Pulse on an Infant)

26. Pediatric Vital Signs Respirations
Older children measured same way as adults
In children younger than 6, observed by rise and fall of abdomen
Movements often irregular; counted for 1 full minute for accuracy
Normal respiratory rate ranges for children
(See Table 27-4: Normal Respiratory Rate Ranges for Children)
(See Procedure 27-6: Measuring Infant’s Respiratory Rate)

27. Pediatric Vital Signs Blood pressure
Not normally taken unless requested by provider
Taken annually in children 3 years of age and older
Measured using electronic or aneroid equipment
Determining size of cuff
Auscultating pulse
Palpating systolic blood pressure
(See Table 27-5: Normal Blood Pressure Ranges for Children)

28. Collecting Urine Specimen from Infant
Pediatric urine collection bag >>
Direct urethral bladder catheterization preferred method for obtaining sterile urine specimen
[FIGURE 27-20]
(See Procedure 27-7: Obtaining a Urine Specimen from an Infant or Young Child)

29. Screening for Hearing Impairment
Immediately after delivery
Automated system for checking hearing ability
For older children, referral to audiologist indicated, especially if delay in speech noted on developmental screening

30. Screening Visual Acuity
Newborns respond to light
Older infants follow objects up and down
Kindergarten chart or Allen cards used to test young children
E chart used for older children >>
[FIGURE 27-22]

31. Common Disorders and Diseases
Otitis media
Common cold
Tonsillitis
Pediculosis
Asthma

32. Common Disorders and Diseases
Croup (whooping cough)
Pertussis
Respiratory syncytial virus
Attention deficit hyperactivity disorder
Child abuse

33. Male Circumcision Surgical removal of foreskin of penis
Religious rite in Jewish and Muslim religions
Proponents and opponents of circumcision
Female circumcision includes variety of surgical procedures performed on genitalia