Child Health

1. Child Health CHAPTER 19

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 • Growth • 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 • 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 • 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 • (AZ-mah) • Defined • 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 • (CLEFT LIP and PAL-at) • Defined • 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 • (CROOP) • Defined • Childhood disease characterized by a barking cough, stridor and laryngeal spasm • Stridor = high-pitched musical sound when breathing in

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

35. Down Syndrome • Pronounced • (DOWN SIN-drohm) • Defined • 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 • (DWARF-izm) • Defined • 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 • (ep-ih-SPAY-dee-as) • Defined • 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 • (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 • (JYE-gan-tizm) • Defined • 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 • (HIGH-droh-seel) • Defined • Accumulation of fluid in any saclike cavity or duct, particularly scrotal sac or along spermatic cord

45. Hydrocephalus • Pronounced • (high-droh-SEFF-ah-lus) • Defined • 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 • (high-poh-SPAY-dee-as) • Defined • Congenital defect in which the urethra opens on the underside of the penis instead of at the end

47. Hypospadias

48. Intussusception • Pronounced • (in-tuh-suh-SEP-shun) • Defined • 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 • (fih-MOH-sis) • Defined • 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