Pediatric training

How child plays, learns, speaks, acts, and moves offers important clues about child’s development. Developmental milestones are things most children (75% or more) can do by a certain age. Psychological changes develop in the mind as well as in child’s behavior.

Everyone will go through the same stages of development during their lives, but no two children are alike, the rate at which one develops is individual.

• Infants grow and develop quickly

• Development is from head down (infants gain control of the muscle neck before lower extremities)

• Formerly dependent, now gains independence and body control

• Learns to speak, gains coordination, bladder and bowel control

• May have tantrums or whine to get their way

Childproof the house for safety!!

• Increases interest in social relationships.

• Plays cooperatively and learns language.

• Learns right from wrong.

• Cognitive development (thinking and learning).

• Builds relationships with others in peer groups.

• Develops conscience and self-esteem.

• Girls may reach *puberty in later years of this stage.

• Grow sense of identity.

• Strongly identifies with peers.

• Relatively calm period.

• Imaginary fears give way to fears based in real world.

*Puberty — when a person develops secondary sex characteristics, such as body hair, breasts and hips

• Boys usually reach puberty during this stage.

• Concern for body image and peer acceptance.

• Unstable moods.

• Need to express themselves socially and sexually.

Common infancy disorders:

Premature — babies that are born before 37 weeks of gestation.

Low Birth Weight — full-term babies weighing less than 5 lb are usually cared for the same way as premature babies.

Common childhood disorders:

Chickenpox — highly contagious viral or bacterial infection that can affect immunocompromised adults as well. The spread of infection can be prevented with vaccination.

Measles, mumps, rubella, diphtheria, smallpox, whooping cough, and polio are no longer common due to vaccines.

Leukemia — a form of cancer which enables white blood cells to fight diseases.

Cognitive disorders — disorders related to thinking and learning, more pronounced in a school-aged child.

Birth Defect — a physical or structural defect that affects an infant from birth. Can be inherited, gestational disease or injury during pregnancy. Examples: Cystic fibrosis, Down Syndrome.

Viral or Bacterial infections

Sudden Infant Death Syndrome (SIDS) — when a baby stops breathing and dies for no reason. Common contributions to SIDS are smoking at home, premature and low birth weight babies.

To decrease chances of SIDS — PLACE THE BABY ON THE BACK TO SLEEP.

Anorexia — eating disorder where one does not eat or exercises excessively to lose weight.

Bulimia — binges (eating a huge amount of food or very fattening foods) and then purge (eliminating the food by vomiting, using laxatives or over-exercising).

Sexually Transmitted Disease (STD) — condoms can reduce spread of diseases and prevent teenage pregnancy. Teenagers that are sexually active should be educated on contraceptives.

Teenage pregnancy can cause terrible consequences for the adolescent, family, and the baby. It is common for teenage mothers to give birth to premature babies due to their own undeveloped bodies.

Child Abuse — refers to physical, emotional and sexual mistreatment.

Child Neglect — is not providing enough food, clothing, or support.

ALL health care personnel are responsible by law to immediately report suspected abuse to the supervisor and state agency (Mandatory Reporter).

TO REPORT ABUSE: 1-800-342-3720 or 911

Child has burns, cuts, bruises, abrasions or fractured bones.

Child stares vacantly or watches intensely.

Child is extremely quiet.

Child avoids eye contact. However, in some cultures it is customary not to make eye contact.

Child is afraid of adults.

Child behaves aggressively.

Child exhibits excessive activity or hyperactivity.

Child tells you that someone is abusing him or her.

The most common developmental disability. Children develop at a below-average rate and have below-average mental functioning.

Causes difficulty in learning, communicating, moving, and may cause problems with social interactions.

Praise and encourage positive behavior often.

Encourage the child to perform ADLs (activities of daily living) by dividing tasks into smaller units.

Encourage social interaction.

Repeat yourself to make sure the child understands.

Be patient.

Caused by damage to the fetal or infant brain. A neurological disorder affecting motor and developmental skills. The child can struggle with muscle tone, balance, and coordination of movement.

Treatment includes many types of therapies (behavioral, speech, physical, occupational) that should be started early and must be tailored to the child’s condition.

The child may take a longer time to adjust their position due to pain — be gentle and patient.

The child may be nonverbal, but they can hear. Communicate clearly and positively.

A condition associated with intellectual disability, characteristic physical appearance and weak muscle tone.

Children with Down syndrome have physical and intellectual disabilities, poor immune function and developmental delay.

Unclear speech, attention problems, stubbornness or tantrums. Be patient and positive.

Various health issues. Mobility could be affected, skin problems, allergy to latex and rubber.

Physical activity is important.

Be a positive role model for the family and child. Assist with skin care and physical exercise, and promote healthy habits.

Cause: unknown, but genetics may be a factor.

It appears in early childhood, usually by age 3.

Lacking social skills. Inability to communicate using words, being withdrawn. Inability to make eye contact. Intense tantrums, aggression, short attention span and repetitive body movements.

Treatment includes many types of therapies (behavioral, speech, and occupational therapies) that should be started early and must be tailored to the child.

When caring for a sick child, the caregiver must pay attention to:

Infant’s daily patterns of eating, sleeping, and diaper changes.

Safety of the home environment.

Family interactions.

New mother’s mental state (postpartum depression).

Infant’s home environment (temperature, bedding).

*The only safe place to leave a baby is in the crib or in an adult’s arms.*

Upright hold — the baby is held against the chest. The baby’s head, neck, and back must be supported with one hand, while keeping the other under the baby’s bottom.

Football hold — the baby’s head is in one hand, supporting the baby’s back with the arm on the same side of the body.

Cradle hold — the baby’s head and neck rest in the crook of one’s elbow and the legs in the other arm.

All women have different breastfeeding styles; some may be comfortable with others in the room and some are not. Provide privacy.

Change the baby’s diaper if needed before giving the baby to the mother for breastfeeding.

If necessary, remind the mother how to hold the nipple and areola between the thumb and forefinger to allow the baby to latch. If the baby does not latch on the right way, have the mother stroke the baby’s cheek with her nipple.

To break the suction, the mother presses down on the breast above the nipple.

Assist with burping the baby.

When the baby is properly latched on, the baby’s mouth covers the whole areola.

How do I know if a newborn is eating enough?

• Baby has at least 5–6 wet diapers and 3–4 poops a day

• Baby is gaining weight

• Baby is content and happy

Ready-to-use formula — often sold in a bottle; should not be diluted or mixed.

Concentrated formula — sold in cans or bottles. Must be mixed with tap, sterile, or bottled water. Follow the care plan for mixing directions. Shake well after mixing.

Powdered formula — sold in cans of various sizes, with a measuring scoop. Any formula remaining in the bottle after feeding should be discarded.

Never use a microwave oven to heat infant formula or cook the formula on a stove top. Microwaving may cause the bottle to remain cool while hot spots develop in the formula.

Before bottle feeding, warm the formula by placing the bottle under warm water. Shake the bottle and check the temperature by placing a few drops on the inside of the wrist.

Clean and sterilize bottle-feeding equipment after every feed.

Wash your hands with soapy water and dry with a clean towel.

Check teats for any cracks. Throw away any damaged teats — bacteria can grow in the cracks.

Wash all bottle-feeding equipment in hot, soapy water. Use a bottle brush to scrub inside bottles and teats and around caps and screw-top areas, where bacteria are most likely to grow.

Squirt water through teats to clear the hole. Rinse everything thoroughly.

Place the equipment in a pot on the stove and bring it to a boil. Boil for 5 minutes.

Let everything cool in the pot until you can take it out with tongs or clean hands without scalding yourself. Shake off excess water. There’s no need to dry the items.

Rest the baby on your thigh in a sitting position, supporting the baby’s head and neck. You may place a burp cloth over your and the baby’s thighs to catch any spit. Support the baby’s chest with your hands. *This position is best for babies who have breathing problems.*

Hold the baby over your shoulder, supporting the baby’s head and neck.

When giving a baby a bath you can encounter body fluids, so wear disposable gloves. Gloves can make hands slippery — be careful when handling a baby during the bath.

Have your supplies ready. Give the baby a bath in a warm place.

Always test the water temperature on the inside of the wrist before placing the baby in the water.

Uncover only the area that you are washing. Always keep one hand on the baby.

Wipe the baby’s eyes with warm water, from the inner to the outer area.

The baby’s head and neck must always be supported.

Dry the baby’s hair immediately after washing. After the bath, dry the skin to prevent rash.

Don’t use baby powder — it can cause breathing problems.

Lay the baby down on the back and remove the used diaper. Wrap it up and stick the tapes down to seal the bundle. Toss the diaper in the diaper pail or set it aside to throw out later; if throwing it into a garbage can, place it in a plastic bag first to reduce odors.

Gently clean the baby’s diaper area, between the folds of skin. You can use gentle diaper wipes or a wet washcloth.

For girls, wipe from front to back and spread the labia to clean as needed.

Let air circulate on the bottom for a moment — exposure to air helps prevent diaper rash.

As part of HHA duties you may be asked to measure a baby’s weight and length.

Weight: Wash hands. For an accurate weight, remove clothing and accessories such as hats. Use the same scale. Place a paper towel on the scale. Place the baby on the scale, protecting the sides so the baby does not roll over. Lock the weight. Remove the baby from the scale and dress the baby. Document the weight.

Length: Wash hands. Place the baby on a clean, firm surface with clean paper with inch markings underneath. Always hold the baby with at least one hand. Place a mark by the baby’s head. Straighten the knees and place a mark by the baby’s feet. Remove and dress the baby. Measure the distance between the marks. Document the length.

Keep the stump (umbilical cord*) dry.

Keep the front of the baby’s diaper folded down to avoid covering the stump. This will prevent irritation.

Stick with sponge baths — they make it easier to keep the stump dry.

Let the stump fall off on its own. Resist the temptation to pull it off yourself.

*Umbilical cord — connects the baby to the placenta inside the mother’s uterus.

Circumcision is the surgical removal of the skin covering the tip of the penis, commonly performed in male babies for religious reasons or parents’ choice.

HHA responsibilities do not include changing the dressing at the circumcision site.

The HHA is responsible for making sure the baby is clean and dry to prevent infections, and may reinforce the dressing with gauze if needed after a change.

If the baby has oxygen equipment in the house, the HHA is not allowed to change the oxygen setting.

Apnea — a state of not breathing.

Introduce yourself.

Maintain a routine.

Give comfort if the child is angry or hurt.

Offer encouragement and praise.

Do not compare to other children.

Use positive phrases such as “let’s try this”.

Respond to the child.

Don’t force feed.

Encourage the child to play.

Recognize individual needs.

Be non-judgmental.