Peds has not been a specialty until the mid 1800’s. Prior to the 1800’s, were dark ages for children and were seen as miniature adults. Families were very large and children were seen as a comadity and used for work. Illnesses were treated at home. Mortality rates were high. 50% did not live to be 1. 1938, Fair labor laws came into effect - established minimum age for working. When children were hospitalized, they were treated like adults. No one was allowed to touch or visit them. This hindered their growth and development.

We now have a more family centered healthe care system. Arthur Jacobie (father of Peds) was first person that started understanding children were different from adults. He started a pediatric hospital. He believed in pasteurizing milk.

With this growing specialty, nurses and doctors needed more education and in 1907, the first college level course was taught. In 1938, Theodore Roosevelt saw the need to look at the needs of children and conviened the White House conferences. They met every 10 years to talk about and identify issues affecting children.

We moved from institutionalized care to family-centered care. Children are a part of family and health is influenced by family and community.

Care for children has gotten more regionalized. Cost containment is a big concern. Some hospitals don’t have Peds units so these children can be transferred to a larger area that does. Problem with regionalized care: too expensive for family to go so they are separated.

Factors that Influence the status of child Health:

• child abuse
• drugs
• alcohol
• adolescent pregnancy
• violence in school
• accidents (MVA)

Focused at social concerns. We are a country of freedom, high technology, and good medical care. We should be concerned that we rank 18th among countries for the highest infant mortality rate. Mothers smoking, drinking and using drugs, etc contributes to this.

Healthy People 2000:

National consortium organized in 1990. 300 organizations got together and developed a set of objectives for the year 2000. The goal is prevention and health promotion. One of the objectives is to improve access to health care for children.

There are as many an 30 million Americans who have limited or no access to health care. Medicade is the largest single course of public health care for pregnant women and children. There are aides to families with dependent children. Enrollment depends upon income established by the state.

Healthy people 2000 wants to teach families the importance of adopting healthy behaviors.

Functions of a Family:

1. To provide physical needs. This responsibility is now shared by mom and dad.

2. To provide socialization. Family is a part of society and where we learn beliefs, customs and values. As part of a society, we learn what is accepted and what is forbidden. We learn how to treat others.

3. To provide emotional and psychological health.

How Has the Structure of Family Changed:

1. Single parent homes: more acceptance. Harder on the children because there is only one parent.

2. Divorce: there is no commitment. Children feel guilty. Adolescent is most effected because they are trying to gain an identity. Younger child may feel abandoned and rejected. May feel anger.

3. Grandparents raising children of their children: can be very straining.

4. Same sex parents.

5. Step parents and step children: also the blended family where there is his, hers, and ours.

6. Cohabitation: have children but not married. Child may not feel secure or stable.

7. Nuclear rather than extended: extended families used to take care of each other. Now it’s just mother, father and children. Much more mobile society.

8. Birth order. First born is the higher achiever, relates well with others because a lot of expectations were put on them. When the second child comes along, parents are more experienced and more laid back so the child exhibits this.

Challenging Issues:

1. Poverty and homelessness - 18% of the population were poor in 1990. Children make up 27% of the nations population and they make up 40% of the people living in poverty. Poverty rate for children under 6 is higher than any other age. Children constitute the largest segment of homeless population.

2. Cancer is the leading cause of death by disease of children between 1-14.

3. By 2000, we expect 10 million infants and hcildren will be HIV infected. Most will die before age 5.

4. Asthma and other respiratory diseases are major cause of hospitalization between ages 1 and 9.

5. Will see more of our children with chronic illness and disabilities.

6. Suicide is 2nd leading cause of death among teens between 15-19. Suicide rate has tripled in 30 years.

Basic Principles of Family Centered Care:

1. Recognized the family as the constant in the child’s life.
2. Facilitate parent/professional collaboration.
3. Share unbiased and complete information on a continued basis.
4. Implement programs to provide emotional, spiritual, cultural, and financial support.
5. Recognize and respect different methods of coping.
6. Encourage and facilitate family to family support.
7. Help create a flexible, accessible and responsive health care system.
8. Appreciate families as families and children as children.
9. When family feels more confidence, less dependence, and learn more skills, health care providers fell more job satisfaction.

Principles of Growth and Development:

In order for assessment to be meaningful, a nurse must have a basic knowledge of G&D. It lets us know of ways we are similar and different. This helps to individualize care.

Growth: increase in body size occurring because cells are dividing and new cells are being made. It is a quantitative change occurring that is easily measured. Focus is on height and weight. Referring to the linear growth that occurs as a result of skeletal growth. Most important variable that influences growth is nutrition. Height and weight is plotted on a growth chart and compared to the normal for that child’s age. More important information is gotten when you look at that particular child’s pattern.

Development: the gradual growth and change froma lower to a more advanced state of complexity of function. It is a qualitative change.

G&D follows a directional trend. Noted more when talking about physical and motor development. It is a cephalocaudal (head to toe) process. It also occurs proximodistal (from center to away from center). Ex: will learn to move arms before fingers. Growth also follows a sequential trend. There has been identified periods when a child is ready for certain activities. These periods are referred to as critical or sensitive periods. It means that this period of time is most favorable for this new development. These are also referred to as developmental tasks. IF the child has not done these by a certain time, then it needs to be investigated.

Common screening tools used for G&D:

1. Growth charts.

2. Denver development screening test: evaluates 4 aspects of child’s development between ages 2 months and 61/2 years. Test given to child before they enter school.

A. gross motor skills

B. fine motor skills

C. language skills

D. personal social skills

It is not an IQ test and there are variables that determine effectiveness of this test. Depends on person giving test, child’s attitude at the time and if parent is present.

Genes, nutrition, socioeconomic status, family factors, birth order, sex differences, etc influence G&D. Boys are 2 years behind girls in maturation.

Anticipatory guidance: teaching the developmental tasks that the child is expected to go thru so the parents will know what to anticipate.

The most common way in which we study children is the age stage approach:

1. Prenatal: extends from conception to birth.

2. Infancy: birth to 12 months.

A. Neonatal: birth to 1 month.

B. Infancy: age 29 days to 12 months.

3. Early childhood.

A. Toddler: 1 to 3.

B. Preschooler: 3 to 5.

4. Middle childhood: 8 to 11, schoolage.

5. Adolescence: 12 to 18.

Maslow: Basic human needs theorist.

Emphasized the development of the individual's identity throughout the lifespan and in the context of parents, family, peers, neighbors and culture. He emphasized the process of socialization - when the child learns the rules of his culture and society.

1. Trust vs. Mistrust: birth to 12 months.

Totally dependent on everything. An individual that is getting their needs met on a constant basis is going to learn that the world is a safe place and a predictable place to live and learn to trust. Mistrust is the opposite. Must complete this stage before going to the next. In nursing, we should know to assign the same nurse to care for this infant so trust can be developed.

2. Autonomy vs. Shame and doubt: 1 year to 3 years.

Typical toddler. Everything revolves around them. Has learned that parents are going to look out for them and will want to assert their independence. Begins to gain control over personal actions and bodily functions. Will protest if don't get their way. Developmental task is to gain control over bowel and bladder. Conflict is shame and doubt. If not given a chance to explore then they develop a feeling they can't "do" things.

3. Initiative vs. Guilt: 3 to 5 years.

Preschool years. 3 year old wants to always please you. Also a time of exploring. Behavior is intrusive. Era of the "whys". Will try to do things that are too difficult and will do things that are unacceptable to people they wish to please. Curious about body parts.

4. Industry vs. Inferiority: 6 to 12 years.

Schoolage. Have to be given tasks they can accomplish and finish. Teachers will be very important to them. They will get a lot of self esteem (how you feel about yourself) and self concept (how you see yourself).

5. Identity vs. Role confusion: 12 to 18 years.

Adolescent. Searching for who they are. Turns to peers for acceptance. They learn that others have the same views as they do. Start off wanting to be a part of a group. Older adolescents desire to be different than the group.

How the individual becomes familiar with the world and the objects in the world thru thinking.

1. Sensorimotor activity: birth to 2 years.

Infants begin to know their world by reflexes such as sucking and grasping. Uses senses to explore. Start off with relfex behavior, then repeatative behavior, and finally imatative behavior. A lot of their learning is cause and effect. Newly learned knowledge can't be transferred from situation to situation. Ex: cannot distinguish from turning over box of toys vs. box of trash. Problem solving is trial and error. They are going to learn object permanence - even if they cannot see it, it still exists. Jack in the Box is a good toy to teach this and so is peek a boo.

2. Pre-operational thought: ages 2 to 7.

A. Preconceptual: ages 2 to 4.

See the world in egocentric terms. In terms of "me". Does not mean the child is self-centered. Unable to put themselves in the place of another. Cannot see things from another person's point of view. Conversation revolves around them. They expect you to know what or who they are talking about. Not able to share.

B. Intuitive: ages 4 to 7.

Egocentric thinking will begin to include other people and see things from another person's point of view. Give simple explanations to their questions. Characteristic of centering. Have the tendency to center their attention on one feature of something. Unable to see that it has other qualities. Ex: give them 4 pennies and will be happier than with a dime. Will begin to share.

3. Concrete operations: ages 7 to 11.

Child's thought is logical. Learn how to classify, to sort, organize. Can problem solve. Age of collection. Learn the concept of conservation - realize that physical property like weight can remain the same even though outward appearances changes. Can't deal in abstraction. Solve problems in a systematic fashion. Are able to see other points of view.

4. Format operations: ages 11 to 15.

Learn to reason logically. Are able to thing in abstract terms. Can draw logical conclusions. Adaptable and flexible. When making decisions, needs to look at pros and cons.

1. Preconventional level: ages 0 to 7.

A. Stage 0: first 2 years.

No moral sensitivity. Decisions are made according to what feels good or what does not. Not aware of how behavior hurts others. Responds to pleasure with love and hurt with anger.

B. Stage 1: 2 to 3 years.

Determines right or wrong by physical consequence of an act.

C. Stage 2: 4 to 7 years.

View a specific act as right if it satisfies the need. Follow rules to benefit themselves. Attitude of eye for an eye.

2. Conventional level: ages 7 to 12.

Make decisions about right and wrong based on expectations of the family or society. Very loyal to their family. Seeks family approval and peer approval. Obey rules, respect authority.

3. Postconventional level: ages 13 and up.

Personal standards are defined by culturally accepted values. Rights must not be violated by the group. At top level - do what they thing is right without regard to what it will cost them.

Infancy: no beliefs to guide behavior.

Toddler: behavior is imitated and will imitate religious behaviors without knowing what they mean.

Preschooler: will believe what parents believe.

School age: strong interest in religion. Conscience begins to bother them when they disobey. Ability to articulate faith.

Adolescent: may be exposed to spiritual disappointment. Compares what they believe to what others believe. A time of searching rather than reaching.