Introduction to Child Health NursingChapter 1

The nurse preparing to care for today's and tomorrow's children and child bearing families faces vastly different responsibilities and challenges that did the child health nurse of even a decade ago. Nurses and other health professionals are becoming increasingly concerned with much more than the care at risk and sick children. Health teaching, preventing illness and promoting most desirable or satisfactory (optimal), physical, developmental and emotional health have become a significant part of contemporary nursing. The contemporary understanding of child health nursing is the science of child care, preventive as well as curative. Therefore, child health nursing pediatric nursing) is concerned with the health of infants, children and adolescents, their growth and development and their attaining full potential as adults. The child health nurses responsibility is not only to care of the physical, mental and emotional health from conception to maturity, but also to demonstrate concern for the social, environmental and cultural influences that are known to have considerable fallout on children and their families.

Now, scientific and technological advances have reduced the incidence of communicable disease and helped to control metabolic disorders such as diabetes. As a result, more health care is provided outside the hospital. Patients now receive health care in the home, at schools and clinics and from their primary care provider. Prenatal diagnosis of birth defects, transfusions, other treatments for the unborn fetus and improved life-support systems for premature infants are, but a few examples of the rapid progress in child care.

Tremendous sociologic changes have affected attitudes toward and concepts in child health. Now, society is a population of highly mobile persons and families. The women's movement has focused new attention on the needs of families in which the mother works outside the home. Many people have come to regard health care as a right, not a privilege and expect to receive fair value for their investment. In addition, the demand for financial responsibility in health care has contributed to shortened hospital stays and alternative methods of health care delivery. The reduction in the incidence of communicable and infectious diseases has made it possible to devote more attention to such critical problems as preterm birth, congenital anomalies, child abuse, learning and behavior disorders; developmental disabilities and chronic illness. Research in these areas continues; as these findings become available, nurses will be among the practitioners, who will help to translate this research into improved health care for children and families. However, nurses’ ability to translate the relevant medical research into practice is based on their understanding of the predictable, 2but variable phases of a child's growth and development and on their understanding of and sensitivity to the importance of family interactions.

Pediatrics took birth over a century back in the prosperous countries of the West. It is, however, too much young in India and other countries of the Third world. Technological advances account for many changes in this last 50 years, but sociologic changes particularly society's view of the child and child needs, has been just as important.

Pediatrics is a relatively new medical specialty, developing only in the mid-1800s. In colonial times, epidemics were common and many children died in infancy or childhood. In some cases, disease wiped out entire families. Families were large to compensate for the children, who did not live to adulthood. Children were viewed as additional hands to help with the family farm chores. Sick children often were cared for by the adults in the family or by a neighbor with a reputation of being able to care for the sick.

The first children's hospital opened in Philadelphia in 1855. Until that point in Western civilization, children were not considered important, except as contributors to family income. Hospitalized children were cared for in hospitals as adults were, often in the same bed. Unfortunately, early institutions for children were notorious for their unsanitary conditions, neglect and lack of proper infant nutrition. Well into the 19th century, mortality rates were commonly 50% to 100% among institutionalized children in asylums or hospitals.

Abraham Jacobi, a German-born physician, has been recognized as the father of pediatrics. Under his direction, several New York hospitals opened pediatric units. He helped to found the American Pediatric Society in 1888. During the early 1900s, intractable diarrhea was a primary cause of death in children's institutions. Initiation of the simple practices of boiling milk and isolating children with septic conditions, lowered the incidence of diarrhea. This practice of pasteurizing milk was instrumental in decreasing the rate of death in children.

In this context, it is interesting to note that India with its long history of civilization produced the Rigveda, which carries the earliest medical information on man and the Atharvaveda (1500 BC), contained the first documents on Indian medical herbs. The world's first pediatricians Kashyapa and Jeevaka were Indians, who lived in the 6th century BC and whose pioneering works on child care and children's diseases are as relevant today, as many of the modern concepts of child health. The first manuscripts on the management of children, some years before Christ, were Kashyapa Samhita and Vridha Jeevakiva Tantra, both scholarly treatises on child care and children's diseases, brought out by Jeevaka, Kashyapa's pupil. The chapter on Kaumarabrita (i.e. service to children) in his Sushruta Samhita, the classical encyclopedia of Ayurvedic medicine, was perhaps the first record of pediatrics anywhere in the world. The colossal work was written by Sushruta (the Indian Hippocrates) and contains many aspects of child rearing, such as infant feeding, diseases of childhood, including exanthematous fevers, diseases of the liver, etc. Charaka, the court physician in Peshawar, wrote at length on the care and management of the newborn in his Sharira Sthana and Ashtanga Hridaya, in the 4th century AD. All these treatises and monumental works emphasize the modern WHO definition of health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease and infirmities’. They agree on ‘Dharmarthakamamokshanam arogyam moolam uttamam’: meaning, health at the root of ethical living, livelihood, family life and spiritual striving. The siddha system of medicine in South India developed pari passu with Ayurveda and their section on pediatrics held the modern concept that service to the child starts from the moment of conception. Their materia medica of herbs is rich in its repertoire of cure.