Essentials of Pediatric Nursing Rimple Sharma
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1Modern Concept of Child Care
Chapter 1 Modern Concepts and Trends in Pediatrics
CONTENTS
  • ► Introduction to Pediatrics
  • ► Definition and Concept of Pediatrics
  • ► Historical Background of Child Health
  • ► Modern Pediatrics
  • ► Factors Responsible for Growth of Modern Pediatrics
  • ► Current Concept of Pediatric Nursing
  • ► Principles of Pediatric Nursing
  • ► Trends in Pediatric Nursing
Chapter 2 Child Welfare
CONTENTS
  • ► Rights of Children
  • ► National Policy and Legislation Related to Child Health and Welfare
  • ► National Programmes Related to Child Health and Welfare
  • ► Agencies Related to Child Welfare
Chapter 3 Difference Between Children and Adults
CONTENTS
  • ► Anatomic and Physiologic Differences
  • ► Pathological Differences
  • ► Psychological Differences
Chapter 4 Care of Sick Child
CONTENTS
  • ► Hospitalization
  • ► Hospital Environment
  • ► Preparation of Hospital Environment for the Child
  • ► Impact of Hospitalization on Child and Family
  • ► Role of Nurse in Care of Hospitalized Children
  • ► Principles of Pre- and Postoperative Care
  • ► Grief and Bereavement
  • ► Child Morbidity and Mortality Rates
2

Modern Concepts and Trends in Pediatrics1

 
 
Introduction to Pediatrics
The health of children has historically been of vital importance to all societies because children are the basic resources of the future of mankind. In any country, mothers and children constitute approximately 60% of the population. In India, woman of child bearing age (15—44 years) constitute 19% of the population and children under 15 years of age constitute about 59% of the total population. By virtue of their large number as well as because of being vulnerable to diseases, mothers and children are the major consumers of health services.
 
Definition and concept of pediatrics
The word “pediatric” is derived from Greek word ‘pedia’ meaning child and ‘iatri’ means treatment and ‘ics’ meaning branch of science. Thus, pediatrics is defined as the branch of medical science that deals with child development and care and with the diseases of childhood and their treatment.
Pediatrics refers to the comprehensive and continued care of children. It serves both in wellness and illness.
Abraham Jacob (1830—1919) is known as the ‘Father of pediatrics’ because of his many contributions to this field.
 
Historical Background of Child Health
The continuance of any society depends on the succeeding generations. Since primitive times, welfare of children has been a sensitive index of general welfare of people.
In India and abroad pediatric population includes children up to 12 years of age. However in developed countries pediatric care is extended up to adolescent age. Previously pediatrics was limited to curative care. Many citations of child care are found in records of ancient civilization.
The historical background of pediatrics is as follows:
  • The first citation of qualities of breast milk and child hygiene was in 225 BC in Indian ‘Susruta Sanhita’.
  • Hippocrates, a Greek philosopher (370—460 BC), also known as ‘Father of Modern Medicine’ has made significant contributions on diseases found in children.
  • The first Indian pediatricians were Kashyapa and Jeevaka (6th century). They worked on children diseases and child care.
  • The first manuscript on management of children diseases was written by Kashyapa and Samhita. Thereafter, Susruta and Samhita wrote about Ayurvedic medicine that can be used for children. It was the first written record of pediatrics anywhere in the world. Susruta was known as ‘Indian Hippocrates’. He wrote on child rearing practices, infant feeding and diseases of childhood.
  • Charak, was the court physician of Peshawar. He wrote on ‘care and management of newborn in his Sansthan and Ashtanga-hridaya.
  • Arab physician Rhazes (850—923 AD) wrote the first book on the diseases of children.
  • In 1472 AD, first book written on pediatrics named ‘Bagallarder's’ was printed in Italian. This book was related to diseases of children.
  • In 1545 AD, Thomas Phare wrote the first book in English on children's diseases.
  • In 1802 first pediatric hospital was opened in Paris. In USA Children's Hospital of Philadelphia was opened.
  • Pediatrics as speciality came into being in 1860, when Dr Abraham Jacob established first child clinic in New York and started giving special lectures on diseases of children.4
  • In 1888 AD the first department of Pediatrics was established in Harvard Medical School. At this time, it was realized that diseases of children are different from diseases of adults.
  • In the 19th century, antenatal care and pediatric care developed. Slowly people started realizing about children's needs. The Lady Chelmsford All India League for Maternal and Child welfare was established in 1920. Efforts were made by the league to create public awareness about health problems of children by putting exhibitions, publishing a journal and celebrating baby weeks.
  • In 1923, the first creche was opened in India to provide day care to children.
 
Modern Pediatrics
It is difficult to say, when Pediatrics became a separate specialty. It developed gradually as the knowledge of developmental needs of children increased in society. Pediatrics as a specialty developed with the establishment of Department of Pediatrics in various medical colleges, establishment of separate pediatric units for children in general hospitals and fondling homes. Today we no longer consider children as miniature adults. Childhood is considered a separate phase of life.
The present concept of health care of child focuses on prevention of illness and promotion of health rather than treatment of illnesses alone. Present focus of pediatrics is shifting from traditional to process oriented one that is based on sound scientific rationale.
Focus of pediatrics is shifting:
Shift from
Focus on
1. Disease centered care.
Child centered care within the family system.
2. Discouraging the families on neglect of female child.
Taking special care of female child as she is future mother.
3. Starting care for woman after she became pregnant.
Health education on planned parenthood and guarding maternal health before conception.
4. Special care of the sick child in hospital.
Comprehensive care of the child from the day of conception throughout the developmental years of childhood.
5. Caring for the physical condition of the child in isolation (hospital).
Holistic care of the child that is family centered.
6. Illness oriented care.
Health promotion oriented care.
7. Not allowing parents to be with the child in hospital and having rigid visiting hours.
Ensuring that child must have one parent with him/her in the hospital and having flexible visiting hours.
8. Care was only hygiene and treatment oriented.
Warmth and love oriented.
9. Providing routine care.
Quality care in terms of play, recreation, nutrition, etc.
10. Traditional practices.
Evidence based practice.
 
Pediatric Nursing
Pediatric nursing is the branch of nursing concerned with care of infants and children. It focuses on providing holistic care to infants, children and adolescents. The goal of pediatric nursing is to foster growth and development of the child and promote optimum state of physical, mental and social wellness.5
 
Current Concept of Pediatric Nursing
  • A — Advocate for child and family
  • C — Communicate for the child
  • A — Activate the Child's activities
  • D — Disseminate information related to child health programs
  • E — Educate the public about child health
  • M — Motivate people to participate in child care
  • I — Investigate available resources
  • C — Collaborate care
 
Principles of Pediatric Nursing
  1. The nurse should begin to build a working relationship with the parents and their children from the time of first contact with them.
  2. The nurse should be aware that all behaviors of child are meaningful.
  3. The nurse should accept the parents and their children exactly as they are.
  4. The nurse should have empathy for parents and children.
  5. The nurse should let the parents and children know that their problems are important and the nurse is there to aid in solution of those problems.
  6. The nurse must be willing to acknowledge the parent's right to decision concerning their children.
  7. The nurse allows the parents and children to express their emotions and even negative emotions.
  8. The nurse should ask questions limited to a single idea or reference so that it is easy for the parents and child to understand what is being asked.
  9. The nurse should speak in language which the parents and child can understand.
  10. The members of health team must make the parents feel that they are working in a collaborative manner for the treatment of their child.
 
Trends in Pediatric Nursing
The latest trends in pediatric nursing are
  1. Flexible visiting hours
  2. Rooming–in
  3. Parents support group
  4. School teachers involved in care of hospitalized child
  5. Play in school and hospital
  6. Care by Parents/Family centered care
  7. Health and nursing team
  8. Evidence based practice
  9. Prevention of disease and promotion of health.
 
Factors Responsible for Growth of Modern Pediatrics
The factors responsible for growth of modern pediatrics are:
  1. Progress of medical science and recent advancements in the field of medicine like newer antibiotics.
  2. Development in the field of basic science including physics, chemistry and biology.
  3. Increasing interest in public health and public welfare.
  4. Improved social laws.
  5. Improved health facilities.
  6. Emphasis on disease prevention and health promotion.6
  7. Separate pediatric hospitals, MCH clinics, under five clinics and family welfare centers.
  8. Child welfare programs.
  9. Health promotion and disease prevention programs.
  10. Growing realization of special needs of infant and children.
  11. Changing attitude of society towards younger members of society.
 
Review Questions
Q.I . Fill in the blanks:
  1. _________ is known as ‘Father of Pediatrics’.
  2. ____________ is known as ‘Father of Modern Medicine’.
  3. The first manuscript on management of children's diseases was written by ______ and _______.
  4. The word pediatrics is derived from greek word ‘pedia’ meaning _______ ‘iatria’ meaning ___________ and ‘ics’ meaning ________.
  5. ________ was known as Indian Hippocrates.
Q.II. Match the following:
Column A
Column B
Shift from
Focus on
a. Disease centered care
i. Quality care in terms of play and recreation
b. Hygiene and treatment oriented care
ii. Taking special care of female child as she is future mother
c. Providing routine care
iii. Evidence based practice
d. Discouraging the families on neglect of female child
iv. Warmth and love oriented
v. Child centered care within the family system
e. Traditional practices
Q. III. Essay Type Questions:
  • Q.1. Explain the historical development of Pediatrics.
  • Q.2. Discuss the modern concepts of Pediatric nursing.
Answer Key
Q. I. Fill in the blanks:
  1. Abraham Jacob
  2. Hippocrates
  3. Kashyapa, Samhita
  4. Child, treatment, branch of science
  5. Susruta
Q. II. Match the following:
  1. v
  2. iv
  3. i
  4. ii
  5. iii