PRECIOUS D.

COLITA BSN 4B Make a health teaching plan for infants, toddlers, preschoolers, school-aged, and adolescents based on the following:

GENERAL HEALTH TEACHING 1. INFANT a. NUTRITION

SPECIFIC HEALTH TEACHING ( 5 or more for each item) a. First 6 months -Encourage mother to breastfeed the infant -Educate mother that all the necessary nutrients, vitamins, minerals, and water are provided by human milk -Vitamin K (1mg IM) is administered at birth -Vitamin D (200IU, drops) is administered daily beginning during the first 2 months of life -Iron supplement is indicated If the mother during pregnancy is deficit of iron - Caution parents that cereal mixed with the infants
formula should not be given in a bottle because of the danger of aspiration. -Advise mother not to give infant unmodified whole cows milk, low fat cows milk, skim milk, other animal milk, and imitation milks because of its limited digestibility, increased risk of contamination, and lack of components needed for appropriate growth. -Caution parents concerning the excessive use of juices and nonnutritive drinks such as fruit- flavored drinks or carbonated beverages (soda or pop) during this period.

b. Second 6 months
-Instruct mother that human milk or formula should be continue. -If breast-feeding is discontinued, a commercial ironfortified formula should be substituted. -Flouride supplementation begins depeding on the infants intake of flouridated tap water.

c. Selection and Preparation of Solid Foods/Quantities & Types of Food -Teach mother that a high-protein and highcaloric food are necessary for the infants diet -both commercial formulas and breast milk contain 20calories/oz -Calorie allowances can be gradually reduced during the first year from level of 120 per kg of body weight to approx. 100/kg of body weight at the end of the first year to prevent babies from becoming overweight -Delay the introduction of solid food until 4-6mos and avoid sweet drinks to prevent obesity in formula fed infants -Teach about the types of food for the infant: cereals, vegetables and fruits, meat eggs, table food d. Introduction of Solid foods -Encourage mother to begin the introduction of solid foods in 4-6mos -Teach mother about the signs of infants ready for solid food introduction: nursing vigorously 1

every 3 to 4 hours, do not seem satisfied or taking more than 32oz (960ml) of formula a day, infants are not ready to digest complex starches until amylase is present in saliva (2-3mos), biting movements begin approx. 3mos, chewing movements at 7-9mos -Introduce one food at a time, waiting 5-7days between new items -Introduce the food before formula or breastfeeding when an infant is hungry -Introduce small amounts of a new food (1-2tsp) at a time e. Weaning -Emphasize that early weaning from breastfeeding can lead to an increase of obesity -Educate mother that prolonged breastfeeding into the preschool period can limit nutrients and might impair a childs growth -To wean from formula or breast milk, the mother chooses one feeding a day -Then begins fluid by the new method at that feeding -do not start weaning the infant during summer because of the hot season, the infant needs a lot of fluid f. Self-feeding -Teach mother that approx. 6 mos. Of age, infants become interested in handling a spoon and beginning to feed themselves -They usually use their fingers first in getting the food because their coordination has not developed -Use plastic cloths or newspaper to catch the fallen food from the infants mouth Sleep Problems -Sleep problems developed in early infancy because of colic or the infant has difficulty sleeping through the night -Caution mother that breastfed babies tend to wake more often because breast milk is more easily digested, so infants becomes hungry sooner -Suggestions for eliminating night waking: delay bedtime by 1 hour; shorten afternoon sleep period; do not respond immediately to infants at night so they can have time to fall back asleep; provide soft toys or music to allow infants to play during wakeful times

b. SLEEP AND ACTIVITY

c. DENTAL HEALTH a. Oral Hygiene

-Advise parents never to put their baby to bed with a bottle because it will leads to baby-bottle syndrome or infant caries and probably result to aspiration. -Encourage parents to fill the bottle with water and use a nipple with smaller hole to prevent the baby from receiving a large amount of fluid. -Teach the parent that if the baby refuse to drink

anything but milk, milk should be diluted with water more and more each night until the bottle is down to water only. -Teach the mother to use a small soft- bristled toothbrush. - Teach the mother that when the primary teeth begin to erupt, cleaning should begin. -Instruct to clean the teeth and gums by wiping it using a damp cloth.

b. Diet
-Instruct the mother to use the foods with concentrated sugar (sucrose) to use sparingly (if at all). -Educate the mother that the practice of coating pacifiers with honey or using commercially available hard-candy pacifiers is not advisable. Educate the mother the effects of frequent and prolonged bottle - or breast- feeding during sleep.

d. INJURY PREVENTION

a. Aspiration of Foreign Objects -Educate mother that a round, cylindrical objects are more dangerous than square or flexible objects -A 1-inch cylinder, such as carrot or hot dog is particularly dangerous because it can totally obstruct an infants airway -Advise mother do not prop the bottles when feeding the infants -Use clothing without decorative buttons -Parents should reassess toys for loose pieces or parts b. Suffocation -Plastics should be kept out-of-reach from the infant -A deflated balloon can be sucked into the mouth, obstructing the airway -When sleeping, do not cover the childs face c. Motor Vehicle injuries/Car Safety -Hold the child firmly and use a seatbelt -when purchasing a car seat, parents should look at the label to be sure the seat meets federal guidelines -Educate mother that the best location for a car seat is the back seat of the car -Do not use a sack sleeper or papoose bunting nor wrap the baby in a bulky blanket d. Falls -Do not left the infant unattended -Teach parents to be prepared for infant to roll over at 2 mos -If the child sleeps at the crib, the mattress should be lowered to its bottom position so the height of side rails increases -Encourage that about 2 mos, the infant can safely sleep in a bassinet e. Poisoning -Do not allow an infant to approach a strange dog -Supervise play with pets 3

-Never present medications with candy -Never leave medication in a pocket or handbag -Use no lead-based paint in any area of the home f. Burns/bodily damage -Test warmth of formula and food before feeding -Do not smoke or drink hot liquids while holding or caring the infant -Buy flame-retardant clothing for infants -Turn handles of pans toward back of the stove -Monitor infants carefully near candle g. Drowning/Bathing and Swimming Safety -Never leave the child unattended in the tub -Monitor the child closely when bathing in the tub -Exposure to chlorinated water can damage lung epithelium that may be a precursor to childhood asthma 2. TODDLER a. NUTRITION a. Nutritional Counseling - One table spoon of food is a good start - Let the child eat one food at a time before going to another - Energy needs are generally met when sufficient food is supplied in a positive environment - Diets high in sugar should be avoided - Fats should not be generally restricted for children under 2 years old a. Sleep Problems -In the toddler period they may begin napping twice a day & sleeping 12hours each night, and end it with one nap a day & only 8hours a night -An insistence that a child may sleep may lead to sleeping problems or refusal to sleep at all -If child cannot sleep at night, its time to omit or shorten afternoon nap -A toddler loves a bed time routine such as: bath, pajamas, a story, brushing teeth, being tucked in bed, having a drink of water or choosing a toy to sleep with -If a child is short-tempered, at dinner time that eating is impossible, perhaps the child needs 2 naps a day a. Regular Dental Examination/Tooth Care - Let the child have his/her own toothbrush to recognize them as their own - Remind parents that it is better for a child to brush thoroughly once a day, probably at bed time than to do it poorly many times a day - After brushing, parents can use dental floss to clean between the childs teeth and remove plaque - Schedule a first visit to a dentist skilled in pediatric dental care at about 12mos. Of age for assessment of dentition - Parents can prepare the child for their first 4

b. SLEEP AND ACTIVITY

c. DENTAL HEALTH

d. DRESSING AND BATHING

e. INJURY PREVENTION/TODDLER SAFETY

ad subsequent visit by reading a story about a dentist, maintaining a positive attitude about the visit, avoiding the use of frightening words, and answering the childs question honestly b. Removal of Plaques - A use of dental floss in between the childs teeth to remove plaque - A regular visit to the dentist for a cleaning c. Fluoride - Provide toothpaste that is solely for the childs use which contains fluoride - Let the child eat foods that are rich in calcium such as cheese, yogurt and drinking his/her milk d. Diet - Encourage the child to drink milk - Yogurt and large amount of food with cheese may be of great help to give the child the calcium and fluoride needed to support his/her teeth - Limit the child from eating foods that are having a lot of carbohydrates Let the child drink fluoridated water if it is available a. Guidelines - Encourage child to give up perfection for the benefit of the childs developing sense of autonomy - Sneakers are ideal toddlers shoe because the soles are hard enough for rough surfaces and arch support limited - Let the parents understand that a child wants to dress by his or herself - Toddlers usually enjoy bath time so, parents should make an effort to make it fun by providing a toy such as: rubber ducks, boat or plastic fish - Remind parents that although toddlers can sit well in bathtub, it is still not safe to leave them alone unsupervised a. Motor Vehicle injuries - Use federally approved car restraint - Do not allow child to play on curb or behind a parked car - Teach child to obey pedestrian safety rules - Lock fences and doors if not directly supervising children - Supervise child while playing outside b. Drowning - Supervise closely when near any source of water, including buckets - Keep bathroom doors closed and lid down on toilet - Have fence around swimming pool and lock gate - Teach swimming and water safety c. Burns - Turn pot handles toward back of stoves 5

Place electrical appliances, such as coffee maker and popcorn machine, toward back of the counter - Store matches and cigarette lighters in locked or inaccessible area, discard carefully - Cover electrical outlets with protective plastic caps - Keep electrical wires hidden out of reach from children d. Poisoning/Lead Screening - Place all potentially toxic agents out of reach or locked in lockers or cabinets - Caution against nonedible items, such as paints - Replace medications or poisons immediately, replace child-guard caps properly - Do not store large surplus of toxic agents - Never remove labels from containers of toxic substances e. Falls - Keep screen window, fasten securely, and use guardrail - Place gates at top and bottom of stairs - Keep doors locked or use child-proof doorknob covers at entry to stairs, high porch, or other elevated area, including laundry chute - Place carpeting under crib and in bathroom - Avoid using wheeled walkers, especially near stairs and floor furnace f. Aspiration and Suffocation - Avoid large, round chunk of meat, such as whole hot dogs - Select safe toy boxes or chests without heavy, hinged lids - Discard old refrigerators, ovens, and so on; if storing and old appliance, remove the door - Remove drawstrings from clothing - Choose large, sturdy toys without sharp edges or small removable parts g. Bodily Damage - Teach safety precautions (e.g how to carry a knife or scissors with pointed end way and face) - Never go with a stranger - Teach stranger safety - Avoid personalized clothing in public places - Tell parents if anyone makes child uncomfortable in any way 3. PRESCHOOL

a. NUTRITION

a.

Promoting Nutritional Health Urge parents to offer foods such as fruit, cheese, or milk rather than cookies and softdrinks. Teach parents to make mealtime a happy and enjoyable part of the day for everyone. Caution parents not to give more vitamins than the recommended daily amount becsuse poisoning from

high doses of fat-soluble vitamins or iron can result. Offer a small servings of food so that a child is not overwhelmed by the amount of food in a plate and is alllowed the succesful feeling of cleaning a plate and asking for more. Never give sugary foods to children because it can dull their appetite and contributes to obesity. Allow the child to help in preparing simple foods, such as making a sandwich or spreading jelly on toast.

b. Diet Parents need to check that children are not snacking so frequently that they miss out of planned meals to be certain children receive a complete range of nutrients. Teach parents that many vegetables, fruits and grains are also good snack foods and are convenient for a child who eats frequently during the day. If vegetarian diets are deficient in any aspects, they usually lack calcium, vitamin B12 and vitamin D. Advise parents to check if the child is ingesting a variety of calcium sources (green leafy vegetables, milk products) as this is so important for bone growth. Vitamin D is found in fortified cereals and milk. Vitamin B12 is found almost exclusively in animal products. Remind parents to stored vitamins out of childrens reach because child view vitamins candy rather than medicine because of its attractive shapes and colors. Advise parents to keep a weekly record of everything the child eats. Measure the amount of food a child eats ,such as setting aside cup of vegetables and serving the child from this measured amount, is strssed to provide a more accurate estimate of food intake at each meal.

b. SLEEP AND ACTIVITY

a.

Sleep Problems For children who delay going to bed, a recommended approach involves counseling parents about the importance of a consistent bedtime ritual and emphasizing the normalcy of this type of behavior in young children. Attention- seeking behaviors should be ignored, and the child should not be taken into the parents bed or allowed to stay up past a reasonable hour. Keeping the childs room lights on. Provide transitional objects such as favorite toy, or leaving a drink of water by the bed. Help children in slow down before bedtime as it contributes to less resistance to going to bed. Establish limited rituals that signal readiness for bed, such as bath or story. Limit the television viewing for at least 30 minutes before bedtime. Suggests parents to ensure that the television shows are not too frightening or overstimulating. b. Exercise Aware parents that rough-housing is a good way of getting rid of tension and should be allowed as long as it does not become destructive.

Instruct parents that preschoolers love time-honored game such as ring-around the rosy, London Bridge,or other more structured games. Advise parents that active game should be promoted. Ensure parents that their children should reduce television watching can help their child develop motor skills as well as be a step toward preventing childhood obesity. Encourage parents to engage their children in many physical activity.

c. DENTAL HEALTH

d. DRESSING

a. HYGIENE

b. INJURY PREVENTION/PRESCHOOLER SAFETY

a. Care of Teeth - Instruct parents that a child should continue to drink flouridated water or receive a prescribed oral flouride supplement if flouride is not provided in the water supply. - Parents must check that all tooth surfaces are cleaned. - Flossing of teeth should be perform by the parents. - Supervise children when using an electric toothbrush and must teach their children not to use it or any other electrical appliance near a basin of water. - Parents should encourage their children to eat apples , carrots, celery, chicken or cheese for snacks rather than candy or sweets to prevent tooth decay. - Do not allow children to chew gum that is sugary. - Advise parents to bring child and make a visit to a dentist to make evaluation of teeth. Guidelines - Advise parents to fold together the matching shirts and pants so a child sees it as a set rather than an individual pieces to prevent mismatching conflicts. - Provide children dresses that makes them dressed up easily. - Assist them in dressing especially on those dresses that have difficult buttons. - If children insist in wearing the mismatched clothes, parents should make no apologies for their appearance. - Prepare dresses or shirts that are bright in colors or prints. a. Guidelines - Advise parents that that the temperature of the water heater should be turn down to help prevent scalds. - Assist the children in cleaning their fingernails. - Assist the children in cleaning the ears during bath time. - Suggest parents to hang a mobile over the tub so they have a reason to look up for rinsing and and using a nonirritating shampoo. - Supervise children during bath time even though they can sit well in the tub. - Caution parents about not using bubble bath with preschoolers as some girls develop vulvar irritation (and perhaps bladder infections) from exposure to such products. a. Keeping Children Safe, Strong, and Free - Warning a child never to talk with or accept a ride from a stranger. - Teaching a child how to call for help in an emergency (yelling or running to a designated neighbors house if outside, or dialing 911 if near a telephone). - Describing what police officers look like and explaining that police officers an help in an emergency situation. - Explaining that if children or adults ask them to keep

secrets about anything that has made them uncomfortable, they should tell their parents or another trusted adult, even if they have promised to keep the secret. - Explaining that bullying bahavior from other children is not be tolerated and should be reported so they can receive help managing it. b. Motor Vehicle and Bicyle Safety - Teach safety with tricycle (look before crossing driveways; do not cross streets). - Teach child to always hold hands with a grownup before crossing a street. - Teach parking lot safety (hold hands with grownup; do not run behind cars that are backing up). - Encourage parents who ride bicycles to demonstrate a safety riding habits by wearing helmets as well. - Children should wear helmets when riding bicycles. - Supervise child while playing outside. - Make certain that parents should safely buckle preschooler into car seats in the back seat. - Parents should stress the important role of seatbelts in preventing injury in accidents and should make it a rule that the car does not move until seat belts are fastened. - Parents should be reminded to check the position of the shoulder harness so it does not go across a childs face or throat.

4. SCHOOLER

a. NUTRITION

c. SLEEP AND REST

a. Establishing Healthy Eating Patterns - Educate mothers that school-age children need breakfast to provide enough energy to get them through active mornings at school - Let the child help in preparing his/her own packed lunch - Encourage to have a snacks when the child arrives from school - Check that children are actually eating school lunches not trading their foods - Teach parents to make every attempt to make mealtime a happy and enjoyable part of the day for everyone b. Diet -Emphasize that adequate nutritional intake is what the child needs -Encourage to include a high caloric, high- protein diet in the childs food -Adequate calcium and fluoride intake remains important to ensure good teeth and bone growth -Vegetarian packed lunches can be varied with foods such as cucumber, tomato or peanut butter sandwhiches. a. Guidelines - Educate mother that the amount of sleep and required during middle childhood depends on the childs age, activity level and state of health - School-age children do not require a nap and they sleep approximately 9 and half hours at night - For children ages 6 or 7, encourage mothers to have a quiet activity before bedtime such as 9

d. EXERCISE AND ACTIVITY

a.

b.

e. DENTAL HEALTH

a.

b.

coloring or reading - Night terrors may continue during the early school years so encourage mother to provide emotional support to the child - Advise parents to understand their child especially when changes occurs such as preferred to talk to friend rather than listening to bedtime stories Sports and Exercise - Encourage parents to let the child play games - Provide ample space for the child to run , jump, skip and climb - Children with disabling situations (obese) need special assessment and help so that activities that appeal to them and that are compatible with their limitations while also meeting their developmental needs can be determined - School-age enjoy competitions - Advise to understand the childs limitations and teach them the proper techniques and safety measures to Acquisition of Skills - Educate mothers that school-age children demonstrate increasing fine motor abilities and complex artistic skills - Help the child develop skills such as painting, writing, drawing, and oration - Encourage the mother to support their childs talents - Let the child exercise being responsible by giving them task in the household chores Dental Problems - Educate the mother about the dental problems that a school-age child might experience such as dental caries, malocclusion and periodontal disease - Dental caries is a multifactorial disease involving susceptible teeth, cariogenic microflora and an appropriate oral environment - Periodontal disease, an inflammatory and degenerative condition involving the gums and tissues supporting the teeth, often begins in childhood and accounts for a significant amount of tooth loss in adulthood - Malocclusion occurs when teeth of the upper and lower dental arches do not approximate in the proper relationships Care of Teeth Encourage mothers to teach children how to perform their own dental care Teach the child the proper way of brushing the teeth Teeth should be brushed after meals, after snacks and at bedtime Encourage to see a dentist and have thorough cleaning on the teeth

10

f.

DRESS

g. INJURY PREVENTION

a. Hygiene -Teach the child the importance of caring for their own belongings -Caution mothers that school-aged children have definite opinions about clothing styles, often based on the likes of their friends or popular rock star -Help the parents aware that a child who wears different clothing than others may become object of exclusion from a school club or group a. Promoting School-age Safety - Educate mothers that school-age children are prone to injuries and accidents although they developed already their cognitive behaviors - Encourage children to wears gears such as helmet when riding a bicycle or motorcycle - Educate the family about the hazards of risk taking and improper use of equipment - Supervise the child when playing in outdoors and have a medical kit ready

5. ADOLESCENT

a. NUTRITION

a. Eating habits and behavior - Encourage mothers to supervise still the food intake of the adolescents because they tend to consume empty-calorie foods - Advise mother to give the adolescents some responsibility for food planning or meals such as making dinner every Wednesday night. This can teach some important lessons about nutrition without conflict - Adolescents who are slightly obese because of prepubertal changes may begin low-calorie or starvation diets to lose excess weight b. Diet - Educate mother that adolescents need an increased number of calories to support the rapid body growth - Emphasize to adolescents that filling their stomachs will not provide adequate nutrition - Vegetarian diet: teach the mother that the adolescent should consume large protein-rich foods to achieve an adequate caloric intake -Glycogen loading: athletes need more carbohydrate or energy than do people who do not engage in strenuous activity, comes from the breakdown of glycogen. Glycogen loading is a procedure used to ensure there is adequate glycogen to sustain energy through an athletic event a. Guidelines - Advise mother to encourage adolescent to sleep atleast 6-8 hours at night - Caution mother that frequent lack of sleep for adolescents can lead to chronic fatigue or depression - Encourage mother to provide a quiet environment so that the adolescent can easily sleep 11

b. SLEEP AND REST

c. EXERCISE AND ACTIVITY

b. Guidelines Encourage the mother to teach the adolescent about the following: - Use protective equipment such as face masks for hockey, pads for football - Do not attempt participation beyond physical limits - Careful preparation for sports through training is essential to safety - Recognize and set own limits for sports participation a. Care of Teeth - Encourage mother to have a regular check-up on a dentist - Adolescents gain their second molars at about 13 years of age and their third molars (wisdom teeth) between 18 and 21 years of age - Encourage to brush the teeth every after meals and before bedtime a. Dress and Hygiene - As a parent, guide your child when it talks about their hygiene and the way they dress, because for some reasons adolescents are prone to be insecure about their appearances - Provide them time for their self, such as : when they are taking a bath, getting dress and many more a. Guidelines - Some adolescents tend to reduce their stress through: hanging out with their friends and exploring new things. Parental guidance is needed for them not to be engage in drugs, alcohol, cigarettes and many other substances that they may abused - Family bonding or by way of asking your child about how his/her day goes, would be a good start to know how your child copes up with his or her stresses - Playing games such as: basketball, volleyball or any ball games, computer games or any type of game in which they may be able to cope up with their stress. Guidance is still needed for them to know their limitations a. Guidelines - Adolescents are very curious when it talks about sex, therefore a good heart to heart talk or reminders about sex is needed - Advise your child to choose the type of friends he/she is going to be friend with - Guidance about having affection towards their partners should also be given. Reminding them that there is always time for everything a. Adolescent Safety Motor vehicle - Encourage to use a seat belt whether as a driver or passenger - Do not drink alcohol while driving and refuse to 12

b. DENTAL HEALTH

b. PERSONAL CARE

b. STRESS REDUCTION

c. SEXUALITY EDUCATION AND GUIDANCE

d. INJURY PREVENTION

ride with anyone who has been driving - Encourage to wear helmet and long trousers as driver or passenger on a motorcycle - Accepting dares has no place in safe driving - Take a driver education course to learn safe driving habits for both two-wheel and four-wheel vehicles Firearms - Always consider all guns are loaded and potentially lethal - Learn safe gun handling before attempting to clean a gun or hunt Drowning - Learn how to swim - Take dares has no place in water safety

CREATE A HEALTH TEACHING PLAN FOR AN EXPECTANT MOTHER. MUST BE MORE THAN 5 SPECIFIC HEALTH TEACHING GENERAL HEALTH TEACHING 1. EXERCISE SPECIFIC HEALTH TEACHING Exercises for pregnant women are very necessary, for them to deliver their babys well: Abdominal exercise lying flat on her back or sitting, a woman should breathe slowly and deeply in and out 5 times, using her abdominal muscles. Chin-to chest lying on her back with no pillow a woman raises her head and bends her chin forward on her chest without moving any other part of her body while exhaling. Repeating it 5 times the first time and then increasing it to 10-15 times in a succession Perineal contraction ask the woman to tighten and relax her perineal muscles 10-25 times in succession as she was trying to stop voiding. Arm raising lying on her back, arms and at her sides, a woman moves her arm out from her sides until they are perpendicular to her body. She then raises them over her body until her hands touch and lowers them slowly to her sides. She should rest for a while and repeat it 5 times. Abdominal crunches lying flat on her back with knees bent, a woman folds her arms across her chest and raises herself to a sitting position. Caution the woman to begin gradually and work up slowly to doing it 10 times a row. Brisk walking early in the morning is also advisable during the pregnancy it can help her from expanding her lungs and taking deep breath as doing the walk. Instruct the woman to have a balance diet during pregnancy, to avoid problems within the stage of her growing baby inside her tummy Teach her the right kind of food to be eaten such as : fruits, green leafy vegetables, drinking milk Advise the woman that during pregnancy folic acid, 13

2. NUTRITION

3. SLEEP AND REST

4. HYGIENE 5. TRAVEL -

vitamin C and iron is needed to reduce the risk of having health problems Prenatal check-ups should always be followed to avoid problems and detect problems throughout the pregnancy process. The woman needs to sleep early around 8 or 9 in the evening and wake up at 5 or 6 in the morning to have her exercise Having siesta hour during noontime is also of great help in the babys development Teach the client to wash from front to back of her perineal area when washing Encourage to take a bath everyday or every other day Keeping her breast clean at all times by cleaning it with cloth A woman is not advised to travel during her 3rd trimester of pregnancy to avoid any miscarriage When traveling by plane the woman needs to be standing or walking once in a while to avoid thrombus formation

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1.

A.

COMMON BEHAVIORAL PROBLEMS/ PARENTAL CONCERNS FOR AN INFANT TEETHING

DESCRIPTION

MANAGEMENT

RATIONALE

Most infants have little difficulty with teething, but some appear very distressed. Generally, the gums are sore and tender before a new tooth breaks the surface. As soon as the tooth is through, the tenderness passes

1.

2.

Over-the-counter medicines are sold for teething pain. As a rule, their use should be discouraged if they contain benzocaine, a topical anesthetic. Acetaminophen (tylenol), 10 to 15 mg/kg every 4 hours, up to four times a day.

1.

Because if applied too far back in the throat, this could interfere with the gag reflex. May be used for teething discomfort. To prevent drug toxicity and adverse reactions. Provide soothing coolness against the tender gums. So parents must screen articles within the baby's reach to be sure they are edible or safe to chew on.

2. 3.

3. Always encourage parents to check with their infant's health care provider before giving any over-the counter drug this way. 4 Provide teething rings that can be placed in the refrigerator provide soothing coolness against the tender gums.

4. 5.

5. B. THUMB-SUCKING Sucking is a surprisingly strong need. Many infants begin to suck a thumb or finger at about 3 months of age and continue the habit through the first few years of life. The sucking reflex peaks at 6 to 8 months, whereas thumb sucking peaks at about 18 months

watch infant closely when holding objects. 1. Parents can be assured that thumb sucking is normal and does not deform the jaw line as long as it stops by school age. 2. Educate parents that it does not cause baby talk or any of the other symptoms commonly attributed to it. 3. Be certain an infant has adequate sucking pleasure and then to ignore thumb sucking. 4. Making an issue of it rarely causes a child to stop; if anything, it usually intensifies and prolongs it. 1. Whether to use pacifiers is a question parents must settle for themselves, depending on how they feel about them and their infant's needs. Infants rarely have such a need for sucking they must have a pacifier in their mouth constantly. 2. If a child is formula-fed, parents should check nipples to be certain the holes are small and the rubber is sturdy. 3. Parents should attempt to wean a child from a pacifier any time after 3 months of age and certainly during the time the sucking reflex is

Prevents anxiety.

C. USE OF PACIFIER

Whether to use pacifiers is a question parents must settle for themselves, depending on how they feel about them and their infant's needs

1.

Discussing a few pros and cons with the parents clarifies the subject. so that an infant can suck hard enough to derive pleasure. Weaning after this age is difficult because a pacifier becomes a comfort mechanism, like a warm blanket or fuzzy toy to which a child may cling.

2. 3.

15

fading at 6 to 9 months. D. HEAD BANGING Head banging in this limited fashion beginning during the second half of the first year of life and continuing through to the preschool period, associated with naptime or bedtime, and lasting under 15 minutes can be considered normal. Children use this measure to relax and fall asleep. 1. Advise parents to pad the rails of cribs so infants cannot hurt themselves. No therapy should be necessary. Refer to counseling if excessive head banging occurs. 1. So infants cannot hurt themselves, 2. Rreassure them this is a normal mechanism for relief of tension in children of this age. 3. Excessive head banging done to the exclusion of normal development or activity, or head banging past the preschool period, suggests a pathologic basis, and such children then need a referral for counseling and further evaluation. Suggestions for eliminating or at least coping with night waking

2. 3.

E.

SLEEP PROBLEMS

Sleep problems develop in early infancy because of colic or because an otherwise healthy infant takes longer than usual to adjust to sleeping through the night.

1. 2. 3.

4. 5.

6.

F.

CONSTIPATION

Constipation may occur in formula-fed infants if their diet is deficient in fluid.

1.

2.

3.

4.

5.

delay bedtime by 1 hour; shorten an afternoon sleep period; do not respond immediately to infants at night so they can have time to fall back to sleep on their own; provide soft toys or music to allow infants to play quietly alone during this wakeful time. Reassuring parents that infants take varying lengths of time to adjust to night sleeping is helpful in assuring them their child is normal. Suggesting parents use the time they are awake at night (e.g., solve a problem at work, watch the late show, plan a shopping list) may help them view the situation as a constructive time rather than a problem. If constipation persists beyond 5 or 6 months of age, encourage parents to check with the infant's health care provider. Adding foods with bulk, such as fruits or vegetables, and increasing fluid intake generally relieves the problem. Apple juice (3 or 4 oz) or prune juice (0.5 to 1 oz daily) may be given as a temporary measure. All infants with a history of constipation for more than 1 week should be examined for an anal fissure or tight anal sphincter. If an unusually tight anal sphincter exists, parents will be given instructions to manually dilate the sphincter two or three times daily until it dilates sufficiently. If no stool is present in the rectum of a constipated infant

1. 2. 3.

Discuss measures to relieve constipation. Dietary measures that relieves constipation. Softening stools and thereby relieving the pain of defecation often solves the problem and helps the fissure to heal. Stimulates the anal sphincter. Indicative of Hirchsprungs disease. May have an underlying condition.

4. 5. 6.

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G. LOOSE STOOLS

H. COLIC

Many new parents are unfamiliar with the consistency or color of normal newborn stools, so they mistakenly report normal stooling as diarrhea. Stools of breast-fed infants are generally softer than those of formula-fed infants. If a mother takes a laxative while breastfeeding, an infant's stools may be very loose. An infant who is formula-fed can have loose stools if the formula is not diluted properly. Occasionally, loose stools may begin with the introduction of solid food, such as fruit. Malabsorption syndrome (celiac disease), or inability to digest fat, may manifest itself first by loose stools and a distended abdomen and deficiency of fat-soluble vitamins Colic is paroxysmal abdominal pain that generally occurs in infants under 3 months of age (Karp, 2004). An infant cries loudly and pulls the legs up against the abdomen. The infant's face becomes red and flushed, the fists clench, and the abdomen becomes tense. If offered a bottle, the infant will suck vigorously for a few minutes as if starved, then stop as another wave of intestinal pain occurs. It may occur in susceptible infants from overfeeding or from swallowing too much air while feeding. In most infants, colic disappears almost

on rectal examination A careful history must then be taken to assess for other symptoms of Hirschsprung's disease: ribbonlike stools, bouts of diarrhea, and a distended abdomen. 1. Ask about the duration of the loose stools, the number of stools per day, their color and consistency, and whether there is any mucus or blood in them. Is there associated fever, cramping, or vomiting? Does an infant continue to eat well? Appear well? Seem to be thriving? Is an infant wetting at least six diapers daily? 6.

1.

Determine any deviation from infants usual elimination patterns or stool characteristics.

1. 2.

Take a thorough history of an infant with signs of colic. Ask parents about the duration of the problem and its frequency . Ask what happens just before the attack (e.g., if it occurs after feeding), and ask the parent to describe the attack itself and associated symptoms. Document the number and type of bowel movements. Determine the baby's feeding pattern (breast-fed or bottlefed). If bottle-fed, ask about the type of formula and how it is prepared. Ask parents if they are holding the baby upright

1.

3.

2. 3.

because intestinal obstruction or infection may mimic an attack of colic and be misinterpreted by the casual interviewer. it usually lasts up to 3 hours a day and occurs at least 3 days every week). A family medical history is important to obtain because allergy to milk may simulate colic. because bowel movements are not abnormal with colic. Constipation; narrow, ribbonlike stools; and the presence of blood or mucus in the stool suggest other problems. Provides comparison and detect any deviation from normal behaviors. so air bubbles can rise and whether they burp the infant adequately after feeding.

4. 5.

4.

5.

6.

7. For a breast-fed baby, a change in maternal diet (e.g., avoiding greasy foods) might be helpful to reduce or limit colicky periods. It may be helpful to

6.

17

magically at 3 months of age, probably because it becomes easier to digest food and an infant maintains a more upright position by this time, which allows less gas to form

recommend that both breast- and formula-fed infants receive small, frequent feedings to prevent distention and discomfort. 7. 8. 9. Offering a pacifier may be comforting. Do not place hot water bottles on infants stomach. Changing formula bottles to the type with disposable bags that collapse as the baby sucks. Ask them to describe carefully what they mean by spitting up. How long has the baby been doing it? How frequently? What is the appearance of the spit-up milk? Burp the baby every after feeding. Parents may try sitting an infant in an infant chair for half an hour after feeding. Frequent diaper changing, as soon as soiled, especially with stool and preferably once during the night. applying A & D or Desitin ointment in a thick layer Use mineral oil. Do not wash completely. Avoid overwashing the skin, especially with perfumed soaps or commercial wipes. Use a moisturizer or nonsoap cleanser, such as cold cream or cetaphil. Gently wipe stool from skin using water and mild cleanser. Changing the brand or type of diaper or washing solution. Keep skin dry. Use superabsorbent disposable diapers. Bathing an infant twice a day during hot weather, particularly if a small amount of baking soda is added to the bath water. reducing the amount of

7.

might be helpful to reduce or limit colicky periods. It may be helpful to recommend that both breast- and formula-fed infants receive small, frequent feedings to prevent distention and discomfort.

8. 9.

I.

SPITTING UP

Associated signs such as diarrhea, abdominal cramps, fever, cough, cold, or loss of activity

1.

Promoting comfort. May burn the infants delicate skin. 10. may help minimize the amount of air swallowed. 1. Almost all milk that is spit up smells at least faintly sour, but it should not contain blood or bile 2. Limits spitting up. 3. To prevent spitting up and aspiration.

2. 3.

J.

DIAPER DERMATITIS

When parents do not change a child's diaper frequently, feces is left in contact with skin, and irritation may result in the perianal area. Urine that is left in diapers too long breaks down into ammonia, a chemical that is extremely irritating to infant skin. Ammonia dermatitis of this type is generally a problem in the second half of the first year of life, when an infant is producing a larger quantity of urine than before. For some infants, however, it is a problem from the first week.

1.

1 2. 3. 4. 5. 6. 7.

2. 3. 4.

8. 9.

5.

To prevent further skin impairment. To protect skin. To remove ointment. May cause irritation. To wipe urine from the skin. To clean the area. Usually relieves the problem, if using the commercial ones or homewashable types. exposing the diaper area to air may relieve the problem. To reduce skin wetness.

6.

7. 8. 9.

K.

MILIARIA

Miliaria, or prickly heat rash, occurs most often in warm weather or when babies are overdressed or sleep in overheated rooms. Clusters of pinpoint, reddened

1.

1. 2.

2.

may improve the rash. Eliminates sweating , should bring almost immediate improvement and prevent further eruption.

18

L.

INFANT CARIES (BABY BOTTLE SYNDROME)

M. OBESITY IN INFANTS

papules with occasional vesicles and pustules surrounded by erythema usually appear on the neck first and may spread upward to around the ears and onto the face or down onto the trunk. Putting an infant to bed with a bottle can result in aspiration or decay of all the upper teeth and the lower posterior teeth Decay occurs because while an infant sleeps, liquid from the propped bottle continuously soaks the upper front teeth and lower back teeth (the lower front teeth are protected by the tongue). The problem, called baby-bottle syndrome, is most serious when the bottle is filled with sugar water, formula, milk, or fruit juice. The carbohydrate in these solutions ferments to organic acids that demineralize the tooth enamel until it decays. Weight greater than the 90th to 95th percentile on a standardized height/weight chart. Obesity occurs when there is an increase in the number of fat cells due to excessive calorie intake.

clothing on an infant or lowering the room temperature.

1. 2.

Advise parents never to put their baby to bed with a bottle. If parents insist a bottle is necessary to allow a baby to fall asleep, encourage them to fill it with water and use a nipple with a smaller hole .

1.

2.

can result in aspiration or decay of all the upper teeth and the lower posterior teeth. to prevent the baby from receiving a large amount of fluid. Prevents further decay of teeth.

3. 3. If the baby refuses to drink anything but milk, the parents might dilute the milk with water more and more each night until the bottle is down to water only.

1. 2.

Investigating what the cry might really mean. As a general rule, an infant should take no more than 32 oz of formula daily. When solid food is introduced, a bottle of water can be substituted for formula at one feeding. Nonfat milk should not be given. add a source of fiber, such as whole-grain cereal and raw fruit, to an infant's diet. Caution parents about giving obese infants foods with high amounts of refined sugars, such as pudding, cake, cookies, and candy. Encourage parents to learn more about balanced nutrition and to provide this for their entire family.

1. 2. 3. 4.

3.

4. 5. 6.

5. 6.

7.

Determines what the child needs. Excess consumption of calories leads to excess storage of fats. Keeps the child hydrated. because it contains so little fat that essential fatty acid requirements may not be sufficient to ensure cell growth. These type of food contains less calories. Sweets contain a high amount of carbohydrates, which in excess intake of it, results to storage of unused glucose as fats. To involve parents in plan of care.

7.

19

ROLES OF THE NURSE IN THE CARE OF A FAMILY WITH AN ILL INFANT (COGNITIVE OR PHYSICAL CHALLENGE). 1. Encourage parents to visit an intensive care nursery regularly to help form a strong parent-child attachment. If parents cannot visit, urge them to telephone the hospital as frequently as they can to inquire about their child. 2. 3. Supply Polaroid photographs of an infant for parents to take home. To encourage a good parent-child relationship, point out the positive things an infant can do. Perhaps the child's facial expression says, Pick me up!! even though he doesn't reach up with his hands; perhaps his eyes follow his mother's actions even though he can't yet call to her. Helping parents to interact more fully with their infants helps to build a sense of trust in an infant. Without a sense of trust, children have difficulty expressing themselves to others; they may not believe they are lovable or people would want to interact with them. Ask parents about secondary concerns. What about everyday things? Any problems there?. Treat these concerns seriously, so parents can feel confident about bringing them to your attention at future health care visits. Also mention they are part of normal infant development so parents can begin to view their child apart from his or her illness. Offering anticipatory guidance to parents can go a long way toward helping them avoid this special concern of infancy. To ensure adequate calorie and protein intake, infants may need to be maintained on nasogastric tube or gastrostomy feedings, or total parenteral nutrition. These methods limit the amount of sucking that is possible. Because sucking provides pleasure as well as satisfying thirst, this is a major loss. Provide an infant with non-nutritive sucking experiences if possible to fill this need. Infants who are ill for a long time may not eat solid foods eagerly once they are introduced because they are not hungry enough to be interested in a new eating method.

4.

5. 6. 7. 8.

9.

10. Help parents to experiment with different foods to find a taste that does appeal to ill children, or teach them to limit foods to only those the child appears to like most from all five food groups.

2.

COMMON BEHAVIORAL PROBLEMS/PARENTAL CONCERNS FOR A TODDLER A. BED WETTING

DESCRIPTION

MANAGEMENT

RATIONALE

It is an involuntary passage of urine past the age when a child should be expected to have attained bladder control.

1. Limit fluids after dinner. 2. Alarm bells that ring when children wet at night are effective in some children. 3. Bladder stretching exercises drinking a large quantity of water and then refraining from voiding as long as possible. 1. Check that training pants pull down readily and that slacks are free of complicated buttons or grippers. 2. Instruct the child to plant the feet on the floor.

1. This minimizes urination at night. 2. The alarm wakes the child, the child stops voiding, and then gets up and uses the bathroom. 3. To increase the functional size of the bladder.

B.

TOILET-TRAINING

It is the physical ability to control the anal and urethral sphincters.

1. To enable the child to undress easily. 2. This facilitates defecation. 3. This allows children a feeling of security. 4. To associate these activities with usual practices. 5. This will boost the self-esteem of the child.

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C.

NEGATIVISM

Negativism is a necessary assertion of control.

D. DISCIPLINE

Discipline means setting rules or road signs so children know what is expected of them.

E.

SEPARATION ANXIETY

This is the fear of being separated from parents beginning at about 6 months of age and persists throughout the preschool period.

3. Choose a freestanding potty chair. 4. It is best to keep the potty in the bathroom and to let the child observe the excreta being flushed down the toilet. 5. Children should be praised for cooperative behavior and successful evacuation. 1. Parents should make a statement instead of asking a question. 2. Use humor. 1. Use time-out technique. 2. Parents should praise correct behavior. 3. Parents need to be consistent. 1. Leave your child with a caregiver for brief periods and short distances at first. 2. Schedule separations after naps or feedings. 3. Develop a goodbye ritual. 4. Minimize scary television. 5. Try not to give in. 1. Encourage mother not to pick up child unless there is actual danger or injury. 2. As eating is a time when tantrums occur, review mother if her actions are different at this time than others. 3. Inform the mother children rarely hurt themselves during tantrums. 4. Continue to be present during tantrums. 5. Offer the child options instead of an all or none position.

1. This can avoid many negative responses from the child. 2. This will get the task done and defuse anger or frustration. 1. This helps children learn that actions have consequences. 2. This is where rules are learned best. 3. This is important to allow child to stick to the rules.

1. To practice separation. 2. Babies are more susceptible to separation anxiety when theyre tired or hungry. 3. Rituals are reassuring and can be as simple as a special wave through the window or a goodbye kiss. 4. Your child is less likely to be fearful if the shows you watch are not frightening. 5. Reassure your child that he or she will be just finesetting limits will help the adjustment to separation. 1. Temper tantrums are a way of expressing frustration. Rewarding the behavior prevents the child from learning more mature methods of coping with frustration. 2. Eating is an area in which children can express independence. 3. Increased knowledge about the minimal risk of injury during tantrums should help to alleviate the mothers anxiety. 4. To provide a feeling of control and security to the child once the tantrum has subsided.

F.

TEMPER TANTRUMS

A tantrum is a normal response when something blocks a young child from gaining independence or learning a skill.

21

3. a.

LIST THE ROLES OF THE NURSE IN THE CARE OF A FAMILY WITH AN ILL TODDLER. Nutrition A special diet may limit typical finger foods. Use imagination to offer other foods not usually eaten this way as finger foods. Allow child to help pour liquid diet for a tube feeding. Toddlers are frightened by vomiting because they have no control over it. Check for possibility of nausea; toddlers have no way to express this other than by eating. Dressing changes A child can hold pieces of tape or put tape in place to maintain sense of control. The child can remove old bandage if it is not contaminated. Allow children to view the incisions and watch dressing changes; explaining each step of a procedure as you perform it helps a child maintain control. Restrain only those body parts necessary during a procedure to allow child sense of control. Remove all supplies after a procedure, or the child may redo the dressing. Medication Allow children no choice regarding whether a medicine will be taken. Do allow a child to choose a chaser, such as milk or juice, after oral medicine. Do not ask a toddler to indicate a choice of site for an injection or intravenous insertion; this is to advance a decision for a toddler to handle. Rest Locate or create a ritual for bedtime. Allow a choice of toy or cover but not a choice of bedtime or naptime hour. Hygiene Allow a child a choice of bathtub toy or clothing. Allow a child to wash face and hands to gain control of the situation. Allow the child to put toothpaste on a brush, but you should brush or touch up teeth afterward to ensure that all plaque has been removed. Pain Encourage a child to express pain. Help channel a childs self-expression to what is acceptable. Stimulation Provide a toddler with a toy that can be manipulated, such as boxes that fit inside one another and can be taken out again, trucks that can be pushed, and pegs that can be pounded. Elimination A child who is toilet trained needs to be encouraged to use a potty chair or toilet during an illness. Help children with ureter or bowel stomas to help with changing bags so they are as independent in bowel function as possible.

b.

c.

d.

e.

f. g.

h.

4. COMMON BEHAVIORAL PROBLEMS/PARENTAL CONCERNS FOR A PRESCHOOLER A. FEAR OF THE DARK

DESCRIPTION

MANAGEMENT

RATIONALE

B. FEAR OF BODY MUTILATION

The tendency to fear the dark is an example of a fear heightened by a childs vivid imagination: a stuffed toy by daylight becomes a threatening monster at night. Reveled by the intense reaction of a preschooler to even a simple injury such as falling and scraping a knee or having a needle inserted for an 22

Monitor the stimuli their children are exposed to, especially around bedtime (e.g. television, adult discussions, and frightening stories.

To know what causes the fear of their children and prevent them from stimuli that causes fear

Good explanations of the limits of health care procedures such as a tympanic thermometer does not hurt or a finger

So that the child will not feel anxious about the procedure and will develop trust on the statement of their parents, thus

immunization.

C. TELLING TALL TALES

D. IMAGINARY FRIENDS

E. REGRESSION

F. DIFFICULTY SHARING

A. SIBLING RIVALRY/PREPARING FOR A NEW SIBLING

prick heals quickly or distraction techniques in order to feel safe. Stretching stories to Caution parents not make them seem to encourage telling more interesting is a stories to the child phenomenon that might terrify frequently them and supplying encountered in this them an expected age group. answer.. Instead, help the child separate fact from fiction. Many preschoolers Ask parents to make have an imaginary certain their child friend who plays with has exposure to real them, although playmates. (as long imaginary friends are as imaginary normal, creative part playmates do not of preschool years take center stage in and can be invented childrens lives or by children who are prevent them from surrounded by real socializing with playmates as well as other children. by those who have Help children few friends. separate fact from fantasy. Some preschoolers, Help parents generally in relation understand that to stress, revert to regression in these behavior they circumstances are previously outgrew, normal, and a childs such as thumb thumb-sucking is sucking, negativism, little different from loss of bladder control the parents and inability to reaction to stress. separate from their parents. Sharing is a concept Assure parents that that first comes to be sharing is a difficult understood around concept to grasp the age of 3 years. and that, as with Before this, children most skills, engage in parallel preschoolers need play. practice to understand and learn it. Defining limits and exposing children to these three categories (mine, yours, ours) Introduction of a new Help parents not to sibling is such a major underestimate the happening that significance of a bed parents need to take to a preschool child. special steps to be The parents might 23

they will not be worried.

This conveys the idea a child has not told the truth, yet does not squash imagination or initiative

So that the children will not be centered on playing with their imaginary friends and will try to socialize with real playmates.

To make the children easier for them to accept and understand. If the babys stress is removed it is easier for the child to discontinue the behavior

So that the parents will not be mad on their children regarding rivalry preventing tension to both the parent and the baby. Helps the children determine which objects belong to which category.

It is security, consistency, and home. If their preschooler is sleeping in the crib

certain their preschooler will be prepared.

explain Its time to sleep in a new bed now because youre a big boy.

B. SEX EDUCATION

C. CHOOSING A PRESCHOOL OR CHILD CARE CENTER

Children during the preschool age become acutely aware of the difference between boys and girls, possibly because it is a normal progression in the development and possibly because this may be the first time in their lives they are exposed to the genitalia of the opposite sex as they watch while a new brother or sister diapers changed, they see other children using bathroom at a preschool, or they see a parent nude. A school or child care experience is helpful for preschoolers, as peer exposure appears to have a positive effect on social development. Children who have learned to be comfortable in a preschool group approach school comfortably and ready to learn.

If the preschool ask questions like Why does James look like that or How does jasmine pee? Explanations should be just as simple: Boys look different from girls. The different part is called a penis. Teaching them to avoid sexual abuse, such as not allowing anyone to touch their body unless they agree it is all right.

that is to be used for the new baby, it is usually best if the preschooler is moved to a bed about 3 months in advance of the birth. The fact that he is growing up is a better reason for such a move because a new brother or sister wants the old bed. It is important for parents not to convey that these body parts are never to be talked about to leave and open line of communication for sexual questions. Because children have been taught this, remember to ask permission before giving nursing care that involves touching.

If there are other 3 4 year old children in a neighborhood with whom a child has almost daily contact, and if a parent can supervise organized play dates and projects, a preschool program may not be necessary. Be sure parents investigate preschools or child care centers carefully before they enroll their child.

Because the main purpose of a child care center is to stimulate childrens sense of creativity and initiative and introducing them to a new experiences and social contacts they would not ordinarily receive at home. To be certain their child will be safe there and have enjoyable experience.

24

D. PREPARING THE CHILD FOR SCHOOL

At the end of the preschool period, children begin a formal school experience as they enter kindergarten. Parents may wonder whether their child is old enough for this, especially if a childs birthday is in the late summer or early fall. Developing language is such a complicated process that children from 2 to 6 years of age typically have some speech difficulty. A child may begin to repeat words or syllables, saying, I-I-I-I want a n-n-new spoon-spoon-spoon. Many preschoolers imitate the vocabularies of their parents or older children in the family so well during this time that they incorporate swear words into their vocabularies.

E. BROKEN FLUENCY

F. BATHROOM LANGUAGE

Urge parents to discuss their concern with school officials. It is important for parents to take time to prepare preschoolers not only physically by being certain their immunizations are up to date but emotionally as well. A parent who knows a persistent stutterer or who was a persistent stutterer as a child may react to this normal broken fluency of the preschooler in a more emotional way than the problem deserves. Parents may have to be reminded that children do not necessarily understand what the words mean; they have simply heart them, just as they have heard hundreds of other words and have decided to use them. Correction should be unemotional; for example, Thats not a word I like to hear you say. When youre angry, why dont you say fudge (or whatever)?

To determine whether their child should be registered for kindergarten or delayed for a year. Because school involves a great deal of childrens time and influences their future greatly. It is a part of normal development and, if accepted as such, will pass.

The correcting is no different from that involved when a child uses poor grammar. If parents become emotional, a child realizes the value of such words and may continue using them for the attention they create.

25

5. COMMON DESCRIPTION BEHAVIORAL PROBLEMS/PARENTAL CONCERNS FOR A SCHOOLER A. SCHOOL REFUSAL OR School refusal is PHOBIA fear of attending school. It is a type of social phobia similar to agoraphobia (fear of going outside the home.)

MANAGEMENT

RATIONALE

Counseling may help the child manage the situation better. If not, parents can attempt to have the child transferred to another classroom or perhaps excused from a disliked situation such as showering to stop the school resistance.

B. LATCHKEY CHILDREN

C. SEX EDUCATION

Schoolchildren who are without adult supervision for part of each weekday. The term alludes to the fact they generally carry a key so they can let themselves into their home after school. Sex education should be continued even during schoo-age.

Many communities offer a special afterschool programs so children do not have to be home alone. Nurses are in a position to educate parents about such services.

Children who resist attending school this way may develop physical signs of illness, such as vomiting, diarrhea, headache, or abdominal pain on school days. This lasts until after the school bus has left or the child is allowed to stay home for the day. A particular child may be reacting to situation such as harsh teacher, having to shower in gym class, or facing a class bully every day. So that their children can feel both safe and stimulated creatively during this time.

It is important that school-age children be educated about pubertal changes and responsible sexual practices so they are well prepared for these. Also, preteens should have adults to whom they can turn for answers to questions about sex. Sex education should be incorporated into health education throughout the school years in a manner that is appropriate to age and development.

So that the children will be cleared on his/her curiosity about sex and will be led to the right definition of sex.

26

D. STEALING

During early school age, most children go through a period during which they steal loose change from their mothers purse or fathers dresser. This usually happens at around 7 years of age, when children first learn how to make change and also discover the importance of money.

Parents should explore the reason for the stealing: Do other children on the block receive an allowance and so have money for small items? Did their child make a bet that must be paid? Is a child buying a bullys friendship by purchasing gum or candy for that child? Does a child need more security and view money as security?

Stealing occurs because, although a child is gaining an appreciation for money, this appreciation is not yet balanced by strong moral principles.

E. VIOLENCE OR TERRORISM

Children basically view their world as safe, so it is a shock when violence such as a school shooting or reports of terrorist enter their lives.

Common recommendations for parents to help children feel safe are: Assure children they are safe Assure children their parents are actively involved in keeping them safe Observe for signs of stress such as sleep disturbances Not allow children or adolescents to view footage of traumatic events over and over. Watch news programs with

Some parents may be reluctant to talk to their children about a disaster plan for the family, believing that these preparations will frighten children unnecessarily, but such preparations should have the major effect of increasing a feeling of safety, not decreasing it. Fear of the unknown is always more intense than fear of something tangible.

27

children so they can explain that the situation portrayed is not near them Explain there are bad people in the world Prepare a family disaster plan Designate a rally point where the family will meet if ever separated by a disaster or evacuation. F. BULLYING A frequent reason of school-age children cite for feeling so unhappy that they turn guns on classmates is that they were ridiculed or bullied to the point they could no longer take such abuse. Suggestion for school personnel to deal with bullies are: Supervise recreation periods closely Intervene immediately to stop bullying Insist that if such behavior does not stop, both school and parents will become involved. Therapy may be needed to correct bullying behavior if it is ingrained So that adults can intervene school bullying and can help the children manage the situation.

G. RECREATIONAL DRUG USE

Advise parents to discuss bullying with their school-age child and tell them how it should be reported. Once considered a Parents should suspect college or high glue sniffing or some school problem, other form of illegal drugs such as recreational drug use if marijuana are now their child regularly 28

Substance abuse in middle school children may be associated with suicide attempts.

available to children as early as elementary school and certainly by the time they reach seventh and eighth grades.

H. CHILDREN OF ALCOHOLIC PARENTS

I.

OBESITY

As many as one in five children live with an alcoholic parent. Such children are at greater risk for having emotional problems than are others because of the frequent disruption in their lives. Alcoholism may have a genetic cause, so children of alcoholics may be more likely to become alcoholics. As many as 50% of school-age children are obese by body mass index guidelines for ideal weight. Some of these children have been overweight since infancy.

appears irritable, inattentive, or drowsy. School health personnel should be aware of the increase in this practice among students and look for warning signs. Counsel children against using steroids to improve muscle mass. School nurses are in an excellent position to identify such children, monitor their school progress, and refer them to organizations that can help them in their problems.

Use of steroids can cause cardiovascular irregularities, uncontrollable aggressiveness, and possible cancer in later life.

Such fears may be revealed by failing marks in school, withdrawal from friends or social activities, and delinquent behavior such as stealing.

A weight- reduction program for school age children that emphasizes long term lifestyle changes is best. It should contain features such as: Intake of about 1200 calories (no more than 30% as fat) with lifestyle changes such as structured family meal An active exercise program A counseling program to discuss aspects such as selfimage and motivation to reduce weight

Those who become so obese that friends leave them out of activities or who cannot play sports because they tire so quickly may develop such poor self-image that they have little motivation for selfimprovement.

29

6. LIST THE ROLES OF THE NURSE IN THE CARE OF A FAMILY WITH AN ILL SCHOOLER a. Nutrition a. Encouraging Fluid intake i. Offer small, full glasses frequently rather than half-full larger glasses ii. Determine the childs favorite fluid, and then offer it. iii. Try changes of temperature in fluid offered for variety. iv. Popsicles and Jell-O count as fluids v. Children can drink more of a clear fluid than a thicker fluid vi. Suggest soothing beverages such as kool-aid, Snapple, or milk for children with mouth lesions. vii. Because ice melts to one half its volume, count a glass of ice chips as only half-full glass of fluid. viii. Unless contraindicated, let children drink fluids with a straw ix. Introduce a game, such as Simon Says or a board game in which a child takes turns and with each turn has to take a drink. b. Encourage Food intake. i. Calorie counting, as the name implies, involves counting the number of calories that children ingest each day. b. Dressing a. Allow preschooler to measure and cut tape or draw a face on it. b. Allow child to see incision site. Explain steps of dressing change as you work to reduce unkowns and areas of fear c. Provide extra bandages to put on a doll so child can see that bandages themselves are not to be feared. c. Medicine a. Allow child to choose a chaser such as juice or milk after oral medicine. b. Choosing site for injection or intravenous line is too advanced for the preschooler; do not suggest such choices. d. Rest a. Sleep Patterns 1. Reduce noise level in room to promote sleep. 2. Use patience to wake a child fully or to offer medicine. 3. Use patience until a child is fully awake, particularly if asking a question. b. Sleep Deprivation i. Managing chronic sleep problems 1. Wake them gently, help them get reoriented, and then return them to bed after reassuring them they are safe. 2. Be certain that the side rails are raised on the bed of a child who tends to sleepwalk. e. Hygiene a. Allow child to choose bathtub toys, clothing. b. Allow child to wash own hands and face. c. Allow child to splash in water as a play activity as well as for cleanliness. f. Pain a. Encourage preschooler to express pain. b. Allow child to handle syringe or suction catheter, and give shots or suction to a doll to alleviate anger or fear. c. Encourage child to ask for analgesic if necessary.

30

g. Stimulation a. Providing Stimulation for Children on Bed rest. i. When possible, encourage a child with restricted mobility to move out of bed into a wheelchair; this can provide some mobility and transportation to a place of interest. ii. Watching television, a common activity for children on bedrest, provides a little cognitive stimulation after the first 24 hours. iii. Encourage family members to include the ill child in as many family activities as possible. b. Providing stimulation for children on transmission based precautions. i. Careful planning must be done to ensure that a child who is isolated this way is not psychologically isolated and that every possible measure is carried out to maintain sensory, social, physical, and cognitive function.

7. COMMON BEHAVIORAL PROBLEMS/PARENTAL CONCERNS FOR AN ADOLESCENT A. HYPERTENSION

DESCRIPTION

MANAGEMENT

RATIONALE

Hypertension is present if blood pressure is above the 95th percentile, or 127/81 mmHG for 16 year old girls and 131/81 for boys

B. POOR POSTURE

Many adolescents demonstrate poor posture, a tendency to round shoulders, and a shambling, slouchy walk. This is due in part to the imbalance of growth that arises from the skeletal system growing a little more rapidly than the muscles attached to it.

C. BODY PIERCING AND TATTOOS

Body piercing and tattoos are a strong mark of adolescence. Both sexes have ears, lips, chins, navels, and breasts pierced and filled with studs, or tattoos applied to arms, 31

Prevention and management of hypertension should be done. Avoid foods that are rich in fat and cholesterol Encourage the teen to have an exercise daily. Urge children of both sexes to use good posture during these rapid-growth years Tall adolescents of both sexes are generally picked out by basketball or track coaches and so may have incentive. Assure posture at all adolescent health appraisals to detect the difference between simple poor posture and the beginning of scoliosis. Be certain they know the symptoms of infection at a piercing or tattoo site (redness, warmness, drainage, swelling, mild pain) and to report these to a health care provider if they occur as a

This measures can help prevent and manage hypertension.

Poor posture particularly seems to develop in adolescents who reach adult height before their peers. They slouch to appear no taller than anyone around them.

Body piercings can be a mode of entry of a microorganism thus it is at risk of infection, carefull monitoring on signs of infection will prevent further

legs, or their central body.

serious staphylococcal or streptococcal infections can occur at piercing site. Caution adolescents that sharing needles for piercing or tattooing carries the same risk as sharing needles for intravenous drug use.

complications and will be treated promptly Parents must be careful of those diseases that can be transmitted through blood, they must educate their children about the risk of body piercing and tattoing. Because all can contribute greatly to fatigue. A short period of extreme tiredness is more likely to suggest disease than a long, illdefined report of always feeling tired.

D. FATIGUE

E. MENSTRUATION

So many adolescents comment they feel fatigued to some degree that this can be considered normal for the age group. Because fatigue may be a beginning of symptom of disease, however, it is important it be investigated as a legitimate concern and not underestimated. Menstrual irregularities can be a major health concern of adolescent girls as they learn to adjust to their individual body cycles.

Assess an adolescents diet, sleep patterns, and activity schedules. Note when the fatigue began.

Explain to the child that menstruation is a normal physiologic changes during puberty. If there is dysmenorrhea to the child, administer pain relievers such as paracetamol.

F. ACNE

Acne is a selflimiting inflammatory disease that involves the sebaceous glands that empty into hair shaft (the pilosebaceous 32

External Medication Medications that are applied externally peel away the superficial skin layer to prevent sebum plugs from forming and are sufficient if only comedones are

This will evade anxiety to the child and that the child be educated of how her menstrual cycle works and its purpose. Some girls experience pain or cramps during their menstruation, it is important to alleviate that pain so it can provide comfort to the child. It is important that the acne must be treated because it can cause psychological effects on the teen, specially the self-esteem of the

unit). It is the most common skin disorder of adolescence, occurring in as many as 80% to 95% of adolescents.

G. OBESITY

Most overweight adolescents have obese parents, suggesting that both inheritance and environment play a part in the development of adolescent obesity.

present. Systemic Medication Isotretinoin, a form of vitamin A, is an extremely effective oral drug for reducing sebum production and abnormal keritinzation of gland ducts; it is prescribed for cystic acne. General measures to help adolescents decrease overeating: Making a detailed log of the amount they eat, the time, and the circumstance s, and then changing those circumstance s. Always eating in one place (the kitchen table) instead of while walking home from school or watching television. Slowing the process of eating by counting mouthfuls and putting the fork down beside the plate between bites, and being served food on small plates so helpings look larger.

teen.

These measures are helpful in adolescents who are always overeating, Overeating can lead to obesity which can affect the child both psychologically and physiologically.

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H. SEXUALITY AND SEXUAL ACTIVITY

I.

STALKING

J.

HAZING

Because of increasing exposure to and acceptance of premarital sexual relations in society, more adolescents than ever before engage in high-risk sexual behaviors exposing them to sexually transmitted infections or conception. Refers to repetitive, intrusive, and unwanted actions directed at an individual to gain the individuals attention or evoke fear. The usual stalker is a male who stalks a female who has rejected him. Stalkers instill fear into their victims by constant and threatening pursuit. Hazing refers to demeaning or humiliating rituals that prospective members have to undergo to join sororities, fraternities, adolescent gangs, or sports teams. Most rituals are secret and in the past were accepted as rites of passage.

Counseling can help adolescents improve their perspective and learn how to say no. In contrast, some adolescents would like to be sexually active but are not because they believe myths: early sexual relations will drain their strength and make them poor athletes. Measures to help avoid being stalked are the same as those for avoiding rape, such as advising adolescents not to put themselves in positions where they will be vulnerable to being alone with a stalker, and report stalking to law enforcement officers.

It is important that your boy/girl will be taught about sex education so to prevent curiosity that will make the child a high-risk of being sexually active.

So that they can obtain a restraining order to prevent the stalker from coming near them any longer.

K. SUBSTANCE ABUSE

Substance abuse refers to the use of chemicals to improve a mental state r induce euphoria. This is so common among adolescents that as many as 50% of 34

Parents need to be aware of what clubs or organizations their adolescent is attempting to join and what the requirements for membership will be. Health care providers can help adolescents make sound decisions about what type of hazing organizations advocates by asking teenagers about the subject at health assessments. It is important for parents to always talk to their child regarding the childs concern and problems. Make sure the parents know what type of person or

Some organizations are dangerous and their requirements for membership is quite harsh to the child and sometimes the child will be faced on an embarrassing moment, this can affect your child mentally and physically. Some teens tend to go on drug abuse specially if they have problem that they feel they cannot handle with. Sometimes peer pressure can lead

L. RUNAWAYS

high school seniors report having experimented with some form of drug. A runaway is commonly defined as a child between the ages of 10 and 17 years who has been absent from home at least overnight without permission of a parent or guardian.

friends his or her child is with all the time. Try to imagine yourself in adolescent runaways circumstances to determine whether your health instructions are sensible for their lifestyle. So that parents and an adolescent can learn to communicate better, it is helpful to urge them to establish ground rules for communication threats are not allowed.

to drug abuse especially if the group of friends is using illegal drugs. It is important for parents to know what are their childs concern and problems so that they can easily manage the problem. No subject is too difficult to be discussed calmly, no emotion or feeling is to be called foolish.

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