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care and lifting the mother to spend much of her time with the child. Drugs may be given to keep the child quiet. It should be ensured that no visitors with colds come to see the child. The stitches are taken out on the third to fifth days. Soft feeds are given by spoon well back on the tongue and followed by sterile water. Cleft palate: is treated similarly by paring the adages and suturing after cutting on either side. Preparation The child should be admitted well before operation to be accustomed with the environment. He should be trained on spoon feeding. His general condition must be improved and he must not be exposed to infection. Pediatric Nursing and child health care 63 After Care: Arms must be splinted Soft feeds are given by spoon placed well back on the tongue and followed by sterile water.(others similar on cleft lip after care) 5.2.2 Club foot Club foot is a foot which has been fell out of shape or position in uteri and can not be moved to uncorrected position. The two most common types of club foot are: Talipes equinovarus Talipes calcaneovalgal Both types are usually bilateral. In Talipes equinovarus, the foot is fixed in palantar fixation and deviates medially i.e. the heel is elevated. The child walks on the toes and outer border of the foot. More than 95% of case of congenital clubfoot are of this type. In Talipes calcaneovalgal as the foot is dorsiflexed and deviates laterally, i.e the heel is turned outward, and anterior part of the foot is elevated on the outer border. The child walks on the outwardly turned heel and the inner border of the foot. Pediatric Nursing and child health care 64 Treatment and Responsibility of the Nurse Treatment should be started as soon as possible. Delay makes correction more difficult, since the bones and muscles of the leg develop abnormally, and the tendons will be shortened. In infancy, the application of cast to hold the foot in correct position may be used the nurse may be responsible for immobilization and holding the child during cast application. If this measure fails to correct, the surgery on the tendons and bones may be done in early childhood, and the leg and food placed in a cast. If the child has undergone operation and cast has been applied the nurse must watch for evidence of impairment of circulation or sensation and bleeding, i.e., for discoloration of the cast over the wound and report these observations to the physician. The nurses circle the area of discoloration and write the time this was done on the cast. After operation it is necessary to change the cast every three weeks to bring the foot gradually into normal position and ensure permanent correction. When the cast is no longer needed exercise may be required and parents need advice to return for checkup. Pediatric Nursing and child health care 65 5.3 Umbilical Hernia: An umbilical hernia is a protrusion at a portion of the intestine through the umbilical ring, muscle, and fascia surrounding the umbilical cord due to imperfect closure or weakness of the umbilical ring. The clinical manifestation is a swelling at the umbilicus which is covered with skin. This protrudes when the infant cries or strains. It can be reduced by gentle pressure over the fibrous ring at the umbilicus. The contents of the hernia are small intestine and omentum. Treatment and Responsibilities of the Nurse • Most small umbilical hernias disappear without treatment, but large ones may require operation. These hernias rarely cause incarceration or strangulation of the bowel. • If the physician orders the hernia to be taped, the hernia is first reduced by gentle pushing the abdominal contents back through the umbilical ring. • A 2 inch strip of adhesive tape can be applied to the abdomen over the skin covering the umbilical hernia. • Usually operation is not done on an umbilical hernia unless it becomes strangulated, enlarges or persists to school age. • Postoperative nursing care requires no special technique. The child may be as active as his desire. A normal diet and fluid may be given; pressure dressing applied at the time of operation must be kept clean and dry to prevent wound contamination. Pediatric Nursing and child health care 66 5.4. Congenital Hypertrophic pyloric stenosis This is a common
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