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They are a vulnerable or special risk group in any population. The reasons why they need special health care are: • Large numbers: constitute 15 – 20% of population in developing countries. • High mortality: Apart from infant mortality which is more than 100/1000 live birth in developing countries, the mortality in age groups 1-4 years is not less than 40/1000 as compared to 0.5 in developed countries. The major causes of death in this group are due to malnutrition and infection, both preventable. • Morbidity: The major diseases which affect this preschool age group are: diphtheria, whooping cough tetanus, diarrhea, dysentery, malnutrition, accidents all are preventable etc... A) Major childhood problems: • Pneumonia • Diarrhea • Malaria • Tuberculosis • HIV ( mother to child transmission) • Perinatal infection • Malnutrition Pediatric Nursing and child health care 10 B) Major child health programs/activities: • CDD see the section on IMCI case management of Diarrhea • ARI see the section on IMCI case management of ARI • Malaria control see the section on IMCI case management of fever • HIV control activities (mother to child transmission prevention) see the section in HIV prevention. C) Antenatal and deliver care: Every child begins as a fetus, and the months before delivery are some of the most important in his life. Pregnant mothers should be checked regularly and advised on their nutrition and any other difficulties they have. Every mother should receive tetanus immunization to protect her new baby. Finally, skilled help during labor and delivery will provide the final step for a good start in life. D) EPI (Immunization): Tuberculosis, diphtheria, whooping cough, tetanus, polio and measles can all be prevented by Immunization. These are some of the main causes of sickness and death among children. These methods of primary prevention are available and effective and should be given to every child. Pediatric Nursing and child health care 11 E) Under Five Clinic: • The aims and objectives of the under-fives clinic are to provide curative, preventive and promotive health services within the resources available in the country such as: • Well baby care • Care in illness • Adequate nutrition • Immunization F) Traditional Practice: Everyone is greatly influenced by the traditional customs of his family, tribe, and country. Some of these traditional practices are good for health, such as breast feeding or the acceptance of modern medicine, should be supported. Those traditional practices and beliefs, which are bad (cutting of uvula, female genital mutilation etc ) need to be gradually changed. This is another important area in which health workers can have a strong influence in improving health. Pediatric Nursing and child health care 12 Study Questions 1. Discuss the components of safe motherhood that can contribute to the reduction of neonatal morbidity and mortality. 2. What are the immediate essential newborn cares? 3. What are the major components of child health program activities? 4. Discuss advantages and disadvantages of traditional practices in relation to child health Pediatric Nursing and child health care 13 CHAPTER TWO HISTORY TAKING AND PHYSICAL EXAMINATION Learning Objectives After studying the material in this unit, the students will be able to: - Take relevant/proper pediatric history - Perform systematic physical examination - Interprate history and physical examination to arrive at differential diagnosis - Out line Lab. Work up and management 2.1 History taking and approach A) The Chief complaint: is the symptom the patient presents himself with. It can be stated briefly as e.g. fever, cut wound, or vomiting etc. B) History of the present illness: this is a chronologic description and duration of the chief complaint. We try to answer the following questions; Pediatric Nursing and child health care 14 • Duration of disease onset • Severity • Aggravating and alleviating factors • Associated symptoms • Any treatment and response to treatment • History of contact with similar illness • Relevant pediatric history (like history of immunizations) related to chief complaints or history present illness C) Past medical history: this is made up of the illness the patient has had in the
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