Chapter 27 Pediatrics

What Is Pediatrics? Branch of medicine that cares for newborns, infants, children, adolescents Patient population has special needs MAs knowledgeable about growth and development phases [FIGURE 27-1]

What Is Pediatrics? Medical assistant responsibilities: Taking history of child Assessing child Measuring vital signs, height, weight, vision, hearing Laboratory work Administration of injections Observing parent–child interactions Noting child’s development level

What Is Pediatrics? First physical examination of newborn Performed immediately after delivery Newborn APGAR scoring PKU and other testing “Well-child” versus “sick-child” visits Prevention of health problems and diseases Immunizations given 17 vaccine-preventable diseases

What Is Pediatrics? Preparation of vaccines for administration Most recommended vaccines administered first 15 to 18 months of life Vaccine storage follows manufacturer’s guidelines Essential to know what allergies child has Symptoms of side effects, contraindications, allergies (See Table 27-1: Vaccine Administration Guidelines) (See Procedure 27-1: Administration of a Vaccine)

What Is Pediatrics? Preparation of vaccines for administration MA responsible for documentation Immunization recordkeeping mandated by state and federal laws TPMS includes immunization recordkeeping Vaccines stimulate immune system to produce antibodies against pathogens (See Procedure 27-2: Maintaining Immunization Records)

What Is Pediatrics? Giving multiple vaccines at the same time [FIGURE 27-6A and FIGURE 27-6B] Giving multiple vaccines at the same time

What Is Pediatrics? Recommended vaccination schedule Repeated doses of several vaccines required Administer only compatible vaccines at any one visit Administered according to schedule to ensure complete vaccination by 15 to 18 months Booster vaccines on school entry

What Is Pediatrics? Considerations for vaccine administration Infection control (Standard Precautions) Hand washing Gloving Syringe selection Needle selection Needle-free injection (See Table 27-2: Injection Guide for Infants and Children)

What Is Pediatrics? Considerations for vaccine administration Inspecting vaccine Reconstitution Prefilling syringes Labeling Multiple vaccinations Nonstandard administration (See Table 27-2: Injection Guide for Infants and Children)

What Is Pediatrics? Considerations for vaccine administration Needle gauge Needle length Infants (younger than 12 months) Injection technique Toddlers and older children (12 months to 10 years) Adolescents and adults (11 years and older) (See Table 27-2: Injection Guide for Infants and Children)

What Is Pediatrics? Giving injections to pediatric patients Infants and toddlers held in such a way that they cannot move Parents informed of procedure for administering injections Birth to about 2 years of age, vastus lateralis muscle preferred site 2 to about 4 years old, deltoid preferred site

What Is Pediatrics? Giving injections to pediatric patients Keep syringe and needle out of child’s sight Do not tell child injection will not hurt; explain it will sting for short while Vastus lateralis preferred site for intramuscular injections Deltoid used for subcutaneous pediatric injections

What Is Pediatrics? Giving injections to pediatric patients Clinical responsibilities for MA same or similar procedures as adult examination Preservatives used in vaccines for 70 years No relationship between thimerosol and neurotoxicity from vaccine administration

Theories of Growth and Development Newborns Infants Toddlers Preschoolers School-aged children Adolescents [FIGURE 27-9]

Growth Patterns Length and weight measurements Used to calculate pediatric doses of medication Measurements plotted on physical growth percentile chart Growth charts aid in diagnosis of growth abnormalities and nutritional disorders and disease Hereditary factors influence growth patterns

Growth Patterns Infant holds and positions Lifting and carrying done safely Be especially careful of infant’s neck Primary positions: Upright Cradle “Football” carry

Growth Patterns Primary positions: Upright Cradle “Football” carry [FIGURE 27-13, FIGURE 27-14, FIGURE 27-15]

Growth Patterns Height and weight measuring devices Infant platform scale Infant measuring board Tape measure on a pad Stature-measuring device

Growth Patterns Height and weight measuring devices [FIGURE 27-17 and FIGURE 27-16]

Growth Patterns Measuring head circumference Alerts provider to abnormal development Flexible paper or metal measuring tape Head and chest circumference equal at age 1 to 2 years Rapid growth may indicate hydrocephalus Slow growth may indicate microencephaly

Growth Patterns Measuring chest circumference Suspicion of overdevelopment or underdevelopment of heart or lungs or calcification of rib cartilage Snugly wrap measuring tape around chest at nipple level (See Procedure 27-3: Measuring the Infant: Weight, Length, and Head and Chest Circumference)

Growth Patterns Infant/child failure to thrive May have organic and inorganic causes May be social and emotional causes Many causes may be treated if found in time

Pediatric Vital Signs Temperature Oral Aural (tympanic) Rectal Axillary Temporal artery (See Procedure 27-4: Taking an Infant’s Rectal Temperature with a Digital Thermometer)

Pediatric Vital Signs Pulse Apical pulse Use of stethoscope Normal heart rate ranges for children Heart rhythm and rate Normal, bounding, or thready (See Table 27-3: Normal Heart Rate Ranges for Children) (See Procedure 27-5: Taking an Apical Pulse on an Infant)

Pediatric Vital Signs Respirations Older children measured same way as adults In children younger than 6, observed by rise and fall of abdomen Movements often irregular; counted for 1 full minute for accuracy Normal respiratory rate ranges for children (See Table 27-4: Normal Respiratory Rate Ranges for Children) (See Procedure 27-6: Measuring Infant’s Respiratory Rate)

Pediatric Vital Signs Blood pressure Not normally taken unless requested by provider Taken annually in children 3 years of age and older Measured using electronic or aneroid equipment Determining size of cuff Auscultating pulse Palpating systolic blood pressure (See Table 27-5: Normal Blood Pressure Ranges for Children)

Collecting Urine Specimen from Infant Pediatric urine collection bag >> Direct urethral bladder catheterization preferred method for obtaining sterile urine specimen [FIGURE 27-20] (See Procedure 27-7: Obtaining a Urine Specimen from an Infant or Young Child)

Screening for Hearing Impairment Immediately after delivery Automated system for checking hearing ability For older children, referral to audiologist indicated, especially if delay in speech noted on developmental screening

Screening Visual Acuity Newborns respond to light Older infants follow objects up and down Kindergarten chart or Allen cards used to test young children E chart used for older children >> [FIGURE 27-22]

Common Disorders and Diseases Otitis media Common cold Tonsillitis Pediculosis Asthma

Common Disorders and Diseases Croup (whooping cough) Pertussis Respiratory syncytial virus Attention deficit hyperactivity disorder Child abuse

Male Circumcision Surgical removal of foreskin of penis Religious rite in Jewish and Muslim religions Proponents and opponents of circumcision Female circumcision includes variety of surgical procedures performed on genitalia