Pediatric Safety and Prevention Susan Beggs, RN MSN, CPN Fall 2009

Improving child health “health maintenance” “preventive health”

Definitions Mortality: the # of deaths/100,000 Morbidity: used to express the ratio of sick to well in a community Infant mortality # of children per 1000 live births who die before 1 st birthday

Major causes of death during infancy and childhood (these represent death rates for the ages of 1-14 yrs per 100,000 Accidents Congenital abnormalities Cancer Homicide Heart disease Pneumonia & influenza Suicide Human immunodeficiency disease

Denver II developmental test (DDST II) Standardized test for surveillance of most children Applied as a developmental chart Nurses make sure the directions are followed:

Specific recommendations by APA: –Minor infections without fever are not contraindication –If reaction occurs, consult dr. before next immunization –Pertussis not give for children over 6

4mos-6 yrs of age: DTaP (4 doses) IPV (3 doses) HepB (3 doses) MMR 12 months) PCV (1 dose) 7-18 yrs of age Td (every 10 years after initial immunizations) IPV (not rec. if >18 yrs of age)

Nurses responsibilites with immunizations Know the action of the vaccine Careful history of patient Aspirate when injecting Educate parents (schedule, side effects) Proper documentation

Assess for reaction min after injection Epinephrine 1:1000 available Check immunization records with each visit Parent teaching: fever, or other symptoms

Safety risks to developmental levels Infant Toddler Preschool School age Adolescent

Major childhood prevention measures Aspiration MVA Burns Drowning Bodily injury/fractures

Leading cause of fatal injury under 1 year of age Prevention: –Inspection of toys, small parts –Out of reach objects –Selective elimination of certain foods –Proper posturing of the infant for feeding –Pacifier with one piece construction

Vehicular risk greatest when child improperly restrained Pedestrian Prevention

Children are inquisitive Become able to climb and explore Prevention of household injury:

Child does not recognize danger of H2O Unaware of inability to breath underwater No conception of water depth Hypoxia greatest concern Prevention

Still developing sense of balance Easily distracted from tasks Prevention:

Common in early childhood (2 yrs) 75% poisons are ingested Major reason for poisoning:

Sources of poison: –Cosmetics –Household cleaners –Plants –Drugs –Insecticides –Gasoline –Household items

Stats on drug poisonings

Therapeutic interventions In every instance, medical eval is necessary Call poison control center 1 st Remove child from exposure Identify poison Prevent absorption

Ask yourself: Why do you think the American Pediatric Association no long advises parents to keep syrup of Ipecac in the home?

Ingestion of lead-based materials “Maybe it’s the lead poisoning!”

Lead poisoning can cause: –Brain and nerve damage –Behavior problems –Learning disabilities –Slowed growth –Headaches –Low energy

Life threatening More likely to drop out of school Become disabled Disturbed brain and nervous system function Prevent child from full potential

Pathophysiology of lead poisoning System assessments Therapeutic Interventions

Criteria for treatment of lead poisoning < 9 not lead poisoned 10-14: prescreen 15-19: nutritional and educational interventions 20-44: environmental eval and medication 45-69: chelation therapy >70: medical emergency

Make environment lead-free Inspect buildings >25 years of age Areas painted with lead paint should be covered with plywood or linoleum Educate the parents Follow up testing for lead levels Screening all school age children (required in some states)