1. 1 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 29 Child and Adolescent Health

2. 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives 1. Describe significant physical and psychosocial developmental factors characteristic of the child and adolescent population. 2. Examine the role of the nurse and discuss appropriate nursing interventions that promote and maintain the health of children and adolescents as individuals, members of their families, and members of the community. 3. Discuss the built environment and how it relates to major health issues for children and adolescents.

3. 3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives, Cont’d 4. Explain the current status of children and their physical, emotional, behavioral, and environmental health issues. 5. Differentiate between the models for delivery of health care to the pediatric populations in the community and other settings.

4. 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Status of Children Poverty Status Access to Care Infant Mortality Risk-Taking Behaviors

5. 5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Poverty Status  73.9 million children through 17 years of age in the United States (2008)  40% of whom live in low-income families  8% live in extreme poverty  20% of households with children experience low food security.  Increasing homelessness of children  More than 10 million children witness or experience violence each year.  Exposure to violence is linked to physical, emotional, and behavioral problems.

6. 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Access to Care  8.1 million children without health insurance (2007)  Uninsured rate for children living in poverty: 17.6% (2007)  Medicaid program  Children’s Health Insurance Plan (CHIP)

7. 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Infant Mortality  Healthy People 2020 target goal: 4.5 infant deaths per 1000 live births  Current infant mortality rate: 6.2 per 1000 live births  Steadily declined over that past decades  United States has a higher infant mortality rate than 44 other nations, and global position has consistently fallen over past years  Critical indicator of a country’s overall health

8. 8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Risk-Taking Behaviors  Any behaviors that place early and middle adolescents at risk for physical, emotional, or psychological harm  Substance use/abuse  Sexual activity  Teen parents  Factors associated with increased adolescent risk-taking behaviors

9. 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Child Development Growth and Development Developmental Theories Developmental Screening

10. 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Growth and Development  An ongoing, dynamic process that results in physical, cognitive, and emotional changes  Health visits and well-child checkups at scheduled intervals  Recommendations for preventive pediatric health care

11. 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Developmental Theories  Erikson’s psychosocial development  Piaget’s cognitive development  Bronfenbrenner’s human ecology theory

12. 12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Developmental Screening  Process designed to identify children who should receive more intensive assessment or diagnosis of potential developmental delays  Promotes early detection of delays and improves child health and well-being for identified children  17% of children have a developmental disability but only 50% of these children were diagnosed prior to school entry.  Individuals with Disabilities Education Act (IDEA 2004)  Individualized Education Plan (IEP)

13. 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Immunizations  Barriers  Immunization theory  Recommendations  Contraindications  Legislation

14. 14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. The Built Environment Obesity Built Food Environments Obesity Prevention Nutrition Assessment Physical Activity Schools Media Injuries and Accidents

15. 15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Obesity  CDC definitions:  Overweight  Obesity  Prevalence rates for obesity have more than quadrupled for most children over the past 30 years  Physiologic consequences  Contributing factors  Modifiable risk factors  Type 2 diabetes

16. 16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Built Food Environments  Macro-level  Reliance on convenience foods and fast foods  Increasing portion sizes  Food landscape  Food deserts  Micro-level  Home food environment Accessibility of fruits and vegetables Parental role modeling Child feeding practices General parenting style

17. 17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Obesity Prevention  Let’s Move! Campaign  Healthy schools  Access to affordable and healthy food  Raising children’s physical activity levels  Empowering families to make healthy choices

18. 18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nutrition Assessment  Body Mass Index (BMI)  24-hour diet recall  Parent’s concerns regarding diet  Family’s meal patterns  Amount of physical activity  Behavior problems that occur during meals

19. 19 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Physical Activity  Fewer children are meeting the recommended physical activity levels compared with previous generations.  Contributing factors  Some children at higher risk for not getting enough physical activity.  AAP recommends every child/adolescent gets 60 minutes of moderate aerobic physical activity daily.

20. 20 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Developmental Guidelines for Physical Activity Promotion

21. 21 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Schools  Children and adolescents spend much of each weekday in school.  Small percentage of schools meet recommended daily physical education requirements  Strategies to increase physical activity in schools

22. 22 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Media  Includes television, movies, Internet, video and computer games, and cell phones  Children and adolescents now spend more time engaged with media than any other activity except for sleeping.  Average seven hours per day  Correlation between increased use of media with increased sedentary lifestyle, obesity, hypercholesterolemia, and hypertension

23. 23 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Injuries and Accidents  Unintentional injuries are leading cause of morbidity and mortality in United States  Falls, drowning, motor vehicle accidents  20 children die each day from a preventable injury  9.2 million children seen in Emergency Department each year  Motor vehicle crashes leading cause of death for unintentional injuries  For infants, leading cause of death is suffocation

24. 24 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Developmental Considerations  Infants  Toddlers and preschoolers  School-age children  Adolescents  Sports injuries  Child maltreatment

25. 25 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Injury Prevention  Reducing gun violence  Promoting safe playgrounds and recreation areas

26. 26 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Health Problems of Childhood Acute Illnesses Chronic Illnesses Environmental Tobacco Smoke

27. 27 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Acute Illnesses  Viruses  Handwashing  Sudden Infant Death Syndrome (SIDS)

28. 28 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chronic Illnesses  Mental health  Environmental health  Lead poisoning  Mercury  Plasticizers

29. 29 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Environmental Tobacco Smoke  Exhaled smoke, smoke from burning tobacco, or smoke from the mouthpiece or filter end of a cigarette, cigar, or pipe  Children exposed experience increased episodes of:  Middle ear infections  Asthma  Upper respiratory infections  Missed school days  Prenatal exposure linked to  Preterm births  Low birth weight  Increase risk for several childhood cancers  Children living with parent who smokes more likely to start smoking

30. 30 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Models for Health Care Delivery to Children and Adolescents  Family-centered medical home  Motivational interviewing  Interactive health communication

31. 31 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Role of the Nurse  Provide care through well-child clinics, immunization programs, federally mandated programs, or specific state-funded programs.  Plan of care includes three major components:  Management of actual or potential health problems  Education and anticipatory guidance  Case management and coordination of care