1. Pediatric Nursing Care
Nursing Care of the Child Born with Physical or Developmental Challenge

2. Physical/Developmental Disorders: GIT
Ankyloglossia
Thyroglossal cysts
Cleft lip and Palate
Pierre Robin syndrome
Tracheoesophagus Atresia and Fistula
Omphalocele
Gastroschisis
Intestinal obstruction

3. Physical/Developmental Disorders: GIT (cont’d)
Meconium Plug syndrome
Meconium ileus
Diaphragmatic hernia
Umbilical hernia
Imperforate anus

4. Ankyloglossia

5. Thyroglossal Cyst

6. Thyroglossal Cyst

7. Cleft Lip and Palate

8. Cleft Lip and Palate

9. Bottle Feeding tips: (cleft Lip and Palate)

10. Bottle Feeding tips: (cleft Lip and Palate)
Feed your baby in a calm quiet environment.  Make sure you are sitting in a comfortable chair.
Seat your baby upright for bottle feeding.  This may prevent milk coming out of the nose during sucking. Hold the baby close to you so they are well supported for feeding.
Feed your baby with a squeeze bottle and cross-cut teat or a Special needs feeder (previously called Haberman feeder). If your baby has a cleft lip, avoid placing the teat into the cleft.

11. Bottle Feeding tips: (cleft Lip and Palate)
Once your baby starts sucking, squeeze the bottle gently to deliver milk into the mouth.  A squeeze every 3 to 4 sucks is usually sufficient however all babies are different so you may need to experiment a little with the rate of pulsing/ squeezing.  Some babies like to suck when a gentle but constant pressure is applied to the teat (if using the Special needs feeder) or the bottle (if using a squeeze bottle) rather than pulsing. 
Experimenting with this technique may also be useful.  Some mothers find it helpful to practice squeezing a water-filled bottle to get an idea of how the flow changes with more rapid squeezing or stronger squeezing of the bottle feeding. Some babies may be able to compress the teat enough themselves to feed quickly.

12. Bottle Feeding tips: (cleft Lip and Palate)
Watch how your baby reacts to the pulsing or prolonged squeezing of the bottle.  If the baby looks uncomfortable or is not managing the mouthful of milk, stop squeezing and let him/her rest and swallow before more milk is given.
Have breaks for burping, as the baby may be more ‘windy’ than usual.
Keep each feed to minutes.  Longer feeds mean the baby will use too much energy during feeding. This can make weight gain difficult.

13. Bottle Feeding tips: (cleft Lip and Palate)
Babies can loose up to 10% of their birth weight but usually regain it in 2 to 3 weeks.  If your baby is having 5 to 6 wet nappies per day and regular motions, and is healthy and alert, then it is likely that he/she is being fed sufficiently.  Your Maternal and Child Health Nurse will help you keep track of your baby’s growth and we will ask you about it when you come to cleft clinic.  Slow weight gain or weight loss may mean the feeding method needs to be changed. 
Some babies have serious feeding problems (dysphagia) which means they need specialised assistance to manage feeding. 

14. Special Bottle

15. Pierre Robin Syndrome

16. Pierre Robin Syndrome
…is a triad of micrognathia (small mandible), cleft palate, and glossoptosis (a tongue malpositioned downward)

17. Tracheoseophageal Atresia

18. Tracheoseophageal Atresia

19. Omphalocele

20. Omphalocele

21. Omphalocele

22. Gastroschisis

23. Intestinal Obstruction

24. Intestinal Obstruction

25. Intestinal Obstruction

26. Meconium Ileus

27. Diaphragmatic Hernia

28. Umbilical Hernia

29. Imperforated Anus

30. Signs and Symptoms of Dehydration
Isotonic
Hypotonic
Hypertonic
Thirst
Mild
Moderate
Extreme
Skin turgor
Poor
Very poor
Skin consistency
Dry
Clammy
Skin temperature
Cool
Warm
Urine output
Decreased
decreased
Activity
Irritable
Lethargic
Very lethargic
Serum sodium level
Normal
Reduced
Increased