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Pediatric Lecture: Family Influences on Child Health Promotion

Explore the impact of family structure, parenting, and community on child health promotion practices. Learn about newborn health, respiratory and circulatory system changes, and strategies for newborn management and thermal regulation.

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Pediatric Lecture: Family Influences on Child Health Promotion

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  1. Pediatric lecture (2) Dr. HananAlHarbi Mrs. Rania Alsabi

  2. Family Influences on Child Health Promotion

  3. FAMILY STRUCTURE AND FUNCTION

  4. Family Size and Configuration • Sibling interactions • The narrower the spacing between siblings, the more children influence one another, especially in emotional characteristics • The wider the spacing between siblings, the greater the influence of the parents • Ordinal position: Effect on personality

  5. Multiple Births • Twins • Identical (monozygotic) • Fraternal (dizygotic) • Higher-order multiples • Increasing incidence related to maternal age and reproductive intervention

  6. PARENTING • Motivation for parenthood • Preparation for parenthood • Transition to parenthood • Parental factors affecting transition to parenthood • Age • Resources • Coping

  7. Parenting Situations • Parenting in dual-earner families • Working mothers

  8. Community-Based Nursing Care of the Child and Family

  9. COMMUNITY HEALTH CONCEPTS • Community • Demography • Epidemiology

  10. Economics • Measure the amount of resources needed to pay for good health • Prioritize health care needs • Methods for defining and estimating cost • Measurement of cost and effects

  11. Distribution of Disease, Injury, or Illness • Morbidity • Incidence: NEW events in a population during a time period • Prevalence: EXISTING events in a population during a time period • May be reported as rates per 1000, 10,000, or 100,000 population, depending on their frequency

  12. Epidemiologic Triangle Environmental Factors Agent Host Factors

  13. Levels of Prevention • Primary: Health promotion, prevention of disease or injury • Immunization, safety • Nutrition • Sanitation measures, environmental efforts • Community parenting classes • Secondary: Screening, early diagnosis of disease • Tuberculosis and lead screening programs • Mental health counseling for stressful events such as divorce, death, or community natural disasters • Tertiary: Rehabilitation, disease management • Asthma, sickle cell disease, cancer • Special education programs for children

  14. Screening • Risk vs. benefit analysis • Psychologic risk associated with false-positive results • Treat a child with a positive screen differently even after further diagnostic testing determines the child is normal

  15. COMMUNITY NURSING PROCESS • Community needs assessment • Community planning • Community implementation • Community evaluation

  16. Health Promotion of the Newborn and Family

  17. ADJUSTMENT TO EXTRAUTERINE LIFE

  18. Respiratory System • Initiation of respiration • Chemical factors stimulate breathing • Hypoxemia • Hypercarbia • Low pH • Thermal stimuli • Newborn leaves warm environment to relatively cooler atmosphere. Sensory impulses to skin are transmitted to respiratory center in the medulla.

  19. Newborn Respiration • Fetal lung fluid removal • Compression of chest with passage through birth canal • Lymphatic vessels and pulmonary capillaries • Expansion of alveoli • Occurs with initiation of breathing • Role of surfactant in keeping alveoli expanded

  20. Do’s and Don’ts in Newborn Management • Do provide tactile stimulation by drying the wet skin of the newly delivered infant. Remove wet linens immediately after drying the newborn. • Do rub or flick the soles of the newborn’s feet if additional stimulation is required. • Don’t slap the newborn’s buttocks (no beneficial effect; can cause cerebral trauma).

  21. Newborn Circulation • Circulatory changes allow blood to flow through lungs • Pressure changes in heart, lungs, and vessels • Functional closure of fetal shunts • Foramen ovale • Ductus arteriosus • Ductus venosus

  22. Sequential Circulatory Changes in the Newborn • Inspired oxygen dilates pulmonary vessels • Pulmonary vascular resistance decreases, and pulmonary blood flow increases • Pressure in RA, RV, and pulmonary arteries decreases • Gradual increase in systemic vascular resistance after clamping of cord

  23. Further Circulatory Changes in the Newborn • LA pressure greater than RA pressure leads to closure of foramen ovale • Increase of pulmonary blood flow and dramatic reduction of pulmonary vascular resistance begins to close the ductus arteriosus

  24. Typical Times for Newborn Circulatory Changes • Foramen ovale: functional closure soon after birth • Ductus arteriosus: functional closure in about 4 days after birth; anatomic closure takes considerably longer • Failed closure of the above shunts takes blood away from newborn’s pulmonary circulation

  25. Thermoregulation • Critical to newborn’s survival • Principal thermogenic sources • Heart • Liver • Brain • Brown adipose tissues (BATs)

  26. Factors Predisposing the Newborn to Excessive Heat Loss • Large surface area results in heat loss to the environment • Newborn’s thin layer of adipose is poor insulator • Newborn cannot shiver to increase heat production

  27. Hematopoietic System • Blood volume of NB depends on amount of blood transferred via the placenta before clamping of the cord • Full-term infant • Total blood volume = 80 to 85 ml/kg of body weight • Immediately after birth • Total blood volume = approximately 300 ml • Depending on how long after delivery infant remains attached to the placenta, as much as 100 ml can be added to the blood volume

  28. Fluid and Electrolytes • Newborn body weight is 73% fluid (adult is 58% fluid) • Infant has higher ratio of extracellular fluid than adult • Infant has higher levels of total body sodium and chloride • Infant has lower levels of total body K, Mg, and phosphate

  29. Implications • Rate of fluid exchange in newborn much faster than in adult • Rate of metabolism in newborn twice as great related to body weight • Acid forms very quickly, leading to rapid development of acidosis • Immature kidneys cannot concentrate urine to conserve body fluid

  30. Newborn Resultant Problems • Infant prone to dehydration • Infant prone to acidosis • Infant prone to overhydration/fluid overload

  31. Gastrointestinal System • Newborn has deficiency of pancreatic lipase for fat absorption, making cow’s milk indigestible • Stomach capacity approximately 90 ml in term newborn • Colon has small volume, leading to frequent stools • Progressive changes in stool pattern in newborn

  32. Stool Patterns in Newborns • Meconium • Should occur within 24 to 48 hours after birth • Description • Transitional stools • Usually appear by day of life (DOL) 3 • Transition from meconium to milk • Milk stools • Usually appear by DOL 4 • Differences in breast milk and formula stools

  33. Renal System • Functional deficiency in kidney’s ability to concentrate urine • Normal newborn urine production 1 to 2 ml/kg/hr • Bladder capacity approximately 15 to 30 ml • First void occurs within 24 hours after birth • Newborn may void 10 to 20 times per day

  34. Newborn Skin • Immature integumentary function • Active sebaceous glands • Eccrine (sweat) glands • Apocrine glands small and nonfunctional • Hair follicles • Amount of melanin low at birth—lighter skin than in later life; UV susceptibility

  35. Musculoskeletal System • Skeletal system contains larger amount of cartilage than ossified bone • Rapid ossification in first year of life • Muscular system almost completely formed at birth • Muscle growth is by hypertrophy rather than hyperplasia

  36. Immune System • Skin and mucous membranes are first line of defense from invading organisms • Second line of defense is cellular elements of the immunologic system: neutrophils, eosinophils, lymphocytes • Third line of defense is formation of antibodies • Breast milk provides passive immunity (IgG)

  37. Endocrine System • Endocrine system developed, but function is immature • Antidiuretic hormone (ADH, vasopressin) production is limited • Risk of dehydration • Effects of maternal sex hormones in newborn

  38. Neurologic System • At birth the nervous system is incompletely integrated • Primitive reflexes • Autonomic nervous system crucial in newborn • Myelination of nerves follows cephalocaudal and proximodistal progression

  39. Sensory Functions • Vision • Pupils react to light; blink and corneal reflexes • Tear glands—minimal function until 2 to 4 weeks of age • Hearing • Smell • Taste • Touch

  40. Newborn Assessment • Apgar score at ages 1 minute and 5 minutes • Reflects general condition of infant • Not used to determine need for resuscitation at birth • Factors affecting Apgar score • Low tone • Reduced reflex irritability • Infection • Congenital anomalies • Maternal sedation or analgesia • Hypovolemia • Neuromuscular disorders

  41. Apgar Scoring System

  42. Transitional Assessments • Periods of reactivity • First reactivity period • 30-60 minutes after delivery: alert, interested in environment • Full-term infant may breast-feed • 2-4 hours after delivery: sleepy and relatively calm • Second reactivity period • Lasts 2-5 hours: alert and responsive • Physiologic changes

  43. Behavioral Assessment • Principal areas • Sleep • Wakefulness • Activity • Brazelton Neonatal Behavioral Assessment Scale (BNBAS) • 28 items organized in clusters • Research or diagnostic tool • Requires special training

  44. Patterns • Sleep • Wakefulness • State modulation by infant

  45. Cry • Strong, lusty cry at birth • Sounds of cry vary for hunger, pain, etc. • Duration varies: 5 minutes to 2 hours or more per day • Variations may indicate underlying abnormalities • A weak, groaning cry or grunting during expiration usually indicates a respiratory disturbance. • Absent, weak, or constant crying may suggest pathology. • A high-pitched, shrill cry may indicate increased intracranial pressure. • Crying status alone is not a diagnostic tool

  46. Attachment • Parent-infant bonding • The Neonatal Perception Inventories (NPI) mother’s image of her real infant compared with her image of an “average” infant • Needs to see her infant as better than an “average” baby • If not rated as better than average, may indicate lack of attachment • Feeding time = opportunity to assess attachment

  47. Assessment of Gestational Age (GA) • New Ballard scale • Appropriate for 20 to 44 weeks of gestation • Perform in immediate postdelivery period for highest accuracy • Dubowitz scale

  48. Weight Related to Gestational Age • Birth weight is poor indicator of gestational and fetal maturity • Gestational age reflects fetal maturity • AGA: growth between 10th and 90th percentiles • SGA: less than 10th percentile • LGA: greater than 90th percentile

  49. Other Descriptions of Newborn Maturity • Term = 36 to 42 completed weeks of gestation • Preterm = fewer than 36 completed weeks of gestation • Postterm = more than 42 completed weeks of gestation

  50. General Measurements of Newborns • Head circumference • Chest circumference • Abdominal circumference • Length • Body weight

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