Pediatric Nursing
Pediatric Nursing tests growth and development, age-specific assessment, integrated management of childhood illness (IMCI) and family-centred communication. Children are not small adults: normal values change with age, deterioration is fast, and the caregiver is part of the assessment.
Development milestones to know
- 2 months: social smile, lifts head when prone.
- 6 months: sits with support, rolls over, babbles.
- 9 months: sits alone, pincer grasp emerging, stranger anxiety.
- 12 months: stands, says a first word, waves bye.
- 18 months: walks well, uses 10–20 words.
- 2 years: runs, two-word phrases, parallel play.
- Red flags: no social smile by 3 months, no sitting by 9 months, no words by 16 months, or loss of skills at any age.
Age-specific normal values
Respiratory rate: newborn 30–60, infant 30–53, preschool 22–37, school age 18–25. Heart rate falls with age: newborn 100–160, infant 90–160, toddler 80–140, school age 70–120. Blood pressure rises; use a cuff covering two-thirds of the upper arm.
IMCI priorities
Pneumonia: cough or difficult breathing with fast breathing or chest indrawing needs oral amoxicillin, with referral if severe. Diarrhoea: assess dehydration. Plan A (home): extra fluids and zinc. Plan B (some dehydration): oral rehydration solution 75 mL/kg over four hours. Plan C (severe): IV Ringer's lactate 100 mL/kg - 30 mL/kg in the first hour then 70 mL/kg over five hours for infants under 12 months, or 30 mL/kg in 30 minutes then 70 mL/kg over 2.5 hours for older children. Continue breastfeeding.
Immunisation
Egypt's compulsory schedule begins at birth with BCG and hepatitis B, then oral polio and pentavalent vaccines at 2, 4 and 6 months, with MMR at 12 and 18 months. Mild illness with low fever is not a contraindication. True contraindications are anaphylaxis to a previous dose and severe immunodeficiency for live vaccines.
Worked example
A 14-month-old has had diarrhoea for three days, with sunken eyes, a skin pinch returning after two seconds and lethargy. What do you do? Reasoning: these are IMCI signs of severe dehydration. Start Plan C IV fluids immediately, weigh the child, monitor pulse and urine output, and continue breastfeeding between infusions. Sending the child home with oral rehydration solution is unsafe.
Traps that cost marks
- Using adult drug doses or adult vital-sign ranges.
- Withholding oral rehydration because of vomiting - give small frequent amounts.
- Giving rapid fluid boluses to a severely malnourished child.