Pediatric and adolescent nursing
Paediatric nursing tests whether you can adapt assessment, dosing and communication to a developing child, and whether you spot the child who is compensating and about to decompensate. Children deteriorate differently from adults and rarely complain.
Assessment
- The paediatric assessment triangle (appearance, work of breathing, circulation to skin) gives a rapid first impression before any equipment.
- Weigh every child in kilograms; doses are per kilogram with a maximum adult dose. Double-check decimal points and concentrations, and measure small volumes in an appropriate syringe.
- Normal ranges are age-dependent: infants breathe faster and have higher heart rates; hypotension is a late sign of paediatric shock, so use prolonged capillary refill, cool peripheries and reduced urine output as early clues.
Common situations
- Dehydration from gastroenteritis: use oral rehydration solution where tolerated, roughly 50 mL/kg over 4 hours for mild and 100 mL/kg over 4 hours for moderate dehydration, with continued breastfeeding.
- Shock: 10-20 mL/kg crystalloid bolus and reassess after each bolus.
- Febrile seizure: usually 6 months to 5 years, under 15 minutes, generalised, no antipyretic prevents recurrence; the priority is airway, positioning and excluding meningitis.
- Never give aspirin to a child with a viral illness because of Reye syndrome.
Worked example
A 12 kg child needs paracetamol at 15 mg/kg. Reasoning: 12 times 15 equals 180 mg. The elixir contains 120 mg in 5 mL, so 180 divided by 120, multiplied by 5, equals 7.5 mL. Check the maximum daily dose and the interval, and record the weight used.
Safeguarding
Unexplained injuries in a non-mobile infant, inconsistent histories or delayed presentation require documentation and referral through the safeguarding pathway, not confrontation with the family.
Traps that cost marks
Adult dosing, misplaced decimals, using a teaspoon as a measure, treating a febrile child without assessing for sepsis or meningitis.