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Pediatrics Exam I Notes

Chapter 1
Mortality vs. Morbidity
o Mortality (death)
The number of individuals who have died over a specific period
Presented in rates per 100,000 population
o Morbidity (illness)
Measure of prevalence of a specific illness in a population at a particular
Presented in rates per 1,000 population
Overall goal of pediatric nursing
o To promote and assist the child in maintaining optimal levels of health while
recognizing the influence of the family on the childs well-being.
o Involves the practice of health promotion and disease prevention as well as
assisting with care during disease or illness.
Characteristics of Pediatric Care (Children need access to care that is)
o Continuous
o Comprehensive
o Coordinated
o Family Centered
o Compassionate
Philosophy of Pediatric Nursing
o Focusing on the family
Providing family-centered care
o Providing atraumatic therapeutic care
Minimizing physical and psychological stress for children
o Using evidence-based practice
Using evidence-based findings to establish a plan of care
These 3 concepts represent the overarching philosophy of Pedi.
Pediatric nurses use these three concepts to provide quality, costeffective care that is continuous, comprehensive, and
o The pediatric nurse also serves as a collaborator, care coordinator, and consultant.
Nurses use the least invasive procedures with the children
Family-centered care is a mutually beneficial partnership between the child, the family,
and health care professionals.
Providing atraumatic care is important and involves providing therapeutic care through
interventions that minimize physical and psychological distress for children and their
Evidence-based practice involves the use of research findings in establishing a plan of
care and implementing that care.
Primary Roles of the Pediatric Nurse
o Providing direct nursing care to children and their families

o Being an advocate, educator, and manager.

o Serving as a collaborator, care coordinator, and consultant
The Goal is to raise awareness of and provide guidance and counseling to
prevent unnecessary deaths/illnesses in children.
The nursing process is used to care for the child and family during health promotion,
maintenance, restoration, and rehabilitation.
o Five steps in the nursing process include:
Nursing diagnosis
Identification and planning
Outcome evaluation
AD-PIE (assessment, diagnosis, planning, implementation,
When prioritizing care for children who witnessed a traumatic incident,
the nurse must remember that assessment is the first step in the nursing
Ethical Principles (know definitions)
o Autonomy freedom to make health decisions
o Beneficence actions that benefit others
o Non-maleficence avoiding causing harm, intentionally or unintentionally
o Justice acting fairly
o Veracity telling the truth
o Fidelity keeping promises and maintaining confidentiality and privacy
Children are entitled to a health care bill of rights just as adults are.
The process of balancing ethical components when with families from various cultures
and religions:
o 1) Identify the problem
o 2) Gather info about the problem
o 3) Weigh the risk against the benefits
o 4) Choose a solution
o 5) implement the solution
o 6) Evaluate the outcome of the situation
Never assume that the adult accompanying the child is the parent or legal guardian.
Always clarify the relationship of the accompanying adult.
Informed consent is required for major and minor surgery; invasive procedures such as
lumbar puncture or bone marrow aspiration; treatments placing the child at higher risk,
such as chemotherapy or radiation therapy; procedures or treatments involving research;
application of restraints; and photography involving children.
o Pregnancy, contraception and mental illness treatment are provided in many states
to adolescents without parental involvement.

o BOX 1.1 (on the test)

Assent is the agreement to something. In pediatric health care, assent is the childs
participation in the decision-making process about health care.
The opposite of assent is dissent (disagreeing with the treatment plan).
o Some dissent may be overridden
o If the decision is made to move forward with treatment despite the childs dissent,
then this decision must be explained to the child in developmentally appropriate

Chapter 2
A child begins to understand his or her culture at approximately 5 years of age.
Examples of cultures using alternative forms of healing:
o The curandero (male) or the curandera (female) of the Mexican American
community is believed to have healing powers as a gift from God.
o Asian Americans may consult a practitioner who specializes in traditional Asian
therapies such as acupuncture, acupressure, and moxibustion.
Chapter 14
It is encouraged that health care professionals assess pain every time that temperature,
pulse, respirations, and blood pressure are assessed and to institute measures to manage
the pain.
If pain is left unmanaged, it can lead to serious physical and emotional consequences,
such as increased oxygen consumption and alteration in blood glucose metabolism.
o The experience if untreated pain early in life may lead to long-term physiologic
and psychological consequences for the child.
o Preterm infants, due to long hospitalizations and numerous painful and invasive
procedures, are often at greater risk for experiencing memories of pain.
Effective pain management involves initial pain assessment, therapeutic interventions,
and reassessment for all children in any healthcare setting.
Classifications of Pain
o Duration
Acute or chronic
o Etiology
Nociceptive or neuropathic
o Source/location
Somatic or visceral
Pain threshold
o The point at which the person first feels the lowest intensity of the painful stimulus
o Substances that appear to modify the pain sensation and change a persons
perception of pain
o Examples of neuromodulators include

Nociceptive pain
o Pain due to noxious stimuli that damages normal tissues or has the potential to do
so if pain is prolonged.
Described as sharp or burning, dull, aching or cramping, deep aching or
sharp stabbing.
Examples of nociceptive pain include chemical burns, sunburns, cuts,
appendicitis, and bladder distention.
Neuropathic pain
o Pain due to malfunctioning of peripheral or central nervous system.
Described as burning, tingling, shooting, squeezing, or spasm-like pain.
Examples of neuropathic pain include posttraumatic and postsurgical
peripheral nerve injuries, pain after spinal cord injury, metabolic
neuropathies, phantom limb pain after amputation, and post stroke pain.
Somatic pain (nociceptive pain)
o Pain that develops in the tissue.
Can be superficial somatic pain which involves cutaneous (skin) pain.
Can b deep somatic pain which involves the muscles, tendons, joints
fasciae, and bones.
Visceral pain (nociceptive pain)
o Pain that develops within organs such as heart, lungs GI tract, pancreas, liver,
gallbladder, kidneys, or bladder.
Factors Influencing Pain
o Age
o Gender
o Cognitive level
o Temperament
o Previous pain experiences (biggie)
o Family and cultural background
Children identify pain based on past experiences. These factors affect how children
perceive and respond to current pain:
o The number of episodes of pain
o The type of pain
o The severity or intensity of the prev. pain experience
o The effectiveness of treatment of pain
o How the child responded
Research suggests that neonates, especially preterm infants, especially preterm infants,
actually experience pain at a greater intensity than older-age children and adults.
Behavioral indicators of pain for newborns:
o Facial expressions
Brow contracting, chin quivering
Most common response to pain

o Body movements
o Crying
Physiologic signs of pain for newborns
o Change in heart rate
o Respiratory rate
o Blood pressure
o Oxygen saturation levels
o Intracranial pressure
o Vagal tone
o Palmar sweating
o Increase in plasma cortisol or catecholamine levels
Preschoolers may not verbally report their pain. Thinking that pain is something to be
expected or that the adults are aware of their pain.
The school-age child is usually able to communicate the type, location, and severity of
pain. Children older than the age of 8 years can use specific words, such as sharp as a
knife, burning, or pulling, to describe their pain. However, they may deny pain in an
attempt to appear brave or to avoid further pain related to a procedure or intervention.
The risk of adverse effects of narcotic analgesics is the same foe children and adults.
When caring for children in pain, the nursing process includes
o Nursing assessment
Subjective and objective using QUESTT
Question the child
Use reliable and valid pain scale
Evaluate the childs behavior and physiologic changes to establish
a baseline and determine effectiveness of intervention.
Secure the parents involvement
Take the cause of pain into account when intervening
Take action
o Nursing diagnosis
o Planning
o Interventions
o Evaluation
Tools used to assess pain
o Wong-Barker FACES Pain Rating Scale
Self-report tool that can be used on children as young as 3 or 4. The nurse
asks the child to select the facial expressions that best describes the level

of pain he or she is feeling.

o FLACC Pain Rating Scale for neonatal

Behavioral scale for postoperative pain in infants and individuals that are
unable to communicate
With the FLACC behavioral scale, five parameters are measured
and scored as 0, 1, or 2. They are then totaled to achieve a
maximum score of 10. The higher the score, the greater the pain.
FLACC = Face, Legs, Activity, Cry, Console ability
o Number Pain Rating Scale
Good for children older than 7 or 8
Pain Management in Children
o Individualize intervention based on the amount of pain experiences and the childs
characteristics, such as developmental level, temperament, previous pain
experience, and coping strategies.
o Use nonpharmacological and pharmacologic approaches to ease or eliminate pain.
o Teach the child and family about pain relief interventions and techniques and
discuss with the child and family expectations of pain management.
o Nonpharmacologic
Relaxation, distraction, guided imagery
For infants
Sucking and sucrose (sweeties)
Heat and cold applications
Massage and pressure
Tylenol and Motrin are the 2 most common analgesics given to children
o Dose for Tylenol 10-15mg/kg/dose up to 5 doses/day (every 4 hrs)
o Motrin, ibuprofen, Advil (all the same) 10 ml/kg/dose up to 4 doses a day (every 6
o Always reassess pain 30 minutes afrer analgesics are given
Required Interventions When a Child is Receiving Conscious Sedation
o Ensuring that emergency equipment is readily available
o Maintain a patent airway
o Monitoring the childs level of consciousness and responsiveness
o Assessing the childs vital signs (especially pulse rate, heart rate, blood pressure,
and respiratory rate)
o Monitoring oxygen saturation levels
Nurses Role in Managing Procedure-Related Pain

o Use tropical anesthetic at site of skin or vessel puncture

o Use nonpharmacologic strategies for pain relief
o Prepare child/family ahead of time about the procedure
o Use therapeutic hugging to secure the child
o Use smallest-gauge needle possible
o Use intermitted infusion device or PICC for multiple samples
o Opt for venipuncture in newborns instead of heel stick
o Use kangaroo care for newborns before and after heel stick.
EMLA cream need to be applied 2 to 3 hours before the time of procedure
When administering Morphine, monitor the patient respiratory status frequently, noting
decrease in respiratory rate or changes in breathing patterns. Have naloxone available in
case of respiratory depression. Assess consciousness, assess for sedation, evaluate
effectiveness of pain control.

Chapter 3
Newborn/Neonatal = birth to 26 days
Infancy = birth t0 12 months old
Heredity influences growth and development by determining the childs potential while
environment contributes to the degree of achievement.
o An increase in functionality of various body systems or developmental skills.
When assessing the growth and development of a premature infant, use the infants
adjusted age to determine excepted outcomes
o The determine adjusted age, subtract the number of weeks that the infant was
premature from the infants chronologic age.
Ex: a 6-month old boy born at 28 weeks gestation was born 12 weeks
early (3 months), so subtract 3 months from his chronological age of 6
months to obtain an adjusted age of 3 months.
Be familiar with the Denver II Developmental Screening Test
Measurements of Infants at Birth and 6 months and 12 months

o Measure weight, length, head circumference
Infants six states of consciousness
o Deep sleep: eyes closed, no movement
o Light sleep: eyes closed, rapid eye movement, irregular movement
o Drowsiness
o Quiet alert state: eyes open, baby calm

o Active alert state: eyes open, body movement

o Crying
Primitive reflexes present at birth include (focus on)
o Moro baby flexes when he feels like hes falling with extension of the head/arms
o Root infant check is stroked and infant turns head to suck
o Suck
o Asymmetric tonic neck
o Plantar- infant grasps bottom of the foot when touched
o Palmer grasp infant reflexively grasps palms when touched (disappears at 9 mo.)
o Step (disappears at 4-8 wks.)
o Babinski (fanning toes)
Disappears around age 1
o Primitive reflexes diminish after over first few months of life
Respiratory System of the Infant
o Nasal passages are narrower
o The trachea and chest wall are more compliant
o The bronchi and bronchioles are shorter and narrower
o The larynx is more funnel shaped
o The tongue is larger
o There are significantly fewer alveoli
Maturation of the cardiovascular system of the Infant
o The heart doubles in size
o The average pluses rate decreases from 120 to 140 in newborn to about 100 in the
o Blood pressure steadily increases from an average of 60/40 in the newborn to
100/50 in the 12-month-old
An infant has a higher risk for respirator compromise. The lack of immunoglobulin A
(IgA) in the mucosal lining of the upper respiratory tract also contributes to the frequent
infections that occur in infancy
Parents should call the primary care provider if the infants stools are red, white, or
black; mucous-like, frequent and watery; frothy or foul-smelling; or hard, dry, formed, or
pellet-like; or if the baby is vomiting.
Infants are more susceptible to dehydration.
Infants may experience physiologic anemia at age 2 to 3 months. During last 3 months of
gestation, maternal iron stores are transferred to the concentration of the fetus.
Acrocynanosis (blueness of the hands and feet) are normal in newborns.
Maternal iron stores are transferred to the fetus throughout the last trimester of
pregnancy. Infants born prematurely miss all or at least a portion of this iron transfer,
placing them at increased risk for iron deficiency anemia compared with term infants.
Erikson (Trust vs. Mistrust)
o Caregivers respond to infants basic needs by feeding, changing, cleaning,
touching. This creates a sense of trust in the infants.

o As nervous system matures, infants realize they are separated beings from
caregiver. Over time infant learns to tolerate small amounts of frustration.
Piaget (Sensorimotor)
o Infant uses senses and motor skills to learn about the world
o Substage 1: uses reflexes (birth to 1 month)
o Substage 2: primary circular reactions (1 to 4 months)
o Substage 3: secondary circular reactions (4 to 8 months)
o Substage 4: coordination of secondary schemes (8 to 12 months)
Freud (Oral stage)
o Pleasure is focused on oral activities: feeding and sucking.
Gross motor skills are developed in a cephalocaudal (from head to tail) fashion.
o The baby learns to left head before leaning to roll over and sit

Warning signs that may indicate problem with motor development: arms and legs are
stiff or floppy; child cannot support head at 3 to 4 months of age; child reaches with one
hand only; child cannot sit with assistance at 6 months of age; child does not crawl by 12
months of age; child cannot stand supported by 12 months of age.

Fine Motor skills deal with the maturation of hand and finger use. Fine motor skills
develop in a proximodistal (from center to periphery) fashion.
o Infant first bats with whole hand, eventually progressing to gross grasping, before
being capable of fine fingertip grasping.

Hearing should be fully developed by birth

Newborns are nearsighted, prefer human face over other objects, like black and white
o Full color vison develops by 7 months of age, as do distance vision and the ability
to track objects.
Sense of touch is the most important of all senses. Even premature infants respond to
soothing stroking.
Warning signs that may indicate problems with sensory development include: young
infant does not respond to loud noises, child does not focus on a near object; infant does
not start to make sounds or babble by 4 months of age; infant does not turn to locate
sound at age 4 months, infant crosses eye most of the time at age 6 months.
o 1-3 months: baby coos
o 4-5 months: infant makes simple vowel sounds, may respond to name and no
o 4-7 months: infant begins to distinguish emotion based on tone of voice; squealing
and yelling begins around 6 months
o 7-10 months: says mamama, dadada, lalalala, without meaning and can respond to
simple commands
o 9-12 months: says mama, dada with meaning, starts imitating speech
o 12 months: uses two or three recognizable words with meaning, recognized objects
by name, starts imitating animal sounds.
o Warning signs that may indicate a problem in language development: infant does
not make sounds at 4 months of age; infant does not laugh or squeal by 6 months
of age; infant does not babble by 8 months of age; infant does not use single
words with meaning at 12 months of age (mama, dada).
Around 8 months, infant may develop stranger anxiety and separation anxiety.

Warning signs of possible problems with social/emotional development include: child

does not smile at people at 3 months of age; child refuses to cuddle, child doesnt not
seem to enjoy people, child shows no interest in peek-a-boo at 8 months of age.
Infants should be in rear facing car seats until the 12 months and 9 kg (20lbs).
The distance between crib slats should be no wider than a soda can (6 cm or less) to
prevent injury.
Avoid feeding popcorn, nuts, carrot slices, grapes, and hot dog pieces to infants.
Exceptions to Recommended Breastfeeding
o Infants with galactosemia
o Maternal use of drugs and few prescription meds
o Maternal untreated active TB
o Maternal HIV infection in developed countries

Foremilk is milk continually produced by breastfeeding mothers.

Hindmilk s fattier milk produced after foremilk that helps breastfed infants grow quickly

Breastfed infants should void 6-8 times a day

Only formulas that are fortified with iron should be used b/c iron stores that the infant
received prenatally are depleted by 4 to 6 months of age.
Infants should be burped 2 to 3 times per feeding
Iron fortified rice cereal is a good first food for infant
Introduce a new food every 3 to 5 days to help identify food allergies

Cups should be introduced at 6-8 months old

o No spill cups are not recommended
Newborns should sleep 20 hrs. a day
o By 3 months 7-8 hrs. per night with 3 naps a day
o By 12 months 8-12 hrs. per night with 2 naps a day
A around 4 months, infants need a consistent night time routine
Toothpaste is unnecessary in infancy. Use damp washcloth
Physical punishment and spanking should never be used in infancy.
o Providing a safe environment, redirecting away from undesirable behaviors, and
saying no in appropriate instances are more effective.

Chapter 9

Types of Vaccines
o Live attenuated vaccines = modified living organism that are weakened
o Killed vaccines = contain whole dead organism
o Toxoid = contain protein products by bacteria call toxins
o Conjugate = chemically linking the bacterial cell wall with protein
o Recombinant = genetically engineered organism
Immunization is the key disease prevention activity during childhood health supervision
When antigens are recognized by the immune system, the immune system responds by
producing antibodies (immunoglobulins) or directing special cells to destroy and remove
the antigen.
Passive immunity is produced when the immunoglobulins of one person are transferred to
another can be obtained by injection of exogenous immunoglobulins
o Immunity lasts only weeks or months
Active immunity is acquired when persons own immune system generates the immune
o Immunity lasts for many years or for a lifetime due to immunologic memory.

o Vaccines mimic the characteristics of the natural antigen. The immune system
mounts a response and establishes an immunologic memory as it would for an

Vaccine side affects

o Most common ones are mild, such as redness, tenderness, and swelling at the site,
low-grade fever, and fussiness.
Children who are severely immunocompromised or women who are pregnant should not
receive live vaccines (such as measles, mumps, and rubella [MMR] and varicella)
Haemophilus influenzae type B is a bacterium that causes several life-threatening
illnesses in children younger than 5 years of age. These infections include meningitis,
epiglottitis, and septic arthritis
o A booster vaccine is needed at 12 to 15 months.
o Hib vaccine is not routinely given to children 5 years of age or older and is
contraindicated in children younger than 6 weeks
Inactivated polio vaccine (IPV) is the only polio vaccine currently recommended in the
United States
o It is a killed virus vaccine that poses no risk for vaccine-acquired disease. Oral
polio vaccine (OPV), a live attenuated virus vaccine, was the preferred polio
vaccine until 2000
Measles, Mumps, and Rubella Vaccines. MMR is a live attenuated virus combination
vaccine. It is the one most commonly used in childhood immunizations.
Hepatitis A vaccine (HepA) is an inactivated whole virus vaccine
o Hepatitis A is spread through close physical contact and by eating or drinking
contaminated food or water. It is one of the most frequently reported vaccinepreventable diseases in the United States. Young children are particularly
susceptible to hepatitis A because of their close contact with other children,
inadequate hygiene practices, and tendency to place everything in their mouth.
HepA is recommended to be given to all children at age 12 months, followed by a
repeat dose in 6 to 12 months.
Hepatitis B Vaccine. HepB is a recombinant vaccine. Hepatits B virus can result in a
serious infection that affects the liver. It is spread through contact with blood and body
fluids and can be spread from an infected mother to a newborn at birth. Hepatitis B

vaccination is recommended at birth, preferably within the first 12 hours, then at 1 to 2

months and 6 to 18 months
o A total of four doses is acceptable when a combination vaccine with hepatitis B is
used after birth
Varicella vaccine is a live attenuated virus vaccine. All children aged 12 to 15 months
who have not had varicella (chickenpox) should be immunized. A second dose is
recommended at age 4 to 6 years
Pneumococcal Vaccines. Streptococcus pneumoniae (pneumococcus) is the most
common cause of pneumonia, sepsis, meningitis, and otitis media in young children
o It stimulates an immune response in infants and is given at 2 months of age as part
of the initial immunization series, but can be given as early as 6 weeks of age
o PPSV is given to children older than 2 years of age who are at high risk for
pneumococcal sepsis. This group includes children with anatomic/functional
asplenia; sickle cell disease; chronic cardiac, pulmonary, or renal disease; diabetes
mellitus; or HIV infection; children getting or who have cochlear implants; and
children with immunosuppression
Influenza immunization is recommended yearly for all persons 6 months of age or older.
All children 6 months to 8 years of age who are receiving the influenza vaccination for
the first time require two doses separated by 4 weeks.
Rotavirus Vaccine. Rotavirus is the most common cause of severe gastroenteritis among
young children
o The rotavirus vaccine is a live vaccine targeting five strains of rotavirus and is
given via the oral route to infants.
o Not given at an older age
Human papillomavirus (HPV) is a DNA tumor virus transmitted through direct skin-toskin contact. HPV is contracted most often during vaginal or anal penetrative sexual acts.
o should be given to children beginning at age 11 to 12 years, with catch-up doses
to begin at 13 to 14 years of age.
Chapter 8

Family-centered care includes: respect for the child and family, recognition of cultural
diversity, identification of the familys strengths, assistance with emotional and other
support of the family, providing honest and unbiased information, and collaborating and
empowering families.

Minimizing physical and psychological distress experienced by families

Therapeutic communication involves the use of open-ended questions, reflection,

paraphrasing, acknowledgement of emotions, and active listening.
The nurse should assess the familys culture and language before planning teaching.
The steps of health education are assessment of learning needs and styles, collaborative
establishment of the goals and plan of education, implementation, evaluation, and
documentation of education.
The child life specialist (CLS) is a specially trained individual who provides programs
that prepare children for hospitalization, surgery, and other procedures that could be

Using positions that are comforting to the child during painful procedures is an important
aspect of atraumatic care

Chapter 10

The health history in children includes more than just the chief complaint, history of
present illness, and past medical history; it is important to include the perinatal history
and developmental milestones.

The developmental history will warrant more attention in the younger child, while school
performance and adjustment will be more important in the school-age child and
Weight and length or height should be assessed at each well-child visit to determine
adequacy of growth
o Measure head circumference until age 3 years to monitor brain growth.

Perform intrusive procedures such as examination of the ears, mouth, and throat last in
the infant or young child.

Having the young boy sit cross-legged for a testicular examination may reduce the
cremasteric reflex.

The infants fontanels should be soft and flat; report a bulging fontanel immediately

Heart murmurs should be assessed for intensity, location, and duration. They may be
innocent or may indicate a congenital heart defect.

Substernal or xiphoid retractions indicate that the child is laboring to breathe, whereas a
fixed, depressed sternum (pectus excavatum) is a structural abnormality.

Chief complaint Concern, onset, duration, characteristics, course (location), family

history, prev. testing, what makes better/worse, concerns for child and family,

COLDSPA Character, onset, location, duration, severity, pattern, associated


Measuring Tympanic (ear) temp

o If younger than 3 years, pull the earlobe back and down.
o The nurse needs to be sure to direct the infrared sensor at the tympanic
Avoid the rectal route of temperature measurement in the immunosuppressed child as
well as the child who has diarrhea, a bleeding disorder, or a history of rectal surgery

Using an accurate cuff size is important: a wider cuff yields a lower reading and a
narrower cuff yields a higher reading

Observation, palpation, percussion, auscultation

Eyes= PERRLA (pupils equal, round, reactive to light and accommodation



Absence of pupillary reflexive action after age 3 weeks may indicate blindness

Indicators of problems with the endocrine system include increased thirst, excessive
appetite, delayed or early pubertal changes, and problems with growth.

For the genitourinary system the nurse would assess urinary patterns and genitals.

For the hematologic system the nurse would assess lymph nodes, skin color, and

Signs of neurologic problems include numbness, tingling, difficulty learning, altered

mood or ability to stay alert, tremors, tics, and seizures.

Health history to physical examination focusing on chief complaint.

Chapter 11

Respiratory system, such as asthma and pneumonia, account for the majority of
hospitalizations in children younger than 5 years of age,
Separation anxiety consists of three stages protest, despair, and detachment.
To prevent otitis externa, the nurse would teach parents and children to wear earplugs
when swimming and to avoid use of cotton swabs, headphones, and earphones. A hair
dryer on a low setting can be used to dry the ear canals.
Bacterial conjunctivitis is manifested by inflamed conjunctiva, a purulent or mucoid
discharge, mild pain, and occasional eyelid edema. Itching and a stringy discharge
suggest allergic conjunctivitis. Photophobia and tearing suggest viral conjunctivitis.
hot, moist compresses to the eye is an intervention for conjunctivitis
Viral conjunctivitis is characterized by lymphadenopathy, photophobia, and tearing. Mild
pain is associated with bacterial conjunctivitis. Itching and watery discharge are
associated with allergic conjunctivitis
Foods that are high in vitamin A include apricots, cantaloupe, carrots, mangos, spinach and dark
greens, and sweet potatoes. Applesauce is high in fiber, and avocados and broccoli are high in