Population-focused nurses:

CHILDREN HEALTH
Kurnia Rachmawati, Ns., MNSc
Introduction
• The future of the world depends on how well it
cares for its youth
• Focusing on the health needs and health
promotion of children increases the chances that
they will become adults who value and practice
healthy lifestyles
Introduction
• Population-focused nurses have two major roles in
the area of child health:
1. The nurse provides direct services to children and
their families: assessing, managing care, educating,
and counseling.
2. Nurses are involved in the assessment of the
community and the establishment of programs to
ensure a healthy environment for children population.
Child health situation
Child health situation
Child mortality
Reducing Child Mortality
• 5.6 million children under the age of 5 years died in 2016.
This translates into 15 000 under-five deaths per day.
• More than half of these early child deaths are due to
conditions that could be prevented or treated with access to
simple, affordable interventions.
• Leading causes of death in children under-5 years are
preterm birth complications, pneumonia, birth asphyxia,
diarrhoea and malaria.
• Children in sub-Saharan Africa are more than 15 times more
likely to die before the age of 5 than children in high income
countries.
• (WHO, 2017)
Reducing Child Mortality
• Ending preventable child deaths can be achieved
by:
• providing immediate and exclusive breastfeeding
• improving access to skilled health professionals for
antenatal, birth, and postnatal care
• improving access to nutrition and micronutrients
• promoting knowledge of danger signs among family
members
• improving access to water, sanitation, and hygiene
• providing immunizations
• Many of these lifesaving interventions are beyond
the reach of the world’s poorest communities.
 Impact of Poverty on Child Health
• Living in poverty is the single
most important determinant for
children’s outcomes
• Gap between groups is
widening
• Children in poverty more likely
to:
• Under achieve
• Get pregnant early
• Be affected by domestic violence
• Be involved in alcohol and drug
misuse
• Die younger, suffer health
problems
• Be a cost to society, not just in
financial terms
Impact of Poverty on Child Health
• Children from poorer families believe that:
• Health is a matter of luck
• Smoking cigarettes is not dangerous
• Children from poorer families are more likely to:
• Play truant from school
• Leave school at 16
• Not want to be a parent or marry
• Have low self esteem
• Become pregnant at an early age
• Perform poorly in education
Immunization
• Vaccines are available for some of the
most deadly childhood diseases, such
as measles, polio, diphtheria, tetanus,
and pertussis, pneumonia due
to Haemophilius influenzae type B
and Streptococcus pneumonia and
diarrhoea due to rotavirus. Vaccines
can protect children from illness and
death.
• Increasing immunization coverage for
children remains a significant focus of
the Healthy People 2020 objectives
• Routine immunization of children is
very successful in the prevention of
selected diseases.
Immunization
Immunization
• Barriers
• vaccine cost,
• vaccine refusal by parents,
• vaccine shortages,
• changes in vaccine scheduling and recommendations.
• Children living in poverty have lower immunization
rates than their peers, and African-American
adolescents have lower immunization rates compared
with white adolescents (Burns, Walsh, and Popovich,
2010).
• It is important to educate parents to obtain
immunizations for their children and to focus on the
issue at every encounter with families.
Health Problems of Childhood
• Acute Illnesess
• For children, it is common for viruses to spread easily
through daycares, preschools, and school systems.
• Nurses use developmental factors at each age to plan
assessment and intervention strategies to prevent the
spread of illnesses between children.
• Community-focused interventions, education, and
programs can prevent many childhood illnesses
Health Problems of Childhood
• Chronic Health Conditions
• Some examples of common chronic
conditions in children are Down
syndrome, spina bifida, cerebral palsy,
asthma, ADHD, diabetes, congenital
heart disease, cancer, hemophilia,
bronchopulmonary dysplasia, and AIDS.
• Identifying barriers for individual
families and overall community barriers
is a focus for nurses. Developing support
groups, advocating for improved
community access to resources, and
educating those working with these
children on their conditions and needs
will promote the family’s functioning.
Health Problems of Childhood
• Mental Health
• Psychosocial stressors have increased over the years for
children
• Causes : ranging from lead poisoning to exposure to violence
• Children who live in poverty, live with a single parent, or are
exposed to violence are at higher risk for developing a mental
health condition.
• Some of the common mental health problems diagnosed in
children and adolescents are anxiety disorders, autism
spectrum disorders, depression, bipolar disorder, conduct
disorder, oppositional defiant disorder, and substance abuse
(AACAP, 2009)
• Nurses can be instrumental in promoting community
awareness about common mental health problems in
children and identifying resources for families.
Health Problems of Childhood
• Injuries and Accidents
• Unintentional injuries are the leading cause of morbidity
and mortality in children.
• Unintentional injuries are any injuries sustained by
accident such as falls, drowning, poisonings, burnt or
motor vehicle accidents
Child Growth & Developmet
• Growth is the measurable aspect of the individual’s
size and follows a predictable pace that is evaluated
at regular intervals to determine if a child is
growing based on standard parameters.
• Development involves the observable changes in
the individual and relates to physical, psychosocial,
and cognitive achievements
Child Growth & Developmet
• Growth Screening
• Developmental
Screening
Undernutrition & Obesity in
Children
Undernutrition
• Consequence of deficiency of nutrients in the body
• Types of undernutrition:
– Acute malnutrition (wasting and bilateral pitting
oedema)
– Stunting
– Underweight (combined measurement of stunting and
wasting)
– Micronutrient deficiencies
Initially starts here

Failure to thrive Healthy baby

Epidemiology
• Under nutrition
• Causes > 50% of all childhood mortality in resource-poor
settings
• Major contributor of morbidity
• Late diagnosis, untimely and improper treatment can be
fatal
Risk factors
• Food insecurity
• Maternal undernutrition
• Low birth weight,prematurity
• Deficiencies of specific nutrients (iodine, vitamin A,
iron, zinc)
• Infection and duration of breastfeeding

WHO 2005, Victora et al 2016

Treatment guidelines
• Mainly focus on in-patient management through 10
steps for malnutrition

• Very little on CMAM

• All treatments centralised to certain centres

• Peripheral sites have none
WHO 10 Steps
1. Prevent/treat hypoglycemia
2. Prevent/treat hypothermia
3. Prevent/treat dehydration
4. Correct electrolyte imbalances
5. Treat/prevent infections
6. Correct micronutrient deficiencies
7. Start cautious feeding
8. Give catch-up diet
9. Sensory stimulation
10. Discharge and follow-up
 Therapeutic Food/Milk

RUTF : Ready to Use Therapeutic Food

Opposite end of spectrum

OBESITY
 Statistics
• Globally
• Increased from 32
million in 1990 to 42
million in 2013
• Current trends
• Estimate globally will
increase to 70 million by
2025
Obesity Prevention
• Promoting good
nutrition and dietary
habits
• Physical activity
• Avoid use of media
(internet, TV, computer,
phone) with an
increased sedentary
lifestyle & obesity
Both spectrums fall under
malnutrition

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