Care of Toddlers with Problem  Severe burning pain in the mouth, throat,

COMMON HEALTH PROBLEMS IN TODDLER stomach

1. Ingestion of injurious agents most cases
occurring in children under 6 years of age
MOST COMMONLY INGESTED POISONS:
 Cosmetics and personal care products (perfume,
cologne, aftershave)
 Cleaning products
 Analgesics
 White, swollen, and/or ulcerated mucous
membranes; edema of lips, tongue, pharynx
(respiratory obstruction)
 Violent vomiting, hemoptysis
 Drooling and inability to clear secretions
 Signs of shock
 Anxiety and agitation
2. HYDROCARBONS

 Plants  Gagging, choking, coughing, nausea, vomiting

 Alterations in sensorium; weakness
 Foreign bodies, toys, miscellaneous  Tachypnea, cyanosis, retractions, grunting
 Arts, crafts, and office supplies 3. SALICYLATES
 Hydrocarbons  Nausea, vomiting, disorientation, dehydration,
COMMON SIGNS OF POISONING diaphoresis, hyperpnea, hyperthermia,
oliguria, tinnitus, coma, seizures
*GENERAL SIGNS
1. GASTOINTESTINAL
EMERGENCY TREATMENT
- abdominal pain
1. ASSESS THE VICTIM
-vomiting
 Take vital signs; reevaluate regularly
-diarrhea  Initiate cardiorespiratory support if needed
-anorexia  Treat other symptoms, such as seizure
2. TERMINATE EXPOSURE
RESPIRATORY AND CIRCULATORY SYSTEMS  Empty mouth of pills, plant parts, or other
 Depressed respirations material
 Labored respirations  Flush eyes continuously with normal saline for
 Unexplained cyanosis 15 to 20 minutes
 Signs of shock  Flush skin and was with soap and a soft cloth;
 Delayed capillary refill remove contaminated clothes
 Increased, weak pulse  Bring victim of an inhalation poisoning into
 Decreased blood pressure fresh air
 Increased, shallow respiration  Give one sip of water to dilute ingested poison
 Pallor 3. IDENTIFY THE POISON
 Cool, clammy skin  Question the victim and the witnesses
CENTRAL NERVOUS SYSTEM  Look for environmental clues
 Be alert to signs and symptoms of ocular or
 Seizures dermal exposure
 Overstimulation
 Loss of consciousness 4. CALL POISON CONTROL CENTER FOR IMMEDIATE ADVICE
 Dizziness REGARDING TREATMENT
 Stupor, lethargy
 Coma CHILD MALTREATMENT
Specific Signs  it includes intentional physical abuse or
1. COROSIVE neglect, emotional abuse or neglect, and
sexual abuse of children, usually by adults
  it is one of the significant social problems
affecting children
 most sexual abuse is committed by family
members or by individuals who are close to
the child
THE CAPTA DEFINITON
 the CAPTA(Child Abuse Prevention and
Treatment Act), defines child abuse and
neglect as, at a minimum, any recent act or
failure to act that results in imminent risk of
death, serious physical or emotional harm,
sexual abuse, or exploitation of a child by a
parent or caretaker who is responsible for the
child’s welfare.
 photographing sexual acts involving children,
FOUR MAJOR TYPES OF MALTREATMENT:
PHYSICAL ABUSE- infliction of physical injury as a
result of punching, beating, kicking, biting, burning,
shaking, or otherwise harming a child
CHILD NEGLECT- characterized by failure to provide
for the child’s basic needs-physical, educational or
emotional)
PHYSICAL NEGLECT -deprivation of basic necessities
EMOTIONAL NEGLECT- failure to meet the child’s
need for affection, attention and emotional
nurturance
SEXUAL ABUSE-includes fondling a child’s genitalia,
intercourse, incest, rape, sodomy, exhibitionism, and
commercial exploitation through prostitution or
production of pornographic materials
EMOTIONAL ABUSE- includes acts or omissions by the
parents or other caregivers that have caused, or could
cause, serious behavioral, cognitive, emotional or
mental disorders
FACTORS PREDISPOSING TO PHYSICAL ABUSE
Parental characteristics
 Abusive parents mostly have low self-esteem
and less adequate maternal functioning
 Tend to have difficulty controlling aggressive
impulses, and the free expression of violence
Characteristics of the child
 Occasionally, the abuse child is illegitimate,
unwanted, brain damage, hyperactive or
physically disabled
Environmental characteristics
 Problems of divorce, poverty, unemployment,
poor housing, frequent relocation, alcoholism,
and drug addiction
 Lower socioeconomic population
TYPES OF SEXUAL ABUSE
 INCEST- any physical sexual activity between
family members
 MOLESTATION- “indicent liberties’ such as
touching, fondling, kissing, single or mutual
masturbation, or oral-genital contact
 EXHIBITIONISM- indecent exposure, usually
exposure of the genitalia by an adult to
children
 CHILD PORNOGRAPHY- arranging and
either alone or with adults or animals,
regardless of consent by the child’s legal
guardian
 CHILD PROSTITUTION- involving children in a
sex act for profit and usually with changing
partners
 PEDOPHILIA- “love of child” the sexual
preference for prepubertal children as the means
of achieving sexual excitement
CHARACTERISTIC OF ABUSERS AND VICTIMS
ABUSER
 Typical abuser is a male that the victim knows
 Are in position that involve working closely with
children
VICTIM
 Tend to be runaways-young adolescents who
engage in prostitution and pornography to obtain
money for food
 Incentuous relationship between father or
stepfather and daughter are generally prolonged
and victims are reluctant to report the situation
because they fear of retaliation and that they will
not be believed
METHODS USED TO PRESSURE CHILDREN INTO
SEXUAL ACTIVITY
The child is offered gifts or privileges
 The adult misrepresents moral standards by
telling the child that it is “okay to do this”
 Isolated and emotionally and socially
impoverished children are enticed by adults
 who meet their needs for warmth and human
contact
 The successful offender pressures the victim
into secrecy regarding the activity by describing
CHARACTERISTICS OF SEXUAL ABUSE
it as a “secret between us” that other people
may take away if they find out
 The offender plays on the child’s fears,
including fear of punishment by the offender,
fear of repercussions if the child tells, and fear
of abandonment or rejection by the family
WARNING SIGNS OF ABUSE
Physical evidence of abuse or neglect, including
previous injuries
 Conflicting stories about the “accident” or injury
from the parents or others
 Injury blamed on the sibling or other party
 An injury inconsistent with child’s development
level
 A complaint other than the one associated with
signs of abuse
 Inappropriate response of caregiver, such as an
exaggerated or absent emotional response,
refusal to sign for an additional tests or to agree
to necessary treatment, excessive delay in
seeking treatment, absence of the parents for
questioning
 Inappropriate response of the child, such as
little or no response to pain, fear of being
touched, excessive or lack of separation anxiety,
indiscriminate friendliness to strangers
 Child’s report of physical or sexual abuse
 Previous reports of abuse in the family
 Repeated visits to emergency facilities with
injuries
CHARACTERISTICS OF PHYSICAL NEGLECT
 Failure to thrive
 Malnutrition
 Poor hygiene
 Poor health care
 Frequent injuries
CHARACTERISTICS OF EMOTIONAL NEGLECT
 Failure to thrive
 Enuresis
 Sleep disorders
CHARACTERISTICS OF PHYSICAL ABUSE
 Bruises
 Burns
 Fracture or dislocation
 Lacerations
 Torn or bloody underclothing
 Bruises, bleeding, lacerations of external
genitalia, anus, mouth, or throat
 Genital discharge or odor
 Recurrent urinary tract infection
NURSING INTERVENTIONS FOR THE MALTREATED
CHILD
A thorough physical examination and a careful, detailed
history are the diagnostic tools needed to identify
abuse
 Observe child for physical and behavioral
evidence of abuse
 Report suspicions to appropriate authorities
 Assist in removing child from unsafe
environment
 Refer family to social agencies
 Collaborate with multidisciplinary team
 Keep factual, objective records
 Be aware of signs for continued abuse or
neglect
 Help parents identify circumstances that
precipitate an abuse act
CEREBRAL PALSY
-neurologic disorders characterized by early onset
and impaired movement and posture
-it is non progressive and may be accompanied by
perceptual problems, language deficits, and
intellectual involvement
CAUSES OF CEREBRAL PALSY
1. PRENATAL
Maternal
- DM or hyperthyroidism
-exposure to radiation or toxins
Gestational
-chromosome abnormalities
-genetic syndromes
-teratogens
2.LABOR AND DELIVERY
-premature deliver
 -prolonged rupture of membranes
-Abnormal presentation
3. PERINATAL
-sepsis or CNS infection
- seizures
-meconium stain
4. CHILDHOOD/POSTNATAL
-brain injury
-meningitis
-traumatic brain injury
CLINICAL CLASSIFICATION OF CEREBRAL PALSY
1. SPASTIC- may involve one or both sides
 Hypertonicity with poor control of posture,
balance and coordinated motion
 Impairment of fine and gross motor
Types of Spastic Cerebaral Palsy
 Hemiparesis- one side of the body affected
 Quadriparesis-(or tetraparesis)- all four
extremities involved, lower affected more than
the upper limb
 Diplegia –similar parts on both sides of the
body involved, such as both arms
 Monoplegia- involving only one extremity
 Triplegia- involving three extremities
 Paraplegia- pure cerebral paraplegia of lower
extremities
2. DYSKENETIC OR ATHETOID-abnormal involuntary
movement
 Athetosis, characterized by slow, wormlike,
writhing movements that usually involve the
extremities, trunk, neck, facial muscles, and
tongue
3. ATAXIC
 Wide based gait, rapid, repetitive movement
performed poorly
4. MIXED TYPE OR DYSTONIC- combination of spasticity and
athetosis
POSSIBLE SIGNS OF CEREBRAL PALSY
PHYSICAL SIGNS
 Poor head control after 3 months of age
Stiff or rigid arms or legs
Pushing away or arching back
Floppy or limp body posture
Cannot sit without support at 8 months
Uses only one side of the body
Clenched hands after 3 months
Persistence of primitive reflexes past 6 months
Hand preference demonstrated before 18
months
 Leg scissoring
 Seizures
 Sensory impairment (hearing, vision)
BEHAVIORAL CHANGES
 Extreme irritability or crying
 Feeding difficulties after 6 months of age,
persistent tongue thrusting
 Little interest in surroundings
 Excessive bleeding
DIAGNOSTIC EVALUATION
 The neurologic examination and history are the
primary modalities for diagnosis
 MRI (Magnetic Resonance Imaging)
 Metabolic and genetic testing is recommended
if no structural abnormality is identified by
neuroimaging
THERAPEUTIC INTERVENTIONS FOR CEREBRAL
PALSY
PHYSICAL THERAPY
 Orthotic devices (braces, splints, casting)
ADAPTIVE EQUIPMENT
 Scooters, bicycles, wheelchairs, boards, and
tricycles
OCCUPATIONAL THERAPY
 Adaptive equipment
 utensils for functional use (eating, writing)
 switches, computers
SPEECH LANGUAGE THERAPY
 Oral-motor skills
 Adaptive communication techniques
SPECIAL EDUCATION
 Early intervention programs
 Specialized learning programs and support services
in school
 Socialization to promote self-concept development

SPECIAL EDUCATION
 Early intervention programs
 Specialized learning programs and support services
in school
 Socialization to promote self-concept
development
NURSING INTERVENTIONS/ MANAGEMENT
 Reinforce Therapeutic Plan and Assist in
Normalization
 Assist the family in devising and modifying
equipment and activities to continue the
therapy program in the home
 Address health maintenance needs
 More frequent rest periods should be arranged
 Diet should be tailored to the child’s activity
and metabolic needs (eg. Gastrostomy feeding)
 Advice parents on how to administer
medication through gastrostomy tube
 Safety precautions are implemented such as
having helmet if the child is subject to falls
 Support family
 Help family cope with emotional aspects
 Acknowledging and addressing their concerns
and frustrations and by noting and appreciating
their problem-solving skills and their
approaches to helping the child
 Find help and support from parent groups,
where they can share their experiences,
accomplishments, problems, and concerns
 Support hospitalized child
 Should be approached and treated in the same
manner as any child in the hospital
 Therapy program should be continued while
they are hospitalized
 Encourage parents to room-in and actively
participate in the child’s care facilitates a
continuation of the home therapy program and
helps the child adjust to unfamiliar
environment
INFECTIOUS DISEASES
 An illness caused by a specific infectious agent
or its toxic products through a direct or
indirect mode of transmission that agent from
a reservoir
Chicken pox (Varicella)
Agents : Varicella-zoster virus (VZV)
Source: primary secretions of respiratory tract of infected
persons; to a lesser degree; skin lesions (scabs not
infectious)
Transmission: direct contact, droplet (airborne) spread,
and contaminated objects
Incubation: 2-3 weeks, usually 14-16 days
Period of communicability: probably 1 day before
eruption of lesions to 6 days after the first crop vesicles
when crusts have formed
Clinical manifestations:
 Prodromal stage: slight fever, malaise
and anorexia for first 24 hours, rah highly
pruritic, begins as macule, rapidly progresses to
papule and the vesicles; all 3 stages present at
varying degrees at 1 time
 Distribution: centripetal, spreading to
face and proximal extremities but sparse on
distal limbs and less on areas not exposed to
heat
THERAPEUTIC MANAGEMENT
 SPECIFIC: Antiviral agent Acyclovir (Zovirax);
varicella zoster immunoglobulin (VZIG) after
exposure in a high risk children
 SUPPORTIVE: diphenhydramine hydrochloride
or antihistamines to relieve itching
COMPLICATIONS
 Secondary bacterial infections (eg. Pneumonia)
 Encephalitis
 Varicella pneumonia
 Hemorrhagic varicella
 Maintain strict isolation, until vesicles have
dried
NURSING MANAGEMENT
 Administer skin care; bath and change clothes
and linen daily; apply calamine lotion; keep
fingernails short and clean
 Keep child cool (may decrease the number of
lesions)
 Teach child to apply pressure on the pruritic
area rather than scratching it
 Reason with the child regarding danger of scar
formation from scratching
DIPTHERIA
 Agent: Corynebacterium diptheriae
  Source: discharges from mucous membranes
of nose and nasopharynx, skin and other
lesions of infected person
 Transmission: direct contact with infected
person, carrier, or contaminated articles
 Incubation period: usually 2-5 days, possibly
longer
 Period of communicability: variable, until
virulent bacilli are no longer present (3
negative cultures);usually 2 wks but as long as 4
week
CLINICAL MANIFESTATIONS
 NASAL: resembles common colds;
serosaguineous mucopurulent nasal discharge
 TONSILLAR/PHARYNGEAL: malaise, anorexia;
sore throat; low-grade fever,; in severe cases
septic shock
 LARYNGEAL: Fever, hoarseness, cough,
potential airway obstruction, dyspnea,
retractions, cyanosis
THERAPEUTIC MANAGEMENT
 Antitoxin (IV); preceded by skin or conjunctival
test to rule out sensitivity to horse serum
 Antibiotics (penicillin or erythromycin)
 Complete bed rest
 Tracheostomy for airway obstruction
Complications: myocarditis (2nd week), neuritis
NURSING MANAGEMENT
 Maintain strict isolation
 Bed rest
 Use suctioning as needed
 Observe respirations for signs of obstruction
 Administered humidified oxygen as needed
MEASLES (RUBEOLA)
Agent: virus
Source: respiratory tract secretions, blood, and urine
of infected person
Transmission: usually by direct contact with droplets
of infected person
Incubation period: 10-20 days
Period of ommunicability:; from 4 days before to 5
days after rash appears, but mainly during
prodromal stage
CLINICAL MANIFESTATIONS
 PRODROMAL STAGE: fever and malaise,
followed in 24 hour by coryza, cough,
conjunctivitis, Koplik spots ( small, irregular red
spots with a minute, bluish white center first
seen on buccal mucosa opposite molars 2 days
before rash)
 RASH: appears 3-4 days after onset of
prodromal stage; begins as erythematous
maculopapular eruption on face and gradually
spreads downward; after 3-4 days assumes
brownish appearance
THERAPEUTIC MANAGEMENT
 Vitamin A supplementation
 Bedrest during febrile period
 Antibiotics to prevent secondary bacterial
infection
 Complications: otitis media, pneumonia,
bronchiolitis, obstructive laryngitis, encephalitis
NURSING MANAGEMENT
 Isolate child until 5th day of rash
 Maintain bed rest
 FEVER: instruct parents to administer
antipyretics
 Agent: paramyxovirus
 Source: Saliva of infected persons
 Transmission: direct contact with or droplet
spread from infected person
 Incubation period: 14-21 days
 Period of communicability: before and after
swelling begins
 EYE CARE: dim light if photophobia is present;
clean eyelids with warm saline solution to
remove secretions
 CORYZA/COUGH: use cool-mist vaporizer;
protect skin around nares with layer of
petrolatum; encourage fluids and soft, bland
foods
 SKIN CARE: keep skin clean, use tepid bath as
necessary
MUMPS
 Agent: paramyxovirus
 Source: Saliva of infected persons
 Transmission: direct contact with or droplet
spread from infected person
 Incubation period: 14-21 days
 Period of communicability: before and after
swelling begins
 CLINICAL MANIFESTATIONS
PRODROMAL: fever, headache, malaise and anorexia for
24 hr, followed by “earache” that is aggravated by
chewing
PAROTITIS: by 3rd day, parotid gland enlarges and
reaches maximum size in 1-3 days, accompanied by
pain and tenderness
THERAPEUTIC MANAGEMENT
 Analgesics for pain and antipyretics for fever
 IV therapy for child who refuses to drink or
vomits
 Complications: sensoneural deafness,
postinfection encephalitis, myocarditis,
arthritis, hepatitis, meningitis, sterility in men
NURSING MANAGEMENT
 Isolate child during period of communicability
 Maintain bed rest
 Give analgesics for pain
 Encourage fluids and soft, bland foods; avoid
foods requiring chewing
 Apply hot or cold compresses to the neck
 To relieve orchitis, provide warmth and local
support with tight-fitting
PERTUSSIS (WHOOPING COUGH)
Agent: Bordetella pertussis
Source:discharge from respiratory tract of infected person
Transmission: direct contact or droplet spread from
infected person; indirect contact with freshly
contaminated articles
Incubation period: 6-20 days, usually 7-10 days
Period of communicability: greatest during
catarrhal stage before onset of paroxysm
CLINICAL MANIFESTATIONS
 CATARRHAL STAGE: begins with symptoms of
upper respiratory tract infection, such as
coryza, sneezing, lacrimation, cough and low-
grade fever; continue for 1-2 weeks, when dry
hacking cough become more severe
 PAROXYSMAL STAGE: cough most often occurs
at night and consists of short, rapid coughs
followed by sudden inspiration associated with
high pitched crowing sound or “whoop”;cheeks
becomes flushed or cyanotic, eyes bulge, and
tongue protrudes, last for 4-6 weeks
THERAPAETIC MANAGEMENT
 Antimicrobial therapy (erythromycin)
 Bed rest
 Increase oxygen intake and humidity
 Adequate fluids
 Intubation possibly
 Complications: pneumonia, atelectasis, otitis
media, seizures, hemorrhage (epistaxis), weight
loss and dehydration, hernia, prolapsed rectum
NURSING MANAGEMENT
 Isolate the child during catarrhal stage
 maintain bed rest
 encourage fluids
 provide high humidity, suction gently but
often to avoid choking on secretions
 observe for signs of airway obstruction
POLIOMYELITIS
Agent: Enterovirus
Source: feces and oropharyngeal secretions of
infected persons
Transmission: direct contact with apparent or
inapparent active infection; spread via fecal-oral
and pharyngeal-oropharyngeal routes
Incubation period: 7-14 days, with range of 5-35 days
Period of Communicability: virus persist about 1
week in throat and about 4-6 weeks in feces
Clinical Manifestations
-ABORTIVE OR INAPPARENT- fever, uneasiness, sore
throat, headache, anorexia, vomiting, abdominal
pain; last a few hours to a few days
-NONPARALYTIC- more severe than abortive, with
pain and stiffness in neck, back, and legs
-PARALYTIC- initial course similar to nonparalytic
type, followed by recovery and then signs of
central nervous system paralysis
THERAPEUTIC MANAGEMENT
SUPPORTIVE TREATMENT: CBR during acute phase
 Assisted respiratory ventilation in case of
respiratory paralysis
 Physical therapy for muscles after acute stage
RUBELLA (GERMAN MEASLES)
 Agent: rubella virus
 Source: nasopharyngeal secretions of person
with apparent or inapparent infection; virus also
present in blood, stool and urine
  Incubation period: 14-21 days
 Period of communicability: 7 days before to
Clinical Manifestations
about 5 days after appearance of rash
PRODROMAL STAGE: abrupt high fever, increased
pulse, vomiting, headache, chills, malaise and
Complications: permanent paralysis, respiratory arrest, abdominal pain
hypertension, kidney stones due to prolonged
ENANTHEMA: tonsils enlarged, edematous,
immobility
reddened, and covered with patches of exudates;
in severe case, pharynx is edematous and beefy
CLINICAL MANIFESTATION red; during the first 1-2 days tongue is coated
and papillae become red and swollen(white
PRODROMAL STAGE: Absent in children, present in
strawberry tongue); 4th to 5th day white coat
adults and adolescents; consist of low grade
sloughs off, leaving prominent papilla (red
fever, headache, malaise, anorexia, mild
strawberry tongue); palate covered with lesions
conjunctivitis, coryza, sore throat, cough and
lymphadenopathy; last 1-5 days, subsides 1 day EXANTHEMA: rash appearing within 12 hours, red
after appearance of rash pinhead-sized punctuate lesions rapidly
becoming generalized but absent on face, which
RASH: first appears on face and rapidly spreads
becomes flushed with striking circumoral pallor,
downward to neck, arms, trunk, and legs; by end
rash more intense in folds of joints
of first day, body covered with discrete, pinkish
red maculopapular exanthema; disappears in THEREPAEUTIC MANAGEMET
same order it began and is usually gone by 3rd
Full course of penicillin
day
Antibiotic therapy for newly diagnosed carriers
THERAPEUTIC TREATMENT
No treatment necessary other than antipyretics for Bed rest
low-grade fever and analgesics for discomforts
Analgesics for sore throat
Complications: rare, greatest danger is teratogenic
Complications: otitis media, peritonsillar and
effect on fetus
retropharyngeal abscess, sinusitis,
Nursing management glomerulonephritis, carditis, polyarthritis
Reassure parents of benign nature of illness
NURSING INTERVENTION
Use comfort measures as necessary  Institute respiratory precautions until 24 hrs
after initiation of treatment
Isolate child from pregnant women
 Ensure compliance of antibiotic therapy
 Maintain bed rest
 Encourage fluids
SCARLET FEVER
Agent: Group A B-hemolytic streptococci
Source: from nasopharyngeal secretions of infected
persons and carriers
Transmissions: direct contact with infected person or
droplet spread; indirectly by contact with
contaminated articles or ingestion of
contaminated milk or other food
Period of communicability: approximately 10 days,
during first 2 weeks of carrier phase, although
may persist for months
Incubation period: 2-5 days, with range of 1-7 days