CHILD HEALTH – INTEG, MS • Because it is much easier to treat during
infancy, DDH screening is a standard
DEVELOPMENTAL DYSPLASIA OF THE HIP
• Developmental dysplasia of the hip
(DDH) is a range of various hip
abnormalities that may be present at birth
or develop during the first few years of life.
• There are many risk factors, including
breech birth, large infant size, and family
history. Although all cases cannot be
prevented, several interventions have been
shown to help reduce the risk of DDH
development.
• Key measures include:
o Proper swaddling technique - infants
should be swaddled with their hips bent
up (flexion) and out (abduction),
allowing room for hip movement
o Choosing infant carriers or car
seats with wide bases - infant seats
should allow for proper hip positioning in
an abducted manner
o Avoiding any positioning device, seat, or
carrier that causes hip extension with
the knees straight and together
• Narrow infant carriers prevent proper hip
abduction, putting a strain on the hip
ligaments and possibly leading to DDH.
• Double/triple diapering is no longer
recommended as a preventive measure for
DDH. This practice can cause extension of
the hip, leading to abnormal development.
• Infant swings, bouncers, wraps, and other
similar items can cause the legs to be
positioned straight and together, which can
increase the risk for DDH.
assessment for newborns and
infants. Manifestations in infants age <2-3
months include:
1. The presence of extra inguinal or
thigh folds
2. Laxity of the hip joint on the affected
side. Hip laxity/instability is tested
through the Barlow and
Ortolani maneuvers. However, these
tests must only be performed by an
experienced health care provider to
avoid further hip injury. If DDH is not
treated, these signs disappear after age
2-3 months due to the development of
muscle contractures.
• Limited hip abduction occurs as
contractures develop, particularly once the
infant is age >3 months.
• In children with one-sided DDH,
the affected leg may be shorter than the
opposite leg. However, this is also
apparent after age 3 months.
• If DDH is not corrected in infancy, additional
manifestations develop when the child
learns to walk. These signs include a
notable limp, walking on the toes, and a
positive Trendelenburg sign (pelvis
tilts down on unaffected side when
standing on the affected leg). In the case of
bilateral DDH, the child may also develop a
waddling gait and severe lordosis.
• Developmental dysplasia of the hip
(DDH) is instability or dislocation of the hip
joint that may be present at birth or develop
during the first few years of
life. Nonsurgical treatment methods, such
as a harness or cast, are most
successful when initiated during the first 6
months of life. After this time, surgery is
frequently required.
• A Pavlik harness, the most common tool
used in treating early DDH, maintains the
infant's hips in a slightly flexed and
abducted position, allowing for proper hip
development.
• Pavlik harnesses are typically worn for
about 3-5 months or until the hip joint is
stable. The straps are adjusted periodically
by the health care provider to account for
infant growth.
• Instructions on care for the infant wearing a
Pavlik harness are as follows:
o Regularly assess skin for redness or
breakdown under the straps
o Dress the child in a shirt and knee
socks under the harness to protect the
skin
o Avoid lotions and powders to prevent
irritation and excess moisture
o Lightly massage the skin under the
straps every day to promote circulation
o Only apply 1 diaper at a time as
wearing ≥2 diapers (previous treatment
practice) increases risk of incorrect hip
placement
o Apply diapers underneath the
straps to keep harness clean and dry
• The Pavlik harness is usually worn all the
time, particularly during the first few weeks
of treatment. Some providers may allow
the harness to be removed for a short bath
once a day, but it should be left in place for
all other care activities, including diaper
changes.
• The Pavlik harness is the most common
tool used to treat early DDH. It maintains
the infant's hips in a slightly flexed and
abducted position (ie, legs bent and spread
apart), allowing for proper hip development
• Pavlik harnesses are typically worn for 3-5
months or until the hip joint is stable.
• The straps are assessed every 1-2 weeks
by the health care provider (HCP) and
adjusted as necessary to account for infant
growth. However, parents should not
alter the strap placements at home as
incorrect positioning can lead to damage to
the nerves or vascular supply of the hip
• Care of the infant wearing a Pavlik harness
includes the following:
• Assess skin 2-3 times daily for redness or
breakdown under the straps
o Dress the child in a shirt and knee
socks under the harness to protect the
skin
o Apply diapers underneath the
straps to keep the harness clean and
dry
o Leave the harness on at all times, unless
otherwise indicated by the HCP
ATOPIC DERMATITIS
• Atopic dermatitis, also known as eczema, is
a chronic skin disorder characterized
by pruritus, erythema, and dry skin. In
infants, red, crusted, scaly lesions may
also be present. It is commonly first
diagnosed before age 1 year.
• The exact cause is unknown, although it is
associated with an impaired skin barrier
that allows penetration of allergens, leading
to an immune response.
• The primary goals of management are
to alleviate pruritus and keep the skin
hydrated to prevent scratching.
• Scratching leads to the formation of new
lesions and predisposes to secondary
infections.
• Important measures to prevent scratching
include cutting and filing nails short, placing
gloves or cotton stockings over the hands,
not wearing rough fabrics or woolen
clothing, and applying moisturizer. These
measures would have an immediate effect
in preventing scratching.
• Atopic dermatitis (AD), also known as
eczema, is a chronic skin
disorder characterized by pruritus,
erythema, and dry skin. The exact cause
of AD is unknown, although it may be
associated with an impaired skin barrier
and resulting immune response to invading
allergens.
• The primary goals of management are
to alleviate pruritus and keep skin
hydrated to reduce scratching. Scratching
 leads to formation of new lesions and
potential secondary infections.
o Parents should be instructed to
give tepid baths using gentle soap; hot
water and long bubble baths dry skin
and should be avoided
o Skin should be gently patted dry after
bathing, followed by immediate
application of an emollient (eg,
Eucerin, Cetaphil) to seal in moisture
o Nails should be trimmed short and
kept filed to reduce scratches
o Clothing should be soft (eg, cotton)
and climate-appropriate to reduce
perspiration, which can intensify
pruritus. Long sleeves should be worn
at night.
o Avoid trigger factors such as heat and
low humidity
OSTEOGENESIS IMPERFECTA
• Osteogenesis imperfecta (OI) (brittle bone
disease) is a rare genetic condition
resulting in impaired synthesis
of collagen by osteoblasts.
• Collagen allows bone to be somewhat
flexible while still maintaining
strength. Impaired collagen causes bones
to be frail and easily fractured.
• Clinical manifestations can range from mild
defects to lethal disease in utero. OI is
usually transmitted by autosomal dominant
inheritance.
• The nurse's priority for a client with OI is
careful handling to minimize additional
fractures. Care of the infant with OI
includes:
o Checking blood pressure manually to
avoid cuff over-tightening, which may
occur with automatic blood pressure
cuffs
o Lifting the infant by slipping a hand
under the broadest areas of the body
(eg, back, buttocks) so the pressure is
distributed
o Repositioning the infant frequently
using supportive devices and gel
padding to avoid molding of the soft
bones of the skull
• Lifting by the ankles or under the arms puts
too much pressure on the delicate bones
(eg, legs, ribcage).
COLD INJURY
• The clinical indications of a cold
injury include redness and swelling of the
skin (chilblains or pernio) and blanched skin
with hardness of the affected area
(frostbite).
• For any cold injury, it is important to re-
warm the area as soon as possible to
restore blood flow and reduce the risk of
permanent tissue damage.
• The recommendation for re-warming is
immersion of the affected area in warm
water (104 F [40 C]) for about 30
minutes or until the area turns pink in
cases of frostbite. The face and ears can
be re-warmed with the application of warm
facecloths
• Once re-warming has been effective, the
child should be seen by an HCP as soon as
possible
• Massaging a body part that has sustained
a cold injury is contraindicated due to the
risk of tissue injury.
COMPARTMENT SYNDROME
• Parents of children with casts are taught to
check for emergency signs of circulatory
impairment, including changes in sensation
and motor function, which could indicate
early signs of compartment
syndrome due to swelling within the
confined space of the cast. However, some
swelling is expected, so this symptom alone
is not indicative of compartment syndrome.
• The 6 Ps of compartment syndrome
include:
1. Pain: Increasing despite elevation,
analgesics, and ice. Pain will also
increase with passive
stretching/movement. Increasing pain is
an early sign and indicates muscle
ischemia
2. Pressure: Affected extremity or digits
are firm and tense; skin is tight and
appears shiny.
3. Paresthesia: Tingling, numbness, or
burning sensation, which is also an early
sign and indicates nerve ischemia
4. Pallor: Skin appears pale; capillary refill
is >3 seconds. These indicate poor
perfusion.
5. Pulselessness: Pulse distal to injury or
compartment is impalpable. Absent
pulses are a late sign.
6. Paralysis: Loss of function or inability to
move extremity or digits. Muscle
weakness occurs before paralysis which
is also a late sign and indicates dead
muscle tissue.
• An itching sensation under the cast is
expected, clients and parents are taught to
avoid inserting anything into the cast to
scratch the skin. Instead, they should use
a hair dryer on the cold setting.
• Arm elevation is indicated for the first 48
hours after cast placement to reduce
edema. However, if compartment
syndrome develops, the arm should be kept
at torso level (not high or low).
BURN
• Proper emergency care immediately
following a burn can prevent infection,
hypothermia, and further tissue damage.
• Once the source of the burn is contained,
the nurse teaches the client home care that
can be given prior to arrival to the
emergency department.
• Client teaching includes:
o Soak area briefly in cool water to stop
the burning process
o Remove any clothing or jewelry
around the burn to avoid constriction as
edema develops. This also allows for
quick assessment of the burn by
clinicians. Only a health care provider
may remove clothing that is stuck to the
burned area
o Cover with a clean, dry cloth to
prevent contamination, further trauma,
and hypothermia
• Medications should not be applied to a burn
until prescribed by a health care provider as
they may interfere with assessment of the
burned area.
• Placing ice on a burn or wrapping the area
in ice can increase tissue damage and may
cause hypothermia with large burns. No
ice, ointments, creams, or butter should
be placed on the open skin.
JUVENILE IDIOPATHIC ARTHRITIS
• Children with JIA are at high risk for
becoming deconditioned due to decreased
muscle strength and endurance and overall
capacity for exercise. They tend to tire
 quickly even when the disease is in
remission.
• Both aerobic and anaerobic exercise can
help minimize this risk, and resistance
training can increase muscle strength and
endurance. Exercise may also have a
positive effect on low bone density, a
secondary condition often associated with
JIA.
• In general, low-impact, weight-bearing,
and non-weight-bearing exercises that
involve range of motion and stretching to
preserve joint mobility and strengthen
muscles are best. High-impact activities
and those that cause overtiring and joint
pain should be avoided.
• Swimming is often considered the ideal
activity for children with JIA as it allows for
exercising a large number of joints with
minimal gravitational pull. Other
recommended activities include riding a
stationary bike, throwing or kicking a ball,
low-impact aerobic dancing, walking, and
yoga.
TINEA CAPITIS
• Tinea capitis (ringworm of the scalp) is a
contagious fungal infection that lives on
the surface of the scalp, resulting in scaly,
pruritic, erythematous, circular patches with
hair loss. The infection is transmitted via
direct contact with infected persons, pets,
or objects (eg, hairbrushes, bedding,
towels, hats).
• Treatment may include 1% selenium
sulfide shampoo applied several times
each week in combination with
an antifungal medication
(eg, griseofulvin oral suspension) that the
client must take for several weeks to
months.
• Keratin-producing cells absorb griseofulvin,
causing resistance to the fungus; because
the fungus requires keratin (protein in hair
and skin cells) to live and grow, it is not
able to reproduce.
• To ensure that infected keratin is shed
completely, treatment
with griseofulvin should not be discontin
ued early, even if symptoms (eg, itching,
scaling) decrease
• The client will best absorb griseofulvin (ie,
suspension, microsized tablets) when taken
after/with high-fat foods (eg, ice cream).
• (Photosensitivity is a common side effect of
griseofulvin treatment, and the client should
avoid prolonged exposure to the sun and
use sunscreen.
• The client should apply medicated
shampoo (eg, 1% selenium sulfide) to the
scalp a few times each week.
DENTAL AVULSION
• Dental avulsion (ie, tooth separated from
the mouth) of a permanent tooth is a
dental emergency.
• The priority nursing action is to rinse
and reinsert the tooth into the gingival
socket and hold it in place (eg, with a
finger) until stabilized by a dentist.
Reimplantation within 15 minutes of
injury re-establishes blood supply,
increasing the probability of tooth survival.
• If the tooth cannot be reinserted it should
be kept moist by submerging it in
commercially prepared solution (eg, Hanks
Balanced Salt Solution), cold milk, sterile
saline, or as a last resort—due to
bacteria—saliva (eg, holding it under the
tongue).
• Scrubbing the root would damage it. The
tooth should be gently rinsed with sterile
saline or clean, running water.
• Placing the tooth in water (a hypotonic
solution) would lyse the cells, killing the
tooth.
• Wrapping the tooth in sterile gauze would
dry it out. In addition, the nurse should
arrange for immediate transfer to a dentist
rather than advise the parent to schedule
an appointment that might not be available
for days.

ACNE VULGARIS
• Acne vulgaris is a skin disorder
characterized by obstructed sebaceous
glands, which form comedones (ie,
blackheads, whiteheads).
• Bacteria consume and metabolize the
obstructed sebum, and the metabolic
products cause inflammation, pustules,
papules, and nodules.
• Acne usually develops during puberty, and
multiple factors influence its development
(eg, overgrowth of normal bacteria,
heredity, stress, hormones).
• Treatment includes topical and oral
medications such as tretinoin (Retin-A),
benzoyl peroxide, isotretinoin (Accutane),
and oral contraceptives.
• Antibacterial soaps are harsh and
ineffective, increase the pH of the skin,
and can dry the skin. The client should
instead gently wash the face with a mild
facial cleanser.
• Additional self-care measures include:
o Using noncomedogenic skin care
products (ie, products that do not clog
pores) to avoid creating new
lesions Maintaining a healthy
lifestyle (eg, moderate exercise,
balanced diet, adequate sleep) to
reduce stress and promote healing
o Refraining from
squeezing, picking, and vigorously
scrubbing lesions to prevent
additional inflammation and worsening
the acne
IMPETIGO
• Impetigo is a highly contagious bacterial
skin infection, most commonly occurring in
children during hot, humid
weather. Impetigo is characterized by itchy,
burning, red pustules that rupture to
form honey-colored crusts. When treated
with antibiotic ointment and/or oral
antibiotics, lesions are no longer contagious
after 24-48 hours and typically heal within a
week. Without antibiotics, impetigo typically
resolves within 2-3 weeks but remains
highly contagious until lesions heal.
• To care for and decrease transmission of
impetigo, interventions include:
o Performing handwashing before and
after touching the infected area
o Isolating the infected person's clothing
and linens and washing them in hot
water
o Keeping the infected person's
fingernails short and clean to prevent
bacteria from collecting under them and
to deter scratching
o Avoiding close contact with
others for 24-48 hours after initiation of
antibiotic therapy
o Keeping the infected area covered with
gauze when in contact with others (eg,
while at school)
• Impetigo lesions should be soaked with
warm water, saline, or Burow's solution (a
skin-soothing astringent) and gently
cleansed with mild antibacterial
soap before applying antibiotic
ointment. This helps remove infected
crusts and reduce irritation. Alcohol is
irritative and should be avoided.
DUCHENNE MUSCULAR DYSTROPHY
• Duchenne muscular dystrophy is an X-
linked recessive (carried by females and
affecting males) disorder that causes the
progressive replacement of dystrophin, a
protein needed for muscle stabilization,
with connective tissue.
• The proximal lower extremities and pelvis
are affected first. In response to proximal
muscle weakness, the calf muscles
hypertrophy (pseudohypertrophy) initially
and are later replaced by fat and connective
tissue.
• Children with Duchenne muscular
dystrophy raise themselves to a standing
position using the classic Gower
sign/maneuver (placing hands on the
thighs to push up to stand) and walk on
tiptoes. Parents may also report frequent
tripping and falling
• There is no effective cure. Most children
are wheelchair bound by adolescence
and die by age 20–30 from respiratory
failure. It is important to avoid floor clutter
(eg, throw rugs) and prevent falls/injury

SCOLIOSIS
• Lateral curvature to the spine of this 10-
year-old girl may indicate scoliosis, which is
one of the most commonly diagnosed
spinal deformities and is characterized
by lateral curvature of the spine
and spinal rotation.
• Although scoliosis may result from
congenital or pathologic conditions, it is
most often determined to be idiopathic (of
unknown cause). It is commonly first
noticed during periods of rapid growth,
particularly during early adolescence in
girls.
• Screenings may occur in schools or at
well-child office visits for girls age 10-12
and for boys age 13-14. Early detection
and prompt treatment may reduce the need
for surgical intervention.