INTRODUCTION TO PEDIATRICS

AND PEDIATRIC NURSING

SIR SILILO
 INTRODUCTION
• This unit presents the foundational material that
you need in order to understand how nursing care
of the child differs from that of the adult.
• The unit provides information about introduction
to Paediatrics and Paediatric nursing.
• In this unit you will review definition of different
key terms that are used in Paediatrics and
Paediatric nursing.
 Cont
• The unit will take you through the historical
development of Paediatric Nursing, the National
health policies and the rights of the child.
• This unit also looks at the concepts of Paediatric
Nursing practice, principles of Paediatrics and
Paediatric Nursing.
• Finally, you will learn about the importance of
parental involvement in the care of children.
• Let us start by reviewing our unit objectives.
 Objectives
– Define different key terms that are used in
pediatrics and pediatric nursing
– Explain the historical development of pediatric
nursing.
– Outline the National health policies
– State the rights of the child.
– Describe the concepts of pediatric nursing practice
 Cont
– Discuss the principles of pediatrics and pediatric
nursing.
– Discuss the roles of a paediatric nurse
– Identify the settings in which a paediatric nurse
may practice.
– Explain the importance of parental involvement in
the care of children.
 DEFINITION OF KEY TERMS
• Paediatrics: This is the field of medicine
concerned with the health of infants, children,
and adolescents; their growth and
development; and their opportunity to
achieve full potential as adults.
• Paediatrician: is a medical practitioner who
specializes in the medical care of infants,
children, and adolescents.  
 cont
• Paediatric Nurse: This is a registered nurse
who, as a result of post basic education in
paediatric and child health nursing practice
possesses the knowledge and clinical skills
necessary to provide paediatric-nursing care.
 cont
• Paediatric and Child Health Specialist Nurse:
This is a registered nurse who, as a result of
postgraduate education and in-depth clinical
experience in paediatric and child health
nursing practice possesses the advanced
knowledge and clinical skills necessary to
provide specialist-nursing care.
 cont
• Paediatric Nursing: It is the art and science of giving
nursing care to children (birth through adolescent)
with emphasis on physical, mental, emotional and
psychosocial growth and development. 
• Child: This is any human being below the age of 18
years according to Zambian Constitution. It refers to
neonate, infant, child, or adolescent/young person
from birth to 18 years (Australian Confederation of
Paediatric and Child Health Nurses, 2006).
 Cont
• Children's Rights: are the human rights of
children with particular attention to the rights
of special protection and care afforded to
minors.
• Policy: a plan of action adopted or pursued by
an individual, government, party, or business.
 HISTORICAL DEVELOPMENT OF
PAEDIATRIC NURSING
• History of paediatrics and paediatric nursing can be
traced from the Colonial America.
• The Colonial American children were born into a world
with many hazards to their heath and survival.
• The physicians were few and the midwives were
untrained in childcare.
• The books that provided information on childcare and
feeding were scarce.
• If available, they could only be accessed by minority of
literate parents.
 Cont
• The Native American children were treated for
diseases according to tradition of each tribe
such as mixture of medicine, magic and religion.
• Epidemic diseases included smallpox, measles,
mumps, chickenpox, Influenza diphtheria, TB,
yellow fever, cholera, whooping cough and
dysentery.
• Dysentery surpassed all others as causes of
childhood death.
 cont
• Consequences of childhood illness, injury and
effects of child labor, poverty and neglect were
widely recognized during the industrial
revolution in the 19th Century.
• Therefore, the end of the 19th Century is
regarded as the ‘Dark’ Ages of Pediatrics.
• The 1st half of the 20th Century is regarded as
the ‘Dawn’ of Improved Healthcare For Children
(Cone, 1976).
 • The study of Paediatrics began
Study of
in the last half of 1800s under
Paediatrics
the influence of Prussian born
physician - Abraham Jacobi
(1830-1919) referred to as The
Father of Paediatrics.
• With other physicians, he
pioneered the scientific and
clinical investigation of
childhood diseases.
• One outstanding achievement
was the establishment of “milk
stations”.
 Cont
• In these stations, mothers brought sick children for
treatment and learnt the importance of pure milk and
its proper preparation.
• The crusade helped bring the dairy industry under
legal control.
• Infant mortality declined in 1900 through prevention
and health promotion measures because of improved
sanitation and pasteurization of milk.
• Before then, unsanitary milk supply was a chief source
of infantile diarrhea and bovine tuberculosis.
 Social Welfare of Children
• With the investigation findings of Dr. Jacobi, social welfare
concerns emerged.
• The concerns were more on those who were homeless.
Madam Lillian Wald (1867-1940) a social reformer
founded the Henry Street Settlement in New York City.
She is regarded as a founder of Community Nursing
(Hockenberry et’al, 2008).
• Her works had far-reaching effects on child health and
nursing. Nursing services, social work and organized
programs of social, cultural and educational activities were
being provided.
 Cont
• From her works, causes of diseases were
identified, emphasis on isolation and asepsis
occurred. 
• In the 1900s, children with contagious diseases
were isolated from adult patients. The parents
were prohibited from visiting because they
would transmit diseases to and from home.
Even toys and personal articles of clothing
were kept away from the child.
 Effects of Isolation and Asepsis
• Spits and Roberson in 1945 in a study of
orphanages in South America reveled that
Separation in early life led to long term ill
effects, particularly adversely affecting
emotional development.
• These were identified as effects of isolation
and maternal deprivation.
 Cont
• This brought a surge of interest in
psychological health of children and brought
in changes for hospitalized children, such as
rooming in, sibling visitation, child life (play)
programs such as pre-hospitalization
preparation, parent education and hospital
schooling.
 Improvement of children’s living
conditions
• In 1909, President Roosevelt called the 1st
White House conference on children.
• The conference addressed the deplorable
working condition of youngsters under care of
dependent children. In 1912, as a result of this
conference, the US Children Bureau was
established.
 Cont
• Studies of economics and social factors i.e.
infant mortality, maternal death and maternal
and infant care stimulated the creation of better
standards of care for mothers and children and
led to the 1st maternity and infants Act.
• The Act provided grants to states to develop a
division of maternal department and influenced
creation of the American Academy of Pediatrics
(AAP).
Evolution of Child Health Nursing in Africa

• From the African perspective, major activities

in the development and growth of Paediatrics
and Paediatric Nurse Specialty were noted in
Kenya, Malawi and South Africa.
• Children make up approximately half of the
total population of southern Afri
 cont
• The Child Nurse Practice Development Initiative at the
University of Cape Town in South Africa had a vision
to achieve the best possible outcomes for children by
finding local solutions with child nurse teams to shift
practice to match research-based evidence.
• Some of the goals to this vision was to establish a
hub of child nurse practice development, research
and training in the region; work with families, nurse
leaders and learners to improve care of children and
train child nurse specialists.
 Cont
• Some of the achievements of the initiative
were; in collaboration with the University of
Malawi launched the first Clinical Masters in
Child Nursing in Africa and establish
partnerships with; Red Cross War Memorial
Children's Hospital in South Africa; Gertrude's
Garden Children Hospital in Nairobi Kenya and
Kamuzu College of Nursing, University of
Malawi.
Evolution of Child Health Nursing in Zambia

• The history of child health in Zambia can be traced

from the establishment of the first children hospital
called Arthur Davison Children Hospital in Ndola
(Locally known as Yengwe) in 1966.
• It was meant for children up to the age of 14 years.
• Nurses and midwives were providing the nursing
services.
• The government passed a policy that teaching, central
and provincial hospitals should have paediatric wards
admitting children up to the age of 12 years.
 Cont
• In the early 1990s, the Zambian Government sent
some nurses to train in Child Health Nursing in
Britain to practice as Registered Sick Children Nurse
(RSCN) in Zambia. However, very few are registered
with the General Nursing Council to practice.  
• In order to reduce morbidity and mortality for
children up to 5 years, the MoH adopted the IMCI
tool. First IMCI training was conducted from 13 th May
1996 to 24th May 1996 in Lusaka. This stimulated
some nurses to become registered nurses
 Cont
• The interest in child health grew between
2009 and 2011 making some nurses going to
train in Kenya and South Africa as Paediatric
Nurses and Paediatric and Child Health
Specialist Nurses. By September 2012, there
were only 14 Paediatric Nurses and 1
Paediatric and Child Health Specialist Nurse on
the GNC Register.
 Cont
• The Government of the Republic of Zambia
through the General Nursing Council saw the
need to train Paediatric Nurses and Paediatric
and Child Health Specialist Nurses locally to
reduce costs of sending Nurses to train outside
the country.
• In December 2012, the first draft of Paediatric
Nurse Training Curriculum was developed in
Kabwe.
 Cont
• The curriculum was developed to prepare
Registered Nurses for Advanced Paediatric
Nurse Diploma.
 Landmarks in development of Paediatric
Nursing
• In 1771, New York hospital, one of the 1st
Teaching Hospitals in USA provided classroom
presentations designed for nurses. In 1851-The
Hospitals for sick children was founded in
London.
• In 1855 one of the earliest known Paediatric
Textbook “How to Nurse Sick Children” was
published and in the same year the Children’s
Hospital of Philadelphia, USA, was founded.
 Cont
• In 1880 – Children Hospital Training School in
San Francisco offered formal classes to
educate nurses in the care of ill children.
• During this period the role of the nurse was
that of a childcare taker.
 Cont
• Nurses were responsible for maintaining
nutrition, hygiene and hydration.
• They played a major role in controlling the
spread of communicable diseases by
observing sanitary measures.
 Cont
• In the 1970, health became a more comprehensive
concept than suggested by the traditional definition,
which indicated merely the absence of diseases.
• Nurses began to view children holistically that is in
relation to their biophysical, cognitive, affective and
social needs.
• The nursing process cleave was developed. Nurses
developed their roles as child advocates ensuring
the highest quality of health care for children.
 Cont

• In 1966, Arthur Davison Children Hospital in

Ndola was established. In 2012 Development
of the first draft for the Paediatric Nurse
Training Curriculum for Zambia and planed
commence training of first cohort in January
2014
 NATIONAL HEALTH POLICIES
• In the history of pediatric nursing, you noticed
that research led to the development of
paediatric nursing. Policies were developed to
uplift the welfare of children. The Government
of the Republic of Zambia through the
ministry of health, government agencies and
line ministries has formulated policies,
strategies, and guidelines regarding child’s
health.
 Cont
• The following are some of the National Health
Policies that promote the health of a child in
Zambia:
• The National Child Health Policy
• Reproductive Health Policy
• National HIV/AIDS Workplace Policy
• Nutritional Policy
 The National Child Health policy
• A review of the child health situation was
done to provide background for formulation
of a national child health policy and accelerate
efforts to improve child survival in May/June
2004.
• The well-being of children is critical for the
social economic development of Zambia.
 Cont
• The policy is aimed at coordination of the
implementation of Child Health activities.
• The policy is also aimed at addressing
promotive, preventive, curative and
rehabilitative aspects of Child Health.
 Cont
• The HCHP has the following parts: -
• Introduction
• Situation Analysis
• Vision
• Rationale
• Guiding principles
• Policy objective
• Implementation framework
 The Reproductive health policy
• The Reproductive Health approach offers
opportunities to improve not only the health
of childbearing women, but also of the next
generation, and to involve men in all aspects
of Reproductive Health. In addition,
Reproductive Health has multidimensional
aspects and hence collaboration with other
sectors, is vital.
 Cont
• The Reproductive Health also raises issues of
human rights, equity, and discrimination,
which must be addressed through
participatory and inclusive processes that
involve communities, families and individuals.
• The policy sets out to respond to the country's
prevailing reproductive health situation so as
to improve the standard of living and quality of
life of Zambians.
 cont
• The areas addressed in the reproductive health
policy are;
• Safe motherhood, which addresses service
delivery for improvement of the health of the
mother and the newborn. This means ensuring
affordable quality care for the mother and the
newborn as close to the family as possible.
• Family planning
• Maternal nutrition
 Cont
• Adolescent sexuality and reproductive health
• Sexually transmitted diseases including
HIV/AIDS
• Abortions
• Infertility
 RIGHTS OF A CHILD
• As you are aware Zambia is signatory to many
conversions. One of such is the conversion on
the rights of children.
 The United Nations Conversion on the
Rights of a Child
• According to the United Nations 1989 Convention
on the Rights of a Child, the rights of Children
include the following:
• The right to life.
• The right from birth to a name,
• The right to know and be cared for by his or her
parents.
• The right to association with both parents,
• The right to human identity
 Cont
• The right to basic needs for food,
• The right to universal state-paid education,
• The right to health care and criminal laws
appropriate for the age and development of
the child,
• The right to equal protection of the child's
civil rights,
 Cont
• The right to freedom from discrimination on
the basis of the child's race, gender,
sexual orientation, gender identity,
national origin, religion, disability, colour,
ethnicity, or other characteristics.
 Types of Rights
• According to Child Rights Information Network
the rights of a child may be categorized as
follows:
• Provision rights: Children have the right to an
adequate standard of living, health care,
education and services, and to play and
recreation. These include a balanced diet, a
warm bed to sleep in, and access to schooling.
 Cont
• Protection rights: Children have the right to
protection from abuse, neglect, exploitation
and discrimination. This includes the right to
safe places for children to play; constructive
child rearing behavior, and acknowledgment
of the evolving capacities of children.
 Cont
• Participation rights: Children have the right to
participate in communities and have
programs and services for themselves. This
includes children's involvement in libraries and
community programs, youth voice activities,
and involving children as decision-makers. In
a similar fashion, the
Child Rights Information Network, or CRIN for
short, categorizes rights into two groups:
 Cont
• Economic, social and cultural rights, related
to the conditions necessary to meet basic
human needs such as food, shelter, education,
health care, and gainful employment. Included
are rights to education, adequate housing,
food, water, the highest attainable standard of
health, the right to work and rights at work, as
well as the cultural rights of minorities and
indigenous peoples.
 Cont
• Environmental, cultural and developmental
rights, which are sometimes called "
third generation rights," and including the
right to live in safe and healthy environments
and that groups of people have the right to
cultural, political, and economic development.
 CONCEPTS IN PAEDIATRIC NURSING
PRACTICE
• First and foremost; you have to understand
the word concept because this will help you
understand the importance of concepts of
paediatric nursing practice.
 cont
• Concept ; these are mental representations
that allow us to draw appropriate inferences
about the type of entities we encounter in our
everyday lives.
• This is to say that it is literally, a symbol or
group of symbols together made from the
physical material of the brain.
 cont
• The use of concepts in paediatric nursing is
necessary for decision making and they also
contribute to the well being of the child.
Please check with me the concepts which are
used in paediatric nursing which are as
follows:
 Cont
• VISITING HOURS
• This concept is an important entity in paediatric
nursing therefore it should be implemented in
the nursing care of a child.
• As a paediatric nurse you need to remember
that the extent of visiting by the parents to the
sick child should be determined by their need
to see the child and more important by the
child’s need for the parents.
 Cont
• ROOMING-IN
• Parents/care takers should never be required
to stay at the bed side but neither should they
be prohibited from doing this if they desire.
• Hospitals should provide a comfortable lounge
or waiting room where mothers can relax.
Mothers of seriously ill children may be
encouraged to stay in the ward if need be.
 Cont
• PLAY AND SCHOOL IN THE HOSPITAL
• Playing is a child’s way of living or as his activities of daily
living.
• Play satisfies the child’s physical, emotional, social and mental
development. Play also alleviates stress.
• Research has proved that play and school activities can help a
child to comprehend intrusive and surgical procedure and can
also express his/her fantasies, fear, and anxieties.
• Hospitals should have teachers, classrooms and play grounds
for children who have recovered from acute illness.
 Cont
• CHILD HEALTH AND THE NURSING TEAM
• The nurse, who is a member of the nursing team,
works closely with one or more professional
nurses.
• The nurse does not substitute the parents of the
child but acts as a father or mother’s friend.
• The nurse plans comprehensive care to the child
and works hand in hand with other members of
the health team.
 PRINCIPLES OF PEDIATRICS AND PEDIATRIC
NURSING
• This section will take you through the principles
of paediatric nursing therefore;
• it is important that you understand these
principles because they are essential
characteristics of a paediatric nurse and they
also give a good reflection of the designed
purpose of paediatric nursing programme.
• The following are the principles of paediatric
nursing:
 Cont
• 1. Nursing a child should be family centered.
The parents should be involved in the care of
the child and a child should be nursed as a
whole.
• Parents speak for their children and should
therefore be included in the assessment and
plan of care.
 Cont
• 2. A nurse taking care of a child should be very
observant and knowledgeable to detect acute
changes and initiate prompt action. E.g. a child
should not only fail to sleep unless there is a
problem physically.
• The nurse should be able to interpret the
needs and be able to use initiative in
implementing interventions.
 Cont
• 3. The nurse should be close to the child but
never to be possessive because the nurse is
only standing-in for the parent/guardian.
 Cont
• 4. Breastfeeding children should be with their
mothers at all times to maintain the bond
between them and facilitate feeding on
demand.
• For older children, visiting parents should be
allowed to lift and care for their children
(unless contraindicated) to maintain family
bond.
 Cont
• 5. Young children should be nursed in railed
beds/cot beds to prevent injury.
 ROLES OF A PAEDIATRIC NURSE
• . It is important to note that the roles of a
paediatric nurse are constantly changing.
• These changes are a result of expanding
medical and nursing practice, emerging
challenges in different aspects of child care,
consumer demands and technological
advancements.
 Cont
• The roles of a paediatric nurse may vary from
one institution to others, but basic
responsibilities remain the same.
• The following are the roles of a paediatric
nurse:
 Cont
• Primary care giver
• Coordinator and collaborator
• Advocate
• Health educator
• Consultant
• Counselor
 Cont
• Case manager
• Recreationalist
• Social worker
• Researcher
 Cont
• Primary care giver: A paediatric nurse should
provide preventive, promotive, curative and
rehabilitative care in all levels of health services.
• In hospital, care of sick children includes comfort,
feeding, bathing, safety and many more.
• At community set up, basic responsibilities include
health assessment, immunization, primary health
care and referral and so on.
 Cont
• Coordinator and collaborator: The paediatric nurse
plays an extremely important role with the
coordination of health care team members.
• The nurse maintains good interpersonal
communication with the child, family and health
members.
• The nurse coordinates nursing care with other
services for meeting the needs of the child for
example; physician, social worker, surgeon,
physiotherapist, dietician e.t.c.
 Cont
• Nurse Advocate: The paediatric nurse acts as an
advocate to safeguard the child’s right, to assist
and to provide best care from the health care
team.
• The nurse acts as a representative for the child,
family and other health care providers for example;
it can range from consulting dietary department for
special foods to arrange team meeting to discuss
plan of care with other health team members.
 Cont
• Health educator: The nurse’s goal of health
teaching is to provide information to the
child’s parents and significant other about
prevention of illness, promotion or health
maintenance.
• The nurse teacher should have four (4)
characteristics abbreviated as 4 Cs which
stands for the following:
 Cont
• C --------------------- Confidence
• C --------------------- Competence
• C --------------------- Communication
• C --------------------- Caring and empathy
 Cont
• Nurse Consultant: The paediatric nurse can
act as consultant to guide parents for
maintenance and promotion of health for
example; guiding parents about breast feeding
practices, accident prevention
 Cont
• Nurse Counselor: The paediatric nurse can
provide guidance to parents in health hazards
of children and help them for own decision
making in different situations.
• Case manager: The paediatric nurse should
organize care, monitor and evaluate patient
treatment for successful outcome.
• She/he acts as a manager of paediatric care
units in the hospital, clinics and community.
 Cont
• Recreationalist: The paediatric nurse plays
supportive role for the child to provide play
facilities for recreation and diversion.
• It helps to decrease crisis imposed by illness or
hospitalization.
 cont
• Social worker: The paediatric nurse can participate
in social services or refer child and family to child
welfare agencies for necessary support.
• Nurse Researcher: Research is an integral part of
professional nursing. Paediatric nurse should
participate or perform research activities.
• It helps to provide basis for changes in nursing
practice, improvement in the child health care and
evaluate the care.
 IMPORTANCE OF PARENTAL
INVOLVEMENT IN THE CARE OF CHILDREN
• Literature tells us that since the days of
Florence Nightingale, patients in hospitals
around the world depend largely on the care
provided by the Nurses.
• This shows that Nurses, more than any other
professional area are involved in direct contact
with children and their parents.
 Cont
• Kristensson-Hallstrom &Elander(1997) report on
the fact that during the twentieth century, there
has been a transition where parental involvement
in hospitalization has changed.
• In the past, parents had been expected to leave
the hospital and allow the staff to take care of the
child and ‘visiting hours were either non-existent’
or few (Gofman, Buchman, & Schade, 1957 as
cited in Kristensson-Hallstrom &Elander, 1997).
 Cont
• History also tells us that this transition did not
happen alone, there are many factors which
have forced parents to take a more active role
in their child’s illness management which
include the following:
 Cont
• Children want their parents more than
anything else.
• Children are not expected to be used to being
away from home amongst unfamiliar
surroundings.
 Cont
• Today, more than ever, there are fears about
strangers as well. Fears of increasing terrorism
throughout the world, and other major events
have had a deep influence on families’ sense
of well being’.
• Children are taught that unfamiliar adults are
not to be trusted and only parents or known
guardians should make decisions on behalf of
the child’s well being.
 Cont
• Parental involvement is important in the care
of children because of the following reasons:
• It helps to reduce the anxiety in both parents and
children. The presence of the father or the mother
of a hospitalized child make them comfortable, it
gives them a kind of psychological support and
emotional balance.
• For example when a surgery is involved, it is often
the case that the child is very nervous.
• Anything to reduce the anxiety should be introduced
and this is possible when parents are around.
 Cont
• It creates room for parents to participate in decisions
about their child’s care
• Parental participation also improves the quality of the
care for the child.
• The child is too young to rely on or to be asked about
their medical history. It is important for parents to be
with their children when decision making is required or
any other specific information is needed.
• Therefore, the parent or guardian is the best person to
make decisions while the child is in a hospital setting.
 Conclusion
• Nurses need to build a trustworthy relationship with
parents based on good communication skills.
• By allowing and encouraging parental involvement,
while addressing problems when they occur, it can
encourage the best outcomes for the paediatric patient.
• It is important to acknowledge that when children are
admitted to the hospital, they are not able to make
their own legal decisions because they are considered
minors and because they need psychosocial support
from their parents.