Modern concept of child care

INTRODUCTION
• The term pediatric is derived from the Greek
words- Pedia –child and iatrike- treatment
and ics- branch of science
• Pediatric means the science of child care and
scientific treatment of childhood disease.
• Pediatric is synonymous with child health
• The term pediatric is derived from the Greek
words- 4 Pedia iatrike ics child treatment
branch of science Pediatric means the
science of child care and scientific treatment
of childhood disease. Pediatric is
synonymous with child health
 DEFINITION
• “Pediatric can be defined as the branch of
medical science that deals with the care of
childhood from conception to adolescent in
health and illness. It concern with
prevention, promotion, curative and
rehabilitative care of children.”
• Pediatrics is concerned with the health of
infants, children and adolescents, their
growth and development, and their
opportunity to achieve full potential as
adults. (Richard E.Behrman in Nelson's
Textbook of Pediatrics)
 Importance of PEDIATRICS
• Major consumers of health care.
• 35 – 40 of total population are children
below the age of 15.
• More vulnerable to various health problems.
• Majority of Childs morbidity & mortality
preventable.
• Needs special care to survive & thrive.
 Pediatric Nursing
• Pediatric nursing is the specialized area of
the nursing practice concerning the care of
children during wellness and illness, which
includes preventive, promotive, curative and
rehabilitative care of children.
 Historical backgroundof childhealth
• Abraham Jacob is known as FATHER OF
PEDIATRICS because of his contribution to
pediatrics
• The first citation of quality of breast milk and
child hygiene was 225 BC. in Indian SUSURTA
SAMHITA
• Hippocrates a greek philosopher also known as
father of modern mediecine has made significant
contribution to diseases found in children
• The first indian pediatrician were kashyapa and
Jevaka .they worked on children diseases and child care.
• The first manuscript on management of children
diseases was written by kashyapa and Samhita
• Thereafter Susruta and Samhita wrote about ayurvedik
medicine that can be used for children. It was the first
written record of pediatrics anywhere in the world.
• Susruta was known as Indian Hippocrates.He wrote on
child’s rearing practices , infant feeding and diseases of
child hood.
• Charak was the physician of Peshawar. He wrote on care
and management of newborn in his Sansthan and
Ashtanga –hridaya
• Arab physician Rhazes wrote the first book on
the diseases of children.
• In 147book written on pediatrics named 2
ad.first
• BAGALLARDERS was printed in italian
• In 1545 Ad.thomas Phare wrote the first book
in english on children’s disease.
• In 1802 first pediatric hospital was opened in
paris .
• In USA children’s hospital of philadelphia was
opened.
•   Pediatrics as speciality came into being in
1860 when Dr.Abraham Jacob established
first child clinic in new yorkand started
giving special lectures on diseases of
children
• In 1888 AD. The first department of
pediatrics was established in hardward
medical school.
• At this time it was realized that diseases of
the children are different from diseases of
adult.
• In the 19 th century antenatal care and
pediatric care developed. Slowly people
started realizing about child’s needs.
• The Lady Chemsford All India League For
Maternal And Child Welfare was established
in 1920.Efforts were made by the league to
create public awareness about health
problems of children.
• In 1920 the first crèche was opened in India
to provide day care to children
 Introduction

• Children's are major consumers of health

care
• There are 472 children in India under 18
years
• It is nations responsibility to ensure
adequate health care and other facilities to
the children to help them grow up to
become robust citizen, physically fit
mentally alert and morally healthy.
 National health policy 1974
• Declaration
“Recognized that programmes for children should
find prominent place in the national plans for the
development of the human resources, so that the our
children grow up to become robust citizen,
physically fit, mentally alert and morally healthy,
endowed with the skills and motivations provided
by society. Equal opportunities for development to
all children during the period of growth should be our
aim , for this would serve our large purpose of
reducing inequality and bring social justice”
 Goal
• The need s of children and our duties
towards them have been expressed in the
constitution
• Give direction to the state policy on
educational needs of children
• Also party to the U N declaration of the child
• Judicious and available use of resources
 Policy and measures
• It shall be the policy of the State to provide
adequate services to children, both before
and after birth and through the period of
growth, to ensure their full physical,
mental and social development.
• Comprehensive health programme
• Nutrition services with the object of
removing deficiencies in the diet of children.
• Nutrition and nutrition education of
expectant and nursing mothers
• Free and compulsory education for all
children up to the age of 14
• Children who are not able to take formal
school education provided other forms of
education
• Physical education, cultural and scientific
activities shall be promoted in schools, community
centers
• Special assistance shall be provided to all children
belong to the weaker sections of the society and
socially handicapped
• Children shall be protected against neglect,
cruelty and exploitation
• To prevent child labor children under 14 years
• Special treatment, education, rehabilitation and
care of children who are physically handicapped,
emotionally disturbed or mentally retarded
• Priority for protection and relief in times of distress or
natural calamity
• Special programmes shall be formulated to spot,
encourage and assist gifted children
• Existing laws should be amended the interest of children
are given paramount consideration
• Organising services for children, efforts would be directed
to strengthen family ties so that full potentialities of
growth of children are realized within the normal family,
neighborhood and community environment
PRIORITY INPROGRAMME FORMULATION

 Preventive and promotive aspects of child health

 Nutrition for infants, pre-schoolers, nursing and
expectant mothers
 Maintenance, education and training of orphan
and destitute children
 Crèches and other facilities for the care of
children of working or ailing mothers
 Care, education, training and rehabilitation of
handicapped children
•  Constitution of National Children’s
Board
 A National Children’s Board shall be constituted for
continuous planning, review and coordination of all
the essential services. Similar Boards may also be
constituted at the State level
• Role of voluntary organizations
 Encouraging voluntary organizations engaged in the
field of child welfare will continue to have the
opportunity to develop, either on their own or with
State assistance, in the field of education, health,
recreation and social welfare services
• Legislative and Administrative action
 State will provide necessary legislative and
administrative support. Facilities for research and
training of personnel will be developed to meet the
needs of the expanding programmes and to improve
the effectiveness of the services People’s
Participation
 Encouraging voluntary organizations engaged in the
field of child welfare will continue to have the
opportunity to develop, either on their own or with
State assistance, in the field of education, health,
recreation and social welfare services
 National policy 2013
• Every child has universal child rights.
• every child has the right to life, survival, development,
education, protection and participation
• right to life, survival and development goes beyond the
physical existence of the child and also encompasses the
right to identity and nationality
• mental, emotional, cognitive, social and cultural
development of the child is to be addressed in totality
• all children have equal rights and no child shall be
discriminated against on grounds of religion, race, caste,
sex, place of birth, class, language, and disability, social,
economic or any other status
 Important measures of state
• Improve maternal health care, including antenatal care, safe
delivery by skilled health personnel, post natal care and nutritional
support
• Provide universal access to information and services for making
informed choices related to birth and spacing of children
• Secure the right of the girl child to life, survival, health and nutrition
• to improve new born and childcare practices at the household and
community level
• Provide universal and affordable access to services for prevention,
treatment, care and management of neo-natal and childhood
illnesses and protect children from all water borne, vector borne,
blood borne, communicable and other childhood diseases
• Prevent disabilities, both mental and physical, through timely
measures for pre-natal, peri-natal and post-natal health and nutrition
care of mother and child, provide services for early detection,
treatment and management
• Prevent HIV infections at birth and ensure infected children receive
medical treatment, adequate nutrition and after-care, and are not
discriminated against in accessing their rights
• Provide adequate safeguards and measures against false claims
relating to growth, development and nutrition
• Provide universal and equitable access to quality Early Childhood Care
and Education (ECCE) for optimal development and active learning
• Ensure that every child in the age group of 6-14 years is in school
• Promote affordable and accessible quality education up to the
secondary level for all children.
• career counseling and vocational guidance
• rehabilitation of children who are out of school such are child
labourers, trafficked children, street children, abused children
NATIONAL PLAN OF ACTION FOR CHILDREN
2005
• Ministry of women and child welfare has
prepared a National Plan of Action for
Children 2005.
• The Prime Minister’s Office is quarterly
monitoring the National Plan of Action for
Children 2005 on the basis of eight
parameters-
1. Reduce IMR to below 30 per 1000 live births by 2010.
2. Reduce Child Mortality Rate to below 31 per 1000 live births by 2010.
3. To reduce Maternal Mortality Rate to below 100 per 100,000 live births
by 2010.
4. Universal equitable access and use of safe drinking water and
improved access to sanitary means of excreta disposal by 2010.
5. 100% rural population to have access to basic sanitation by 2012.
6. To eliminate child marriages by 2010
7. To eliminate disability due to poliomyelitis by 2007
8. To reduce the proportion of infants infected with HIV by 20 percent by
2007 and by 50 percent by 2010, by ensuring that 80 per cent of
pregnant women have access to ante natal care, and 95 per cent of
men and women aged 15-24 have access to care, counselling and
other HIV and prevention services.
 LEGISLATION RELATED TO CHILDREN
HEALTH AND WELFARE

•   Legislation - the act of making or enacting

laws
• The word Legislation is derived from two Latin
words- Lex=Law Latus=Raised
 Constitutional Provisions
• Article 14 provides that the State shall not deny to any person
equality before the law or the equal protection of the laws
within the territory of India.
• Article 15(3) provides that, “Nothing in this article shall
prevent the State for making any special provision for women
and children.”
• Article 21 provide that no person shall be deprived of his life or
personal liberty except according to procedure established by
law.
• Article 21A directs the State shall provide free and compulsory
education to all children of the age of six to fourteen years in
such manner as the State may, by law, determine.
 • Article 23 prohibits trafficking of human beings and forced labour.
• Article 24 prohibits employment of children below the age of fourteen
years in factories, mines or any other hazardous occupation.
• Article 25-28 provides freedom of conscience, and free profession,
practice and propagation of religion.
• Article 39(e) and (f) provide that the State shall, in particular, direct its
policy towards securing to ensure that the health and strength of
workers, men and women and the tender age of children are not
abused and that the citizens are not forced by economic necessity to
enter avocations unsuited to their age or strength and that the children
are given opportunities and facilities to develop in a healthy manner
and in conditions of freedom and dignity and that the childhood and
youth are protected against exploitation and against moral and
material abandonment.
• Article 45 envisages that the State shall endeavor to provide early
childhood care and education for all children until they complete the
age of six years.
  LEGISLATION
• The Child Marriage Restraint Act, 1929
• The Child Labour (Prohibition and Regulation) Act, 1986.
• The Juvenile Justice (Care and Protection of Children) Act,
2000.
• The Infant Milk Substitutes, Feeding Bottles and Infant Foods
(Regulation of Production, Supply and Distribution) Act, 1992.
• The Pre-Conception and Pre-natal Diagnostic
Technique(Prohibition of Sex Selection) Act, 1994.
• The Persons with Disabilities (Equal Opportunities, Protection
of Rights and Full Participation) Act, 1995.
• The Immoral Traffic (Prevention) Act, 1956
• The Guardian and Wards Act, 1890.
•  CHILD WELFARE AGENCY AN
ADMINISTRATIVE UNIT RESPONSIBLE FOR
SOCIAL WORK CONCERNED WITH THE
WELFARE AND VOCATIONAL TRAINING OF
CHILDREN
 PURPOSES
• To education of children
• To promote and conduct research
• To help training and education of teachers
• To provide health support for children
• To ensuring safety of child
• To strengthening families to successfully
care for their children
 UNITED NATION AGENCIES
1. WHO ( world health organisation)
2. UNICEF (united nations international children emergency
fund)
3. FAO (food and agricultural organisation)
4. ILO (international labour organisation)
5. WFP (world food programme)
6. UNESCO (united nations educational scientific and
cultural organisation)
7. USAID (united state agency for international development)
8. UNDP (united nations development programme)
9. UNFPA (united nation fund for population activities)
 NON GOVERNMENTAL AGENCIES
1. AMI (association of Montessori
international)
2. CRS (catholic relief services)
3. CARE ( cooperative for American relief
everywhere )
4. ICUW ( international union for child welfare)
5. MMF (meals for millions fund )
6. SCF (save children fund)
 WORLD HEALTH ORGANISATION (WHO)
• Established on 7th April 1948
• It Headquarter is at Geneva
responsibility
• Global health matter
• Shapping the health research agent
• Setting notes and standard
• Articulating evidence based policy option
• Providing technical support to country
• Monitoring and assessing the health trends
 Function
• Prevent and control specific disease
• Development of comprehensive health service
• Family health
• Environmental health
• World health statistics
• Biomedical research
 IN CHILD WELFARE
• National polio surveillance project
• Routine immunization
• Integrated management of neonatal and childhood illness
• Integrated disease surveillance project
• RNTCP
• NACP
• Leprosy elimination
• National vetorborn disease control programme
• Integrated prevention and control of non-communicable
diseases
 . UNITED NATIONS INTERNATIONAL
CHILDREN’S EMERGENCY FUND(UNICEF)

• Established in 1946
• Headquarters Newyork
• Active in more than 190 countries
• South central Asia regional office located in
Newdelhi
 MILESTONES
• 1946 – Focus on food to europe
• 1953 – UNICEF become a permanent
organisation
• 1959 - Declaration of the rights to the children
• 1961 - Education
• 1989 - Convention of rights of the child
 Function
• Infant and child feeding ( promote breast feeding)
• Delivering vital micronutrients
• Virtual elimination of Vit A and Iodine def
• Promoting maternal nutrition preventing low birth
weight
• Monitoring the infant growth rate
• Provide nutrition in emergency young children
• Nutrition and HIV prevention
• Child survival and development & protection
• Basic education and gender equality& rights
FOOD AND AGRICULTURAL ORGANISATION(FAO)

• Established in 1945
• Headquarters in Rome
• FAO has 191 members nations
work
• To help nation to raise their living standard
• To help to improve farming,forestry,and
fisheries
• Ensuring nutrition and food security for all
• Prevent and controll specific disease
• Development of comprehensive health service
• Family health
• Environmental health
• World health statistics
• Biomedical research
INTERNATIONAL LABOUR ORGANISATION

• Established in 1919
• Headquarters Geneva
 AIM
• Promote rights at work, encourage decent
employment oppurtunities,enhance social protection
and strengthen dialogue on work related issues
• ILO’s International Programme on Elimination of
Child labour (IPEC) was created in1992 with overall
goal of the progressive elimination of child labour
 WORLD FOOD PROGRAMME(WFP)

• Established on 1961
• Headquarters ROME
OBJECTIVES
• Save life and protect livelihood in emergency
• Support food security and nutrition and build livelihood in
fragile settings and following emergency
• Reduce risk and enable people , communities and countries to
meet their own food and nutritional needs
• Fight micronutrient deficiency
• Reduce child mortality
• Reduce nutrition and break the intergenerational cycle of hunger
UNITED NATIONS EDUCATIONAL SCIENTIFIC
AND CULTURAL ORGANISATION(UNESCO)
• Established on 1945
• Headquarters in Paris
Function
• Helps to develop textbook and promotion and
teaching of national languages to the children of
the migrant workers
• Training of staff for preschool children and assist
project to setup production of children’s book
and libraries
 UNITED STATES AGENCY FOR INTERNATIONAL
DEVELOPMENT (USAID)

• Established on Nov 1961

• Headquarters in Washington
• Work in over 100 countries
SERVICES
• Promote economic prosperity
• Strengthen democracy and good governance
• Protect human rights
• Improve global health
• Advance food security and agriculture
• Further education
• Help societies prevent and recover from conflict or disaster
 UNITED NATIONS DEVELOPMENT
PROGRAMME (UNDP)
 • Established on 1966
• Headquarters Newyork
• Work with 177 coutries
WORKING AREA
• Povety reduction
• Crisis prevention and recovery
• Environment and energy protection
• Work closely with NACP in India
• Human development
• Women empowerment
 UNITED NATION FUND FOR POPULATION
ACTIVITIES(UNFPA)

• Established on 1969
• Headquarters Newyork
 MISSION
• Delivers a world where every pregnancy is
wanted ,every birth is safe , every young
potential is fulfilled
• RCH 2,NACP3,NRHM in India
 NONGOVERNMENTAL AGENCIES
1. AMI (association of Montessori
international)
2. CRS (catholic relief services)
3. CARE ( cooperative for American relief
everywhere )
4. ICUW ( international union for child welfare)
5. MMF (meals for millions fund ) 6. SCF (save
children fund)
National Agencies/ Voluntary Health care
Agencies
• Indian Red Cross
• Indian Council for Child Welfare
• Family Planning Association of India
• Tuberculosis of India
• Hindu Kusht Nivaran Sangh
• Central Social Welfare Board
• All India Women’s Conference
• Blind Association of India etc.
National health programmes
related to child health and
welfare
PROGRAMMES FOR COMMUNICABLE DISEASES

1. National Vector Borne Diseases Control

Programme (NVBDCP)
2. Revised National Tuberculosis Control Programme
3. National Leprosy Eradication Programme
4. National AIDS Control Programme
5. Universal Immunization Programme
6. National Guinea worm Eradication Programme
7. Yaws Control Programme
8. Integrated Disease Surveillance Programme
 PROGRAMMES FOR NON COMMUNICABLE
DISEASES
1. National Cancer Control Program
2. National Mental Health Program
3. National Diabetes Control Program
4. National Program for Control and treatment of
Occupational Diseases
5. National Program for Control of Blindness
6. National program for control of diabetes,
cardiovascular disease and stroke
7. National program for prevention and control of
deafness
 NATIONAL NUTRITIONAL PROGRAMS

• Integrated Child Development Services

Scheme
• Midday Meal Programme
• Special Nutrition Programme (SNP)
• National Nutritional Anaemia Prophylaxis
Programme
• National Iodine Deficiency Disorders Control
Programme
 PROGRAMS RELATED TO SYSTEM
STRENGTHENING /WELFARE
1. National Rural Health Mission
2. Reproductive and Child Health Programme
3. National Water supply & Sanitation
Programme
4. 20 Points Programme
• Various national health programs are currently
in operation for the improvement of child
health and prevention of childhood diseases.
The brief lists of these programms are:
 Reproductive and Child Health Program.
Universal Immunization Program
 Integrated Child Development Services
Scheme
 School Health Program
Nutritional Program
THE REPRODUCTIVE AND CHILD HEALTH (RCH)
PROGRAMME
  It was launched in October 1997. The main aim of
the programme is to reduce infant, child and
maternal mortality rates.
 The main objectives of the programme in its first
phase were:
• To improve the implementation and management
of policy by using a participatory planning
approach and strengthening institutions to
maximum utilization of the project resources
• To improve quality, coverage and effectiveness of
existing Family Welfare services
• To gradually expand the scope and coverage
of the Family Welfare services to eventually
come to a defined package of essential RCH
services.
• Progressively expand the scope and content
of existing FW services to include more
elements of a defined package of essential
• Give importance to disadvantaged areas of
districts or cities by increasing the quality
and infrastructure of Family Welfare services
  RCH-I had a number of successful and unsuccessful
outcomes. Base line statistics were recorded in 1998-99
and compared to 2002-03.
• Percentage of women receiving any ANC rose by about 12
% to reach 77.2%. But use of government health facilities
has declined.
• Use of contraceptives increased by 3.3 % to 52.0 %, while
family planning due to spacing method rose by 3.3% to
10.7 %. Use of permanent methods did not change.
• Infant mortality came down from 71to 63 but the aim of
universal immunization was far from reach. Polio though
reduced has not met the eradication target.
• Not enough attention was paid to awareness of diarrhoea
management and Acute Respiratory Infection danger
signs hence resulting in a rise of case incidents.
 The child health programmes is now its second
phase: RCH-II. Following are the aims of the
programme:
• Expand services to the entire sector of Family
Welfare beyond RCH scope
• Holding States accountable by involving them in
the development of the programme
• Decentralization for better services
• Allowing states to adjust and improve
programmes features according to their direct
needs.
• Improving monitoring and evaluation processes
at the District, state and the Central level to
ensure improved program implementation.
• Give performance based funding, by rewarding
good performers and supporting weak
performers.
• Pool together financial support from external
sources
• Encourage coordination and convergence, within
and outside the sector to maximize use resources
as well as infra structural facilities
 The recommended package of services
1.For the children:
 Essential newborn care
 Exclusive breast feeding and weaning
 Immunization
 Appropriate management of diarrhoea  Appropriate
management of ARI  Vitamin A prophylaxis
 Treatment of Anaemia For eligible couple:
• Prevention of pregnancy
• Safe abortion Prevention and treatment of
reproductive tract infection (RTI) and sexually
transmitted diseases (STD).
UNIVERSAL IMMUNIZATION PROGRAMME
• Sponsored by Central Government
• Funding Pattern-It is a Centrally sponsored scheme, so
the total funding is managed by the Central Government.
• Ministry/Department- Department of Health & Family
Welfare Department
• Description-Universal immunization programme, UIP,
was launched in 1985 in a phased manner. Immunization
is one of the most cost effective interventions for disease
prevention. Traditionally, the major thrust of
immunization services has been the reduction of infant
and child mortality.
• The aim is to achieve 100 percentages of full
immunization status by 2009 to 2010 and to
maintain it for long.
The objectives of the mission are:
I. Contribute to global eradication of Polio by 2007.
II. Elimination of Neonatal Tetanus, Diphtheria and
Pertussis by 2009.
III. Establish sufficient sustainable and accountable
fund flow at all levels.
IV. Ensure that there is sustained demand and reduced
social barriers to access immunization services.
• The strategies of the programme are:
I. Reducing drop outs rate and missed opportunities.
II. Strengthen institutional training at all levels.
III. Strengthen coordination and review meeting at all
levels.
IV. Strengthening micro planning processes in all
districts and urban areas.
V. Strengthening coordination with national
operational guidelines, supervision practices and
prioritizing poorly performing districts and under
served populations.
VI. Reaching the under served by influencing behaviour
at household level through BCC
 INTEGRATED CHILD DEVELOPMENT SERVICES
(ICDS)
• ICDS being implemented by Ministry of Women
and Child Development is the world’s largest
programme aimed at enhancing the health,
nutrition and learning opportunities of infants,
young children (0-6 years) and their mothers.
• It is the foremost symbol of India’s commitment
to its children – India’s response to the challenge
of providing pre school education on one hand
and breaking the vicious cycle of malnutrition,
mortality and morbidity o the other.
The Scheme provides an integrated approach for
converging basic services through community based
workers and helpers.
The services are provided at a centre called the
‘Anganwadi’, which literally means a courtyard play
centre, a childcare centre located within the village itself.
The package of services provided are:
• Supplementary nutrition,
• Immunization,
• Health check-up
• Referral services,
• Pre-school non-formal education and
• Nutrition and health education
• It is a centrally sponsored scheme implemented
through the State Governments with 100%
financial assistance from the Central Government
for all inputs other than supplementary nutrition
which the States were to provide from their own
resources.
• However, from the year 2005-06, the Government
of India has decided to provide Central assistance
to States for supplementary nutrition also to the
extent of 50% of the actual expenditure incurred
by States or 50% of the cost norms, whichever is
less.
 SCHOOL HEALTH PROGRAM
• School Health program is a program for school health
service under National Rural Health Mission, which has
been necessitated and launched in fulfilling the vision of
NRHM to provide effective health care to population
throughout the country.
• It also focuses on effective integration of health concerns
through decentralized management at district with
determinant of health like sanitation, hygiene, nutrition,
safe drinking water, gender and social concern.
• The School Health Programme intends to cover
12,88,750 Government and private aided schools
covering around 22 Crore students all over India
• The School health programme is the only public
sector programme specifically focused on school
age children.
• Its main focus is to address the health needs of
children, both physical and mental, and in
addition, it provides for nutrition interventions,
yoga facilities and counselling.
• It responds to an increased need, increases the
efficacy of other investments in child
development, ensures good current and future
health, better educational outcomes and improves
social equity and all the services are provided for
in a cost effective manner.
 COMPONENTS OF SCHOOL HEALTH
PROGRAM
1. Screening, health care and referral:
• Screening of general health, assessment of
Anaemia/Nutritional status, visual acuity, hearing
problems, dental check up, common skin conditions,
Heart defects, physical disabilities, learning disorders,
behaviour problems, etc.
• Basic medicine kit will be provided to take care of
common ailments prevalent among young school going
children.
• Referral Cards for priority services at District / Sub-
District hospitals.
2. Immunisation:
• As per national schedule
• Fixed day activity
• Coupled with education about the issue
3. Micronutrient (Vitamin A & IFA) management:
• Weekly supervised distribution of Iron-Folate tablets
coupled with education about the issue
• Administration of Vitamin-A in needy cases.
4. De-worming:
• As per national guidelines
• Biannually supervised schedule
• Siblings of students also to be covered
5. Health Promoting Schools:
• Counselling services
• Regular practice of Yoga, Physical education, health
education
• Peer leaders as health educators.
• Adolescent health education-existing in few places
• Linkages with the out of school children
• Health clubs, Health cabinets
• First Aid room/corners or clinics.
6. Capacity building
7. Monitoring & Evaluation
8. Mid Day Meal
• Nutritional programme
 INTRODUCTION
• The various nutritional programmes are in
operation in India since 1st five year plan
period.
• International agencies such as WHO, UNICEF,
FAO, CARE are assisting the Govt. in these
programmes of India to improve nutrition of
the people with special emphasis on mother
& children.
 FUNCTIONS FALL IN 3 CATEGORIES
 To eradicate major causes of malnutrition. -Increase food
production -Provide safe drinking water -improve
environmental sanitation -control of communicable diseases -
nutritional education to the masses -promoting kitchen gardan
 Aspects specially related to women and children -to improve
the employment opportunities for women -provision of better
health care to parents & children -promoting breast feeding -
weaning at right time
 Special reference to pregnant & lactating mothers -to raise
nutritional status through nutritional education -promoting
small handicrafts scheme through self employment
Nutritional Anaemia Control Programme

• The programme was launched in 1970 to

prevent nutritional anemia in mothers and
children.
• the expected and nursing mothers as well as
acceptors of family planning are given one
tablet of iron and folic acid containing 60 mg
elementary iron which was raised to 100 mg
elementary iron, however folic acid content
remained same (0.5 mg of folic acid).
• Children in the age group of 1-5 years are
given one tablet of iron containing 20 mg
elementary iron (60 mg of ferrous sulphate
and 0.1 mg of folic acid) daily for a period of
100 days.
• This programme is being taken up by
Maternal and Child Health (MCH) Division of
Ministry of Health and Family Welfare.
• Now it is part of RCH programme.
• National programmes to control and prevent
anemia have not been successful.
• Experiences from other countries in controlling
moderately-severe anemia guide to adopt long
term measures i.e. fortification of food items like
milk, cereal, sugar, salt with iron.
• Nutrition education to improve dietary intakes in
family for receiving needed macro/micro nutrients
as protein, iron and vitamins like folic acid, B,C,
etc. for haemoglobin synthesis is important.
• Nutritional Anemia Control Programme
should be comprehensive and incorporate
nutrition education through school health
and ICDs infrastructure to promote regular
intake of iron/ folic acid-rich foods, to
promote intake of food which helps in
absorption of iron and folic acid and
adequate intake of food.
• The technology for the control of anemia
through iron fortification of common salt has
also been developed at the NIN, Hyderabad.
Vitamin A prophylaxis programme
•  Launched by Ministry of Health and Family
Welfare in 1970
• On the basis of technology developed at NIN this
was launched.
• Component- control of Blindness
• Beneficiary group – preschool children 200,000
IU of oily preparation of Vitamin A (retinol
palmitate 110mg) administered orally every 6
months for every preschool child above 1 year.
 Age of the child Quantity of vitamin A
administered At 9th month 1,00,000 IU 15th -
16th months Mega dose of 2,00,000 IU 18 - 24
months 2,00,000 IU 24 - 30 months 2,00,000
IU 30 - 36 months 2,00,000 IU
• 1 IU is equivalent to 0.3 microgram of retinol.
• Vitamin A deficiency increases the severity of
mortality from measles and diarrhoea.
• Increased infectious morbidity and mortality
is apparent even before the appearance of
xerophthalmia
• Improving the vitamin A status of deficient
children aged 6 months to 6 years can
dramatically reduce their morbidity and
mortality from infection
• Prompt administration of large doses of
vitamin A to children with moderate to severe
measles, particularly if they may be vitamin A
deficient, can reduce individual mortality by
50% and prevent or moderate the severity of
complications.
 Control of iodine deficiency disorders
• The government of India, launched the National
Goiter control programme (NGCP) in 1962.
• It aimed at replacement of ordinary salt by
iodised salt, particularly in the goiter endemic
regions.
• The program of universal iodisation of edible
salt was started from first April 1986 in phases
with the aim of total salt iodisation by 1992.
• IN 1992, the NGCP was renamed as national
iodine deficiency disorder control programme.
• The central government provides case grants for
health education and publicity campaign for
promoting the consumption of Iodised salt.
• The central government also provides cash
grants for establishing IDD control cells in the
state health directorates.
•   A national reference laboratory monitoring
of IDD has been set up at the bio-chemistry
division of the national institute of
communicable disease, Delhi.
• It monitors the Iodine content of salt in urine
• The medical and paramedical personnel
monitoring laboratories have been
established at the district level also in many
districts in allocation of Rs.75,000/- district
laboratory has been provided for this
purpose.
 SNP
• The programme was launched in the country in
1970-71 for the benefit of children below 6 years of
age, pregnant and nursing mothers.
• Originally launched as a central programme and
was transferred to the state sector in fifth Five year
plan as part of the Minimum Needs Programme.
• AIM
To improve the nutritional status of the target
groups.
OBJECTIVES:
• To improve the nutritional status of women,
pre- school children, pregnant women and
lactating women in urban, slums, tribal areas
and drought prove rural areas 
• The main activities of the program are:
-To provide supplementary nutrition
-To provide health services, including supply of
vitamin-A solution and iron and folic acid
• It provides supplementary feeding of about 300
calories and 10 grams of protein to preschool
children and about 500 calories and 25 grams of
protein to expect at and nursing mothers for six
days a week.
• This programme was operated under Minimum
Need Programme.
• The programme was taken up in rural areas
inhibited predominantly by lower socio-economic
groups in tribal and urban slums.
• Fund for nutrition component of ICD
programme is taken from the SNP budget.
• This supplement is provided for 300 days in a
year.
 Balwadi nutrition programme
• This programme which was started in December
1970.
• It is under the overall charge of the Department of
Social Welfare.
• It is being promoted with the help of four national-
level voluntary organisations, namely, the Indian
Council for Child Welfare, Harijan Sewak Sangh,
Bharatiya Adamjati Sewak Sangh and Central Social
Welfare Board.
• Beneficiary group – 3 to 6 years.
• Visualizes on the provision of supplementary
nutrition to the extent of 300 calories and 15
grams of protein during 250 days in a year for
children attending Balwadis.
 ICDS
• Started in 1975 in pursuance of the National
Policy for children.
• Strong nutritional component in this
programme is in the form of
• -Supplementary nutrition
• -Vitamin A prophylaxis
• -Iron and folic acid distribution
• Beneficiary group:
• children below 6 years
• adolescent girls
• elderly pregnant and lactating women
• Services:
• Supplementary nutrition,
• immunization
• Health checkups,
• medical referral services,
• nutrition and health education to women
• non formal education.
• Service Delivery : Anganwadi Workers
• Each Anganwadi unit covers a population of
about 1000.
• A network of Mahila Mandals has been built
up in ICDS Project areas to help Anganwadi
workers in providing health and nutrition
services.
• The work of Anganwadis is supervised by
Mukhyasevikas.
• Field supervision is done by the Child
Development Project Officer(CDPO).
APPLIED NUTRITION PROGRAMME
• The ANP was first introduced in 1960 in Orissa and
Andhra Pradesh.
• It was extended there after to Tamilnadu in 1961
and Uttar Pradesh in 1962, during 1973, it was
extended to all the states.
 Specific objectives:
• To make people conscious of their nutritional needs
• To increase production of nutrition foods and their
consumption
• To provide supplementary nutrition to
vulnerable groups through locally produced
foods.
 Components:
-Production of protective foods
-Training of functionaries involved in
production of these foods
-Nutrition education and demonstration
• Specific activities:
 Supplementary feeding
 Non-formal preschool education
 Nutrition education
 Poultry forming
 Providing better seeds and seedling
 Raising kitchen gardens
• Beneficiaries:
 Children between 2-6 years, pregnant and
lactating mothers.
 The children and women are given
supplementary nutrition's worth 25paise /
day / child , 50paise / women/day
respectively.
 A single supplementary meals is given
weekly for 25 days/year.
• Evaluation:
 Studies show that ANP has not generated
and desired awareness for production and
consumption to protective food, the
community kitchens and school gardens
could not function properly. In reality the
program lacked effective supervision and has
almost become defunct.
 MID DAY MEAL PROGRAMME
• Also known as School Lunch Programme.
• 1st organised in 1957 in TamilNadu.
• In operation since 1961 throughout the
country.
• AIM: 1/3rd of the required food per day for
the child be furnished through this
programme.
• OBJECTIVE:
- To improve the nutritional status of children
and imparting nutritional education.
- To ensure universal primary education.
- To attract more children for admission to
schools and retain them to improve literacy
rate
• The feeding programme is the joint venture
of the health and educational department
with aid from UNICEF, CARE, and other
agencies.
• Skimmed milk, banana, rice meals etc. are
provided.
• Cost is fixed as 12 paise per child.
 Principles:
• supplement, not substitute
• 1/3 total energy and ½ total protein
• low cost
• easily prepared
• locally available food
• change menu frequently
 Role of nurse in programme
• Have to study the food habits of people, their
views etc.
• Needs to impart the knowledge of
importance of good nutrition without hurting
their cultural habits.
• Needs to demonstrate simple recipes which
are affordable and locally available.
• Needs to use all media of health education.
• Needs to identify the malnourished children
and refer them appropriately to the nutrition
programme.
• Assists in nutrition rehabilitation
programme.
• Takes part in research activities.
Changes trends in hospital care
 Introduction
• The hospitals are necessary places for providing the
health care of ill children. Previously, the care of ill child
used to be completed at their birth places or at their
homes. Nowadays, the hospitals have become a
necessary organ of health chain, where all types of
health professionals can easily be made available.
• Previously, many young adults will remember their time
spent in the hospital with fear and trembling because of
the loneliness and pain they felt at an age when they
could not cope alone with these feelings. Nowadays
needless to say, practices in use, in some hospital today
have changed little over the past 20 years.
• This is based on preventive, promotive, curative aspects
of the child health. There are modern trends/modern
concepts of hospitalized child which are as follows:
1.Visitig
• In earlier days, parents were permitted to visit their
hospitalized child for only 1hour once a month. Children
were deprived from parental love. Today, many hospital
permits visiting from 2 to 8pm or from early in the
morning to bedtime, while some hospital have flexible
unlimited visiting at any time during the day or night.
• If parents are unable to visit the child frequently ,
grandparents, aunts, un closer baby sitters may visit
instead.
• Some hospital permits visiting by siblings between 2 and
12 years of age during certain hours of the day. A parent must
accompany a younger sibling during the visit. Siblings of ill child
are not permitted to visit of they have been exposed to an
infectious disease or have colds or other infection.
• If child’s room is restricted, some hospitals have a closed-circuit
television or telephone video system that allows two-way visit
between the child and visitors of all ages.
• If parents, family members, friends are not able to visit the
hospital because of difficulty in travelling or any other reason,
tape recordings can be made and played to the child to maintain
some contact with home, thus, reducing separation anxiety.
Topics such as favourite story or song, talking letter from the
family, or just a conversation with the child are appropriate for
recording.
2. Rooming-in
• Parents should never be required to stay at a child’s
bed side, but they are not prohibited from doing so if
they desire.
• The parents who stay during the day time in the
pediatric unit, some hospital provide a comfortable
lounge or waiting room where they can relax. In
some institution, meals can be served to the parents
in the child’s room so they can eat with their child or
they may eat in the hospital cafeteria or coffee shop.
Food may be brought from home for the child
if there are no dietary restrictions and if the policy
of the institutions permits.
• Parents usually mothers of seriously ill children may
be encouraged to stay in the hospital if they desire to
do so and if facilities are available for their comfort.
Some hospital have rooms such as playroom in the
pediatric unit where the parents may sleep. Some
hospitals have a wing of the hospitals or a motel type
of accommodation for parents and other relatives.
The parents may sleep on a chair, a cot, a folding
bed, or a convertible chair in the child’s room if it is
large enough
• 3.Care by Parent Units
• Some hospitals have care by-patient unit or family
participation unit with the child. This method of care
has its root in the orient, where the whole family
becomes involved with the care of the sick. In
this system, the child gets attention when it is needed
each day from a familiar person, under the
supervision of the nurse. When the parents are near,
children can continue to learn to grow throughout the
hospital experience. In these units, parents may
be too anxious or guilty or just may not want to
participate in the care of their children in the hospital,
others may welcome the opportunity to give their
children a sense of security through their presence.
• 4.Pare t Support Groups
• Many support groups for parents meet outside
the hospital, some hospital started within the
hospital for parents of hospitalized children.
Such group may be conducted by nurses, by
play therapist or by child life programme staff.
In these groups, a non-threatening
atmosphere is provided, where parents may
feel comfortable enough to move away from
the hospital routine and ventilate their feelings
and concerns to relieve their anxiety and stress
• 5.Self-care
• By the self-care framework nurses have
the responsibility of assessing the abilities of
the hospitalized child and then helping the
child to learn self-care skills. The time and
methods used in teaching these skills depend
on the child’s cognitive abilities, emotional
state, and readiness to learn.
 Different types/Approaches of care on hospitals for pediatrics

• 1.Private care:
• A physician, either a pediatrician or a general practitioners,
provide care for children in the home and in the hospital
when necessary. Many pediatrician work closely with
pediatric nurse practitioners on a collegial basis in providing
such care. Parents feel more secure if they can telephone
the office of a known physician or a pediatric nurse
practitioner about any problems of the child. For this reason,
usually a specific time is set aside each day when such calls
can be received. Telephone calls concerning emergencies are
handled at any time of the day or night. Before advice can be
given over the telephone, the parents’ capabilities in
describing symptoms and in providing care must be known
• 2. Ambulatory care
• Ambulatory care facilities should provide a
needed range or a services, be locally
accessible, and focus on health promotion,
illness prevention and health maintenance.
• Quality pediatric health care can be given in
neighbourhood health centre or clinics, out-
patients department of hospitals, emergency
facilities and hospital based or freestanding
facilities for surgical care.
• 3. Neighbourhood Health Centre or Clinic
• The neighbourhood or clinics are primarily
concerned with the care of children and the
guidance of their parents. If sickness occurs,
the child may be cared at the clinic for a mild
temporary illness or referred to another
facility in further treatment.
• 4. Emergency Facilities
• Facilities where emergency care is given, may be
located in hospital emergency department or in
community based emergency centres. They have
been designed primarily to fulfil a need for
convenient, accessible, low-cost medical services.
• These community-based emergency care facilities are
relative new to the health care field. They have been
designed primarily to fill a need for convenient
accessible low cost medical services. Some of them
provide services at all hours of the day and night and
on weekends, combining many to the functions of
hospital emergencies room.
• The activity and drama often seen in an
emergency room may be very frightened to
children. To reduce their anxiety when an
emergency does occur, they may be taken to
an emergency facility under non-stressful
condition and oriented to the for play in this
stressful environment should be a vital part of
care to reduce children’s anxiety to a tolerable
level.
• 5. Hospital Based and free Standing Facilities for
Minor Surgical Care
• The advantage of care given in an ambulatory
setting is that the child does not have to remain
away from home for more than a few hours,
resulting in less trauma and family disturbance
and less chance of infection from seriously ill
children in the in patient hospital setting. Parents
must assume responsibility for the pre-operative
routine preparation usually carried out by nurses
in the hospital including post-operative
• 6. Pediatric Unit
• Hospitalized children are usually segregated by
care requirement or by age or by both,
children need are adequate provision for care,
protection from physical danger .infection and
accidents, and protection from a
psychologically threatening environment. In
the pediatric unit the surrounding should be
home like and cheerful.
• 7.Pediatric newborn and Pediatric intensive
care unit (PICU)
• Newborn and pediatric intensive care unit for
the critically ill are found in many pediatric
hospitals and the large pediatric departments
in general hospital in some states. Newborn
infants who are critically ill are transferred
from local hospital to these centres for care.
These units based on electrical instrument
related to vital signs and other physiology of
newborn and pediatric.
• 8. Intermediate Care Unit
• Here children who have been in the intensive
care can be moved if their conditions have
improved. These children may still be too ill
for care in a standard pediatric unit.
• 9.The Pediatric Research Centre
• Some children’s hospital have pediatric
research centres where little understood
diseases are under investigation. These
centres give nurses an opportunities to
provide comprehensive care to children.
• 10.Outpatient department’s hospitals.
• During the 19th  Century, hospitals in America
began to provide services for outpatients.
• Increasing number of private physicians use
the outpatient department for children with
the problems requiring careful diagnosis and
treatment, such as complex medical or
surgical problems or psychological difficulties.
• CHILD MORBIDITY AND MORTALITY
RATE
 A. CHILD MORBIDITY
• Deviation from a state of physical or mental
well-being as a result of disease, injury or
impairment.
• In a given population morbidity for a given
time, may be measured in terms of incidence,
in terms of prevalence.
   Total no. of new cases of illness during a defined
period
incidence =
rate

Population exposed to risk in the same period

 prevalence
• Prevalence Indicates how common is an
event in a population.
• It is used to measure the frequency of an
illness in existence during a defined period.
• It includes all the cases in the defined period,
new and old case, during the same period
Total no.of new and old cases found during a specified period

Population exposed to risk at the same period

 B.MORTALITY RATE
• INFANT MORTALITY RATE: it is the number of
infant deaths under one year of age per
1000live births in one year.
 • Number of deaths under one year of age
1000
• Total live b IMR birth in the year

• IMR
Neonatal mortality rate
• NMR = 1000 No. Of deaths
under 28 days of age
Total live births x1000
 Still birth
Fetal deaths
weighing over1000gms at birth
x1000
Total live + still births weighing over
1000gms at birth 1000
 • globally the under-five child mortality had reduced only by
48 per cent…whereas in India by 2013 we had reduced the
under-five child mortality by 61 per cent,”
• India has the highest number of child deaths in the world,
with an estimated 1.2 million deaths in 2015 — 20 per cent
of the 5.9 million global deaths.
• The fourth Millennium Development Goal (MDG-4) aimed to
reduce mortality — between 1990 and 2015 — among
children under five by two-thirds.
• India tops child deaths due to #pneumonia #Diarrhoea,
#congenital Abnormalities #Haemorrahgic Disease
Diff btw adult child
• INTRODUCTION: • There are a many
differences between children and adults like
physiological, anatomical, cognitive, social
and emotional. • these all impact on the way
illness and disease present in children and
young people, as well as the way healthcare
is provided.
• Difference Between Child &Adult Systemic
Changes Psychological Difference Pathologic
changes
• Anatomic & Physiologic Difference CHILDREN
ADULTS New-born's head is larger & heavier as
compared to his body Adults head is not heavier
than body Thinner skin- Children have thinner skin
than adults. Adult skin not as much thinner than
children. Rapidly dividing cells- Children's cells
divide more rapidly than adults Normal cell division
No tears in early infancy There is tears formation in
eyes. No voluntary control over the environment or
activity. Voluntary control On body
• Systemic Difference Integumentary System
Respiratory System Heart & Circulatory
System Hematologic System Urinary System
Gastrointestinal System Endocrine System
Reproductive System Musculoskeletal
System Neurologic System Lymhoid &
Immune System
Hospital environment for a sick
child
 INTRODUCTION
• Sick usually means physically ill, but it can
sometimes be used to mean mentally ill .
• The sick children need hospitalization.
• It is a stressful environment for both children
and their families.
• Hospitalization leads to interruption of the
child’s active growth and development.
 HOSPITAL ENVIRONMENT FOR SICK CHILD
• 1. SOCIAL ENVIRONMENT :- it means the people around in
the hospital which includes member of health team and
other patients and relatives of their family. This is a
strange social environment for the child.
• 2. PHYSICAL ENVIRONMENT :- it means the setting or place
and the things around which include the ward or room,
machines , equipments . These are stressful for the child.
• 3. CHANGE IN ROUTINE:- children may have to undergo
various diagnostic and therapeutic procedures which are
stressful for both the children and their family. It leads to
altered nutritional and sleep pattern and reduce appetite
and may cause anxiety in the child.
PREPARATION OF HOSPITAL ENVIRONMENT
FOR THE CHILD
• INFANTS :-
 Bring your child's favourite toy, blanket or stuffed animal.
 Nursing staff should know about the baby schedule.
 Patients remain calm.
 Bring music that helps relax your baby.
 Keep routines as normal as possible.
• TODDLER –
 Use simple words that your child will understand.
 Tell truth.
 Allow your child to choose his or her favorite things to
bring to the hospital.
 Read books about going to the hospital.
 Encourage your child to use play medical kits and dolls to
act out his or her understanding of the experience.
• PRE-SCHOOL AGE-
• Use simple words without too many details.
• Help your preschooler understand that he or she did not do
anything to cause the hospitalization, procedure or surgery.
• Encourage your preschooler to talk about his or her
feelings.
• Give your preschooler the opportunity to ask questions.
• Read books with pictures of medical equipment.
• Use play medical kits to allow expression of feelings. .
• SCHOOL-AGE –
• Let your child know that you will answer any of his or her
questions.
• Talk about your child's fears and questions openly and
honestly.
• Help your child understand exactly why he or she needs a
certain procedure or to be hospitalized.
• Encourage child’s friends to visit
• Continuous school work
 ADOLESCENT –
• Include your adolescent in any discussions and decisions
about his or her healthcare experience.
• Encourage your adolescent to ask questions about hospital
care, procedures and schedules.
• Allow and support your adolescent's privacy.
• Provide journal and read books
• Be patient with mood swings
• Leave alone
IMPACT OF HOSPITALIZATION ON CHILD
AND FAMILY
• A. IMPACT ON PARENTS /RESPONSE OF
PARENTS-
• Lack of information and knowledge related
to child’s illness.
• Fear of procedures and treatment of child
• Fear of unknown that what will happen to
child in future .
• Fear of financial burden on family
•  B. IMPACT OF HOSPITALIZATION ON CHILD – IT
DEPENDS UPON THEIR AGE AND STAGE DEVELOPMENT –
• Infants reaction are mainly separation anxiety and
disturbance of development of basic trust , when the
infant is separated from mother and when illness and
hospitalisation .
• Emotional withdrawal and depression are found in the
infants of 4 to 8 months of age , interference of growth
and delayed developments also found.
• Older infants 8 to 12 months of age may have limited
tolerance due to separation anxiety which is found as
fear of strangers , excessive crying , clinging and
overdependence on mother
• REACTIONS OF TODDLERS –
 The toddlers PROTESTS by frequent crying , rejecting
nurses attention , urgent desire to find mother and
showing signs of distrust with anger and
tears ,especially when with mothers.
 In DESPAIR , the toddler becomes hopeless , apathetic
, anorectic ,looks sad , cry continuously or
intermittently and use comfort measures like thumb
sucking , fingering lip and tightly clutching a toy.
 In DENIAL ,the child reacts by accepting care without
protest and represses all feelings. The child does not
cry in the absence of mothers and may seem more
attached to nurses.
• REACTIONS OF PRESCHOOL CHILD –
 The preschool children adopt various mental
mechanisms (defence mechanisms) to adjust
with the stressful experiences of
hospitalization and prolonged illness.
 They react by exhibiting
regression ,projection , replacement ,
identification , aggression , denial ,
withdrawal and fantasy .
 The stage of PROTEST in preschool children
is usually regression.
 Reaction of school age children
• Concerned with fear, worry, fantasies,
modesty and privacy
• Defense mechanism used is Regression
separation anxiety, negativism Depression,
Suppression denial, phobia- unrealistic fear
•  REACTIONS OF ADOLESCENTS –
• Adolescents are concerned with lack of privacy ,
separation from peers or family and school ,
interference with body image or independence or self
concept and sexuality
• They react with anxiety related to loss of control and
insecurity in strange environment
• They may show anger and demanding or un co-
operative behaviour or increased dependency on
mothers and staff.
• They may adopt mental mechanism like
intellectualization about disease , rejection of
treatment , depression ,denial or withdrawal.
• EFFECTS OF HOSPITALISATION ON THE FAMILY-
 Break in the unity of family.
 Separation from the children.
 Feeling of inadequacy as others care for their children .
 They feel anxiety, anger, fear, disappointment , self
blame, and possible guilt feeling due to lack of
confidence and competence for caring the child in
illness and wellness.
 Parental anxiety
 Strange environment in the hospital.
 Society will look upon the illness as a reflection of
something wrong with the parents.
 ROLE OF NURSE TO HELP TO COPE
WITH HOSPITALISATION OF CHILDREN
• The nurse should earn sufficient confidence to
develop positive relationship with the children
and their parents .
• Nurse should have patience, tenderness and
emotional strength in times of stress.
• Provide family centred care with different
approach to specific age group.
 IN NEONATE:
 rooming in and sensory motor stimulation
 IN INFANTS :
 encourage mother to balance her responsibilities and minimize
separation , mother can be allowed during procedure , providing toys
to relieve tension. IN
 SCHOOLCHILDREN :
 Help the parent to prepare child for elective hospitalisation , provide
privacy , thorough nursing history should be obtained for plan of
care , explain the procedures and its purpose , encourage play , self
care and continue schoolwork, ensure parents to cope with their own
anxieties, introduce to other parents in the same unit and consistent
visiting pattern. IN
 ADOLESCENTS:
 Prepare the parents for planned hospital admission , available hospital
facilities should be explained soon after admission, respect the
personal preference on selfcare and food habit , explain all procedure,
provide opportunities for recreation , peer relationships, interaction
with other adolescent patients and expression of feelings.
GRIEF & BEREAVEMENT
 • DEFINITION: - Grief is powerful emotional
reaction to a separation or loss like declining
health, impeding health, death of loved ones
or loss of valuable object. Healthy grieving is
time limited, becoming less intense as time
passed but takes 1 year or more to resolve
fully.
•  BEREAVEMENT:- Bereavement is a state of
being deprived of someone by death & refers
to being in the state of mourning
• MOURNING:- Mourning is the normal
psychological processes that follows the loss
of loved one.
• A short phase of numbness and denial
• Protest marked by intense pining for the
dead
• Disorganization marked by pain and despair
• Detachment and reorganization
Grief is a multi-faceted response to
loss, particularly to
• the loss of someone or something to which a
bond was formed. Although conventionally
focused on the emotional response to loss, it
also has physical, cognitive, behavioral, social,
and philosophical dimensions.
• • The loss may be a person, thing,
relationship, or situation.
• • Bereavement is the reaction of the survivor
to the death of a family member or close
friend.
Children and adolescents may expe
rience grief differently
• from adults
• • They may react differently to the death of
someone close to them or even when
experiencing a loss just from being apart from
their family, whether in a group home or in
foster care.
• When working with children who have
experienced any type of loss, it is important to
be aware of their developmental stage and
any cultural considerations.
 Children’s Grief
• Based on developmental stages
• Can be normal or complicated
• Symptoms unique to children
Factors Influencing the Grief Proces
s
•  Survivor personality
• Coping skills, patterns
• History of substance abuse
• Relationship to deceased
• Spiritual beliefs
• Type of death
• Survivor ethnicity and culture
 5 Stages of Grief 
•  Denial
• Anger
• Bargaining
• Depression
• Acceptance
Long term effects of bereavementon children

• Up to 40% of bereaved children show disturbance

after one year
• 37% of prepubertal children in a recent study had a
major depressive disorder within one year of the
death.
• Longing for reunion is common and may lead to
suicidal thinking in children but not usually acted
on.
• Bereaved children are 5 times more likely to
develop a psychiatric disorder. Coping with Loss:
Bereavement in Childhood
Age Groups
 Birth to 2 years
•  Types of loss would be the death of the primary
caregiver, loss of primary caregiver because of the
birth of a sibling, or removal from primary
environment.
• Sense of security and well being is challenged
• Surroundings are no longer familiar
• Child may display excessive crying, rocking, whining,
biting, and/or other anxiety related behaviours.
• Child may not be able to process death as anything
other that separation anxiety.
 Ages 2 to 5
• May have feelings of sadness, anxiety,
insecurity, irritability and anger.
• Tend to believe that death is a temporary
state that can be reversed.
• May equate death with sleeping or being
gone on a trip.
• Magical thinking may occur.
• Some children will act as if nothing has
happened while others may regress in areas
such as toileting or wanting a bottle.
 Ages 6 to 9
• Are able to understand the biology of death and
comprehend the finality of it.
• May develop fears associated with their own
death or the death of a surviving parent
• Feelings of insecurity may be expressed in a
reluctance to separate from caregivers.
• Some may be hyperactive, aggressive and
disruptive, while others are withdrawn and sad.
• May have nightmares, difficulty sleeping, or
display regressive behaviors.
 Ages 9 to 12
• Understand that death is final and that it
happens to everyone.
• Continuity is important at this age. They
may want to go out and play instead of
talking.
• They may have a strong need to control
their feelings while at the same time
they have great difficulty doing so.
 Ages 13 to 19
•  Adolescents may have difficulty coping with the
loss for months or years
• Want to be in control of their emotions so may
isolate from others.
• May engage in risk taking behaviors such as reckless
driving, drug/alcohol use, sexual promiscuity,
cutting, and/or defiance of authority.
• May become more easily distracted, experience
sleeping and eating disturbances, perform better or
worse in school, and display strong emotional
mood changes.
 Grief Interventions for Survivors
• Provide presence
• Active listening, touch, silence,
reassurance
• Identify support systems
• Normalize & individualize the grief
process • Actualize the loss & facilitate
living without deceased
• Use bereavement specialist and
resources
 Care of child at time of grief
• Remember to be honest and ask what the child wants to
know.
• Allow the child to see your emotions and tears.
• Do not try to fix the child, they need to process on their
own terms.
• Allow them to experience the death if appropriate and
warranted.
• Maintain a regular routine.
• Try not to expect more than they can give.
• Allow children to mourn small losses (pets) and be open to
discussion
 • Give them the opportunity to say goodbye.
• Use concrete terms and use language the child will
understand.
• Do not make promises that are out of your control. 
Difference between child and adult
 INTRODUCTION:
• There are a many differences between
children and adults like physiological,
anatomical, cognitive, social and emotional.
• these all impact on the way illness and
disease present in children and young
people, as well as the way healthcare is
provided.
 classification
• Anatomical and physiological difference
• Systemic difference
• Psychological difference
• Pathological change
• Social and emotional development
• Cognitive development
Anatomical/ physiological changes
• Size- influences the methods and instruments
used in caring children
• Greater size and weight of head in comparison
to body in newborn baby
• Suture of the skull are not united; Brain is not
protected by the skull at fontanel's.
• When ICP increases head enlarges in infants.
• Shape of the head and chest of the infant can
alter by constant pressure by lying in one
position.
 INTEGUMENTARY SYSTEM
• Larger BSA- Children have a proportionately
larger body
•  surface area (BSA) than adults do.
• The smaller the patient, the greater the
ratio of surface area (skin) to size.
• As a result, children are at greater risk of
excessive loss of heat and fluids; children
are affected by more quickly and easily
toxins that are absorbed through the skin.
• Thinner skin- Children have thinner skin than adults.
Their epidermis is thinner and under-keratinized,
compared with adults.
• As a result, children are at risk for increased
absorption of agents that can be absorbed
through the skin.
• Rapidly dividing cells- Children's cells divide
more rapidly than adults to assist in their rapid
rate of growthAs a result, children are more
susceptible to the effects of radiation than adults.
 RESPIRATORY SYSTEM
• Higher RR- Children have higher respiratory rates
than adults. Higher respirator rates lead to
proportionately higher minute volumes.
• As a result, children may be more susceptible
to agents absorbed through the pulmonary
route than adults with the same exposure.
Children may also respond more rapidly to
such agents. Signs and symptoms in children
may be an "early warning" of a chemical,
biological, or radiological incident.
• Fetal lung immature.
• Alveolar surface and weight of adult lung is
about 20 times that of neonate.
• During infancy, respiratory tract is delicate
and do not produce mucus as they do in
childhood.
• Infection travel quicker to other areas
because of the proximity of the Eustachian
tube to the throat.
• Eustachian tube is shorter and straighter in
infants than older child and adult-
infection • Tonsils and adenoids are
large in children and are involved in the
production of immune bodies.
HEART AND CIRCULATORY SYSTEM
• During infancy heart sounds are of higher pitch and
greater intensity than adult life.
• Pulse rate 140 in newborns then it decreases.
• Normal systolic and diastolic BP reading of
children increases with advancing age from
newborn to adolescents.
• Variations in BP occurs more frequently in infants.
• During newborn period ECG is unique because of
the many changes occurring in the heart.
 HEMATOLOGICAL SYSTEM
• RBC of the newborn infants are different from those
of adult- macrocytic.
• Life span of RBC in normal adult is app.
120days but in neonates 90 days.
• • Soon after the birth erythropoietic bone
marrw becomes
• hypoactive- Physiologic anemia which is more
common in premature babies than term
babies. It becomes normal after two months.
 FLUID AND ELECTROLYTE
• Total body water in infants is about 750ml/kg
body weight and in adult 550ml/kg body
weight.
• Proportion of total body water and total
body fat is different in infants and young
children from that in adults.
• Newborns 75-80% of body weight is of
body water where as 60% of body weight
is water in adults.
• Infants retain less body water within the cells than do
adults.
• • Infant has a potentially greater water loss than
the adults. They loose fluid more than adults.
• Fasting infants develop ketosis more quickly
than adults because of their relatively higher
metabolic rates.
• Higher metabolic rate- More susceptible to
contaminants in food or water; greater risk for
increased loss of water and when ill or stressed
 GASTRO INTESTINAL SYSTEM
• Cardiac sphincter of stomach is fairly tight in the adult.In the
infants more relaxed.
• Vomiting is so frequent, hence proper positioning of the
child during feed is so important.
• Gastric emptying time in infants 2-3 hours but in adults 3-6
hours.
• Neonate and infant stool relatively loose as food passes
rapidly.
• Increase motility causes infection and trauma.
• The liver is approximately 4% of body weight in the
newborn, infant and occupies a much larger portion of the
abdominal cavity than in adult life.
 URINARY SYSTEM
• When the infants under stress, kidneys
functional reserves are reduced compared
with those of adults.
• • Young infants cannot concentrate their
urine as well as older children and
adults.
• CRF usually does not follow ARF in child.
• GLOMERULAR FILTRATION RATE:
Concentration of urine in newborn is 800
mOsmol /L whereas in adults it is 1400
mOsmol /L. GFR and tubular functions
are lower in neonates than adult
because low blood supply to kidney,
smaller pore size and less filtration
power across nephrons . GFR- 38 ml/
min (neonate) GFR- 125 ml/min (adult)
 ENDOCRINE SYSTEM
• The levels of growth hormone are greater in
girls and women than in younger children
and men.
• Thyroid hormone levels vary in preterm,
newborns, infants, children and
adolescents.
• Adrenal glands are small during infancy
and have limited function, but their
function increase until puberty.
 REPRODUCTIVE SYSTEM
OVARY: In normal full term baby girl, the ovary is
approximately 10mm in length and 2-4mm
in width. 12-13 years ovulation starts.
• TESTES: Genitalia is small. Begins to enlarge
between 9-13 years of age. Development
completes between 13-17years.
 MUSCULOSKELETAL SYSTEM

• At puberty the male hormone androgen

causes increase muscle size in boys.
• Bone growth takes place after birth until
the end of adolescents.
• The length of the head is one quarter of
total body length in the newborn infant,
about 1/6th in 6year old and about
1/8th in the adult.
 NEUROLOGICAL SYSTEM
• The weight of the brain in neonate 300-
350gram. Doubles the size by 1 year, at
which time its weight is two thirds that of
the adult.
• By 2 years of age, child can perform
motor movement like an adult, but with
less speed and coordination.
• Neonatal eyes are not anatomically
matured.
• TEMPERATURE REGULATION:
• TEMPERATURE REGULATION: Poor
thermo regulation is attributed to
immaturity of the hypothalamus.
• Shivering and sweating mechanisms are
absent in newborn.
 PSYCHOLOGICAL DIFFERENCES
• An infant cannot complain about pain or
localize the pain.
• Older child can successfully
communicate.
• Infants and little children are in general
better patients than adults because they
live in the present, easily forgetting the
past, not concerned about future, and
their attention span is poor.
• Fear , escape and avoid strangers till 5 years of age.
• Explore the environment.
• INFANCY- more bonding with parents.
Separation anxiety is very common.
• TODDLERS – Negativistic behavior
• PRE SCHOOLER- short attention span, easily
distractible .
• ADOLESCENTS- Identity of peer, confusion.
• Medication doses must be carefully calculated
based on the child's weight and body size
• Immature immune systems- Greater risk
of infection; less hard immunity from
some infections.
DIFFERENCES OF ILLNESS IN CHILD
REN AND ADULTS
• Erythroblastosis fetalis only seen in neonates.
• Nutritional disorders commonly seen in
infancy and childhood.
• Curiosity activities can cause accidents in
children.
• Less immunity make cause prone for
infection in children than the adult.
• Failure to thrive seen in children.
Emotional disturbances – conduct disorders,
psychosomatic disturbances seen in
children.