This book is intended to provide an easily comprehensible non-intimidating and concise text on the subject matter of Child Health Nursing to nursing student of all levels. There was a felt need among nursing students and teachers to have text which suits them. Significant changes have been made in the presentation of the subject with the requirement of the nursing students in mind. Subject areas have been regrouped and made more concise and relevant to the needs of the today’s students. The information provided is based on established knowledge and practice. Every attempt has been made to maintain simplicity and lucidity of language and style.

Contents
1. Introduction to Child Health Nursing 1
• Evolution of Child Health Nursing 2
• Rights of the Child 3
• Goals of Children Health 4
• Child Health Movements in India 5
• National Policy for Children 6
Š Maternal and Child Health 9
Š Maternal and Child Health Programs 11
• Reproductive and Child Health Program 13
• Child Welfare Services in India 16
• Nutrition Programs 17
• Integrated Management of Neonatal and
Childhood Illness Strategy 21
• Philosophy of Child Health Nursing 21
• Goals of Child Health Nursing 23
• Role of Pediatric Nurse 24
Š Expanded Roles of Pediatric Nurse 29
• Standards of Care and Professional Performance of
Pediatric Nurse 30
• Current Trends in Child Health Care 31
2. Assessment of Pediatric Client 35
• Health Interview 36
Š Techniques of Obtaining Client History 38
• Physical Examination 43
3. Hospitalized Child 72
• Problems of Hospitalization of Children 72
• Children Reactions to Hospitalization 73
• Factors Affecting Children’s Response to
Hospitalization 75
• Family Reactions to the Hospitalized Child 76
Š Nursing Care for a Hospitalized Child 77
Š Admitting the Child to the Hospital 81
Š Maintaining Safety during Hospitalization 82
Š Providing Basic Care to the Hospitalized Child 85
Š Addressing the Effects of Hospitalization
Developmentally 87
Š Providing Play, Activities and Recreation for
the Hospitalized Child 88
Š Promoting Schoolwork and Education during
Hospitalization 89
Š Addressing the Needs of Family Members 89
4. Genetics and Prenatal Pediatrics 91
• Chromosomes 91
• Traditional Inheritance Pattern 92
• Non-traditional Inheritance Patterns 94
• Conception 98
• Development of the Embryo 99
• Fetal Maturation 104
• Significance of Screening to Families 109
• Prenatal Diagnosis for Genetic Abnormalities 110
• Genetic Evaluation and Counseling 112
• Genetic Counseling 113
• Role of the Nurse in Genetic Counseling 116
5. Growth and Development in Children 123
• Principles of Development 125
• Factors Influencing Growth and Development 130
• Biological Growth and Development
in Children 135
• Intellectual Development in Children 137
• Psychosocial Development in Children 141
Š Moral Development 143
Š Development of Intergroup Attitudes 145
Š Personality Development (Freud) 146
Š Defense Mechanisms (Coping Mechanism) 147
Š Role of Nurses in Psychosocial
Development 148
Š Development of Sexuality 149
• Need for Developmental Assessment 151
• A Summary of Growth and Development 152
• Assessment of Physical Growth 163
Š Growth Monitoring 166
Š Assessment of Development 170
6. Behavioral Pediatrics and Nursing 174
• Child Behavior and Family 174
• Motivation for Parenthood 175
• Preparation for Parenthood 175
• Transition to Parenthood 175
• Parenting Behaviors 177
• Strategies to Minimize Misbehavior and
Maintain Discipline 179
• Strategies for Implementing Discipline 180
• Influence of the ‘Experts’ in Child Rearing 181
• Behavior Problems in Children 182
Š Conduct Disorder 183
Š Oppositional Defiant Disorder 184
Š Pervasive Developmental Disorders 184
Š Autism Spectrum Disorder 185
Š Attention Deficit Hyperactivity Disorder 186
Š Specific Developmental Disorders 189
Š Anxiety Disorders 191
Š Mood Disorders 193
Š Developmental Disorders 195
Š Habit Disorders 196
Š Eating Disorders 197
• Abuse and Violence 198
• Management of Child with Behavioral Problems 200
• Nursing Management of Child with a
Mental Health Disorder 205
7. Community Pediatrics and Nursing 210
• Levels of Prevention 211
• Vital Statistics of Children 211
• National Health Programs 213
Š National Rural Health Mission 2005–2012 213
Š National Programs Related to Mother and
Child Care 215
Š National Programs Related to Control of
Communicable Diseases 230
Š National AIDS and STD Control Program 235
Š Nutritional Programs Related to Control of
Nutritional Deficiencies and Disorders 236
Š National Programs Related to Control of
Non-communicable Diseases 238
Š Under Five Clinics 241
• Areas in Community Pediatrics Requiring
Special Attention 243
Š Child Labor 243
Š Handicapped Child 246
Š Girl Child 247
Š Accidents 249
8. Neonatal Nursing (Normal) 251
• Factors Interfering with on Adjustment of
Normal Full-term Newborn in Each Body System 251
• Physical Characteristics of Newborn 255
• Physiological Characteristics of Newborn 256
• Assessment of Newborn 257
• Care of the Normal Neonate 263
Š Nourishment and Fluids for Newborn 273
Š Love—Parent-Infant Attachment 281
• Special Needs of Neonate 281
• Nursing Management of Normal Newborn 284
9. Neonatal Nursing (High-risk) 290
• Classification of High-risk Neonate 290
• Preterm Newborn 291
• Post-term Newborn 292
• Common Problems of High-risk Newborn 297
Š Apnea of Prematurity/Neonatal Apnea 297
Š Idiopathic Respiratory Distress Syndrome 299
Š Meconium Aspiration Syndrome 301
Š Extraneous Air Syndrome 302
Š Bronchopulmonary Dysplasia 303
Š Pulmonary Dysmaturity
(Wilson-Mikity Syndrome) 304
Š Atelectasis 304
Š Neonatal Sepsis 305
Š Necrotizing Enterocolitis 306
Š Patent Ductus Arteriosus 308
Š Persistent Pulmonary Hypertension of
Neonate 309
Š Physiologic Anemia 310
Š Polycythemia 311
Š Retinopathy of Prematurity 311
• Neurologic Problems of Neonate 312
Š Perinatal Hypoxic-Ischemic Brain Injury 312
Š Germinal Matrix-Intraventricular Hemorrhage 313
Š Intracranial Hemorrhage 314
Š Neonatal Seizures 314
Š Infants of Diabetic Mother 316
Š Narcotic Addiction/Drug Exposed Infants 317
Š Fetal Alcoholic Syndrome 318
• Neonatal Defects in Physical Development 319
Š Defects of Neural Tube Closure 319
Š Spina Bifida 319
Š Hydrocephalus 327
• Problems of Physiologic Factors 331
Š Hyperbilirubinemia 331
Š Blood Incompatibility 333
• Metabolic Complications 336
• Maternal Infections 336
• Congenital Abnormalities 339
• Chromosomal Abnormalities 339
• Defects Caused by Chemical Agents 340
• Inborn Errors of Metabolism 341
• Congenital Hypothyroidism 341
• Phenylketonuria 342
• Galactosemia 344
10. Pediatric Intensive Care Unit 346
• Pediatric Nursing Unit 346
Š Location 346
Š Design 346
Š Introduction to PICU 347
Š Problems at PICU and its Measures 348
Š Organization of PICU 349
Š Human Resource for PICU 350
Š Services of PICU 350
• Techniques of Monitoring Child in PICU 351
Š Evaluation of Ventilatory Status 353
• Cardiopulmonary Resuscitation 355
• Neonatal Care Unit 359
11. Respiratory Nursing in Children 363
• Respiration 363
• Common Symptoms Related to
Respiratory Diseases 365
• Acute Respiratory Infections 367
Š Common Cold (Acute Viral Rhinitis) 367
Š Sinusitis 368
Š Influenza 369
Š Pharyngitis (Acute Sore Throat) 370
Š Tonsillitis 371
Š Infectious Mononucleosis 372
Š Otitis Media 372
Š Tonsils and Adenoids 375
Š Acute Obstructive Laryngitis (Croup) 378
Š Tracheobronchitis 381
Š Epiglottitis 381
Š Bronchiolitis 383
Š Pneumonia 386
Š Bronchitis 391
Š Tuberculosis 391
Š Epistaxis 395
Š Foreign Body Aspiration 396
Š Respiratory Distress Syndrome 396
Š Pneumothorax 397
Š Allergic Rhinitis 398
Š Asthma 399
Š Chronic Lung Disease 408
Š Cystic Fibrosis 408
Š Apnea 411
Š Respiratory Failure 413
12. Gastrointestinal Nursing 419
• Assessment of Gastrointestinal Disorder 420
• General Care for Gastrointestinal Disorders 421
• Diarrheal Diseases in Children 427
Š Acute Diarrhea 427
Š Cholera 435
Š Acute Bacillary Dysentery (Shigellosis) 438
Š Pseudomembranous Colitis (Clostridium
difficile-associated Diarrhea) 438
• Oral Rehydration Therapy 439
• Persistent Diarrhea 440
• Chronic Diarrhea 442
• Oral Candidiasis (Thrush) 445
• Oral Lesions 446
• Vomiting 446
• Dehydration 449
• Anorectal Malformations 450
• Inguinal and Umbilical Hernias 451
• Omphalocele and Gastroschisis 451
• Meckel Diverticulum 452
• Esophageal Atresia and Tracheoesophageal
Fistula 453
• Cleft Lip and Cleft Palate 454
Š Speech, Hearing and Dentition 456
Š Surgical Nursing Management 457
• Hypertrophic Pyloric Stenosis 459
• Rumination 462
• Gastroesophageal Reflux 463
• Appendicitis 467
• Malrotation and Volvulus 468
• Intestinal Obstruction 468
Š Duodenal Obstruction 468
Š Jejunal and Ileal Atresias 469
Š Volvulus 469
• Peptic Ulcer Disease 469
• Intussusception 471
• Constipation 472
• Encopresis 474
• Hirschsprung Disease (Congenital Aganglionic
Megacolon) 476
• Short Bowel Syndrome 477
• Inflammatory Bowel Disease 478
• Crohn Disease 479
• Ulcerative Colitis 480
• Celiac Disease 483
• Recurrent Abdominal Pain 485
• Chronic Abdominal Pain 487
• Pancreatitis 488
• Cholelithiasis 488
• Jaundice 489
• Biliary Atresia 490
• Hepatitis 491
• Cirrhosis and Portal Hypertension 492
• Liver Transplantation 493
13. Reno-urological Nursing 494
• Retroperitoneal Structure 494
• Development of Kidney and Ureter 495
• Assessment of Kidney and Urinary Tract 496
• Assessment of a Child with a Urologic Problem 498
• Urinary Tract Infection 500
• Enuresis 506
• Nephrotic Syndrome 508
• Acute Glomerulonephritis 515
• Chronic Glomerulonephritis 517
• Hemolytic-Uremic Syndrome 518
• Henoch-Schönlein Purpura (Anaphylactoid) 519
• Familial Renal Disease 519
• Renal Failure 520
Š Acute Renal Failure 520
Š Chronic Renal Failure 523
• Dialysis and Transplantation 525
Š Continuous Ambulatory Peritoneal Dialysis 527
Š Hemodialysis in Children 528
Š Renal Transplantation 529
14 Cardiovascular Nursing 534
• Assessment of Cardiovascular System 535
• Congenital Heart Disease 542
• Tetralogy of Fallot 545
• Tricuspid Atresia 546
• Atrial Septal Defect 548
• Ventricular Septal Defect 549
• Atrioventricular Canal Defect 550
• Patent Ductus Arteriosus 551
• Coarctation of the Aorta 553
• Aortic Stenosis 554
• Pulmonary Stenosis 555
• Transposition of the Great Vessels Arteries 557
• Total Anomalous Pulmonary Venous
Connection 558
• Truncus Arteriosus 559
• Hypoplastic Left Heart Syndrome 561
• Nursing Management of the Child with
Congenital Heart Disease 562
• Cardiac Surgery in Children 563
• Nursing Management of Cardiac
Surgery in Children 565
• Heart Failure 576
• Congestive Heart Failure 576
• Infective Endocarditis 584
• Acute Rheumatic Fever 585
• Cardiomyopathy 586
• Hypertension 587
• Kawasaki Disease 590
• Hyperlipidemia 591
• Atherosclerosis 592
• Heart Transplantation 593
• Nursing Care of the Child with a
Cardiovascular Disorder 595
15. Endocrinological Nursing 600
• Assessment of a Child with an Endocrine
Problem 601
Disorders of Endocrine Gland 604
• Disorders of Pituitary Gland 604
Š Anterior Pituitary Primary Disorders 604
Š Posterior Pituitary Disorders 608
• Disorders of Thyroid 611
Š Congenital Hypothyroidism 611
Š Acquired Hypothyroidism (Juvenile
Hypothyroidism) 613
Š Hyperthyroidism 615
Š Transient Neonatal Thyrotoxicosis 617
• Disorders of Parathyroid 618
Š Hypoparathyroidism 618
Š Hyperparathyroidism 619
• Adrenal Disorders 619
Š Congenital Adrenal Hyperplasia 619
Š Addison’s Disease 621
Š Cushing Syndrome 622
Š Hyperaldosteronism 623
Š Tumors of the Adrenal Medulla 623
Š Polycystic Ovary Syndrome 624
Š Diabetes Mellitus 625
• Nursing Management of the Child with
Endocrine Disorders 629
16. Neuromusculoskeletal Nursing 634
• Neurological Examination of Children 635
• Congenital Neuromuscular Disorders 636
• Acquired Neuromuscular Disorders 637
Š Spina Bifida 637
Š Meningocele 637
Š Anencephaly 638
Š Hydrocephalus 638
Š Myelomeningocele 640
• Muscular Dystrophy 643
• Muscular Hypotonia in Infancy
(Floppy Infant Syndrome) 647
• Arthrogryposis Multiplex Congentia 647
• Spinal Muscular Atrophy 648
• Spinal Cord Injury 649
• Birth Trauma 650
• Guillain-Barre Syndrome 650
• Myasthenia Gravis 652
• Dermatomyositis 653
• Botulism 654
• Skeletal Disorders in Children 657
Š Congenital Malformations 657
Š Skeletal Dysplasias 662
Š Osteogenesis Imperfecta 662
Š Osteopetrosis 664
Š Infantile Cortical Hyperostosis
(Caffey-Symth-Roske Syndrome) 664
Š Legg-Calve-Perthes Disease 665
Š Osteomyelitis 666
Š Pyogenic Arthritis 666
Š Septic Arthritis 667
Š Non-rheumatic Arthritis 667
Š Transient Synovitis of the Hip 668
Š Scoliosis 668
Š Skeletal Injuries 670
Š Sprains 674
Š Overuse Syndromes 674
Š Dislocated Radial Head 675
Š Trauma Related to Birth 675
Š Sports Injuries 676
Š Casts and Cast Application 678
Š Assisting with Cast Removal 680
Š Skin Care 681
Š Traction 681
Š Care of the Child in Traction 683
17. Oncological Nursing 688
• Etiology 688
• Diagnostic Tests 689
• Chemotherapy in Cancer and Nursing 692
• Radiation Therapy in Cancer and Nursing 698
• Nursing Management for the Child with a
Neoplastic Disorder 700
• Leukemia 705
• Lymphomas 708
• Hodgkin Disease 708
• Brain Tumors 712
• Neuroblastoma 714
• Bone and Soft-tissue Tumor 716
• Osteogenic Sarcoma 716
• Wilms’ Tumor 723
• Retinoblastoma 725
• Histiocytosis X 728
• Other Malignant Tumors of Childhood 729
• Cancers in Adolescents 730
18. Hematological Nursing 736
• Anemia 736
Š Iron Deficiency Anemia 736
Š Folic Acid Deficiency and Pernicious Anemia 739
Š Aplastic Anemia 739
• Lead Poisoning 741
• Bone Marrow Transplant 741
Š Hypoplastic Anemia 746
• Hemoglobinopathies 746
Š Sickle Cell Disease 746
Š Thalassemia Major 754
Š Thalassemia Minor 754
• Leukocytosis 756
• Coagulation and its Abnormalities 758
Š Clotting Disorders 758
Š Assessment of Hemostasis 759
Š Thrombocytopenia 759
Š Henoch-Schönlein Purpura 761
Š Disseminated Intravascular Coagulation 762
Š Hemophilia 762
Š Von Willebrand Disease 767
19. Dermatological Nursing 768
• Infectious Disorders of the Skin 769
• Bacterial Infections 769
Š Paronychia 770
Š Cellulitis 770
• Parasitic Infections 773
Š Pediculosis 773
Š Scabies 773
Š Fungal Infections 774
• Hypersensitivity Reactions of the Skin 777
Š Atopic Dermatitis (Eczema) 777
Š Contact Dermatitis 782
Š Diaper Dermatitis 783
Š Intertrigos 785
Š Miliaria 785
Š Erythema Multiforme 785
Š Urticaria 786
Š Seborrheic Dermatitis 786
Š Psoriasis 787
Š Acne 788
Š Pressure Ulcers 789
Š Minor Injuries 790
Š Burns 790
Š Sunburn 795
Š Cold Injury 796
Š Human and Animal Bites 796
Š Insect Stings and Spider Bites 797
• Developmental Defects of Skin in Children 800
20. Ophthalmological Nursing 803
• Assessment of the Eye 803
• Care of the Normal Eye 804
• Conjunctivitis and its Management 804
• Nasolacrimal Duct Obstruction and its Management 806
• Eyelid Disorders and their Management 806
Š Chalazion 806
Š Stye 806
Š Ptosis 807
Š Blepharitis 807
Š Coloboma 807
• Periorbital Cellulitis 807
• Eye Injuries and their Management 808
• Managing Emergent Conditions 810
• Emergency Treatment for Eye Injuries 810
• Visual Disorders 812
Š Refractive Errors 813
Š Hyperopia (Hypermetropia, Farsightedness) 813
Š Myopia (Nearsightedness) 813
Š Astigmatism 815
Š Strabismus (Squint) 815
Š Dacryocystitis 817
Š Xerophthalmia 817
Š Amblyopia 818
Š Nystagmus 818
Miscellaneous Disorders 819
Š Tips for Ophthalmic Medications 819
Š Prevention of Ocular Problems in Childhood 820
Š Infantile Glaucoma 820
Š Congenital Cataract 821
Š Visual Impairment 821
Š Red Eye 823
Š Membranous Conjunctivitis 823
Š Uveitis 824
Š Watering 824
Š Lid Edema 824
Š Proptosis 824
Š Congenital Anomalies 825
Š Acute Glaucoma 825
Š Retinoblastoma 825
21. Otological Nursing 827
• Otitis Media 827
Š Acute Otitis Media 827
Š Otitis Media with Effusion 829
• Otitis Externa 830
• Hearing Loss 831
• Assessment of Hearing Disorders 832
Š Criteria for Infants at High Risk for Hearing Loss 833
Š Nursing Management 833
22. Dental Health Nursing 840
• Assessment of Oral Cavity 840
Š Development of Teeth 841
Š Eruption of Teeth 841
Š Functions of Primary Dentition 842
• Dental Caries 843
Š Early Childhood Caries 844
Š Dental Caries of the Dentin 845
• Disorder of Teeth 846
• Dietary Guidelines to Prevent Dental Caries 848
• Periodontal Disease in Children 849
Š Chronic Gingival Diseases 850
• Dental Malocclusion 851
• Injuries of the Teeth 852
Š Fractured Roots 852
• Prevention of Dental Disease 853
• Dental Health Care for Children at Home 853
23. Developmental Disturbances in Children 855
• Learning Disability (Dyslexia) 855
• Childhood Autism 857
• Attention Deficit Hyperactivity Disorder 859
• Enuresis (Bedwetting) 862
• Conduct Disorder 863
• Oppositional Defiant Disorder 866
24. Challenged Child and Nursing 867
• Handicapped Child 867
• Cerebral Palsy 870
• Mental Retardation 875
• Medically Fragile Child 881
• Failure to Thrive 886
25. Nursing Intervention in Crisis 890
• Meaning 890
• Characteristics 891
• Responses to Dying and Death 893
• Nurse’s Reaction 894
• Child’s Understanding of Death 895
Š Family’s Reaction 897
• Settings for Care of the Dying Child 899
Š Nursing Management 902
26. Pediatric Medications 905
• Actions of Drugs on the Body 906
• Pharmacokinetics 907
• Routes of Administration 908
• Medication Orders 909
• Legal Aspects of Medication 909
• Administering Medications 910
• Nurse’s Responsibility in the
Administration of Medications 911
• Abbreviations Used in Medication 913
• Drug Dosage Calculations 915
• Calculating Dosage 915
• Common Drugs and Drug Dosage
Used in Pediatrics 916
• Drug Therapy in Newborn 924
• Administration of Fluids and Electrolytes 931
27. Common Child Health Nursing Procedures 936
• Hospitalization of a Child 936
• Preadmission Programs 936
• Hospital Policies 937
• Parent Participation 938
• Nursing Procedures 939
Š Administering a Tepid Water
Administering an Enema to a child 940
Š Teaching the Mother for
Breastfeeding Procedure 941
Š Breastfeeding the Ill or Hospitalized Infant 942
Š Infant Formula and Bottle Feeding 942
Š Weaning 945
Š Nasogastric Feeding 945
Š Gastrostomy Feeding 947
Š Nasojejunal Feeding 948
Š Specimen Collection 950
Š Assisting with Collection of
Blood Specimen 953
Š Catheterization of the Urinary Bladder 959
Š Twenty-four Hour Urine Collection from
Small Children 959
Š Stool Examination 961
Š CSF Examination 963
Š Assisting with a Spinal Tap (Lumbar Puncture) 964
Š Maintenance of Fluid and Electrolyte for
Infants and Children 965
Š Total Parenteral Nutrition (Hyperalimentation) 968
Š Assisting with Exchange Transfusion 971
Š Chest Physiotherapy 974
Š Assisting the Child with Coughing 975
Š Suctioning 976
Š Care of a Child with Tracheostomy 978
Š Oxygen Therapy for Children 980
Š Continuous Positive Airway Pressure 983
Š Preservation of Shunt and Separation of the
Cannula 986
Š Cardiopulmonary Resuscitation in Children 988
• Artificial Respiration 990
Š Technique for Artificial Respiration 990
Š External Cardiac Massage 992
Š General Principles 992
• Administration of Medication and Fluids 993
Š Intramuscular Injection 993
Š Subcutaneous Injection 993
Š Intradermal Injection 994
Š Venipuncture 994
Š Intravenous Infusion 995
Š Scalp Vein Infusion 995
Š Umbilical Vein Catheterization 997
Š Arterial Puncture 998
Š Intraosseous Infusion 998
Š Subcutaneous Infusion 999
Š Intraperitoneal Infusion 999
Š Rectal Infusion 1000
Š Bone Marrow Aspiration 1000
Š Subdural Puncture or Tap 1002
Š Ventricular Tap 1003
Š Pericardiocentesis 1004
Š Abdominal Paracentesis 1004
Š Suprapubic Bladder Aspiration 1005
Š Heel Puncture 1005
Š Kidney Biopsy 1006
Š Intubation 1007
Š Phototherapy 1007
Š Exchange Transfusion 1008
Š Lymph Node Biopsy 1008
• Cardiac Resuscitation 1010
28. Nursing Process in Child Health Nursing 1015
• Nursing Process 1015
• Steps of Nursing Process 1016
Š Assessment 1017
Š Nursing Diagnosis 1019
Š Planning 1020
Š Implementation 1022
Š Evaluation 1023
Index 1037

• A comprehensive and concise text on the subject.

• Covers syllabus prescribed by the statutory bodies.

• Contains chapters on topics, such as management of specific disorders, pathophysiology, clinical manifestations, assessment and diagnosis, medical and nursing management.

• Presents the nursing care plans to clarify the nurses’ responsibility in caring for children with specific disorders.

• Includes the common procedures related to child health nursing.