Pediatric Nursing – Key Vocabulary

School-Age Child (6 – 12 yr)

Physical & Biological Development

• Growth pace varies significantly among children, influenced by GENETICS, NUTRITION, and ACTIVITY levels.

• Loss of deciduous (primary) teeth begins around 6 years, followed by the eruption of permanent teeth.

• Increasing body-awareness develops as physical changes occur; onset of puberty is possible towards the later end of this age range (9 ext{–}12 yr for girls, 10 ext{–}14 yr for boys), bringing secondary sexual characteristics.

Motor Milestones

• Gross motor skills become smoother, stronger, and more refined over time, allowing for participation in complex sports and activities.

  • Recommend at least 1 ext{ h} daily of moderate-to-vigorous physical activity to support healthy development and prevent obesity.

• Fine motor skills continue to refine, evidenced by improved handwriting, independent dressing, ability to perform intricate chores, and engaging in more detailed art projects.

• Wide variation in motor skill acquisition is normal, but it is crucial to monitor a child's progress and refer for further evaluation when milestones are unmet to identify potential developmental delays.

Cognitive / Language / Play

• The school environment becomes central to a child's life and cognitive development.

  • In early grades (K-2), emphasis is on rules, routines, and concrete thinking.

  • Around Grade 3 (8 ext{–}9 yr), children begin to develop more abstract and complex reasoning abilities, including problem-solving and critical thinking.

• Language development progresses rapidly.

  • Children typically begin reading around 5 ext{ yr}, becoming independent readers by 10 ext{–}12 ext{ yr}.

  • Vocabulary expands significantly, and they are able to understand and use more complex sentence structures.

• Play involves a mix of structured activities (e.g., organized sports, board games) and unstructured, highly active play (e.g., running, playing make-believe), which fosters social, emotional, and physical development.

Psychosocial Issues

• Peer acceptance and school success are crucial in shaping Erikson's developmental stage of “Industry vs. Inferiority.” Children strive for competence and achievement in school and social groups.

• Self-esteem is largely built from academic success, positive peer relationships, and consistent parental support and encouragement.

  • High self-esteem is associated with better adaptation to challenges, improved mental health, and greater academic achievement.

• Body-image concerns begin to emerge, with 40 ext{%–}50 ext{%} of school-age children expressing dissatisfaction with their bodies, influenced by media and peer comparisons.

• Sexual identity and orientation begin to form between 10 ext{–}17 ext{ yr}, along with the evolution of gender roles and relationship ideals.

• Discipline should involve clear rules and boundaries, consistent application of logical consequences, and positive reinforcement, which promotes healthy cognitive development and mental health.

Stress & Fears

• Children face multiple pressures from school, peers, and family expectations. They often somaticize stress, presenting with physical symptoms like headaches (HA), gastrointestinal (GI) upset (e.g., stomachaches, nausea), and tachycardia (rapid heart rate).

• Behavioral manifestations of stress can include anxiety, regression (e.g., bedwetting), avoidance of school or social situations, nightmares, and changes in appetite or sleep patterns.

Bullying

• Bullying behavior typically peaks in middle school years, with approximately 1/3 of children reporting victimization.

• Outcomes for victims can include physical injury, increased risk of depression, school absenteeism, and psychosomatic complaints.

• Prevention strategies are multifactorial:

  • Whole-school policies that clearly prohibit bullying and outline consequences.

  • Social-emotional learning (SEL) curricula to teach empathy, conflict resolution, and self-regulation.

  • Increased adult supervision in common hotspots like hallways, playgrounds, and cafeterias.

  • Peer-support programs that empower students to intervene and support victims.

  • Digital citizenship training to address cyberbullying and safe online practices.

School Health & Safety

• Healthy learners are foundational to improved academic performance and overall well-being.

• School health programs often encompass areas such as:

  • Nutrition education and healthy meal options.

  • Promotion of physical activity.

  • Support for students with chronic health conditions (e.g., asthma, diabetes) including medication administration and emergency plans.

  • Implementation of social-emotional learning (SEL) programs.

  • Provision of on-site health services (e.g., school nurse, counseling).

• Injury-prevention topics commonly addressed include:

  • Bicycle safety (helmet use).

  • School bus safety.

  • Firearm safety and safe storage.

  • Internet and social media safety (e.g., avoiding predators, cyberbullying).

Nutrition & Activity Guidelines

• Energy needs vary significantly based on age, sex, and activity level, ranging from 1200 ext{–}2600 ext{ kcal d}^{-1}.

• MyPlate serving recommendations for school-age children:

  • Vegetables: 1 ext{–}3.5 ext{ c}

  • Fruits: 1 ext{–}2 ext{ c}

  • Grains: 3 ext{–}9 ext{ oz}

  • Dairy: 2 ext{–}3 ext{ c}

  • Protein foods: 2 ext{–}6.5 ext{ oz}

• Added sugar intake should be less than 10 ext{%} of total daily calories.

• Sodium intake should be less than 1500 ext{ mg d}^{-1}.

• Sleep guidelines recommend 9 ext{–}12 ext{ h night}^{-1} for optimal health and cognitive function.

Selected Population Health Concerns

• Substance use: Initiation of substance use, including alcohol and tobacco, can occur as early as 10 ext{ yr}. A significant number (8.7 million children) live with a caregiver affected by a Substance Use Disorder (SUD).

• Learning disabilities: Affect approximately 5 ext{%} of the world's child population and 10 ext{%} in the US. Early identification and intervention are essential for academic success.

• ADHD (Attention-Deficit/Hyperactivity Disorder): Typically has an onset before 12 ext{ yr}. Diagnosis criteria include persistent symptoms (inattention, hyperactivity, impulsivity), present in multiple settings (e.g., home and school), and causing significant impairment in functioning.

• Obesity: Affects approximately 18.5 ext{%} of children, with boys aged 6 ext{–}11 having a higher prevalence than girls in the same age group. Annual BMI (Body Mass Index) checks are crucial for monitoring growth trends.

• Food insecurity: Affects about 10.3 ext{%} of households with children, leading to potential nutritional deficiencies and health problems.

• Dental Caries (Cavities): More than 40 ext{%} of children aged 2 ext{–}19 yr have experienced dental caries, highlighting the need for regular dental check-ups and good oral hygiene.

• Nocturnal enuresis (bedwetting): Present in about 10 ext{%} of 7-year-olds; often resolves spontaneously but can be managed with behavioral interventions or medication if persistent.

• Encopresis: Involuntary fecal soiling, often stemming from chronic constipation and stool retention. Requires comprehensive management including diet, hydration, toileting routines, and occasional laxatives.

• PTSD (Post-Traumatic Stress Disorder), anxiety, and depression: These mental health conditions can manifest in school-age children and require thorough assessment, appropriate therapy (e.g., CBT, play therapy), and sometimes medication.

Nursing Process — Across Topics

• The nursing process provides a systematic approach to care: Recognize Cues → Analyze Cues → Prioritize Hypotheses → Generate Solutions → Take Action → Evaluate Outcomes. This framework applies universally across all pediatric health topics.

Gastrointestinal System Highlights

(Each disorder slide set contained the same analytic headings; key points below focus on distinguishing features)

Common Presentations

• Vomiting: A common symptom that carries a significant risk of dehydration in children.

  • Assessment: Evaluate emesis character (bilious, non-bilious, bloody), timing (post-feeding, cyclic), and associated weight loss.

  • Treatment: Oral Rehydration Solutions (ORS) are first-line for mild-moderate dehydration. Antiemetics (e.g., ondansetron) may be used in severe cases, and it's critical to identify and treat the underlying cause.

• Diarrhea:

  • Acute: Viral (e.g., rotavirus, norovirus) or bacterial (e.g., Salmonella, Shigella, E. coli) in origin. Characterized by sudden onset and typically resolves within 14 ext{ d}. Stool studies (culture, O&P, C. difficile toxin) may be screened for in severe or persistent cases.

  • Chronic: Lasts longer than 14 ext{ d}. Often indicative of malabsorption disorders (e.g., Celiac disease, lactose intolerance), Inflammatory Bowel Disease (IBD), or chronic non-specific diarrhea. Requires thorough growth assessment to evaluate for nutritional impact.

• Constipation / Encopresis: Characterized by a stool retention cycle, where painful defecation leads to withholding, resulting in harder, larger stools. Management includes education on high-fiber diet, adequate hydration, establishment of a regular toileting routine, and occasional use of laxatives (e.g., polyethylene glycol) to relieve impaction and facilitate regular bowel movements.

• Dehydration Types: Classification based on serum sodium levels ( ext{Na}^+).

  • Isotonic Dehydration: Most common type in pediatric patients, where water and sodium are lost in equal proportions. Serum Na^+ is 130 ext{–}150 ext{ mEq L}^{-1}. Treatment typically involves rapid intravenous fluid bolus of Isotonic Normal Saline (NS) at 20 ext{ mL kg}^{-1} over 20 minutes.

  • Hypotonic Dehydration: Sodium loss is greater than water loss, resulting in serum Na^+ < 130 ext{ mEq L}^{-1}. Can be caused by excessive intake of plain water or inappropriate use of hypotonic fluids. Requires careful rehydration to avoid rapid fluid shifts.

  • Hypertonic Dehydration: Water loss is greater than sodium loss, leading to serum Na^+ > 150 ext{ mEq L}^{-1}. Carries a higher neurological risk (e.g., seizures, cerebral edema) if rehydrated too rapidly, necessitating cautious rehydration over a longer period.

Structural / Surgical Conditions

• Cleft Lip vs Palate: Congenital anomalies resulting from failure of facial structures to fuse during embryonic development, typically around 5 ext{–}8 ext{ wk GA}.

  • Cleft Lip: Affects the lip. Primarily cosmetic but can impact feeding. Repaired surgically, usually within the first few months of life (often around 3 ext{ months of age}).

  • Cleft Palate: Affects the roof of the mouth. Has significant impacts on feeding (difficulty creating suction), speech development, and increased risk of recurrent otitis media due to Eustachian tube dysfunction. Requires staged repair, often between 6 ext{–}18 months.

• Pyloric Stenosis: Hypertrophy and hyperplasia of the pyloric muscle leading to gastric outlet obstruction. Classic presentation is projectile non-bilious vomiting in infants, typically between 2 ext{–}8 ext{ wk} of age. On examination, an "olive-shaped" mass may be palpable in the right upper quadrant. Treatment is surgical pyloromyotomy (Ramstedt procedure).

• Intussusception: A condition where one segment of the bowel telescopes into another, causing obstruction and potentially ischemia. Classic presentation includes sudden onset of acute, colicky abdominal pain, drawing knees to chest, and passing "currant-jelly" stools (mucus and blood). Diagnosis and often reduction are achieved with an air or contrast enema.

• Appendicitis: Inflammation of the vermiform appendix. Common presentation starts with periumbilical pain that migrates to the Right Lower Quadrant (RLQ). Associated symptoms include anorexia, nausea/vomiting, and low-grade fever. Risk of perforation significantly increases if not treated within 48 ext{ h} of symptom onset, leading to peritonitis.

Functional / Inflammatory

• GER (Gastroesophageal Reflux): Physiologic in most infants, characterized by effortless spitting up.

• GERD (Gastroesophageal Reflux Disease): Occurs when GER symptoms are severe enough to cause complications such as Failure to Thrive (FTT), apnea, esophagitis, or recurrent respiratory infections. Management includes elevating the head of the bed, thickening feeds, and sometimes pharmacotherapy like PPIs (proton pump inhibitors) for severe cases.

• IBD (Inflammatory Bowel Disease): Chronic inflammatory conditions of the GI tract, primarily Crohn's Disease and Ulcerative Colitis (UC). Growth failure is common due to chronic inflammation and malabsorption. Treatment involves corticosteroids to reduce inflammation, immunomodulators, and biologics to induce and maintain remission.

• IBS (Irritable Bowel Syndrome): A functional abdominal pain disorder characterized by recurrent abdominal pain altered by defecation. Management focuses on diet modifications (e.g., low FODMAP diet), stress management techniques, and symptom-based pharmacological interventions.

• Celiac Disease: An autoimmune disorder characterized by an abnormal immune response to gluten (proteins found in wheat, barley, and rye) in genetically predisposed individuals. Diagnosed by positive tissue Transglutaminase IgA (tTG IgA) antibodies and intestinal biopsy. Requires life-long adherence to a strict gluten-free diet.

Failure to Thrive (FTT)

• Defined as weight less than the 5^{th} percentile for age, or a drop of more than 2 major percentiles from the child's established growth curve. Can be organic (due to an underlying medical condition) or non-organic (due to environmental or psychosocial factors, such as inadequate caloric intake or neglect).

• Nursing role is comprehensive:

  • Obtaining a detailed diet history and feeding assessment.

  • Providing extensive parent teaching on appropriate feeding techniques and caloric needs.

  • Meticulously monitoring weight trends and other growth parameters.

  • Collaborating with an inter-professional team (e.g., dietitian, social worker, developmental specialist).

Genitourinary System Overview

Normal A&P Pearls

• Kidneys are vital organs that filter blood to produce urine, each containing approximately 1 ext{ million} nephrons. The concentrating ability of the kidneys is immature until approximately 2 years of age, making infants and young children more susceptible to dehydration.

Infection & Inflammation

• UTI (Urinary Tract Infection) Spectrum:

  • Asymptomatic Bacteriuria: Presence of bacteria (>10^{5} ext{ CFU/mL}) in the urine without symptoms.

  • Acute Cystitis: Infection localized to the bladder, presenting with dysuria, frequency, urgency, and suprapubic pain, typically without fever or flank pain.

  • Pyelonephritis: Infection of the renal pelvis and kidney parenchyma, characterized by fever, chills, flank pain, and systemic signs of illness. Requires prompt treatment to prevent renal scarring.

  • Recurrent UTIs: Defined as ext{ extgreater}=2 febrile UTIs or ext{ extgreater}=3 total UTIs (febrile and/or afebrile) in a 6 month period.

• Glomerulonephritis: Often occurs post-streptococcal infection (e.g., pharyngitis, impetigo), typically 1 ext{–}3 weeks after the initial infection. Classic signs include hematuria, which gives the urine a characteristic "tea-cola" appearance, periorbital edema, and hypertension. Management is supportive.

• Nephrotic Syndrome: A clinical syndrome characterized by significant proteinuria ( ext{ extgreater}3.5 ext{ g day}^{-1}), leading to hypo-albuminemia (low serum albumin), generalized edema (especially periorbital and scrotal/labial), and hyperlipidemia. It commonly responds to corticosteroid therapy, but relapses are frequent.

Congenital Anomalies (CAKUT)

• CAKUT (Congenital Anomalies of the Kidney and Urinary Tract) are structural abnormalities that can affect any part of the genitourinary system. Examples include:

  • Cryptorchidism: Undescended testes.

  • Bladder Exstrophy: Bladder protrudes outside the abdominal wall.

  • Epispadias/Hypospadias: Urethral opening is on the dorsal (epispadias) or ventral (hypospadias) surface of the penis/urethra.

  • Hydrocele: Fluid collection around the testicle.

  • Phimosis: Foreskin cannot be retracted over the glans penis.

  • VUR (Vesicoureteral Reflux): Backflow of urine from the bladder into the ureters and potentially kidneys.

  • Hydronephrosis: Swelling of the kidney due to urine buildup.

• Early detection and intervention of CAKUT are crucial to prevent progressive renal damage and preserve fertility, especially in conditions like cryptorchidism.

Kidney Injury

• AKI (Acute Kidney Injury): A rapid onset condition characterized by a sudden rise in BUN (Blood Urea Nitrogen) and Creatinine (Cr) levels, often accompanied by oliguria (decreased urine output).

  • Causes: Can be pre-renal (e.g., dehydration, poor perfusion), intra-renal (e.g., acute tubular necrosis, glomerulonephritis), or post-renal (e.g., obstruction) in origin.

• CKD (Chronic Kidney Disease): Defined as impaired Glomerular Filtration Rate (GFR) lasting for more than 3 months. Complications in children include growth and bone disorders (renal osteodystrophy), anemia, and cardiovascular issues. It can progress to ESRD (End-Stage Renal Disease), requiring dialysis or kidney transplant.

Tumors

• Wilms Tumor (Nephroblastoma): A common kidney tumor in children, often presenting as an asymptomatic flank mass. Crucially, abdominal palpation should be avoided post-diagnosis due to the risk of tumor rupture and seeding. Treatment typically involves nephrectomy (surgical removal of the kidney) followed by chemotherapy.

• Germ Cell Tumors: Can occur in testicular, ovarian, or extragonadal sites (e.g., mediastinum, sacrococcygeal). Specific tumor markers like Alpha-Fetoprotein (AFP) and beta-human chorionic gonadotropin (eta ext{-hCG}) are used for diagnosis and monitoring.

Musculoskeletal & Neuromuscular

Soft-Tissue Injuries

• Contusion: A bruise resulting from direct trauma, causing bleeding into soft tissues without breaking the skin. When assessing, it's important to look for NAT (Non-Accidental Trauma) red flags, such as suspicious patterns, varying stages of healing, or inconsistency between history and injury.

• Sprain (ligament) vs Strain (muscle/tendon):

  • Sprain: Injury to a ligament (connects bone to bone), often caused by twisting or hyperextension of a joint.

  • Strain: Injury to a muscle or tendon (connects muscle to bone), often due to overuse or overstretching.

• Dislocation: Complete displacement of joint surfaces from their normal alignment. Requires urgent reduction by a healthcare professional to restore alignment and protect neurovascular (NV) status by preventing compression of nerves or blood vessels.

• Overuse Injuries: Common in active children due to repetitive stress on growing bones and soft tissues. Examples include:

  • Sever’s Disease (Calcaneal Apophysitis): Inflammation of the growth plate in the heel, common in active adolescents.

  • Osgood-Schlatter Disease: Inflammation of the patellar ligament at its insertion point on the tibial tuberosity, common in jumping sports.

  • Treatment: Primarily rest, physical therapy (PT) to strengthen surrounding muscles, and activity modification.

Fractures

• Pediatric bone has unique characteristics: it is more porous, more flexible, and has a thicker periosteum (outer membrane), leading to unique fracture patterns like:

  • Greenstick fractures: Incomplete breaks where the bone bends and splinters, but doesn't break all the way through.

  • Buckle (Torus) fractures: Compression injury causing a bulge in the bone's cortex.

• Physeal injuries (Salter-Harris fractures) affect the growth plate and carry a significant risk of growth arrest and limb length discrepancy if not properly managed.

• Care for fractures involves:

  • Reduction: Realigning the bone fragments (closed or open reduction).

  • Immobilization: Maintaining alignment using a cast, splint, traction, or external fixator.

• Compartment syndrome: A serious complication characterized by increased pressure within a confined muscle compartment, compromising circulation. Classic "5 ext{ Ps} " signs include:

  • Pain (out of proportion to injury, unrelieved by analgesia)

  • Pallor (paleness)

  • Paresthesia (numbness or tingling)

  • Pulselessness (diminished or absent pulses - a late sign)

  • Paralysis (loss of function - a very late sign)

Infections & Bone Disorders

• Osteomyelitis: Bacterial infection of the bone, most commonly caused by Staphylococcus aureus. Requires prolonged course of intravenous (IV) antibiotics for 4 ext{–}6 ext{ wk}. Surgical debridement may be necessary.

• Osteogenesis Imperfecta (OI): A genetic disorder characterized by a defect in collagen type I production, leading to extremely fragile bones that fracture easily. Other classic signs include blue sclera (bluish tint to the whites of the eyes) and small stature. Management includes bisphosphonates to increase bone density, and extensive safety teaching to prevent fractures.

• Legg-Calvé-Perthes Disease: Avascular necrosis of the femoral head, commonly affecting boys aged 4 ext{–}8 years. Characterized by a limp and limited hip abduction and internal rotation. Treatment involves containment therapy (e.g., bracing) to maintain the femoral head within the acetabulum.

• SCFE (Slipped Capital Femoral Epiphysis): Although not detailed in the provided notes, it is another important hip disorder to keep in mind for adolescents, where the femoral head slips posteriorly and inferiorly at the growth plate, often presenting with hip or knee pain and a limp.

Spinal & Hip Disorders

• Scoliosis: Lateral curvature of the spine. School-based screening programs are common to detect early signs. Bracing is recommended for Cobb angles between 25^{ extdegree} ext{–} 45^{ extdegree} to prevent further progression. Surgery (>45 ext^{ extdegree} Cobb angle) may be considered for severe curves.

• Developmental Dysplasia of the Hip (DDH): Abnormal development of the hip joint. Early detection is paramount. Clinical screening tests in infants include Barlow's maneuver (to dislocate a reducible hip) and Ortolani's maneuver (to reduce a dislocated hip). The Pavlik harness is the primary treatment for infants younger than 6 ext{ mo}.

• Clubfoot (Congenital Talipes Equinovarus - CTEV): A congenital deformity where the foot is twisted inward and downward. The most common treatment is the Ponseti casting series, a non-surgical method involving serial casting, followed by a brace (foot abduction orthosis) to maintain correction.

Chronic Arthropathies & Auto-Immune

• JIA (Juvenile Idiopathic Arthritis): A chronic autoimmune inflammatory disease affecting joints in children under 16 years of age. Different types exist:

  • Oligoarthritis: Affects <5 joints, typically large joints.

  • Polyarticulitis: Affects >5 joints, often small joints symmetrically.

  • Systemic JIA: Affects joints and causes systemic symptoms like fever and rash.

  • Treatment: Involves NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), DMARDs (Disease-Modifying Anti-Rheumatic Drugs), and physical therapy to preserve joint function.

• SLE (Systemic Lupus Erythematosus) in pediatric patients: A chronic autoimmune disease that can affect multiple organ systems. Management involves sun protection to prevent photosensitivity, corticosteroids for acute flares, and immunosuppressant medications to control disease activity.

Neuromuscular

• Cerebral Palsy (CP): A non-progressive motor disorder caused by brain injury or abnormal brain development occurring during fetal development or early childhood. Spastic CP, characterized by increased muscle tone and hyperreflexia, is the most common type. Early and consistent physical and occupational therapy (PT/OT) is crucial. Medications like baclofen may be used to reduce spasticity.

• Hypotonia (Floppy Baby Syndrome): Decreased muscle tone, which can be a symptom of many underlying etiologies, including genetic disorders (e.g., Down Syndrome, Prader-Willi Syndrome) and neuromuscular diseases (e.g., Spinal Muscular Atrophy).

• SMA (Spinal Muscular Atrophy): A genetic disorder characterized by progressive motor neuron loss, leading to muscle weakness and atrophy. Revolutionary new gene therapies, such as onasemnogene abeparvovec (Zolgensma), have significantly improved outcomes.

• Muscular Dystrophy: A group of genetic disorders characterized by progressive muscle weakness and degeneration. Duchenne Muscular Dystrophy (DMD) is the most common type, an X-linked recessive disorder caused by a lack of dystrophin (a muscle protein). Management includes corticosteroid therapy, and ongoing cardiac and respiratory support as the disease progresses.

Amputation & Prosthetics

• Amputations in children can be congenital (present at birth) or traumatic (due to injury).

• Post-operative pain management, including phantom limb pain, is crucial.

• Early prosthetic fitting is highly beneficial for a child's development, promoting mobility, body image, and independence.

Mobility Aids

• Education on the proper use and safety of mobility aids (crutches, canes, walkers, wheelchairs) is essential.

• Promoting peer inclusion and adapting environments to accommodate mobility aids helps children participate fully in school and social activities.

Integumentary System

Skin Basics

• The skin is the largest organ of the body, serving multiple vital functions:

  • Protection: Acts as a barrier against pathogens, UV radiation, and physical trauma.

  • Fluid Balance: Prevents excessive water loss from the body.

  • Thermoregulation: Helps regulate body temperature through sweating and vasodilation/vasoconstriction.

  • Sensation: Contains nerve endings for touch, pain, temperature, and pressure.

• It consists of three main layers:

  • Epidermis: The outermost protective layer.

  • Dermis: Contains connective tissue, hair follicles, sweat glands, and nerve endings.

  • Hypodermis (Subcutaneous Tissue): Deeper layer composed of fat and connective tissue, providing insulation and cushioning.

Contact Dermatitis Group

• Irritant/Allergic Contact Dermatitis: Caused by direct contact with an irritating substance (e.g., detergents, chemicals) or an allergen (e.g., poison ivy, nickel).

  • Treatment: Remove the offending agent, apply cool compresses for symptom relief, topical corticosteroids for inflammation. Systemic prednisone may be required for severe, widespread reactions.

• Diaper Dermatitis (Diaper Rash): Common inflammatory skin condition in the diaper area.

  • Treatment: Frequent diaper changes (every 2 ext{–}3 ext{ h}), use of barrier creams containing zinc oxide or petroleum.

  • Consider Candida infection if satellite lesions (small red papules beyond the main rash) are present; this requires topical antifungal agents like nystatin.

• Seborrheic Dermatitis (“Cradle Cap”): A self-limited, greasy, scaly rash primarily on the scalp of infants. Management often involves emollients (e.g., mineral oil) applied before gentle brushing to loosen scales, followed by a mild shampoo. Anti-fungal shampoo may be used if severe or persistent.

• Atopic Dermatitis (“Eczema”): A chronic, relapsing inflammatory skin condition, part of the "atopic triad" (eczema, asthma, allergic rhinitis). Characterized by intensely itchy, dry, red skin. Management focuses on skin hydration (e.g., frequent moisturizing, lukewarm baths), dilute bleach baths to reduce bacterial colonization, topical corticosteroids to reduce inflammation, and antihistamines for pruritus.

Medication Reactions

• Exanthematous drug eruption: The most common type of drug reaction, characterized by a widespread, symmetric, maculopapular rash, typically appearing a few days after drug initiation. Management involves discontinuing the causative drug, providing symptomatic relief (e.g., antihistamines, topical steroids), and educating on future avoidance of the drug.

Bites & Stings

• Insect Bites: Most cause localized reactions (redness, swelling, itching). However, some can cause anaphylaxis (severe allergic reaction).

  • Treatment for Anaphylaxis: Immediate intramuscular (IM) administration of epinephrine (0.01 ext{ mg kg}^{-1} with a maximum dose of 0.3 ext{ mg}).

• Tick Bites: Can transmit diseases like Lyme disease.

  • Lyme Disease: Characterized by a distinctive erythema migrans ("bull's-eye") rash. Treatment for children older than 8 years is doxycycline 4 ext{ mg kg}^{-1} ext{/day}; amoxicillin is typically used for younger children.

• Animal/Human Bites: Carry a high risk of bacterial infection.

  • Management: Thorough wound cleansing. Assess tetanus status (Tdap vaccine as indicated) and rabies risk (based on animal type and exposure). Prophylactic antibiotics (e.g., amoxicillin-clavulanate/augmentin) are often prescribed due to polymicrobial risk.

Miscellaneous Skin Disorders

• Psoriasis: A chronic inflammatory skin condition characterized by well-demarcated erythematous plaques with silvery scales. Management includes topical steroids, phototherapy, and systemic biologics for severe cases. Trigger management (e.g., stress, infections) is also important.

• Acne Vulgaris: A common inflammatory skin condition affecting hair follicles and sebaceous glands, classified by grades 1 ext{–}4 based on severity. Treatments include:

  • Topical benzoyl peroxide to reduce bacteria and unclog pores.

  • Topical retinoids (e.g., tretinoin) to normalize follicular keratinization.

  • Topical or oral antibiotics to reduce bacterial load and inflammation.

  • Isotretinoin (oral): A potent retinoid reserved for severe nodulocystic acne due to significant side effects. Requires strict adherence to the iPLEDGE program (to prevent pregnancy due to teratogenicity) and close monitoring for side effects like severe dryness and depression.

• Cellulitis: A bacterial infection of the dermis and subcutaneous tissue, typically caused by Staphylococcus aureus or Streptococcus pyogenes. Presents as a rapidly spreading area of erythema, warmth, pain, and swelling. Requires systemic antibiotics, and careful monitoring for signs of sepsis.

• Burns: Classified by depth (superficial, partial-thickness, full-thickness) and TBSA (Total Body Surface Area) involvement. Lund-Browder chart is used for accurate TBSA estimation in children due to their different body proportions compared to adults.

  • Fluid Resuscitation: Crucial for severe burns (e.g., partial-thickness >10 ext{% TBSA}). The Parkland formula (4 ext{ mL} imes ext{kg} imes ext{%TBSA} of lactated Ringer's solution administered over the first 24 ext{ h}, with half given in the first 8 ext{ h}) is commonly used.

  • Nutrition: Patients with burns have significantly increased caloric and protein needs to support wound healing and prevent catabolism.

Cross-Cutting Nursing Roles & Teaching Themes

• Use developmentally appropriate communication strategies: employing play, visual aids (pictures), and simple, concrete language when interacting with children and explaining procedures or conditions.

• Incorporate family-centered care, recognizing the family as the constant in the child's life, and culturally competent care that respects diverse beliefs and practices. Empower caregivers as active partners in decision-making and care delivery.

• Emphasis on prevention: This includes promoting safety gear (e.g., helmets, car seats), ensuring up-to-date immunizations, guiding on healthy nutrition and regular exercise, conducting mental health screening, and educating on sun protection.

• Provide psychosocial support: Address emerging issues like body image concerns, teach effective coping mechanisms for stress, encourage school participation, and facilitate healthy peer relationships.

• Develop comprehensive education plans: Provide clear, concise instructions for home care, explain the purpose and correct dosage of medications, teach caregivers when to seek professional help (warning signs), and provide specific return-to-play or activity guidelines after injury or illness.

Key Numerical / Formula Reminders

• Oral Rehydration Solution (ORS) for mild dehydration: Administer 50 ext{ mL kg}^{-1} of ORS over 4 ext{ h}.

• Maintenance IV fluids for pediatric patients ( Holliday-Segar formula, 100, 50, 20 rule):

  • For the first 10 ext{ kg} of body weight: 100 ext{ mL kg}^{-1} ext{ per day} (4 ext{ mL kg}^{-1} ext{ per hour})

  • For the next 10 ext{ kg}: 50 ext{ mL kg}^{-1} ext{ per day} (2 ext{ mL kg}^{-1} ext{ per hour})

  • For any remaining weight above 20 ext{ kg}: 20 ext{ mL kg}^{-1} ext{ per day} (1 ext{ mL kg}^{-1} ext{ per hour})

• Blood Pressure (BP) cuff sizing: The width of the BP cuff bladder should be approximately 40 ext{%} of the arm circumference (midpoint between acromion and olecranon), and the bladder length should be 80 ext{%} of the arm circumference.

• BMI (Body Mass Index) percentiles for children:

  • Overweight: BMI ext{ extgreater}=85^{th} percentile to <95^{th} percentile for age and sex.

  • Obese: BMI ext{ extgreater}=95^{th} percentile for age and sex.

(End of consolidated study notes)