Chapter 11: Pediatric Nursing — Growth, Development, and Child Health

Pediatric nursing requires adapting all aspects of care to the child’s developmental stage. What is normal for an adult may be pathological in an infant, and vice versa. Family-centered care — involving parents and caregivers as partners — is the foundation of pediatric nursing.

Growth and Development Theories

Erikson’s Psychosocial Stages

Age	Stage	Task	Nursing Implication
Infant (0–1 yr)	Trust vs. Mistrust	Consistent caregiving → trust	Minimize separations; involve parents
Toddler (1–3 yr)	Autonomy vs. Shame/Doubt	Control over own body	Offer limited choices; use play
Preschool (3–6 yr)	Initiative vs. Guilt	Exploring, purposeful activity	Explain procedures simply; allow “helping”
School age (6–12 yr)	Industry vs. Inferiority	Mastery of skills	Explain rationale; involve in care
Adolescent (12–18 yr)	Identity vs. Role Confusion	Self-identity	Privacy; confidentiality; peer norms

Piaget’s Cognitive Development

• Sensorimotor (0–2 yr): learns through senses; object permanence develops
• Preoperational (2–7 yr): magical thinking, egocentrism; cannot understand abstract causation
• Concrete Operational (7–12 yr): logical thinking about concrete events; understands cause and effect
• Formal Operational (12+ yr): abstract reasoning; can understand disease mechanisms

Pediatric Assessment Triangle (PAT)

The PAT provides a rapid 30-second across-the-room assessment:

1. Appearance: tone, interactivity, consolability, look/gaze, speech/cry (TICLS)
2. Work of Breathing: abnormal sounds (stridor, grunting, wheezing), retractions, nasal flaring, abnormal positioning
3. Circulation to Skin: pallor, mottling, cyanosis

A child who is sick in all three components is in cardiopulmonary failure.

Fever Management

Fever: rectal temperature ≥ 38.0°C (100.4°F) in infants, or oral ≥ 37.8°C in older children.

Infants < 3 months: fever is a medical emergency — sepsis must be ruled out. No antipyretics until fully evaluated.

Antipyretics:

• Acetaminophen: 10–15 mg/kg PO/PR q4–6h; safe from birth
• Ibuprofen: 5–10 mg/kg PO q6–8h; safe from 6 months; avoid in dehydration (renal risk)
• Aspirin is CONTRAINDICATED in children (Reye’s syndrome risk)

Vaccination Schedule (Key Milestones)

Age	Vaccines
Birth	HepB #1
2 months	DTaP, IPV, Hib, PCV, RV, HepB #2
12–15 months	MMR, Varicella, PCV #4, Hib #4
4–6 years	DTaP #5, IPV #4, MMR #2, Varicella #2
11–12 years	Tdap, HPV, MenACWY

Pediatric Medication Dosing

Pediatric doses are weight-based (mg/kg). Clark’s Rule (old) and weight-based dosing are standard. Always verify:

• Double-check weight (kg, never pounds)
• Use a length-based resuscitation tape (Broselow) in emergencies
• Maximum dose: never exceed adult dose even if weight-based calculation exceeds it

Key Checklist

• Match Erikson’s developmental stage to the appropriate nursing approach for a 2-year-old and a 10-year-old during a painful procedure
• Describe the Pediatric Assessment Triangle components and explain when each finding suggests a life-threatening emergency
• State why aspirin is contraindicated in children and identify the two preferred antipyretics with age restrictions