Chapter 14 Health Problems of Early Childhood Copyright

Chapter 14 Health Problems of Early Childhood Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved.

Sleep Problems Initiation of sleep, staying asleep Nightmares or terrors Elaborate rituals Media use Consequences of sleep disturbances Cultural differences Ø Co-sleeping Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 2

Ingestion of Injurious Agents Cosmetics and personal care products Cleaning products Plants Foreign bodies, toys, and miscellaneous substances Hydrocarbons (gasoline) Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 3

Principles of Emergency Treatment Poison control center Ø Call first, before initiating any interventions Assessment Gastric decontamination Induce vomiting, absorb toxin, or perform gastric lavage depending on agent ingested Ø Ipecac not recommended for in-home use Ø Activated charcoal usage Ø Prevent recurrence Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 4

Heavy Metal Poisoning Most common is lead ingestion Mercury toxicity (less frequently) Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 5

Lead Poisoning Most common by peeling lead-based paint Microparticles of lead contaminate bare soil Can be inhaled or ingested Affects renal, hematologic, and neurologic systems; developing brain and nervous systems are especially vulnerable Relationship between lead anemia Long-term effects—behavioral and cognitive Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 6

Effects of Lead on Body Systems Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 7

Lead Poison Screening and Treatment Rarely symptomatic Venous blood sample of 10 mcg/dl Screening for lead poisoning at ages 1 and 2 years Chelation therapy with Ø Ø Ø Calcium disodium edetate (EDTA)—IV or IM British antilewisite—IM (along w/EDTA) Succimer (DMSA)—Oral Prognosis Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 8

Child Maltreatment Intentional physical abuse or neglect Emotional abuse or neglect Sexual abuse of children Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 9

Types of Neglect Physical neglect Ø Emotional neglect Ø Deprivation of food, clothing, shelter, supervision, medical care, and education Lack of affection, attention, and emotional nurturance Emotional abuse—destroy or impair child’s self-esteem Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 10

Physical Abuse Deliberate infliction of physical injury on a child Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 11

Abusive Head Trauma “Shaken baby syndrome”, “Inflicted traumatic head injury, ” “Neuroinflicted brain injury” Intracranial bleeding (subdural and subarachnoid) Retinal hemorrhages Fractures of ribs and long bones Most often there are no signs of external injury Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 12

Munchausen Syndrome by Proxy Caregiver fabricates signs and symptoms of illness in child (the proxy) to gain attention from medical staff Child may undergo needless and painful procedures and treatments— 10% of cases may be fatal to the child Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 13

Factors Predisposing to Physical Abuse Parental characteristics Ø Ø Parental low self-esteem Inadequate maternal functioning Single parents with limited support Unrelated partners Characteristics of the child Environmental characteristics Ø Ø Ø Social isolation, poor support systems Stressful situations Unrelated caregivers Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 14

Sexual Abuse Defined as “the use, persuasion, or coercion of any child to engage in sexually explicit conduct (or any simulation of such conduct) or producing visual depiction of such conduct, or rape, molestation, prostitution, or incest with children” Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 15

Characteristics of Abusers and Victims Typical abuser is a male the victim knows but may be ANYONE All socioeconomic backgrounds Risk factors putting children at risk: Ø Ø Ø Parental unavailability Lack of emotional closeness and flexibility Social isolation Emotional deprivation Communication difficulties Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 16

Nursing Care of the Maltreated Child Identify abusive situations as early as possible History pertaining to the incident Physical evidence of maltreatment Pattern or combination of indicators that arouses suspicion and further investigation Ø Protect child from further abuse Ø Support the family Ø Plan for discharge Ø Prevention Ø Copyright © 2015, 2011, 2007, 2003, 1999 by Mosby, Inc. , an imprint of Elsevier Inc. All rights reserved. 17