Pediatric Nursing

Pediatric nursing requires specialized knowledge of childhood growth and development, age-specific physiological differences, pediatric disease processes, medication dosing, and family-centered care. Children are not simply small adults — their anatomical, physiological, and psychosocial characteristics differ significantly from adults, and these differences profoundly affect nursing assessment, intervention, and communication. In the UAE, pediatric nurses work in diverse settings including neonatal intensive care units (NICUs), pediatric wards, pediatric emergency departments, and community health centers. The HAAD examination tests pediatric nursing to ensure nurses can provide safe, competent, developmentally appropriate care to children from neonates through adolescence.

Growth and Development

Understanding normal growth and development is essential for assessing whether a child is developing appropriately and for identifying deviations that may indicate underlying pathology.

Growth Parameters

Weight: Most sensitive indicator of nutritional status and health. Infants should double their birth weight by 4–5 months and triple it by 12 months. Average weight gain: 25–30 g/day for first 3 months, 20 g/day for months 3–6, 10–15 g/day for months 6–12.

Length/Height: Infants grow approximately 25 cm in the first year; grow about 12 cm in the second year; thereafter, they grow approximately 6 cm/year until puberty.

Head Circumference: Reflects brain growth. At birth, HC is about 33–35 cm. It increases by about 12 cm in the first year (reaches ~47 cm). Fontanelles (soft spots) close by: anterior fontanelle by 18 months; posterior fontanelle by 2 months.

Milestones of Growth:

• 0–1 month: Rooting, sucking, grasping reflexes present; Head lag when pulled to sit
• 2 months: Lifts head slightly when prone; social smile
• 4 months: Holds head steady when held upright; reaches for objects; rolls front to back
• 6 months: Sits with support; babbles; transfers objects; Stranger anxiety begins
• 9 months: Sits alone steadily; crawls; pulls to stand; pincer grasp
• 12 months: Stands alone; walks with support; says 1–3 words; wave bye-bye
• 15 months: Walks alone; builds tower of 2 blocks
• 18 months: Runs; builds tower of 3–4 blocks; 10–15 words
• 2 years: Runs well; climbs stairs; 2–3 word sentences; toilet training begins
• 3 years: Tricycle; catches ball; knows full name; preschool activities
• 4–5 years: Hops; skips; knows colors; tells stories; can draw a person

Developmental Theories

Erikson’s Psychosocial Development:

• Infant (0–1): Trust vs. Mistrust — develops sense of security through consistent caregiving
• Toddler (1–3): Autonomy vs. Shame/Doubt — developing independence; “terrible twos”
• Preschool (3–6): Initiative vs. Guilt — developing purpose and direction
• School-age (6–12): Industry vs. Inferiority — developing competence and skills
• Adolescent (12–18): Identity vs. Role Confusion — developing sense of self

Piaget’s Cognitive Development:

• Sensorimotor (0–2): Learning through senses and motor actions; object permanence develops around 8–9 months
• Preoperational (2–7): Symbolic thought; egocentrism; intuitive rather than logical thinking
• Concrete Operational (7–11): Logical thought about concrete objects; conservation
• Formal Operational (11+): Abstract and hypothetical thinking

Pediatric Assessment

Assessing children requires modified techniques and awareness of age-appropriate norms. Key differences from adult assessment:

Vital Signs by Age:

Age	HR (bpm)	RR (br/min)	Systolic BP
Newborn	100–160	30–60	60–80
1–12 months	80–140	24–40	80–100
1–3 years	80–130	20–30	90–105
3–6 years	70–110	18–24	95–110
6–12 years	60–100	16–22	100–120
>12 years	60–100	14–20	110–130

Respiratory rate: Count for a full 60 seconds in infants (irregular and more rapid than adults).

Blood pressure: Cuff size is critical — bladder width should be at least 40% of arm circumference; too small → falsely elevated.

Approach to the child:

• Infants: Assess first while quiet (before disturbing with painful procedures); use parent’s voice and presence for comfort
• Toddlers: Allow some control; use simple explanations; do not separate from parent unless absolutely necessary; offer choices; reward cooperation
• Preschoolers: Concrete explanations (use dolls to demonstrate); fear of bodily harm is common; allow comfort items
• School-age: Can understand explanations; respect their sense of privacy; involve in care decisions; explain procedures clearly
• Adolescents: Respect privacy and independence; same-sex examiner preferred for genital examination; maintain confidentiality

Common Pediatric Conditions

Bronchiolitis (especially RSV)

Most common in infants < 2 years. Causative agent: Respiratory Syncytial Virus (RSV) — most common cause. Presents with URI symptoms progressing to lower respiratory tract involvement: tachypnea, wheezing, cough, retractions, poor feeding, irritability. Peak severity at days 3–5; resolves in 7–21 days.

Nursing management: Supportive care — oxygen (if SpO₂ < 90–92%); suctioning (nasal); adequate hydration (small, frequent feeds — IV fluids if unable to feed); humidified oxygen; acetaminophen for fever. Ribavirin (antiviral) is occasionally used for high-risk infants (premature, congenital heart disease).

Asthma (in children)

Common chronic disease in children; leading cause of school absences. Presentation: episodic wheezing, cough (especially at night), dyspnea, chest tightness.

Management: See Medical-Surgical Nursing chapter for asthma management. In UAE, dust mite allergy is a major trigger (common in desert environment).

Febrile Seizures

Most common seizures in children (6 months to 6 years). Associated with rapid temperature rise (usually > 39°C). Simple febrile seizure: Generalized, < 15 minutes, single in 24 hours, no neurological abnormalities afterwards. Complex febrile seizure: Focal, > 15 minutes, multiple in 24 hours, or neurological deficits post-ictally.

Management: Reassure parents — most febrile seizures are benign and do not cause brain damage or lead to epilepsy. Treat underlying cause of fever. Antipyretics for comfort (though they do not prevent febrile seizures). If seizure is prolonged (> 5 minutes), administer benzodiazepine (midazolam IM/intranasal or diazepam PR).

Gastroenteritis and Dehydration

Most common cause of diarrhea in children: Rotavirus (in infants and young children); norovirus (all ages). Leading cause of death in children < 5 worldwide is diarrheal disease — mainly dehydration.

Assessment of dehydration (WHO classification):

• No dehydration: < 5% weight loss; normal HR, mucous membranes, skin turgor
• Some dehydration: 5–10% weight loss; restless/irritable; sunken eyes; thirst; decreased skin turgor
• Severe dehydration: > 10% weight loss; lethargic/unconscious; very sunken eyes; unable to drink; very decreased skin turgor

Oral Rehydration Solution (ORS): WHO-ORS contains glucose, sodium chloride, trisodium citrate, potassium chloride. For mild-moderate dehydration: ORS 75 mL/kg over 4 hours + maintenance. For severe dehydration: IV Ringer’s lactate 100 mL/kg (30 mL/kg bolus over 30 min for shock, then 70 mL/kg over 2.5 hours).

Meningitis

Inflammation of the meninges. Most common in children < 5 years. Signs:

• Neonates/infants: Irritability, lethargy, poor feeding, vomiting, temperature instability (hypo- or hyperthermia), bulging fontanelle, high-pitched cry
• Older children: Headache, neck stiffness (meningismus), photophobia, vomiting, altered consciousness, fever, positive Brudzinski’s sign (neck flexion causes hip flexion), positive Kernig’s sign (pain on extending flexed knee with hip flexed)

Nursing management: Immediate assessment (ABC); airway and breathing support if needed; IV antibiotics (empiric: ceftriaxone + vancomycin + dexamethasone before or with first antibiotic dose); isolation precautions; seizure precautions; neurological monitoring; fluid management (careful — cerebral edema risk).

⚡ Exam tip: Anterior fontanelle closes by 18 months; posterior fontanelle closes by 2 months. Febrile seizures are the most common type of seizure in children aged 6 months to 6 years — they are benign but frightening to parents. For pediatric dehydration, ORS is first-line for mild-moderate dehydration; IV fluids are needed for severe dehydration. Meningitis in neonates presents differently from older children — watch for nonspecific signs like irritability and poor feeding rather than classic meningeal signs.

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