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HISTORY OF PEDIATRICS
ANCIENT WORLD
It is believed that childcare was somewhat like that still found in isolated tribes
living in the world today.
Psychologist consider childcare during those times as almost ideal.
Childhood is a period of relative freedom and preparation for adulthood.
ANCIENT CIVILIZATIONS (3000 BC TO 500 AD)
In the ancients of Egypt, India and China, children were reared in the traditions
passed down from the previous generations.
The practice of medicine combined both medical knowledge and magic.
In ancient Jews, hygienic measures greatly influenced the maternal and childcare.
Widespread acceptance of infanticide.
MEDIEVAL WORLD (450 TO 1350 AD)
Prevalent diseases – Influenza, Leprosy
Death rate was high among children
In 787 AD, the first known infant asylum or hospital was founded in Italy.
RENAISSANCE AND EARLY MODERN WORLD (1350-1800 AD)
2 books influenced the practice of pediatric medicine in 16th century.
Thomas Phaer, the father of English Pediatrics wrote the “Broke of Children” and in
Germany Felix Wurtz wrote the “Children’s Book”.
St. Vincent de Paul, the “Patron Saint of Orphans” aroused the interest of the public
in the care of children.
In the early modern period – Industrial Revolution
Many advances in science, medicine and literature.
In England, Edward Jenner developed the small pox vaccine.
William Harvey discovered the circulation of blood.
Rosseau wrote his famous book “Emile” which included a section on rights of
children.
MODERN WORLD
Remarkable changes happened
1. Scientifically gained knowledge
People are curious about themselves and the world around them.
The scientific method was applied.
Purification of water supplies and sanitary waste and sewage disposal.
Pasteurization of commercial milk supplies.
Testing of milk cows for tuberculosis.
Immunization programs against communicable diseases.
Development and mass production of antibiotics and other drugs.
Maternal and child health programs that include free food and medical care.
Laws to control child labor and childcare facilities.
Counseling and recreation programs.
2. Humanitarianism - is the idea that all people are created with an inherit dignity and value.
Childcare throughout the World
1946 – the chief international organization concerned with child welfare was
established and was called United Nation International Children’s emergency Fund
(UNICEF)
Goal: to meet the distress of children caused by widespread disasters.
Programs:
- Training primary health workers
- Providing vaccines for immunizations, drugs, medical supplies and oral
rehydration salts for supplemental nutrition.
- Assists with water and sanitation projects and indigenous food procurement.
1948, the World Health Organization (WHO) was established as the major
international organization.
Various organizations and individuals within nations have initiated projects to assist other
people to the world such as:
- Peace Corps: technical advisors, educators and medical personnel are sent to
underdeveloped countries to work with people to improve their lives.
- Project Hope: is devoted to medical teaching and treatment and is staff entirely by
volunteers.
Other milestone in child welfare
- 1959: Declaration of the Rights of the child adopted by the UN General Assembly.
- 1979: International Year of the Child
- 1985: International Youth Year designated by the UN
THEORIES OF G & D
THEORY
A systematic statement of principles that provides a framework for explaining
some phenomenon.
Developmental theories provide road maps for explaining human
development.
DEVELOPMENTAL TASK – a skill or a growth responsibility arising at a particular time in
an individual’s life, the achievement of which will provide a foundation for the
accomplishment of future tasks.
ERIKSON’S THEORY OF
PSYCHOSOCIAL DEVELOPMENT
His theory stresses the importance of culture and society in personality development.
Main tenet of his theory – person’s social view of himself/herself is more important than
instinctual drives in determining behavior, allows for a more optimistic view of the
possibilities for human growth.
While Freud looked at ways mental illness develops, Erikson looked at actions that lead to
mental health.
Erikson describes eight developmental stages covering the entire life span.
ERIKSON’S STAGES OF CHILDHOOD
STAGES/AGE DEVELOPMENTAL TASK
INFANT Sense of trust vs mistrust. Child learns to love and be loved.
(Birth to 18 months)
TODDLER Autonomy vs shame. Child learns to be independent and make
(18 months to 3 decisions for self.
years)
PRESCHOOLER Initiative vs guilt. Child learns how to do things (basic problem
(3 to 6 years) solving) and that doing things is desirable.
SCHOOL-AGE (6 to 12 Industry vs inferiority. Child learns how to do things well.
years)
ADOLESCENCE Identity vs role confusion. Adolescents learn who they are and what
(12 to 20 years) kind of person they will be by adjusting to a new body image,
seeking emancipation from parents, choosing a vocation and
determining a value system.
YOUNG ADULT Intimacy vs isolation.
(20 to 25 years) Develop commitments to others and to a life work (career)
ADULTHOOD Generativity vs self-absorption/Stagnation
(25 to 45 years) Establish a family and become productive
SENESCENCE Ego integrity vs disgust and despair
(45+ years) View one’s life as meaningful and fulfilling
Formal operations 11+ years Able to see relationships and to reason in the abstract
KOHLBERG’S STAGES OF
MORAL DEVELOPMENT
Developed a theory on the way children gain knowledge of right and wrong or moral
reasoning.
He described changes in thinking about moral judgments and reflected social norms and
values.
He was interested in the underlying rationale for the moral decisions rather than the
decision itself.
He also believed the process of moral development was influenced by:
Internal factor includes: empathy, intelligence, impulse control, ability to judge.
External factors includes: rewards, punishment, family structure, parent/perr
contracts.
KOHLBERG’S STAGES OF MORAL DEVELOPMENT
LEVEL AND STAGE DESCRIPTION
Level I: Preconventional Authority figures are obeyed (self-centered orientation)
Age 4 to 10 years Misbehavior is viewed in terms of damage done.
Stage 1: Punishment & obedience A deed is perceived as “wrong” if one is punished; the
orientation activity is “right” if one is not punished.
Stage 2: Hedonistic and “Right” is defined as acceptable to and approved by the self.
instrumental orientation When actions satisfy one’s needs, they are “right”.
Level II: Conventional Cordial interpersonal relationships are maintained. (able to
see victim’s perspective)
Age 10 to 13, but can go into Approval of other’s is sought through one’s action.
adolescence
Stage 3: Good boy/girl orientation Authority is respected.
Stage 4: Law-and-order Individual feels “duty-bound” to maintain social order.
orientation Behavior is “right" when it conforms to the rules.
Weaning
Readiness develops during 2nd half of the first year because of pleasure from receiving
food by a spoon and desire for more freedom and control over body and environment.
Gradually replace one bottle at a time with cup and finally end with a nighttime bottle.
After 6 months, wean directly to a cup.
Immunizations against diseases
Immunizations – the process whereby a person becomes immune or able to resist
diseases.
It serves to be the safest, most effective and least expensive, method of preventing
illness.
Active immunity – the person produces its own antibodies.
Passive immunity – when readymade antibodies are injected into an individual to provide
immediate immunity to some diseases, which is temporary.
Contraindications
Severe febrile illness
Has an altered immune system
Has a history of allergic response prior to vaccination
Recently acquired passive immunity like blood transfusion, immunoglobulin (antibodies).
Common vaccines
BCG – preliminary dose: 1-14 months; booster dose: school entry.
Diphtheria, Pertusis, Tetanus (DPT) – P: 2, 4, 6 months / B1: 1 year after / B2: 4-6 years.
Hepa B vaccine – P: 0,1,6 months / B: 5 years after.
Polio – P: 2,4,6 months / B1 – 1 year after / B2 – 4-6 years.
Measles – P: 9 months as order / B1 – 15 months / B2 – 5-12 years.
Mumps, Rubella (German measles) – MMR – 12 months as order / B – 5 to 12 years after.
Varicella (Chicken pox) – 1st dose: 9 months to 12 years / 2nd dose: 13 years.
Meningococcemia
Hemophilus Influenza B (HIB) – 2 months to 5 years.
Dental health
Usually starts from lower front incisors at about 6 months of age.
It’s normal to see teething begins as early as 3-4 months or as late as 1 year old.
The child will experience some discomforts when teething like: crankiness, restlessness,
temporary loss of appetite.
Management: give the child something to chew on such rubber teething ring in order to
relieve sore gums.
During this period multivitamins containing fluoride maybe given.
THE IMPORTANCE OF PLAY
Play is an excellent stress reducer and tension reliever.
Play provides a source of diversional activity, alleviating separation anxiety.
Play provides the child with a sense of safety and security.
Developmentally appropriate play fosters the child’s normal G & D, especially for children
who are repeatedly hospitalized for chronic conditions.
Play puts the child in the driver’s seat, allowing him to make choices and giving him a
sense of control.
FUNCTIONS OF PLAY
1. Physical and motor development
2. Social development
3. Emotional expression
4. Intellectual education
5. Development of moral values
6. Recreational
Criteria for judging the suitability of toys:
1. Safety – the most important
2. Compatibility or suitability to:
Child age
Level of development
Experience
3. Usefulness
Challenge to the development of the child
Enhancing personality, social and moral development
Expressing emotions
Achieving mastery
Developing creativity
Implementing therapeutic procedures
Means to cope with fears
ILLNESS AND HOSPITALIZATION
A. REACTIONS TO ILLNESS
There are no general findings regarding the response of preverbal children to illness or
fear of bodily injury.
Younger infants respond to pain with generalized body responses including, loud crying
and some facial gestures.
Older infants respond with generalized body responses and deliberate withdrawal of the
stimulated area, loud crying, facial gestures and anger and physical resistance.
B. REACTIONS TO HOSPITALIZATION
Infants under age 3 months tolerate short-term hospitalization well if provided with a
nurturing person who meets their physical needs consistently.
Between 4 and 6 months infants begin to recognize mother and father as separate from
self (known as “stranger anxiety”); therefore, infants at this age may also experience
separation anxiety when hospitalized.
NURSING MANAGEMENT
1. Provide general interventions
Spend time with parents within the infant’s sight so the baby identifies you as safe
person.
Allow the parents to provide as much of the care as possible.
Follow the infant’s home schedule (eg, feeding times and bedtime) as closely as
possible.
Provide sensorimotor stimulation
2. Provide physical comfort and safety interventions
Keep the infant warm and dry
Meet hunger needs consistently
Ensure safety
3. Provide cognitive interventions
Provide a variety of stimulating toys (eg, mobiles, music boxes, busy boxes, rattles)
Promote language development (eg, make sounds and talk to infants)
Encourage learning through sensorimotor experience (eg, allow repetition of acts
and a variety of toys and textures for manipulation)
4. Provide psychosocial and emotional interventions
Maintain a good relationship with parents of children in all age groups, encouraging
them to give care, hold the child, play with the child and room in with the child as
appropriate.
Maintain consistent staffing
Promote a sense of security (eg, handle gently, cuddle, talk and respond to cues)