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Chapter 30 Basic Pediatric Nursing Care
History of Child Care?Then and Now
  • Industrializion in America
  • Population shifted from rural to urban settings.
  • People lived in overcrowded and unsanitary
  • Children were looked at as little adults and
    worked in factories 12 to 14 hours a day.
  • They had no legal rights and there were no work

History of Child Care?Then and Now
  • 1860 Dr. Abraham Jacobi, a New York physician
    referred to as the father of pediatrics, first
    lectured to medical students on the special
    diseases and health problems of children.
  • At milk stations, infants were weighed and
    mothers were taught how to prepare milk before
    giving it to their babies.
  • Late 1800s Increasing concern developed for the
    social welfare of children, especially those who
    were homeless or employed as factory laborers.

History of Child Care?Then and Now
  • Lillian Wald founder of public health or
    community nursing
  • Early 1900s Children with contagious diseases
    were isolated from adult patients parents were
    prohibited form visiting.
  • 1940s Famous works of Spite and Robertson on
    institutionalized children the effects of
    isolation and maternal deprivation were
  • 1909 White House Conference on Children focused
    on issues of child labor, dependent children, and
    infant care.
  • 1912 U.S Childrens Bureau was established.

History of Child Care?Then and Now
  • 1919 First funded program for mothers and
  • 1929 Depression caused conditions for children
    to decline, once again
  • 1987 National Commission on Children formed
    served as a forum on behalf of the children of
    the nation
  • Children are the focus of many reform initiatives
    in the twenty-first century, and solutions will
    emphasize collaboration among various disciplines.

Pediatric Nursing
  • Purpose of Pediatric Nursing
  • Preventing disease or injury
  • Assisting all children, including those with a
    permanent disability or health problem, to
    achieve and maintain an optimum level of health
    and development
  • Treating and rehabilitating children who have
    health deviations

Pediatric Nursing
  • Must enjoy working with children of all ages
  • Family-centered nursing in its truest sense
  • Must have keen observation skills
  • Support children through difficult procedures or
  • Requires establishing a level of trust
  • Must convey respect, talk at their level, and be
  • Function as a child and family advocate
  • Ability to communicate effectively essential

Pediatric Nursing
  • Children with Special Needs
  • Infants and children may have congenital
    abnormalities, malignancies, gastrointestinal
    disease, or central nervous system anomalies.
  • With appropriate services and support, even
    children with very severe disabilities are living
    at home with their families and attending school
    with their peers.

Pediatric Nursing
  • A philosophy of care that recognizes the family
    as the constant in the childs life and holds
    that systems and personnel must support, respect,
    encourage, and enhance the strengths and
    competence of the family
  • Nurses and other in the community support
    families in their natural caregiving and
    decision-making roles by building on the familys
    and individual members unique strengths.

Pediatric Nursing
  • Partnerships with Parents
  • Concept of partnerships with parents
  • Parental involvement in their childrens care has
    evolved from that of relinquishing their role to
    institutions to todays role of planners, in
    addition to recipients, of services.
  • Parents are treated as equals and have a rightful
    role in deciding what is important for themselves
    and their family.
  • Parents of special needs children often become
    experts on their childs condition.

Pediatric Nursing
  • Future Challenges for the Pediatric Nurse
  • The shift from treatment of disease to promotion
    of health is likely to further expand nurses
    roles in ambulatory care, with prevention and
    health teaching receiving a major emphasis.
  • Technological advances will influence the
    pediatric nurse to increase technical skills
    related to patient care.
  • Nurses will need to keep abreast of developments
    in adolescent medicine and continually adapt
    their care to the cultural environment in which
    they practice.

Pediatric Nursing
  • Nursing Implications of Growth and Development
  • One of the nurses primary responsibilities is to
    identify an infant or child who is demonstrating
    cognitive impairment.
  • Knowledge of child development allows the nurse
    to use a developmental rather than a chronologic
    approach to pediatric nursing care.
  • Understanding normal growth and development
    enables a nurse to select age-appropriate toys
    for the infant or young toddler and to devise
    activities that appeal to the school-aged child
    or adolescent.

Pediatric Nursing
  • Nursing Implications of Growth and Development
  • A knowledge of growth and development also is the
    basis for anticipatory guidance with parents.
  • Psychological preparation of a patient for an
    event expected to be stressful.

Physical Assessment of the Pediatric Patient
  • Growth Measurements
  • Measurement of physical growth is a key element
    in evaluation of the health status of children.
  • Measurements are plotted by percentiles on growth
    carts and compared with those of the general
    pediatric population to determine deviation from
    the norm.

Physical Assessment of the Pediatric Patient
  • Growth Measurements (continued)
  • Length
  • Measurements are taken when children are supine
    recumbent length is usually measured until 2
    years of age.
  • Height
  • Measurement is of a child standing upright.

Figure 30-1
(From Hockenberry-Eaton, M.J., Wilson, D.,
Winkelstein, M.L., Kline, M.D. 2003. Wongs
nursing care of infants and children. 7th ed..
St. Louis Mosby.)
Measurement of head, chest, and abdominal
circumference and crown-to-heel measurement.
Physical Assessment of the Pediatric Patient
  • Growth Measurements (continued)
  • Weight
  • Fluid loss and inadequate calories are reflected
    in a childs weight, especially that of infants
    and toddlers.
  • Same scale should be used, and the child should
    be weighed at the same time every day.
  • Skin Thickness
  • Skinfold thickness should be determined at one
    site with at least two measurements.
  • Arm circumference measures muscle mass.

Figure 30-2
(From Hockenberry-Eaton, M.J., Wilson, D.,
Winkelstein, M.L., Kline, M.D. 2003. Wongs
nursing care of infants and children. 7th ed..
St. Louis Mosby.)
A, Infant on scale. B, Toddler on scale.
Physical Assessment of the Pediatric Patient
  • Vital Signs
  • Temperature
  • Reflects metabolism
  • Fairly stable from infancy through adulthood
  • Primary purpose of measuring body temperature to
    detect abnormally high or low values
  • Routes oral, rectal, axillary, and tympanic
  • Normal findings approximately 97 F to 99 F

Physical Assessment of the Pediatric Patient
  • Vital Signs (continued)
  • Heart Rate/Pulse
  • Great variations exist.
  • Infection and physical activity increase heart
    rate. Note any irregularities in volume, rate,
    and rhythm.
  • Apical pulse is taken on infants and young
    children a radial pulse is often taken on
    children 5 years of age and older.
  • Pulse rate should be counted for 1 full minute.
  • Apical beat of a newborn may be 152 beats per
    minute and gradually slows to 72 to 75 beats by

Physical Assessment of the Pediatric Patient
  • Vital Signs (continued)
  • Respirations
  • Infants respirations are mainly diaphragmatic
    observe abdominal movement for 1 full minute.
  • In older children, respirations are chiefly
  • Respiratory rate slows as a child progresses from
    infancy to adolescence.
  • Newborns are obligate nasal breathers.
  • Rate, depth, and quality should be assessed.
  • Rate may be as rapid as 40 to 50 breaths per
    minute, gradually slowing to 25 to 32 per minute.

Physical Assessment of the Pediatric Patient
  • Vital Signs (continued)
  • Blood Pressure
  • Blood pressure should be measured in children 3
    years of age and older.
  • Blood pressure is low in a newborn and gradually
    rises at the end of adolescence, it is about
  • It is important to use the correct size cuff to
    ensure accuracy.
  • Measure blood pressure before any
    anxiety-producing procedures.

Figure 30-3
(From Hockenberry-Eaton, M.J., Wilson, D.,
Winkelstein, M.L., Kline, M.D. 2003. Wongs
nursing care of infants and children. 7th ed..
St. Louis Mosby.)
Sites for measuring blood pressure.
Physical Assessment of the Pediatric Patient
  • Head-to-Toe Assessment
  • Skin
  • Genetic and physiologic factors affect assessment
    of color.
  • Pallor may be a sign of anemia, chronic disease,
    edema, or shock.
  • Erythema may be the result of increased
    temperature, local inflammation, or infection.
  • Skin texture should be smooth, soft, and slightly
    dry to the touch.

Physical Assessment of the Pediatric Patient
  • Head-to-Toe Assessment (continued)
  • Accessory Structures
  • Hair
  • Should be lustrous, silky, elastic
  • Nails
  • Should be pink, convex, smooth, and hard but
  • Handprints and footprints
  • Palm normally shows three flexion creases

Physical Assessment of the Pediatric Patient
  • Head-to-Toe Assessment (continued)
  • Eyes
  • At birth, visual acuity is 20/400 when holding a
    baby, assume an en face position.
  • By the second week of life, tear glands begin to
  • Newborns can follow bright, colorful objects by
    the second or third week of life.
  • Vision improves to 20/30 by age 2 to 3 years.
  • Accommodation and refraction are present by
    school age.

Physical Assessment of the Pediatric Patient
  • Head-to-Toe Assessment (continued)
  • Ears
  • Inspect for general hygiene.
  • Advise parents and children to clean the ears
    with a washcloth wipe only the outer portion of
    the canal with a swab.
  • Mineral oil may be used to soften cerumen.

Physical Assessment of the Pediatric Patient
  • Head-to-Toe Assessment (continued)
  • Nose, Mouth, and Throat
  • Nose should lie from the center point between the
    eyes to the notch of the upper lip.
  • Normally there is no discharge from the nose.
  • Inspect the lining of the mouth and the number of

Physical Assessment of the Pediatric Patient
  • Head-to-Toe Assessment (continued)
  • Lungs
  • Make sure the child is not crying.
  • Have them blow out.
  • Listen systematically.
  • Chest
  • Chest is almost circular.
  • As the child grows, the chest normally increases
    in a transverse direction.
  • Asymmetry may indicate serious underlying

Physical Assessment of the Pediatric Patient
  • Head-to-Toe Assessment (continued)
  • Back
  • Newborn is C-shaped.
  • Older child typically has S-shaped curve.
  • Marked curvature in posture is abnormal.
  • Abdomen
  • Inspection cylindrical and flat
  • Auscultation listen for peristalsis

Figure 30-7
(From Hockenberry-Eaton, M.J., Wilson, D.,
Winkelstein, M.L., Kline, M.D. 2003. Wongs
nursing care of infants and children. 7th ed..
St. Louis Mosby.)
Development of spinal curvatures.
Physical Assessment of the Pediatric Patient
  • Head-to-Toe Assessment (continued)
  • Extremities
  • Examine for symmetry, range of motion, and signs
    of malformation.
  • Fingers and toes should be counted.
  • Toddlers are usually bowlegged.
  • Observe for arch development and correct gait.
  • School-aged walking posture is more graceful and
  • During puberty, adolescents may experience
    awkward posture from rapid growth of extremities.

Physical Assessment of the Pediatric Patient
  • Head-to-Toe Assessment (continued)
  • Renal Function
  • There is a functional deficiency in the kidneys
    ability to concentrate urine and to cope with
    conditions of fluid and electrolyte fluctuation,
    such as dehydration or fluid overload.
  • Urine output varies and depends on the size of
    the infant or child.
  • Urine is colorless and odorless.

Physical Assessment of the Pediatric Patient
  • Head-to-Toe Assessment (continued)
  • Anus
  • Check the anal sphincter.
  • History of bowel movements should be noted.
  • Assess for perianal itching may be pinworms.
  • Genitalia
  • This is an excellent time to elicit questions
    concerning body functions or sexual activity.

Factors Influencing Growth and Development
  • Nutrition
  • Nutrition is probably the single most important
    influence on growth.
  • A childs appetite fluctuates in response to
    growth spurts.
  • Infants begin life outside the womb, nursing at
    the breast or ingesting formula or breast milk
    via bottle or tube.
  • Most infants are given solid foods at 4 to 6
    months of age, when they begin to need more iron
    in the diet and their teeth begin to erupt.

Factors Influencing Growth and Development
  • Nutrition (continued)
  • It is important for each new food to be
    introduced at weekly intervals so that food
    allergies can be identified.
  • By 9 months, several teeth have erupted and
    junior foods, which are a more coarse texture,
    can be offered.
  • By 12 to 15 months, toddlers should be eating
    table food prepared for the family.
  • As the child moves through toddler and preschool
    stages, fads with strong preferences develop
    encourage a balanced diet.

Factors Influencing Growth and Development
  • Metabolism
  • Metabolic needs vary among individuals.
  • Rate of metabolism is highest in the newborn
    infant because of ratio of total body surface to
    body weight is much greater than it is in the
  • The body uses energy provided by foods.
  • Because metabolism is so high in infants and
    children, their ability to recover from surgery
    or a fractured bone is swift compared with that
    of an adult.

Factors Influencing Growth and Development
  • Sleep and Rest
  • Children spend less total time sleeping as they
  • Most babies are sleeping through the night by the
    latter part of their first year and take one or
    two naps a day the 3-year-old has usually given
    up daytime naps.
  • The best way to prevent sleep problems with the
    infant/child is to establish bedtime rituals that
    do not foster problematic patterns.

Factors Influencing Growth and Development
  • Speech and Communication
  • Crying at birth is the earliest evidence of
    speech, followed by other sounds?cooing,
    laughing, or babbling.
  • By 9 months, infants practice and painstakingly
    repeat the noises they can make.
  • A 1-year-old has a three- to four-word
    vocabulary by 18 months, they usually know 25 to
    50 words by 2 years, they may know more than 250
  • The nurse should know what typifies speech at
    certain stages of childhood.

Factors Influencing Growth and Development
  • Nonverbal Communication
  • Young children become very adept at understanding
    nonverbal communication.
  • They sense anxiety or fear by the rise in pitch
    of the parents voice.
  • Nonverbal symbols include nodding of the head,
    using direct eye contact tapping finger or foot
    avoiding eye contact and sign language.

Hospitalization of a Child
  • Preadmission Programs
  • Many hospitals have orientation programs for
    children who are to be admitted.
  • Programs are based on the childs level of
    understanding and stage of development.
  • Children should be allowed to prepare for this
    new experience in their own way.
  • An emergency admission thrusts the child into an
    unknown environment surrounded by strange
    equipment, frightening sounds, and unfamiliar

Hospitalization of a Child
  • Admission
  • Child may be assigned to a nursing unit according
    to their age group.
  • Characteristics of providers should include
    compassion, warmth, understanding, and an ability
    to communicate with the child.
  • Pediatric units are usually bright, colorful, and
    cheery areas with cartoon figures on the walls.
  • Instruct on how equipment works, when meals are
    served, visiting hours, etc.

Hospitalization of a Child
  • Hospital Policies
  • Parents who are involved in care have a sense of
    contribution to the childs recovery.
  • Certain hospitals allow children to wear their
    own clothes.
  • After a child is admitted, a nursing history is
    obtained an identification bracelet is usually
    worn on the wrist.
  • Vital signs and weight are measured and recorded.
  • All newly admitted infants and children have
    routine blood samples drawn by a laboratory

Hospitalization of a Child
  • Developmental Support for the Child
  • Hospitalization interrupts childrens normal
    routines and threatens their normal developmental
  • It is not unusual for children to regress when
    hospitalized this often persists for several
    months after discharge.
  • Nurses should be especially concerned with
    meeting the psychosocial needs of children with
    special needs who are hospitalized.

Hospitalization of a Child
  • Pain Management
  • Health care professionals tend to underestimate
    pain in children.
  • Anything that is painful to adults should be
    assumed to be painful to infants and children.
  • Knowing when a child is in pain and how intense
    the pain is can sometimes be difficult the nurse
    must rely on physiologic variables and behavioral
  • Wong-Baker Faces Scale may be helpful in
    assessing pain level.

Hospitalization of a Child
  • Surgery
  • Preparing a child for surgery entails providing
    information to parents and the child about what
    will happen and what the child will experience.
  • Six Common Stress Points
  • Admission, blood tests, the afternoon of the day
    before surgery, injection of preoperative
    medication before and during transport to the
    operating room, and return to the postanesthesia
    care unit

Hospitalization of a Child
  • Parent Participation
  • It is essential to establish an effective working
    relationship with parents as soon as possible.
  • Parents are the most significant individuals to a
    child they know their child better than anyone
  • On admission parents need specific information on
    routines, hospital policies that affect them, any
    limitations that exist, and what is expected of
  • Explain diagnostic tests, medications, or
  • As the parents comfort increases, they become
    more involved in meeting their childs physical

Common Pediatric Procedures
  • Bathing
  • This provides an opportunity for skin assessment.
  • Check temperature of water.
  • Protect child from drafts.
  • Bathe from the trunk down.
  • If umbilical cord is still present, give sponge
    bath and clean around cord with alcohol.
  • Be careful to remove soap, rinse, and dry
  • Cotton-tipped applicators are never used inside
    the ear canal.

Common Pediatric Procedures
  • Bathing (continued)
  • Infants enjoy being placed in basins for baths.
  • Use dry hands to pick up the infant.
  • Allow this child to play and splash.
  • Most toddlers love to be placed in a tub for
    their bath.
  • Toys should be provided.
  • The child should never be left in a tub without
  • School-aged children may be reluctant to bathe
    encourage them to participate in their care.
  • Adolescents bathe or shower daily privacy is

Common Pediatric Procedures
  • Feedings
  • Breastfeeding
  • The mother may wish to continue breastfeeding her
    baby who is ill or hospitalized.
  • Provide a quiet environment and a comfortable
    chair for nursing.
  • If the mother is unable to be present for every
    feeding, encourage her to use a breast pump
    bottles of breast milk can be frozen and given
    later by bottle or tube feeding.

Common Pediatric Procedures
  • Feedings (continued)
  • Formula
  • Positioning should be comfortable for the adult
    and the infant infant should be held securely.
  • If a burp is not elicited in one position, try
  • After feeding, the infant is positioned on the
    right side.

Common Pediatric Procedures
  • Feedings (continued)
  • Solids
  • Infant should be fed in an infant seat.
  • Older infants can be placed in a high chair with
    a safety strap.
  • Toddlers may resist high chairs nurse may need
    to try an alternative to prevent injury.
  • Parents should provide three regular meals and
    planned snacks each day so that the child eats
    about every 2 to 3 hours.
  • Children should sit down to eat choking is more
    likely if children eat on the run.

Common Pediatric Procedures
  • Feedings (continued)
  • Gavage
  • Some infants and children require the passing of
    a feeding tube through the nose or mouth, down
    the esophagus, and into the stomach.
  • To measure for placement measure from the nose
    to the bottom of the earlobe and then to the end
    of the xiphoid process or go by height.
  • Restraint may be needed to pass the tube.
  • Because infants are nose breathers, the mouth is

Common Pediatric Procedures
  • Feedings (continued)
  • Gavage
  • Older children can be asked to swallow as the
    tube is placed.
  • Once the tube is in place, secure with tape.
  • Before feeding, check placement.
  • Infants are given a pacifier to associate sucking
    with satisfying hunger.
  • Allow to flow into the stomach via gravity.
  • At the completion of feeding, flush the tube with
    sterile water.

Common Pediatric Procedures
  • Feedings (continued)
  • Gastrostomy
  • This is often used in children when passing a
    gastric tube is contraindicated or in children
    who require tube feeding over an extended period.
  • A tube is inserted into the abdominal wall and
    into the stomach and secured with a purse-string
  • Feedings are carried out in the same manner and
    rate as in gavage feeding.
  • After feedings, the child is placed on the right
    side or in Fowlers position.

Common Pediatric Procedures
  • Feedings (continued)
  • Total Parenteral Nutrition
  • A highly concentrated solution of protein,
    glucose, and other nutrients is infused
    intravenously through conventional tubing with a
    special filter attached to remove particulate
    matter and microorganisms.
  • Wide-diameter vessels, such as the subclavian
    vein, are the usual sites of infusion.
  • Nursing responsibilities include control of
    sepsis, monitoring infusion rate, and continuous

Common Pediatric Procedures
  • Safety Reminder Devices
  • At times, for safety, children should be
    restrained after surgery or during a procedure or
  • This is used only as a last resort.
  • The device should be applied correctly, and
    circulation and skin integrity must be monitored
  • The device should be removed every 2 hours so
    that the body area can be exercised.
  • Release extremities one at a time so that the
    child cannot pull out an IV or NG tube.

Common Pediatric Procedures
  • Safety Reminder Devices (continued)
  • Types
  • Elbow safety reminder
  • Mummy safety reminder
  • Clove-Hitch safety reminder
  • Jacket safety reminder

Figure 30-10
(From Lowdermilk, D.L., Perry, S., Bobak, I.M.
1997. Maternity womens health care. 6th
ed.. St. Louis Mosby.)
Mummy restraint.
Common Pediatric Procedures
  • Urine Collection
  • Collecting a urine specimen can be a major
    problem in pediatrics when the child is not
    toilet trained.
  • Methods of Collection
  • Suprapubic bladder tap
  • Plastic urine collection bags
  • Catheterizations

Figure 30-11
Suprapubic bladder aspiration.
Figure 30-12
(From Wong D.L., Perry, S.E., Hockenberry-Eaton,
M.J. 2002. Maternal-child nursing care. 2nd
ed.. St. Louis Mosby.)
Application of a urine collection bag.
Common Pediatric Procedures
  • Venipunctures to Obtain Blood Specimens
  • In infants and young children, a jugular or
    femoral vein may be used to obtain a blood
  • The nurses responsibility is to prepare,
    position, and restrain the child.
  • Holding the head or lower extremities absolutely
    immobile is critical.
  • Pressure should be applied to the site to prevent
    the formation of a hematoma.
  • Sometimes the veins of the extremities,
    especially the arm and the hand, are used.

Figure 30-13
(From Wong D.L., Perry, S.E., Hockenberry-Eaton,
M.J. 2002. Maternal-child nursing care. 2nd
ed.. St. Louis Mosby.)
Correct position for jugular venipuncture
Figure 30-14
(From Wong D.L., Perry, S.E., Hockenberry-Eaton,
M.J. 2002. Maternal-child nursing care. 2nd
ed.. St. Louis Mosby.)
Position for femoral venipuncture procedure.
Common Pediatric Procedures
  • Lumbar Puncture
  • Explain the procedure and answer any questions.
  • EMLA, a local anesthetic cream, may be applied to
    the lumbar area it should be applied at least 1
    hour before procedure.
  • Position the child at the edge of the exam bed,
    on the side, facing nurse with neck and legs
    gently flexed.
  • Observe for any signs of difficulty.
  • A toddler may need to have the legs wrapped in a
  • The child should be held securely until the
    spinal tap is completed.

Figure 30-15
(From Wong D.L., Perry, S.E., Hockenberry-Eaton,
M.J. 2002. Maternal-child nursing care. 2nd
ed.. St. Louis Mosby.)
A, Modified side-lying position for lumbar
puncture. B, Older child in side-lying position.
Common Pediatric Procedures
  • Oxygen Therapy
  • This is used to improve the childs respiratory
    status by increasing the amount of oxygen in the
    blood it is also used in children who have
    cardiac or neurologic disorders.
  • Infants and young children receiving oxygen are
    monitored on an oximeter.
  • Methods
  • Hood and incubator
  • Mist tents
  • Nasal cannula

Figure 30-16
(From Wong D.L., Perry, S.E., Hockenberry-Eaton,
M.J. 2002. Maternal-child nursing care. 2nd
ed.. St. Louis Mosby.)
Oxygen is administered to an infant by means of a
plastic hood (Oxy-Hood).
Common Pediatric Procedures
  • Suctioning
  • Suctioning should be used when secretions are
    audible in the airway or when signs of airway
    obstruction or oxygen deficit are present.
  • Various devices are used to suction children such
    as a bulb syringe or a straight suction catheter.
  • Depth approximately 1/4 to 1/2 inch
  • Timing not more than 5 seconds
  • Frequency allow 30 seconds between attempts

Common Pediatric Procedures
  • Intake and Output
  • Many health disorders require accurate monitoring
    of the amount of solids and liquids taken in and
    the amount excreted.
  • All fluids given to a child are documented on a
    record kept at the bedside.
  • All urine voided is measured before it is
    discarded weigh diapers if appropriate.

Common Pediatric Procedures
  • Medication Administration
  • The nurse must know how to compute the dose
    correctly and administer it properly.
  • All computed dosages must be checked by a second
    nurse for safety.
  • The right amount of the right medication must be
    given to the right child at the right time and
    via the right route.
  • Nurses must also observe and document a childs
    response to the drug.
  • Methods of calculating dosages for children
    consider age, body weight, and body surface area.

Common Pediatric Procedures
  • Medication Administration (continued)
  • Routes of Administration
  • Oral
  • Intradermal, subcutaneous, and intramuscular
  • Intravenous
  • Optic, otic, and nasal
  • Rectal

Figure 30-17
(Courtesy of Marjorie Pyle, RNC, Lifecircle,
Costa Mesa, California.)
Intramuscular injection sites.
  • Protecting a child from harm is a major issue in
  • Anticipatory guidance for parents of infants and
    toddlers and health teaching for school-age
    children and adolescents are two methods of
    preventing accidents.
  • Injuries cause more deaths and disabilities in
    children than do all causes of disease combined.
  • Parents and children should talk and listen to
    each other to prevent many accidents.
  • The adult who is a role model can influence a
    child immensely.