COMMUNITY NURSING WK 12

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Chapter 16

Child and Adolescent Health

The Health of a Child Has Long-Term Implications

Health habits adopted by children and youth profoundly influence their potential to lead healthy, productive lives.

The physical and emotional health of a child plays a pivotal role in the overall development and well-being of the entire family.

Children who are healthy, well-nourished, well cared for at home, and safe and secure in their world achieve a higher potential.

U.S. Children by Race/Ethnicity

Figure 16-1 From Federal Interagency Forum on Child and Family Statistics: America's children in brief: key national indicators of well-being, 2012. www.childstats.gov/americaschildren/demo.asp. Accessed March 8, 2013.

Impact of Pregnancy on a Child’s Health

The health of the mother before, during, and after pregnancy has a direct impact on the health and well-being of her children.

A comprehensive approach is needed to…

Identify and treat potential risks

Overcome barriers to good health before, between, and beyond pregnancy

Protect and promote the health of women and children

Ensure the health of future generations

Risk Factors

Risks to mother  Risks to baby

Not in optimal health  Poor pregnancy outcome

Uncontrolled medical conditions  Low birth weight with serious medical conditions

Exposure to drug, alcohol, tobacco, poor nutrition  Chronic conditions that affect health and well-being

Unsafe environment (secondhand smoke, lead-based paint)  Chronic conditions throughout childhood and maybe adolescence/adulthood

Risks to Children

No preventive health care and immunizations  preventable diseases or chronic conditions in life

Infant Mortality

Infant mortality reflects the health and welfare of an entire community and is used as a broad indicator of health care and health status.

Infant mortality is related to several factors:

Maternal health

Medical care quality and access

Socioeconomic conditions

Public health practices

Infant Mortality (Cont.)

Leading causes of infant death in the United States (almost 60% of all infant deaths)

Congenital defects

Disorders relating to short gestation and low birth weight

Sudden infant death syndrome (SIDS)

Maternal complications of pregnancy

Accidents such as suffocation

United States ranks 27th in infant mortality among industrialized nations

U.S. Infant Mortality

Has dropped every year since 1940 (not 2002)

Attributable to public health measures and improved standard of living

Improved sanitation

Clean milk supply

Immunizations

Nutritious food

Enhances access to maternal health care

Technological advances also contributed

e.g., synthetic lung surfactant

International Comparisons of Infant Mortality Rates* (2011)

*Infant mortality rate represents infant deaths per 1000 live births.

World Rank	Country	1960	2011
1	Iceland	13.0	0.9
2	Sweden	16.6	2.1
3	Japan	30.7	2.3
4	Finland	21.0	2.4
4	Norway	16.0	2.4
6	Czech Republic	20.0	2.7
7	Republic of Korea	--	3.0
8	Portugal	77.5	3.1
9	Spain	43.7	3.2
10	Belgium	31.4	3.3

International Comparisons of Infant Mortality Rates* (2011) (Cont.)

*Infant mortality rate represents infant deaths per 1000 live births.

World Rank	Country	1960	2011
11	Italy	43.9	3.4
11	Greece	40.1	3.4
13	France	27.7	3.5
13	Israel	--	3.5
13	Ireland	29.3	3.5
16	Germany	35.0	3.6
16	Austria	37.5	3.6
16	Denmark	21.5	3.6
16	Netherlands	16.5	3.6
20	Switzerland	21.1	3.8

International Comparisons of Infant Mortality Rates* (2011) (Cont.)

*Infant mortality rate represents infant deaths per 1000 live births.

World Rank	Country	1960	2011
20	Australia	20.2	3.8
22	United Kingdom	22.5	4.3
23	Poland	54.8	4.7
24	Slovakia	28.6	4.9
24	Hungary	47.6	4.9
26	New Zealand	22.6	5.5
27	United States	26.0	6.1
28	Chile	120.3	7.4
29	Turkey	189.5	7.7
30	Mexico	92.3	13.6

Infant Mortality Rates

Figure 16-2 From Murphy SL, Xu J, Kochanek KD: Deaths: Final Data for 2010, National Vital Statistics Report, Vol 61, No.4, May 8, 2013. http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdf. Accessed September 3, 2013.

Preterm Birth and Low Birth Weight

Preterm: Birth before 37 weeks of gestation

LBW: Infant born less than 5.5 pounds

Important predictors of infant health

Greater risk of death than full term

Greater risk of mental and physical disabilities

Cerebral palsy

Visual problems (e.g., retinopathy of prematurity)

Feeding problems

Hearing loss

Developmental delays

Preterm Birth and Low Birth Weight (Cont.)

Factors associated with preterm and LBW

Minority status

Chronic stress

Maternal age of <17 years and >35 years

Chronic health problems of mother

Lack of prenatal care

Multiple births

Certain problems with the uterus or cervix

Low socioeconomic status

Unhealthy maternal habits

Induced labor and elective C-section births

Preconception Health

Half of all pregnancies are unintended.

Impact on developing fetal organ systems by:

Healthy maternal weight and good nutrition

Tending to chronic maternal diseases

Being up-to-date on vaccinations

Avoiding environmental toxins

Decreasing stress and eliminating abusive relationships

Avoiding illicit drugs, tobacco, and alcohol

Preconception Health (Cont.)

Preconception counseling as a prevention strategy:

Effective contraception to avoid unintended pregnancies and pregnancy spacing

Recommend intake of folic acid daily

Encourage healthy lifestyle modifications

Prenatal care

Prenatal substance use

Prenatal Care

Early and regular prenatal care enhances chance of a healthy, full-term baby.

Health education and counseling

Risk identification

Monitoring and treatment of symptoms

Referral to health, nutrition, social services

Medicaid, WIC, food stamps, smoking cessation services, housing, child care, job training, substance abuse treatment, domestic violence screening and counseling

Prenatal Substance Use

The use of tobacco, alcohol, or illicit drugs in any combination is dangerous to a woman’s health and worsens infant health and development outcomes.

Smoking is one of the most preventable causes of infant morbidity and mortality

Alcohol can lead to FAS

Drugs can cause permanent harm to an unborn baby

Breastfeeding

“Breastfeeding is a natural and beneficial source of nutrition and provides the healthiest start for an infant. In addition to the nutritional benefits, breastfeeding promotes a unique and emotional connection between mother and baby.”

– American Academy of Pediatrics, 2012

Breastfeeding (Cont.)

AAP recommends

Exclusive breastfeeding for first 6 months

Breastfeeding in combination with introduction of complementary foods until at least 12 months

Continuation of breastfeeding for as long as mutually desired by mother and baby

2011Surgeon General’s Call to Action to Support Breastfeeding

Actions aimed at increasing society support

Nurses, other professionals, and support groups

Breastfeeding Advantages

Mother

Lower risk of breast and ovarian cancer

Lower risk of postpartum depression

Lower risk of type 2 diabetes

Saves money on formula

Baby

Cells, hormones, and antibodies in breast milk

Lower risk of asthma

Lower risk of obesity

Lower risk of diabetes

Lower risk of SIDS

Fewer illnesses

Sudden Unexplained Infant Death

Definition of SUID

Less than 1 year of age

Occurs suddenly and unexpectedly

Cause of death not immediately obvious before investigation

Half of SUID are SIDS

Definition of SIDS

Death cannot be explained after a thorough investigation, including autopsy, examining death scene, and review of clinical history

Sudden Unexplained Infant Death (Cont.)

Back to Sleep campaign (1994)

Heighten awareness of the safety of positioning infants on their backs for sleep

SIDS death declined by >50%

Safe to Sleep campaign (2010)

Included other actions to reduce risks of other sleep-related causes of death (e.g., suffocation)

http://www.nichd.nih.gov/sts

Safe to Sleep Campaign Recommendations

Always place baby on back to sleep for naps and night

Place baby on firm surface with fitted sheet

Not in adult bed, couch, or chair alone or with adults

Keep soft objects, toys, and loose bedding out of sleep area

Do not smoke during pregnancy

Do not allow smoking around baby

Do not let baby get too hot during sleep

Follow vaccine and health check-up recommendations

Avoid advertised SIDS products

Get regular health care during pregnancy

– National Institute of Child Health & Human Development: Safe sleep for your Baby, 2013

Childhood Health Issues

Accidental injury is the leading cause of death in children ages 1 to 14.

Childhood obesity is a health crisis; it can lead to numerous health problems.

Childhood immunization is a benchmark of child health.

Environmental concerns can be found in air, water, and from toxic exposure to chemicals.

Child maltreatment is an indicator of children’s physical and emotional health status.

Children with special health care needs frequently need multiple health care services.

Adolescent Health Issues

Adolescent sexual activity is often unprotected and can result in pregnancy and STIs.

Teen childbearing and parenting often have long-term negative consequences for both child and mother.

Violence among youth is a multifaceted problem.

The use of tobacco, alcohol, and drugs has serious and long-lasting consequences for adolescents and society.

Factors Affecting Child and Adolescent Health

Significant factors in overall well-being:

Parents’ or caregivers’ income, education, and stability

Security and safety of the home

Nutritional and environmental issues

Health care access and use

Specific issues:

Poverty

Racial and ethnic disparities

Health care use

Children Lacking Health Insurance

Figure 16-5 Data from DeNavas-Walt C, Proctor D, and Smith J: Income, poverty, and health insurance coverage in the United States: 2011. U.S. Census Bureau Current Population Reports, September 2012. http://www.census.gov/prod/2012pubs/p60-243.pdf. Accessed March 8, 2013.

Strategies to Improve Child and Adolescent Health

Collect/analyze data tracking well-being of children and adolescents.

Establish goals and set measurable objectives using Healthy People 2020.

Implement health promotion and disease prevention strategies.

More significant and cost-effective for children than other age groups.

Utilize public health programs targeted to children and adolescents.

Public Health Programs Targeted to Children and Adolescents

Health Care Coverage Programs

Affordable Care Act

Medicaid and CHIP

EPSDT (Early and Periodic Screening, Diagnosis, and Treatment)

Direct Health Care delivery programs

Maternal and Child Health Block Grant (Title V)

Community & Migrant Health Centers program

School-Based Health Centers

WIC

Sharing Responsibility for Improving Child and Adolescent Health

Parents’ role

Community’s role

Employer’s role

Government’s role

Community health nurse’s role

Community Health Nurse’s Role

An advocate for improved individual and community responses to children’s needs.

A researcher for effective strategies to serve women and children.

A participant in publicly funded programs.

A promoter of social interventions that enhance the living situations of high-risk families.

A partner with other professionals to improve service collaboration and coordination.

Understand the legal and ethical implications of decision making.

Monitoring the Health and Well-Being of Children

Resource	Website address
Centers for Disease Control and Prevention (CDC)	http://www.cdc.gov
Federal Interagency Forum on Child and Family Statistics	http://www.childstats.gov
National Center for Education Statistics (NCES)	http://nces.ed.gov
National Center for Health Statistics (NCHS)	http://www.cdc.gov/nchs
US Bureau of Justice	http://www.ojp.usdoj.gov/bjs
US Bureau of Labor Statistics	http://www.bls.gov
US Census Bureau	http://www.census.gov
USDHHS Healthy People 2020	http://www.healthypeople.gov

D ea

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li ve

b irt

1940 1970 1980 1990

Neonatal

Postneonatal

Figure 7. Infant, neonatal, and postneonatal mortality rates: United States, 1940-2010

1950 1960 2000

Infant

NOTE: Rates are infant (under 1 year), neonatal (under 28 days), and postneonatal (28 days-11 months) deaths per 1,000 live births in specified group.

SOURCE: CDC/NCHS, National Vital Statistics System, Mortality.

2010

National Vital Statistics Report, Vol. 61, No. 4, May 8, 2013 68