AN OVERVIEW

Esther A. Saguil MD
Clinical Associate Professor,
UP College of Medicine
 The child is a miniature adult, whose fluids
and electrolytes needs may be determined
based on ratio and proportion, and whose
management parallel that of the adult.

TRUE OR FALSE?
The child is not a little adult……..

Large head : body ratio

High total body water content

Immature organ systems- kidneys,
hematopoietic system, lungs, immune system

Small glycogen stores

Pliant body cavities

Rapid metabolic rates

THERMOREGULATION

FLUID BALANCE

EASILY DEPLETED NUTRTIONAL STORES

CARDIORESPIRATORY CONCERNS

COMMUNICATION DEFICIENCIES

PAIN PERCEPTION AND REPORTING
 THERMONEUTRALITY: TEMPERATURE
WHERE NEONATE MAINTAINS ITS
BASAL METABOLIC RATE
• Large skin surface area

• Large head

• High % of total body water

• Poorly developed shivering mechanism

• Inability to perform heat conserving motions


Hyperthermia - > 37.5%
Increase TFI by 10% for every degree above
normal
Dehydration
Electrolyte problems
Seizures

Hypothermia - temp < 36.5
shift to anaerobic metabolism
metabolic acidosis- pallor, poor activity
impaired peripheral perfusion-mottling,
poor urine output

Incubators, radiant warmers, heating pads

Blankets

Plastic or cloth wraps

Warm gastric and rectal lavages

Warm intravenous fluids

High total body water content

Small volumes in children
e.g. 3 kg baby only needs 300ml of fluids daily
Total body water: 2.4 kg
Total blood volume: 240 ml

Use of Solusets, measuring devices for accurate
fluid administration, infusion and syringe
pumps

Urine output monitoring

Measurement of all losses (gastric, diarrhea,
fistulae, drains, bleeding), replacing with the
appropriate fluids as necessary

Select a vein which can be stabilized easily with
splints and secure with tapes.

Extravasation - dehydration, loss of
therapeutic effects of medications, burns

Gentle IV push

Report “out” IV lines in NPO patients ASAP

Avoid using scissors during the removal of IV
catheters

The neonate only has glycogen reserves for 3
hours .

A 10% glucose solution is usually needed for
patients on NPO.

Hypoglycemia is very common so frequent
glucose monitoring is needed

Dire consequences of hypoglycemia in
neonates

Obligate nasal breathers

Pliant abdominal wall and diaphragm

Easily fatigued respiratory muscles

Inability to clear secretions effectively

Incoordinated swallowing reflexes

High metabolic rates

History is provided by caregiver

Patient is unable to express or interpret his
symptoms

Caregiver interprets the patient’s symptoms

NEED TO HAVE A PATIENT’S TRUSTED
COMPANION AT BEDSIDE DURING
PROCEDURES
Conjoined twins are considered as 2
separate patients.

TRUE OR FALSE?

The FIFTH vital sign

VISUAL ANALOG SCALE

Allows the older child to determine his pain
levels

Neonates also have pain receptors!

Pain medications review

ABDOMINAL WALL DEFECTS

ANORECTAL ANOMALIES

INGUINOSCROTAL CONDITIONS

COMMON GASTROINTESTINAL
CONDITIONS

SOFT TISSUE PROBLEMS

Omphalocoele

Gastroschisis

Cloacal exstrophy, bladder exstrophy

PROLONGED FASTING STATE

FLUID BALANCE/ I AND O MONITORING

ABDOMINAL DISTENSION AND ILEUS

RESPIRATORY COMPROMISE

SEPSIS, INFECTION CONTROL

NUTRITIONAL SUPPORT

HIRSCHSPRUNG’S DISEASE

IMPERFORATE ANUS

ANAL FISTULA

PERIANAL ABSCESS

Abdominal distension (air, retained feces,
ascites)

Fecaloid vomitus or gastric tube output

I and O monitoring

Perineal care

Stoma care – difficult fluid and electrolyte
management with high output stomas and
fistulas, peristomal excoriations

Properly sited and constructed colostomies

Use of stomal appliances

Avoidance of spillage or leakage of feces to
skin

Prevention of stomal trauma

HERNIAS AND HYDROCOELES

UNDESCENDED TESTES

HYPOSPADIAS

INTERSEX ANOMALIES
MALE OR FEMALE?

DRESSING CHANGES, URINE STASIS

CATHETER CARE

COUNSELLING /PSYCH SUPPORT

OUTPUT MONITORING AND REPORTING

Appendicitis

Intussusception

Intestinal obstruction – bands, malrotation,

Esophageal surgery

Feeding stomas (gastrostomies and
jejunostomies)

Post-operative ileus is usually prolonged in
pediatric patients – abdominal circumference
monitoring.

Longer duration of IV line

More rigorous electrolyte and fluid
management

Replacement of losses

Care of tubes

NASOGASTRIC TUBE

ENDOTRACHEAL TUBE

URETHRAL CATHETERS

FEEDING GASTROSTOMY/JEJUNOSTOMY

DRAINS

Check patency (inflow and outflow)

Secure anchorage

Protect from pull and mobile body parts

Report change in quality of output and /or
aspirate.

Verify depth, length of inserted tubes, and if
these may be reinserted if accidentally
removed.

Disfiguring masses

High cribs,, fall prevention

Side rail management, slipping through the
cracks

Eye , neck, gonad protection during
phototherapy

Asphyxia from pillows and blankets items on
the bed

Burns from heating lamps

Wet beddings

Sensitivity

Avoid trauma

Disclosure of information to other people other
than immediate family

Trust and non accusatory behavior