1. Di s e a s e s o f t h e
Ne wb o r n
Pr e p a r e d b y : Ha n s Ch r i s t i a n f . Vi t u g RN,
MA N c
F a c u l t y /C l i n i c a l I n s t r u c t o r /R e v i e w e r

2. "Necrotizing"
means the death
of tissue, "entero"
refers to the
small intestine,
"colo" to the large
intestine, and
"itis" means
inflammation.

3. An acute
inflammatory
disease of the bowel
with increased
incidence in
preterm and high
risk infants

4. Theories to Support that Explains NEC
1.Little supply of oxygenation -> plus feeding ->
stress to the intestinal wall -> allowing bacteria
to invade intestinal wall and bloodstream ->
necrosis/perforation of the intestinal wall ->
decrease absorption of the vitamins and
minerals and Leak of bacteria into abdomen
causing peritonitis.
2.Difficult deliveries -> deprived oxygenation ->
vital organs receives more oxygen
3.Increased RBC counts – thickens the blood
and impaired circulation -> hinder the
transport of oxgenation

5. How does it happen?
• Prematurity remains the most prominent risk
factor
• Great damage to mucosal lining  diminished
blood supply  stop secreting protective
lubricating mucus  unprotected bowel attacked
by proteolytic enzymes  unable to synthesize
IgM  Gas-forming bacteria invades damaged
area  produce intestinal pneumatosis (presence
of air in the submucosal or subserosal surfaces of
the bowel)

6. Signs and Symptoms
• Infant may “not look well”
• Poor feeding
• Apnea
• Vomiting (often bile stained)
• Decreased U/O
• Hypothermia
• Distended abdomen
• Gastric residuals
• Blood in the stools

7. Diagnostic Evaluation
Radiography
Sausage-shaped
dilation of the
intestines
“Soap suds” or
bubbly appearance o
f thickened bowel
wall

8. Diagnostic Evaluation
Laboratory
examinations
– Anemia
– Leukopenia
– Leukocytosis
– Metabolic acidosis
– Electrolyte
imbalance

9. Therapeutic Management
• Oral feedings withheld
for at least 24 to 48
hours
• Breast feeding is
preferred
• Antibiotics
• Probiotics
– Lactobacillus acidophilus
– Bifidobacterium infantis

10. Nursing Management
• Observation and assessment
• Infants left undiapered
• Position infant supine or on the
side
• Vital signs including blood
pressure
–Avoid rectal temperature

11. TRANSIENT TACHYPNEA OF THE NEWBORN

12. Some newborns' breathing during
the first hours of life is more rapid
and labored than normal because
of a lung condition called transient
tachypnea of the newborn (TTN).

13. Definition
• A respiratory problem seen in the newborn
shortly after delivery
• It is likely due to retained lung fluid
• Common in 35+ week gestation babies who are
delivered by caesarian section without labor
• Resolves over 24-48 hours
• Causative Factors
– Pulmonary immaturity
– Mild surfactant deficiency

14. Causes of TTN
TTN, also called "wet lungs" or type II
respiratory distress syndrome, usually
can be diagnosed in the hours after
birth.
TTN can occur in both preemies
(because their lungs are not yet fully
developed) and full-term babies.

15. New borns at higher risk for TTN
include those who are:
delivered by cesarean section
(C-section)
born to mothers with diabetes
born to mothers with asthma
small for gestational age (small
at birth)

16. Pathophysiology
• Lower levels of circulating catecholamines
after a caesarean section which are
necessary to alter the function of channels
that absorb excess fluid from the lungs
• Delayed absorption of fetal lung fluid from
the pulmonary lymphatic system
increased fluid in the lungs  increased
airway resistance and reduced lung
compliance

17. Clinical Manifestations
• Period of rapid breathing
• Tachypnea
• Intracostal and subcostal
retractions
• Grunting
• Nasal flaring
• Possible cyanosis

18. Diagnostic Evaluation and Therapeutic
Management
• Diagnostic evaluation
– Chest X-ray
– Levels of PG were found to be negative in
certain newborns
• Management
– Supplemental oxygen
– Antibiotics

19. ERYTHROBLASTOSIS FETALIS/HEMOLYTIC DISEASE OF THE
NEWBORN
Abnormal, rapid
destruction of RBC
Hyperbilirubinemia
in the first 24
hours of life is
most often the
result

21. Hemolytic disease of the newborn (HDN)
Major causes of RBC destruction
– Rh Incompatibility (Isoimmunization)
• Mother is Rh negative, and infant is Rh positive
• May not occur in first pregnancy
• Increased risk of fetal blood being transferred to
maternal circulation  subsequent pregnancy with
Rh (+) fetus maternal antibodies formed will attach
and destroy fetal erythrocytes
• Progressive hemolysis in utero  fetus
compensates, accelerates rate of erythropoesis 
immature RBCs appear  erythroblastosis fetalis
(hydrops fetalis)

22. Hemolytic disease of the newborn (HDN)
Major causes of RBC destruction
– ABO Incompatibility
• Between a mother with type O and an infant
with A or B blood groups.
• Anti-A and Anti-B already present in the
maternal circulation cross the placenta and
attach to fetal RBCs  hemolysis
• Less severe hemolytic reaction the Rh
incompatibility
• May occur in first pregnancy

23. Signs and Symptoms
Jaundice
–Most not
jaundice at
birth
Anemia
Hypovolemic
shock may develop
Hypoglycemia

24. Diagnostic Evaluation
• Maternal antibody titer
(Indirect Coomb’s test)
• Amniocentesis
• Ultrasound

25. Therapeutic Management
Prevention of Rh Isoimmunization
–Administration of RhIg
–RhIg (RhoGAM) – must be administered
to unsensitized mothers within 72 hours
after the first delivery
–Admin of RhIg at 26 to 28 weeks of
gestation further reduces risk of
isoimmunization

26. Therapeutic Management
• Exchange Transfusion
–Infants blood is removed in small
amounts (5 to 10 ml at a time) and
replaced with compatible blood
–For severe hydrops
• ABO incompatibility
–Early detection and phototherapy

27. Nursing Management
• Recognizing jaundice – initial nursing
responsibility
• Prepares family incase of transfusion and
assist practitioner
– Infant remains NPO during procedures
– Maintain documentation of blood volume
exchange, time, cumulative record of the total
blood exchanged
– Vital signs
– Signs of transfusion reactions

28. DOWN SYNDROME

29. Down Syndrome
• The genetic disorder most frequently seen as
causing moderate to severe mental
retardation
• Etiology is unknown
– Genetic predisposition
– Exposure to radiation before conception
– Immunologic problems
– Infection

30. Clinical Manifestations
• Bradycephaly
• Back of the head is flat
• Epicanthal folds
• Palpebral fissure slanting
laterally upward
• Tongue may protrude
• Narrow palate
• Low-set ears
• Short broad hands
• Transpalmar crease (simian
line)
• Short stature
• Rag-doll appearance
• IQ of 50-70

31. Diagnostic Evaluation
• Evident at birth
• Prenatal testing
• Chromosomal
analysis

32. Therapeutic Management
• Surgery to correct cardiac
abnormalities, GI malformations
and craniofacial deviations
• Neck radiography before the child
participates in any sports

33. Nursing Management
• Options for fluid and calorie intake
– Breastfeeding may not be possible, immature
sucking reflex
– Special bottles and utensils
• Routine
– Changes causes frustration and decreased coping
abilities
• Encourage self-care
• Advise X-rays before participating in sports

34. TEMPERATURE CONTROL

35. Cold Stress
• Infants lack shivering response
• Norepinephrine (SNS) stimulates fat metabolism
to produce internal heat  blood  surface
tissues
• Increased in metabolism  increased oxygen
consumption
• Norepinephrine  vasoconstriction  decrease
oxygen decreased glucose metabolism
• Results: Hypoxia, Metabolic acidosis,
Hypoglycemia

36. Three primary methods for maintaining a
neutral thermal environment
• Incubator
• Radiant warming
panel
• Open bassinet
with cotton
blankets

37. Temperature control
• Warm items
first
• Plastic wrap
• Careful drying
• Kangaroo care

38. Incubator Care
• Double walled incubators
–improve infants ability to maintain a
desirable temp reduces energy
expenditure r/t heat regulation
• Pre-warm incubator first
• Head covering when outside of the
incubator

39. Essential public strategy that enables
the early detection and management of
several congenital metabolic disorders,
which if left untreated , may lead to
mental retardation and even death
For early detection and management of
congenital metabolic disorders
THE NEWBORN SCREENING PROGRAM

40. Newborn Screening Program (NBS)
• Mandated through RA 9288 (The
Newborn Screening Act of 2004)
• Done between 24-72 hours after
birth

41. Collection of NBS Samples
• Through heel prick method: 4
drops of blood is drawn from
heel puncture blotted onto a
filter paper
• Air dry 4-6 hours
• Sent to laboratory within 24
hours
• BEST - 48th to 72nd hours of life
• ACCEPTABLE - anytime after 24
hours from birth until 2 weeks
of age

42. Sample collection done
before the ideal time may
result in:
Falsely elevated thyroid stimulating
hormone (TSH) = false (+) screen for
CH
Falsely elevated 17
hydroxyprogesterone (17-OH-P) =
false (+) screeen for CH
Falsely low galactose and
phenylalalnine = false (-) screen for
GAL and PKU

43. Disorders tested for newborn screening
• Congenital Hypothyroidism (CH)
• Congenital Adrenal Hyperplasia
(CAH)
• Galactosemia (GAL)
• Phenylketonuria (PKU)
• Glucose-6-Phospate-Dehydrogenase
Deficiency (G6PD)

44. Congenital Hypothyroidism (CH)

45. Congenital Hypothyroidism (CH)
• aka Cretinism
• Lack or
absence of
thyroid
hormone

46. (H-U-Mi-D)
Hereditary conditions
Underdevelopment of the fetal
thyroid glands
Maternal Intake of anti thyroid drugs
during pregancy
Deficiency, Maternal Iodine

47. *Manifestations
Poor suck and feeding
Jaundice
Hypotonia
Cool pale dry skin
Swelling around the eyes
Large swollen tongue
Large fontanels with late closure
Poor weight gain and growth
Hoare sounding cry
Delayed milestone (sitting, crawling, walking
and talking)

48. *Treatment
Lifetime oral doses of thyroid hormone. L-
Thyroxine
Nursing Considerations:
Instruct parents to avoid Soy-based
formulas and iron supplements.
Avoid adjusting medications without
MD’s order to prevent under
medication or over medication.

49. Excessive medication can
cause : D-I-T-S
Diarrhea
Inability to sleep
Tachycardia
Shakiness in the child

50. *Treatment
Regular
monitoring of
the child’s
weight, overall
health and
thyroid
hormones level

51. Congenital Adrenal Hyperplasia (CAH)

52. Congenital Adrenal Hyperplasia (CAH)
• Excessive or deficient production of
sex steroids
• Severe salt loss, dehydration and
abnormally high levels of male sex
hormones in both boys and girls
• If not detected and treated early,
infants may die within 7-14 days

53. Congenital Adrenal Hyperplasia (CAH)
CAH is caused by a
deficiency of adrenal
gland hormones.
21 hydroxylase
is missing or not
working correctly.

54. Congenital Adrenal Hyperplasia (CAH)
21-OH is responsible for the production
of hormones :
CORTISOL is involved in glucose
metabolism and in normal inflammation
and immune response.
ALDOSTERONE is responsible for blood
pressure and sodium retention.

55. Congenital Adrenal Hyperplasia (CAH)
*Manifestations
• Poor feeding
• Listlessness and drowsiness
• Vomiting
• Diarrhea
• Weight loss
• Hypotension
• Hyponatremia
• Metabolic acidosis

56. Muscle growth at an early age
Enlargement of penis during childhood

57. Early deepening of the
voice
Early beard

58. Pubic hair and underarm hair during
childhood
Severe acne

59. M-E-E-E-P-S-S
Muscle growth at an early age
Enlargement of penis during childhood
Early deepening of the voice
Early beard
Pubic hair and underarm hair during
childhood
Smaller than normal testicles

60. Severe acne
Male pattern baldness

61. Early puberty changes such as hair in
airmpits and pubic area
Lack of menstrual periods or scanty or
irregular periods

62. Excess hair on the face and body
Deep, husky voice

63. (S-M-E-L-E-D)
Severe acne
Male pattern baldness
Early puberty changes such as hair
in airmpits and pubic area
Lack of menstrual periods or scanty
or irregular periods
Excess hair on the face and body
Deep, husky voice

65. *Treatment
Lifetime administration of the
deficient or missing hormones
HYDROCORTISONES
lessens the amount of
androgens (prevents early
puberty and allows for more
typical growth and

66. Over medication can results to
Cushing’s syndrome (Stretch
marks, rounded face, weight
gain, hypertension and bone
loss).
Under medication can occur
during periods of stress and
illness when higher doses of the

67. Corrective
surgery for
enlarged clitoris
(can be done as
early as one to
three years of
age. To separate
labia and to

68. Galactosemia (GAL)

69. Galactosemia (GAL)
This hereditary disorder is
characterized by the lack of the
enzyme Galactose-1-Phosphate
uridyl Transferase (GALT) that
converts galactose to glucose, the
form of sugar that can be used by
body cells.

70. Galactosemia (GAL)
Initial symptoms also include: (F-L-I-P)
Failure to gain weight
Lethargy
Irritability
Poor feeding and poor suck

71. Galactosemia (GAL)
Treatment: Giving the child a special
lactose free formula and exclusion of
lactose and galactose foods such as
milk (including breast milk) and other
dairy products from the diet through
out life.

72. Galactosemia (GAL)
Foods that should be avoided:
Milk and all dairy products
Processed and pre packaged foods
Tomato sauces
Certain medications
Any foods or drugs which contain the ingredients
Lactulose, Casein, Caseinate, Lactalbumin, Curds,
Whey or Whey solids

73. Galactosemia (GAL)
Calcium and Vitamin D
deficiency is likely to develop
in a child on a lactose free.
Therefor, the child is given
supplements to prevent
deficiencies

74. Phenylketonuria (PKU)

75. Phenylketonuria (PKU)
A metabolic disorder characterized by
lack of enzyme Phenylalanine
hydroxylase (PAH) needed to process
the amino acid phenylalanine
The resultant build up of the said
protein in the body leads to mental
retardation

76. Phenylketonuria (PKU)
• Excessive accumulation of
phenylalanine = brain
damage
• Dx – Guthrie test
• Mx - Low protein diet;
breastmilk

77. Glucose-6-Phospate-Dehydrogenase
Deficiency (G6PD)

78. G6PD is one of
many enzymes
that help the
body process
carbohydrates
and turn them
into energy.

79. Glucose-6-Phospate-Dehydrogenase
Deficiency (G6PD)
• A condition where the body lacks
the enzyme called G6PD a
metabolic enzyme especially
important in RBC metabolism
• Hemolytic anemia resulting from
exposure to certain drug, food
and chemical

80. Child during Hospitalization

82. STRESSORS AND THE CHILD’S REACTION
Illness and Hospitalization:

83. Children are particularly vulnerable
to the crises of illness and
hospitalization because:
1.Stress represents a change from
the usual state of health and
environmental routine
1.Children have limited number of
coping mechanisms to resolve
stressors

84. SEPARATION ANXIETY
• Also known as Anaclitic depression
• Major stress especially for children
ages 16 to 30 months
• Three Phases:
–Phase of Protest
–Phase of Despair
–Phase of Detachment

85. SEPARATION ANXIETY
Three Phases:
Phase of Protest
• React
aggressively to
separation from
parent
• Behavior is from
a few hours to
several days

86. SEPARATION ANXIETY
Three Phases:
Phase of
Despair
•Child is less
active
•Withdraws
from others

87. SEPARATION ANXIETY
Three Phases:
Phase of
Detachment
• Also called denial
• Appears detached
and uninterested in
parents’ visits
• Appears to finally
adjust to the
surroundings

88. Loss of Control
INFANTS
– Trust
– Inconsistent care and deviations from daily routine
• TODDLERS
– Autonomy
– Egocentric pleasures
– Rely on the consistency and familiarity of daily rituals
– Altered routine and rituals
– Regression
• PRESCHOOLERS
– Egocentrism and magical thinking
– Physical restriction, altered routines and enforced dependency

89. Bodily Injury and Pain
• INFANTS
– Infants younger than 6 months
• no obvious memory of previous pain
– Facial expression of discomfort
– React with physical resistance
– Distraction and anticipatory preparation does little to
lessen immediate reaction to pain
• TODDLERS
– Intrusive experience produce anxiety
– React with intense emotional upset and physical resistance
– Communicate about their pain

90. Bodily Injury and Pain
• PRESCHOOLERS
– Cause of illness is seen as concrete action the child
does or the child fails to do  self-blame
– Contagion – proximity of two object or persons
causes the illness
– Injection - fear that the puncture will not close
• SCHOOL-AGE CHILDREN
– May be less concerned with pain than disability
– Major concern is their fear of being told that
something is wrong with them
– Aware of the significance of different illnesses

91. Bodily Injury and Pain
• SCHOOL-AGE CHILDREN
– Passive acceptance of pain
– Nondirective request for support
– When someone identifies unspoken messages
and offers support, they readily accept it
• ADOLESCENTS
– The nature of bodily injury may be more
important based on the adolescents’ perception
rather than the actual degree of severity of the
illness
– Changes in body image is their concern
– Privacy
– Reluctance to disclose pain

92. NURSING CARE OF THE CHILD WHO IS
HOSPITALIZED

93. Communication
• Speak in quiet pleasant tones
• Bend down
• Do not use clichés.
• Explain all procedures
• Be honest
• Be careful in making promises
• Observe nonverbal communication for clues to level of
understanding
• Do not threaten
• Allow child to show feelings
• Provide time to talk

94. Communication
• Teach parents to anticipate next stage of development
• If teaching is interrupted, start over from the beginning
• Provide independence
• Do not compare child’s progress to that of anyone else
• Provide praise
• Instead of asking what something is, ask child to give it
a name or tell you about it
• Allow choices where possible
• Involve parents in child’s care

95. Communication
• Keep routines
• If parents cannot stay with child, encourage
them to bring in a favorite toy, pictures of
family members or to make tape to played for
the child

96. Play

97. • Toddler
– Enjoys repetition
– Solitary play
– Parallel play
• Preschooler
– Role play, make believe, associative play
• School-age
– Group, organized activities
– Group goals with interaction

98. Play
• Play is a very important part of development for your
growing child.
• Not only is play time entertaining for your child, but it
also provides stimulation, increases skills and
coordination, provides an outlet for your child's
energy, and helps to encourage exploration by your
child.

99. Play is also important for the following
reasons (Lippincott Williams & Wilkins, 2005)
Play is an excellent
stress reducer and
tension reliever. It
allows the child
freedom of
expression to act out
his fears, concerns
and anxieties

100. Play is also important for the following
reasons (Lippincott Williams & Wilkins, 2005)
Play provides a
source of
diversional
activity,
alleviating
separation
anxiety

101. Play is also important for the following
reasons (Lippincott Williams & Wilkins, 2005)
Play provides the
child with a sense of
safety and security
because while he is
engaging in play, he
knows that no
painful procedures
will occur.

102. Play is also important for the following
reasons (Lippincott Williams & Wilkins, 2005)
Developmentally
appropriate play fosters
the child’s normal
growth and
development, especially
for children who are
repeatedly hospitalized
for chronic conditions

103. Play is also important for the following
reasons (Lippincott Williams & Wilkins, 2005)
• Play puts the
child in the
driver’s seat,
allowing him to
make choices
and giving him a
sense of control

104. Play
– Way to solve problems
– Express creativity
– Decrease stress
– Prepare for procedures
– Enhance fine and motor skills
• Make play appropriate for mental age and
physical/disease state
• Multisensory stimulation
• Safe toys for mental age
• Offer play specific to age group

105. NURSING CARE OF THE CHILD IN PAIN

106. Concept of Pain
Preoperational Thought (2-7 yrs)
Relates to pain primarily as physical concrete experience
Magical disappearance of pain
Pain as punishment
Hold someone accountable for own pain
Concrete Operational Thought (7-10 yrs)
Relates to pain physically
Perceive psychologic pain
Fears bodily harm & annihilation
Pain as punishment
Formal Operational Thought (13 yrs and older)
Give reason for pain
Perceives several types of psychologic pain
Fears losing control during painful experience

107. Q-U-E-S-T (PAIN ASSESSMENT)
QUESTION the child’s parents and child
too, if he is old enough to respond
USE appropriate pain assessment
EVALUATE the child’s behaviour
SECURE the parent’s active participation
in treatment
TAKE the cause of the pain into
consideration

108. ASSESSMENT
• Wong-Baker FACES Pain Rating Scale

110. ASSESSMENT
• FLACC (Face, Legs, Activity, Cry and
Consolability) – for infants and very
young children
• Behavior is observed to assess pain
Measures each of the five identified
categories on a 0 to 2 scale
• The higher the total score, the more pain

112. CRIES Neonatal Postoperative Pain
Measurement Scale
Crying
Requires oxygen to maintain saturation
about 95%
Increased heart rate and blood
pressure
Expression
Sleeplessness

113. Neonatal Infant Pain Scale
Facial Expression
Crying
Breathing
patterns
State of arousal
Movement of
arms and legs

114. Premature Infant pain Profile
Gestational age
Heart rate
Oxygen saturation
Behavioral state
Brow bulge
Eye squeeze
Nasolabial furrow

116. INFANT Mouth stretched open
Eyes tightly shut
Facial expression
Brows and forehead
knitted
Cheeks raised high enough

117. Younger Children
Narrowing of the eyes
Grimace or fearful appearance
Frequent and longer lasting bouts of
crying with a tone that is higher and
louder than normal
Less receptiveness to comforting by
parents or other caregivers
Holding or protecting the painful
areas

118. P-A-I-N Management
Pharmacologic interventions
Anticipate and prevent or minimize pain
related to hospitalization, procedure and
treatment
Identify and relieve existing pain
Non pharmacologic interventions to reduce
stress, increase comfort and enhance

119. Pharmacologic Intervention – mainstay of pain
management and it depends on the specific
needs of the patient
Opioid analgesics
-Highly effective pain relievers and
constitute the core of most pharmacologic
interventions to manage acute pain in
infants and children
-Oral, sublingual, rectal, nasal,
subcutaneous, transdermal, IV and
intraspinal
*Morphine (MS contin)
*Fetanyl (Duragesic)

120. Non Opioid Analgesics
-are prescribed to manage
mild to moderate pain.
-infants and children
metabolize non opioid
analgesics in the same manner
and at the same rate as adult.

121. NSAIDS
-relieve for mild to moderate pain and
anti inflammatory effects
-Ibuprofen (advil); Naproxen
(Naprosyn); Tolmetin (Tolectin);
Indomethacin (Indocin) & Ketorolac
(Toradol) are approved for use in
children
-S.E: Inhibition of platelet aggregation
and GI irritation

122. Acetaminophen
-Is the DOC for treating mild pain.
Available in suppository, liquid and table
form.
-it has the added benefit of helping
reduce fever and is very safe, even for
neonates.
-long term can cause risk of liver
damage

123. EMLA Cream (lidocaine 2.5% and
prilocaine 2.5%),
applied to intact skin
under occlusive
dressing, provides
dermal analgesia by
the release of
lidocaine and
prilocaine from the
cream into the
epidermal and dermal
layers of the skin

124. • Complementary and alternative medicine (CAM)
– Complementary Pain Medicine
• Music Therapy
• Hypnosis
• TENS (transcutaneous electric nerve stimulation) unit
• Acupuncture
– Non-Pharmacologic Care
• Comfort, positioning and non-nutritive sucking
• Distraction
• Relaxation
• Guided Imagery
• Biofeedback
• Behavioral Contracting

125. Pediatric Surgery

126. Pediatric Surgery
• Preoperative classes
– Younger – simple and as close to the time of the
procedure as possible
• Allow to play with equipment
• Teach and provide time to practice
• Show pictures
• Describe sensations
• Detect misconceptions or fantasies
• Parents can often be helpful in preparing

127. PEDIATRIC SURGERY
• Preoperative class
• Listen to child for clarifying misunderstandings
• Give simple information about the system that
will be affected
• Use of anatomically correct dolls
• Preschool boys: allow to look at penis after
surgery
• Post surgery: helping child master a threatening
situation and minimizing physical and
psychological complications

128. CHRONICALLY ILL PEDIATRIC CLIENTS:
CONCEPTS OF DEATH DYING AND GRIEVING

129. Concept of Death in Childhood
(Lippincotts William and Wilkins, 2005)
Infancy
Concept of death – NONE
Nursing considerations:
Be aware that the older infant
will experience separation
anxiety
Help the family cope with death
so they can be available to the
infant

130. Concept of Death in Childhood
(Lippincotts William and Wilkins, 2005)
Early childhood
Knows the words “DEAD” and
“DEATH”. Reactions are influenced
by the attitude of the parents.
Nursing considerations:
Help the family members including
siblings cope with their feelings
Allow the child to express his own
feelings in an open and honest
manner.

131. Concept of Death in Childhood
(Lippincotts William and Wilkins, 2005)
Middle childhood.
Understands universality and
irreversibility of death. May have
a fear of parents dying.
Nursing considerations
Use play to facilitate the child’s
understanding of death
Allow siblings to express their
feelings.

132. Concept of Death in Childhood
(Lippincotts William and Wilkins, 2005)
Late childhood
Beings to incorporate family and cultural beliefs
about death. Explores views of an afterlife and
faces the reality of own mortality
Nursing considerations
Provide opportunities for the child to verbalize his
fears
Help the child discuss his concerns with the family

133. Concept of Death in Childhood
(Lippincotts William and Wilkins, 2005)
Adolescence
Adult perception of death, but still focused on the
HERE and NOW
Nursing considerations
Use opportunities to open discussion about death
Allow expression of feelings of guilt, confusion and
anxiety
Support and maintain self esteem

134. Helping Families to Cope
• Accept and support participants
• Be available and express your availability
• Encourage parents to assist in the care of
their child
• Encourage involvement of siblings
• Religious associations as source of
strength and support

135. Helping parents to talk with their child about dying
if he is ready to do so
Encouraging all family members to express their
feelings, even though they might be difficult to
hear
Allowing families to spend as much time as
possible with the dying child
Allowing and encouraging parents to continue to
take an active role in their child’s care
Reminding parents that they don’t always have to
be strong and ask for help

136. Thank you for Listening!