This chapter provides an overview of common sleep disorders that affect children and specific information on sleep assessment in pediatric patients. Sleep disorders are common among children and adolescence, with the prevalence varying according to developmental stage. The chapter examines that children often exhibit symptoms of sleep disorders in ways that differ from the presentation of similar disorders in adults. Snoring, the most common symptom of obstructive sleep apnea (OSA) in children from infancy through adolescence, results from turbulence in airflow through the narrowed oronasopharynx. The importance of incorporating a developmental approach to sleep assessment and treatment into nursing care is underscored by the profound effects of sleep and sleep disorders on children’s behavior, learning, and daily function. Many sleep disorders can be addressed by the nurse and members of the interdisciplinary team with behavioral treatments.
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Pediatric primary care providers (P-PCPs), who are educated about resiliency, are in the unique position to assess child and family strengths, identify behaviors indicative of stress, and offer guidance and recommend services to help build child, adolescent, and family resilience. This chapter presents the evidence for building resiliency in children and the role of P-PCPs, which includes attention to the office environment and structure, comprehensive assessment, ongoing support, and community referrals. Building resiliency in children intercepts the impact of adversity on a child’s emotional, social, and behavioral health. Analysis of the results of screening tools completed by the parents and the child, appropriate assessment questions, office-based interventions, and timely referrals to therapy in community resources are critical components of the behavioral health assessment to enable the P-PCPs to intercept problems and build child, adolescent, and family resiliency.
The overarching goal for providing behavioral and mental health services in pediatric primary care settings is to provide immediate and effective services to children, adolescents, and their families to change the course from potential adverse behavioral health outcomes to supportive positive directions in growth and developmental behavioral health. This textbook provides an analysis of evidence-based behavioral health practices to foster growth and developmental behavioral health through early behavioral health screenings and assessments with the goal of intercepting behavioral development and characteristics that are not within the “norm” of pediatric and adolescent development. The conceptual model for Intercepting Behavioral Health problems focuses on identifying the very earliest presentation of even one symptom that may lead to a behavioral health problem and immediately beginning the process for intercepting the potential problem with evidence-based treatments. Pediatric primary care providers play a unique role in caring for children with behavioral health problems.
Experiences for the obstetric and pediatric clinical areas are becoming difficult to acquire for students, as increasing numbers of students compete for a small number of slots, and constraints on the numbers of students allowed in clinical settings continue to rise. As postpartum hemorrhage (PPH) constitutes an obstetric emergency and remains a major cause of maternal morbidity and mortality in high- and low-resource countries, using a simulator offers an ideal opportunity for students to practice their skills in simulated PPH. This chapter presents a scenario that was modified and used at the University of British Columbia (UBC) School of Nursing (SoN) since January 2015. Student preparation requires readings, videos, and evidence-based practice protocols for PPH. This scenario is a high-risk case that could be used to educate new staff to family birthing units and obstetric floors, as well as undergraduate and graduate nursing students.
Innovations in fields such as neuroscience, developmental psychology, sociology, and molecular biology have sparked a paradigm shift toward a multidisciplinary approach to health. This paradigm shift is illustrated in the concept known as the social determinants of health (SDH). This chapter provides an overview of concepts of SDH and their effects on child and adolescent development, focusing on behavioral, mental, and biological health. In addition, this chapter describes the role of pediatric primary care providers (P-PCPs) in addressing SDH at each healthcare visit with a goal of under- standing the important role of SDH in achieving or in failure to achieve positive behavioral health outcomes. By incorporating the ways environmental factors interact with biological and behavioral factors, healthcare delivery systems can deliver optimal comprehensive care to improve overall health outcomes for the U.S. pediatric population, thus leading to a medically and behaviorally healthy adult population.
Adolescence is a critical transition period within the life course during which adolescents experience rapid and substantial changes in physical, sociocultural, psychological, emotional, behavioral, and cognitive growth and development. Typically, this period is considered the transition from childhood toward adulthood. This chapter provides an analysis of adolescent brain growth and development, typical physical development, and the interrelationship of brain growth and physical development to social, emotional, and behavioral development during the entire adolescent and emerging adult age span, with a focus on evidence-based behavioral interventions to immediately intercept atypical behaviors. Disruptions in typical development processes may negatively influence adolescent brain development, manifesting as behavioral problems or psychopathology. Pediatric primary care providers (P-PCPs) play a critical role in identifying and intercepting adverse behaviors through screening adolescents at all healthcare visits and implementing evidence-based interventions and referral to treatment as needed.
Much consideration and discussion should take place between physicians, dosimetry, physics, and therapists before a patient is brought into the simulator and scheduled on a treatment machine. One should try to anticipate factors such as how the patient will be immobilized, target and organ at risk dose goals, and beam angles. Whenever possible, patient’s care should be referred to a high-volume pediatric oncology center, and clinical trial enrolment should be considered. Patients should be in a tolerable, reproducible position. Patients under anesthesia are often very limp, so immobilization should be maximized to limit movement. The treatment time for a pediatric patient is an important factor. Treatment can affect the growth of developing organs, particularly growth plates in the bone. The chapter provides a brief description on patient setup, immobilization, and treatment planning for Wilms’ tumor, Ewing’s sarcoma, rhabdomyosarcoma, craniopharyngioma, craniospinal irradiation of embryonal tumors, and total body irradiation.
The comprehensive rehabilitation of children with cancer requires an interdisciplinary team approach across the continuum of care. Childhood cancers account for approximately 1% of all cancers diagnosed in the United States each year. The type of treatment for childhood cancer can include any combination of chemotherapy, surgery, radiation, and biologic therapies depending upon many factors including tumor pathology, genetics, and staging. Pediatric rehabilitation is an important component in minimizing the adverse effects and maximizing the return of independence and function in these children and young adults. In pediatric rehabilitation, prescriptions for therapy programs, adaptive equipment, orthoses, and prostheses must be appropriate to the age and the developmental level of the child and include considerations related to ongoing growth and development. The chapter discusses specific childhood cancers like leukemia, central nervous system tumors, bone sarcomas its and rehabilitation issues.
This chapter delves into some of the frequently encountered cancers in childhood, their incidence, and common presenting features from a rehabilitation practitioner’s point of view. It highlights the multimodality approach in treatment for various types of pediatric cancer. Pediatric cancer is fairly rare compared to cancer in adults. There has been a remarkable progress in the outcomes for cancer in childhood overall, over the past half-century. One of the key determinants for this success has been a collaborative effort by pediatric oncologists all over the world in enrolling majority of the patients in cooperative group studies. With improved survival, there have been efforts to decrease the intensity of treatment to curtail some of the long-term effects in low-risk cancers. Recently, there has been explosive growth in genomic information that led to a better understanding of various subtypes, revised classifications, and therapeutic strategies for various cancers.
This chapter discusses child development and hypnosis with children. Most children learn hypnosis easily. If a child is intellectually disabled, the hypnotic training approach should relate to his cognitive, not his chronological, age. It also presents hypnosis as primary or adjunct therapy in pediatrics. Children may benefit from learning hypnosis as either primary or adjunct therapy for a variety of problems. The problems include sleep problems, performance anxiety, habit problems, enuresis, warts, chronic conditions, tics, conditioned fears or anxiety, pain associated with procedures, chronic pain, dysfluencies and conditioned physiological responses. If the child is learning self-hypnosis to control a habit or to reduce performance anxiety, it is important to include suggestions about a future without the problem. In situations where the child is chronically ill or very young, it may be preferable to involve parents in coaching and also to teach parents how to use self-hypnosis for themselves.