Transcript Common Pediatric Procedures

Chapter 30
Basic Pediatric Nursing Care
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History of Child CareThen and
Now
• Industrialization in America
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Population shifted from rural to urban settings.
People lived in overcrowded and unsanitary
conditions.
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 laws.
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Slide 2
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.
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Slide 3
History of Child CareThen and
Now
• Lillian Wald: founder of public health or community
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nursing
Early 1900s: Children with contagious diseases were
isolated from adult patients; parents were prohibited
from visiting.
1940s: Famous works of Spite and Robertson on
institutionalized children; the effects of isolation and
maternal deprivation were recognized.
1909: White House Conference on Children focused
on issues of child labor, dependent children, and
infant care.
1912: U.S Children’s Bureau was established.
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Slide 4
History of Child CareThen and
Now
• 1919: First funded program for mothers and children
• 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.
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Slide 5
Pediatric Nursing
• Purpose of Pediatric Nursing
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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
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Slide 6
Pediatric Nursing
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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
illnesses
Requires establishing a level of trust
Must convey respect, talk at their level, and be
honest
Function as a child and family advocate
Ability to communicate effectively essential
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Slide 7
Pediatric Nursing
• Children with Special Needs
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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.
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Slide 8
Pediatric Nursing
• A philosophy of care that recognizes the family as
the constant in the child’s 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 family’s and individual member’s
unique strengths.
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Slide 9
Pediatric Nursing
• Partnerships with Parents
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Concept of partnerships with parents
 Parental involvement in their children’s care has
evolved from that of relinquishing their role to
institutions to today’s 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 child’s condition.
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Slide 10
Pediatric Nursing
• Future Challenges for the Pediatric Nurse
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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.
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Slide 11
Pediatric Nursing
• Nursing Implications of Growth and Development
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One of the nurse’s 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.
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Slide 12
Pediatric Nursing
• Nursing Implications of Growth and Development
(continued)
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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
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Slide 13
Physical Assessment of the
Pediatric Patient
• Growth Measurements
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Measurement of physical growth is a key element in
evaluation of the health status of children.
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Measurements are plotted by percentiles on growth
carts and compared with those of the general pediatric
population to determine deviation from the norm.
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Slide 14
Physical Assessment of the
Pediatric Patient
• Growth Measurements (continued)
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Length
• Measurements are taken when children are supine;
recumbent length is usually measured until 2 years of
age.
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Height
• Measurement is of a child standing upright.
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Slide 15
Figure 30-1
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
Measurement of head, chest, and abdominal circumference and
crown-to-heel measurement.
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Slide 16
Physical Assessment of the
Pediatric Patient
• Growth Measurements (continued)
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Weight
• Fluid loss and inadequate calories are reflected in a
child’s weight, especially that of infants and toddlers.
• Same scale should be used, and the child should be
weighed at the same time every day.
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Skin thickness
• Skinfold thickness should be determined at one site
with at least two measurements.
• Arm circumference measures muscle mass.
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Slide 17
Figure 30-2
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
A, Infant on scale. B, Toddler on scale.
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Slide 18
Physical Assessment of the
Pediatric Patient
• Vital Signs
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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
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Slide 19
Physical Assessment of the
Pediatric Patient
• Vital Signs (continued)
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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 adolescence.
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Slide 20
Physical Assessment of the
Pediatric Patient
• Vital Signs (continued)
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Respirations
• Infants’ respirations are mainly diaphragmatic; observe
abdominal movement for 1 full minute.
• In older children, respirations are chiefly thoracic.
• 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.
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Slide 21
Physical Assessment of the
Pediatric Patient
• Vital Signs (continued)
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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 120/78.
• It is important to use the correct size cuff to ensure
accuracy.
• Measure blood pressure before any anxiety-producing
procedures.
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Slide 22
Figure 30-3
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
Sites for measuring blood pressure.
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Slide 23
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment
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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.
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Slide 24
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
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Accessory structures
• Hair
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Should be lustrous, silky, elastic
• Nails
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Should be pink, convex, smooth, and hard but flexible
• Handprints and footprints
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Palm normally shows three flexion creases
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Slide 25
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
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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
function.
• 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.
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Slide 26
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
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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.
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Slide 27
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
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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 teeth.
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Slide 28
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
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Lungs
• Make sure the child is not crying.
• Have them “blow out.”
• Listen systematically.
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Chest
• Chest is almost circular.
• As the child grows, the chest normally increases in a
transverse direction.
• Asymmetry may indicate serious underlying problems.
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Slide 29
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
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Back
• Newborn is C-shaped.
• Older child typically has S-shaped curve.
• Marked curvature in posture is abnormal.
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Abdomen
• Inspection: cylindrical and flat
• Auscultation: listen for peristalsis
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Slide 30
Figure 30-7
(From Hockenberry-Eaton, M.J., Wilson, D., Winkelstein, M.L., Kline, M.D. [2003]. Wong’s nursing care of
infants and children. [7th ed.]. St. Louis: Mosby.)
Development of spinal curvatures.
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Slide 31
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
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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
balanced.
• During puberty, adolescents may experience awkward
posture from rapid growth of extremities.
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Slide 32
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
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Renal function
• There is a functional deficiency in the kidney’s 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.
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Slide 33
Physical Assessment of the
Pediatric Patient
• Head-to-Toe Assessment (continued)
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Anus
• Check the anal sphincter.
• History of bowel movements should be noted.
• Assess for perianal itching; may be pinworms.
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Genitalia
• This is an excellent time to elicit questions concerning
body functions or sexual activity.
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Slide 34
Factors Influencing Growth and
Development
• Nutrition
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Nutrition is probably the single most important
influence on growth.
 A child’s 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.
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Slide 35
Factors Influencing Growth and
Development
• Nutrition (continued)
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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.
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Slide 36
Factors Influencing Growth and
Development
• Metabolism
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Metabolic needs vary among individuals.
 Rate of metabolism is highest in the newborn infant
because the ratio of total body surface to body weight
is much greater than it is in the adult.
 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.
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Slide 37
Factors Influencing Growth and
Development
• Sleep and Rest
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Children spend less total time sleeping as they
mature.
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.
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Slide 38
Factors Influencing Growth and
Development
• Speech and Communication
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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 words.
 The nurse should know what typifies speech at certain
stages of childhood.
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Slide 39
Factors Influencing Growth and
Development
• Nonverbal Communication
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Young children become very adept at understanding
nonverbal communication.
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They sense anxiety or fear by the rise in pitch of the
parent’s voice.
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Nonverbal symbols include nodding of the head; using
direct eye contact; tapping finger or foot; avoiding eye
contact; and sign language.
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Slide 40
Hospitalization of a Child
• Preadmission Programs
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Many hospitals have orientation programs for children
who are to be admitted.
 Programs are based on the child’s 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 adults.
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Slide 41
Hospitalization of a Child
• Admission
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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.
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Slide 42
Hospitalization of a Child
• Hospital Policies
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Parents who are involved in care have a sense of
contribution to the child’s 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 technician.
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Slide 43
Hospitalization of a Child
• Developmental Support for the Child
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Hospitalization interrupts children’s normal routines
and threatens their normal developmental process.
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.
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Slide 44
Hospitalization of a Child
• Pain Management
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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 variables.
 Wong-Baker Faces Scale may be helpful in assessing
pain level.
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Slide 45
Hospitalization of a Child
• Surgery
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
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
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Slide 46
Hospitalization of a Child
• Parent Participation
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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 else.
 On admission parents need specific information on
routines, hospital policies that affect them, any
limitations that exist, and what is expected of them.
 Explain diagnostic tests, medications, or procedures.
 As the parents’ comfort increases, they become more
involved in meeting their child’s physical needs.
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Slide 47
Common Pediatric Procedures
• Bathing
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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 creases.
Cotton-tipped applicators are never used inside the
ear canal.
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Slide 48
Common Pediatric Procedures
• Bathing (continued)
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Infants enjoy being placed in basins for baths.
Use dry hands to pick up the infant.
Allow the 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
supervision.
School-aged children may be reluctant to bathe;
encourage them to participate in their care.
Adolescents bathe or shower daily; privacy is
important.
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Slide 49
Common Pediatric Procedures
• Feedings
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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.
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Slide 50
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 another.
• After feeding, the infant is positioned on the right side.
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Slide 51
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.
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Slide 52
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
preferred.
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Slide 53
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.
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Slide 54
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 suture.
• 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
Fowler’s position.
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Slide 55
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 observation.
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Slide 56
Common Pediatric Procedures
• Safety Reminder Devices

At times, for safety, children should be restrained after
surgery or during a procedure or examination.
 This is used only as a last resort.
 The device should be applied correctly, and
circulation and skin integrity must be monitored
closely.
 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.
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Slide 57
Common Pediatric Procedures
• Safety Reminder Devices (continued)

Types
•
•
•
•
Elbow safety reminder
Mummy safety reminder
Clove-Hitch safety reminder
Jacket safety reminder
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Slide 58
Figure 30-10
(From Lowdermilk, D.L., Perry, S., Bobak, I.M. [1997]. Maternity & women’s health care. [6th ed.]. St. Louis:
Mosby.)
Mummy restraint.
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Slide 59
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
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Slide 60
Figure 30-11
Suprapubic bladder aspiration.
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Slide 61
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.
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Slide 62
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 specimen.
 The nurse’s 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.
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Slide 63
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 procedure.
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Slide 64
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.
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Slide 65
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
blanket.
 The child should be held securely until the spinal tap
is completed.
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Slide 66
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.
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Slide 67
Common Pediatric Procedures
• Oxygen Therapy



This is used to improve the child’s 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
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Slide 68
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).
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Slide 69
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
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Slide 70
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.
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Slide 71
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 child’s
response to the drug.
 Methods of calculating dosages for children consider
age, body weight, and body surface area.
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Slide 72
Common Pediatric Procedures
• Medication Administration (continued)

Routes of administration
•
•
•
•
•
Oral
Intradermal, subcutaneous, and intramuscular
Intravenous
Optic, otic, and nasal
Rectal
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Slide 73
Figure 30-17
(Courtesy of Marjorie Pyle, RNC, Lifecircle, Costa Mesa, California.)
Intramuscular injection sites.
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Slide 74
Safety
• Protecting a child from harm is a major issue in
•
•
•
•
pediatrics.
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.
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Slide 75