Y khoa, y dược - Chapter 12: The child and the children’s act

Chapter 12The Child and the Children’s Act IntroductionThe Registered Nurse needs knowledge of children whether they are practising in a specialist children’s area or not. Recent changes in the law have made it everybody’s business to contribute to child safety.The nurse caring for a patient who has been subject to violence, is now required, as are every other professional, to ensure that this child, and its circumstances are highlighted to the child protection team. Previously, the fact that the patient was an adult would have led to the presumption that such matters were the business of others.Childhood, Infants & Adolescents There are various definitions for childhood, some of which are driven by age, and others by events in development. General definition in terms of time might be from birth until adulthood. Other definitions use the period of time from infancy to the onset of puberty. Within most contemporary definitions of childhood, there is reference to this period as being one of nurturing by parents or equivalent to allow the child to become an individual and to reach full potential. Age & Informed ConsentA medically directed definition of adolescence might be the period of physical and psychological development from the onset of puberty to maturity. Such matters become important in consent for procedures. While 16 years might be regarded as the legal age of consent, Frazer Competence has meant that consideration needs to be given to the views of the young person. While EU law might have superseded Frazer Competence, most practitioners would wish to have the consent of the young person as well as the parent/guardian. Why are Children Different? Children, from babies through to adolescents, differ from adults, as they are vulnerable outside of their normal environment.They have special needs that health services, including preventative health services, need to be aware of. The modern history of child care has been described many times, but continues to be central to understanding why children’s acute healthcare is designed in its current form. In the UK, during the Second World War, the removal of children from dangerous areas of big cities during periods of bombing, to the safety of the countryside, was seen at the time as being idyllic and good for the children.Without their parents, however, these children were vulnerable, and some of them showed the psychological effects of this for the rest of their lives. The NSF For the acutely ill child and their family there have been many changes in the last few years. Medical technology has changed the viability of many seriously ill children however, this has meant that families have had to deal with prolonged and open ended periods and quantity of care. Approaches to care, such as family-centred care, emphasize the importance of the family.In practical terms, the Labour (UK) government has adopted many of the principles of family-centred care within its National Service Framework. Physical Differences in Children – Physiological/Anatomical One of the most obvious differences between adults and children is that children are smaller than adults. Children have a high surface to area ratio and can get hypo and hyperthermic very quickly. Young children have an immature temperature control system leaving them vulnerable to the effects of high and low temperatures.When young children acquire infections and are pyrexial, this is a concern and opens up the potential for febrile convulsions. Vital Signs ABCA. Children have much smaller airways thereby the potential for airway obstruction increases. Infants breathe through their nose only up until the age of six months. In children, the cricoid ring is the narrowest part of the upper airway; within adults it is the larynx.B. Children have a higher metabolic rate and accompanying oxygen demand, contributing to a higher respiratory rate than in adults. Initially children compensate well for a mild breathing difficulty but due to immature muscle development and in the infant diaphragmatic breathing they are more prone to muscle fatigue and sudden respiratory failure.C. Children have a comparatively smaller stroke volume, and a higher cardiac output than adults; this is facilitated by relative tachycardia. The stroke volume increases with age; consequently heart rate falls as the child matures. Children do not possess the cardiac reserve of an adult therefore when confronted with severe blood or fluid loss a child will quickly become critically ill. Child Protection “All those who come into contact with children and families in their everyday work, including practitioners who do not have a specific role in relation to child protection, have a duty to safeguard and promote the welfare of children”. This is an important principle for child protection, because it makes explicit the role of every professional. In the past, non-children’s specialists shied clear of child protection, understandably as it is a challenging area of practice. Current legislation makes it everybody’s business. What is Abuse & Neglect? “Abuse and neglect are forms of maltreatment. Somebody may abuse or neglect a child by inflicting harm, or by failing to act to prevent harm”Working Together to Safeguard Children (2006)There are many forms of abuse and they have been categorised in the flowing manner:Physical Abuse NeglectEmotional Abuse Sexual AbuseRoles & Responsibilities in the Health Services Health professionals have a key role to play in actively promoting the health and well-being of children. Nurses working directly with children need to ensure that safeguarding and promoting the welfare of those children forms an integral part of the care they offer. Other health care professionals who come into contact with children share the same responsibilities. In cases of suspected abuse, the duty of care that a health professional owes to a child as his or her patient will take precedence over any obligation to the parent who may be suspected of abuse. All Professionals Should Be alert to the indicators of abuse and neglectBe Alert to the risks potential abusers pose to children Share and help analyse information to assess need Contribute to whatever actions needed Take part in regular reviews of plans Work cooperatively with parents - unless inconsistent with safety of childWorking Together to Safeguard Children: A Guide to safeguard and promote the welfare of children. HM Government (2006) ConclusionThis presentation has discussed something of the nature of childhood, particularly milestones, and the notion of infancy, childhood and adolescence.The vulnerability of children has been discussed. For psychological development the need for a prime carer, particularly for the young has been made clear. Physiological differences and the vulnerability to temperature changes discussed.The NSF for children have also been described. The notion of child protection has been described and the legislative as well as the processes to ensure that the welfare of the child as paramount.