11 Pediatric Nursing
A practical guide to pediatric growth and development, assessment, common childhood conditions, urgent warning signs, and partnership with families.
Foundations of pediatric care
adapts assessment and care to a child’s age, , health status, and family context. Children may worsen quickly, and changes in behavior, feeding, play, or activity can signal illness before a child can explain what feels wrong. Observe carefully, include caregivers as partners, and escalate concerns promptly.
and
and are related but distinct. is measurable physical change; is progress in movement, communication, thinking, and social-emotional skills. Assess patterns over time rather than judging a single measurement or milestone in isolation.
Measure and plot weight, length or height, and—when appropriate—head circumference using accurate technique and the correct age-appropriate chart. In the United States, WHO standards are recommended from birth to age two, and CDC charts are recommended from age two onward. For children age two and older, BMI is interpreted using age- and sex-specific percentiles. A helps build an overall picture; it is not a diagnosis by itself.
For a child born prematurely, is generally used to consider developmental milestones during the first two years.
Developmental patterns and follow-up
varies among children. Use broad age-related patterns to tailor communication and care, not as rigid pass-or-fail rules.
Infants: Sensory, motor, and attachment is rapid, and infants rely on adults for all care. Keep the caregiver close when possible; use soothing touch and a calm voice; assess feeding, sleep, interaction, and consolability.
Toddlers: Growing independence and mobility may accompany resistance to separation and limited language for feelings. Offer simple choices, keep routines predictable, and use brief, concrete explanations.
Preschoolers: Children are imaginative, increasingly verbal, and learning to play with others; they may interpret explanations literally. Use simple, honest language and play or demonstration. Avoid threatening expressions and promises that a procedure will not hurt.
School-age children: Competence, friendships, and more logical understanding are developing. Explain what will happen in steps, invite questions, and offer a meaningful role in care.
Adolescents: Independence and identity are developing, alongside a need for privacy and peer connection. Speak directly to the adolescent, provide appropriate private time, and explain confidentiality and its safety-related limits.
Developmental milestones describe skills that most children can do by a given age. They are guides for conversation, not diagnostic standards. should include caregiver concerns and observation. Standardized developmental screening is recommended at nine, eighteen, and thirty months, and autism screening at eighteen and twenty-four months; screen at other times when there is concern. A missed milestone, loss of a previously acquired skill, or caregiver concern warrants follow-up and referral through the appropriate clinical pathway.
Assessment and communication
Begin by confirming the child’s identity, age, allergies, relevant history, medications, and the caregiver’s relationship to the child. Ask what is normal for this child and what has changed. Use an interpreter when needed; do not rely on a child or family member to interpret important clinical information.
Approach at the child’s level, explain each step in age-appropriate terms, and include the child as much as allows. A caregiver can often help comfort, position, and reassure the child. Observe before touching: note appearance, interaction, alertness, work of breathing, skin color, and ability to feed, speak, or play. A sudden change from the child’s usual behavior can be clinically important.
A systematic assessment
Prioritize immediate threats. Check airway, breathing, circulation, mental status, and exposure as appropriate. Escalate promptly for respiratory distress, poor perfusion, altered responsiveness, or other signs of instability.
Obtain age-appropriate vital signs. Use correctly sized equipment and the measurement method required by facility policy. Interpret results in context, including age, activity, fever, and overall appearance. Repeat abnormal findings and report concerning trends.
Gather focused history. Ask about onset and course, fever, pain, intake, urine output, stools and emesis, sleep, activity, exposures, immunizations, medical conditions, and medicines. Caregivers can provide essential information, especially for infants and children who cannot describe symptoms.
Assess pain appropriately. Ask the child when able and consider behavior, caregiver observations, and response to comfort measures. Reassess after an intervention.
Use a calm, flexible exam sequence. Complete observation and less upsetting assessments first; save distressing steps for later when clinically safe. Follow infection-prevention practices and maintain privacy, especially for adolescents.
Document and communicate. Record objective findings, intake and output when relevant, the child’s response to care, caregiver concerns, actions taken, and whom you notified.
Common conditions and priorities
Respiratory and ear conditions
Viral upper respiratory illness or ear pain: Congestion, cough, fever, ear discomfort, or reduced sleep and intake may occur. Assess breathing, hydration, pain, and temperature. Support comfort and fluids as appropriate; give medicines only as prescribed or directed by protocol. Report worsening symptoms, severe pain, poor intake, or concerning fever. Give antibiotics only when prescribed.
: Cold-like symptoms may progress to cough, wheezing, reduced feeding, or breathing difficulty. Monitor work of breathing, oxygenation as ordered, feeding, hydration, and activity. Use suction or other supportive measures as directed by the care plan. Seek urgent clinical review for difficulty breathing, inadequate fluid intake, apnea, or worsening symptoms.
: Cough, wheeze, chest tightness, or shortness of breath may worsen at night or with triggers. Follow the child’s written action plan and prescribed medication orders, and assess response to treatment and work of breathing. Severe breathing difficulty, blue coloration, or poor response to the prescribed rescue plan requires emergency escalation.
: A barking cough, hoarse voice, and sometimes stridor—a harsh sound on inhalation—may occur. Keep the child calm and observe breathing closely, since distress can worsen airway symptoms. Give ordered treatment and escalate stridor at rest, retractions, cyanosis, drooling, trouble swallowing, or increasing fatigue as an emergency.
Gastroenteritis and fluid loss
Vomiting or diarrhea may occur with reduced urine, dry mouth, fewer tears, thirst, or lethargy. Infants can become dehydrated quickly. Track intake, output, weight when ordered, and perfusion. For a child able to drink, oral rehydration solution may be given in small, frequent amounts according to the care plan; continue feeding as directed. Report blood in stool, inability to keep fluids down, markedly reduced urine, lethargy, or signs of poor perfusion. Severe or shock is an emergency.
Fever, urgent signs, and medication safety
A rectal temperature of () or higher in an infant three months old or younger requires immediate contact with a health professional, even if the infant otherwise seems well. Follow local policy for temperature measurement and escalation.
At any age, urgent warning signs include difficulty breathing, blue lips or skin, inability to awaken normally, poor perfusion, markedly reduced urine, or a sudden concerning rash.
Pediatric medication administration requires particular care. Verify the child’s current weight and allergies, check the prescribed dose and concentration, use an appropriate measuring device, and follow required independent checks and facility policy. Never give aspirin to a child unless specifically directed by a qualified prescriber.
Partnering with children and families
Patient- and treats the child and family as partners. Caregivers know the child’s usual behavior, needs, and strengths; the child should participate to the extent appropriate for age and ability.
Ask about family priorities, language, culture, routines, and concerns without making assumptions. Share information in plain language, invite questions, check understanding, and include caregivers in planning and comfort measures when appropriate. Respect the adolescent’s developing autonomy and privacy while following consent, confidentiality, and safeguarding requirements.