Why you should read this article: • To enhance your knowledge of the cardiovascular system • To increase your awareness of some of the congenital heart defects found in children and young people • To count towards revalidation as part of your 35 hours of CPD, you may wish to write a reflective account (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) This article is the third in a series on the biological basis of child health. It outlines how the cardiovascular system develops during gestation and how congenital heart defects (CHDs) may arise in the process. The article details the pathophysiology and treatment of some of the common CHDs, including patent ductus arteriosus, atrial septal defect, ventricular septal defect and transposition of the great arteries. It explains the possible causes of CHDs and explains how these defects are detected and diagnosed. The article also provides an overview of the initial management of acutely unwell infants and children who present with a CHD. The first two articles in the series looked at cells and genetics, and embryology.
Our continuing professional development (CPD) articles are designed to assist with your nursing skills and practice.
The period from fertilisation to birth is crucial in the development of an individual
An introduction to cell biology and genetics for children’s nurses
Research and advances in technology have enabled children and young people with life-limiting conditions to live longer. To maintain their well-being and quality of life many of these children usually require some form of intravenous access for treatment. Children’s nurses should have the skills and training to ensure they are competent to practise using totally implanted central venous access devices such as portacaths (ports). This article addresses the care and management of these ports in children and the wide variation in practice that exists in the UK, and makes recommendations for practice.
This article explores communication and decision-making with children and young people in healthcare. Children and young people report that healthcare professionals are good at explaining and helping them to understand what will happen to them, but that they do not feel involved in decision-making about their care or treatment. To improve communication with children and young people, they need to be involved in decision-making about their care and treatment. In partnership with children, young people and healthcare professionals Common Room Consulting, Great Ormond Street Hospital for Children NHS Foundation Trust and Health Education England have co-produced a communication model, Me first, to support decision-making with children and young people in healthcare. This article introduces the Me first model and explores how it can be applied in clinical practice.
This article gives an overview of migraine in children. It outlines the epidemiology of the condition and describes presentation with headache and other symptoms and linked conditions. It aims to raise awareness of the diagnosis of migraine and its impact on children and young people, their families and school life. The author also describes methods of diagnosis and management, and the importance of recognising and of avoiding medication overuse.
Complementary feeding is an important developmental milestone in children and occurs at a formative time for the development of healthy eating habits that can continue into later childhood and beyond. The timing of weaning has been a controversial subject and recommendations in the UK differ from those in Europe. In the UK and New Zealand, baby-led weaning is becoming increasingly popular. The importance of responsive feeding is highlighted to make parents aware of a baby’s cues indicating hunger or fullness. There have also been advances in the science of immunology that deem the early introduction of allergens to be a preventive strategy for food allergies. This article discusses the nutritional requirements for infants and reviews the foods that should be introduced and avoided. Guidelines are changing all the time, so nurses must keep up to date with current research to be able to offer advice to parents of infants.
Nocturnal enuresis – or bed-wetting – is one of the most common chronic conditions of childhood. It has a significant effect on the quality of life of affected children and their families and is associated with several comorbidities, some of which resolve on successful treatment. The causes of this troublesome condition are explored and the principles of assessment and treatment are discussed with reference to National Institute for Health and Care Excellence guidance as well as research. Response to treatment resistance is considered and appropriate onward referral discussed.
Suctioning to clear airway secretions is an important part of the nursing care for children with respiratory conditions. While the principles of safe suctioning are known widely, they are not closely adhered to. The adverse effects of suctioning can easily be overlooked to the detriment of the patient. Careful risk assessment and patient observation are needed to ensure that suctioning is performed only when necessary and the risks to the patient are minimised.
Part two of this article focuses on the care and management of infants and children who are seriously ill and who have lost so much fluid that they have entered a state of shock. The pathophysiology of shock is reviewed and the types and stages of shock are considered. The challenges of identifying shock are explored and the management of fluid resuscitation with colloids rather than crystalloids is analysed. An overview of the complex management of a young person in shock is provided using a case history format. The article offers the opportunity to extend readers’ knowledge of some of the special tests that may be required to support the diagnosis of shock and provides an overview of the expected results.
Fluid requirements differ between infants and children. It is important for children’s nurses to understand the principles of fluid mechanics and apply this understanding to ensure each child’s state of hydration, and thereby preserve their safety and well-being. This two-part article aims to introduce the concept of fluid balance and electrolytes to children’s nursing students, help them identify what is normal and what is not, and provide guidance on what actions should be taken when problems occur. It may also be useful for registered nurses to use for revalidation.
Primary ciliary dyskinesia (PCD) is a rare, genetic disorder of the motile cilia characterised by chronic lung disease, nasal and sinus disease, chronic ear infections with glue ear leading to possible hearing impairment, and subfertility. Half of patients have organ laterality defects. Despite symptoms being present from birth, PCD remains underdiagnosed. Early diagnosis and symptom management may reduce morbidity, improve quality of life and ensure children are adequately supported to meet their full potential. This article seeks to raise awareness of PCD in children’s nurses who are well placed to identify children for referral to the national PCD diagnostic service. It examines the clinical characteristics of the disease along with the complexities and limitations of diagnostic testing. In addition, it explores the management of children with PCD within the national PCD management service for children.