Child development is a continuous process, with physiological, pathological, and psychological characteristics varying at different ages. Compared to adults, children exhibit distinct differences in the causes, progression, and outcomes of diseases. As a result, treatment approaches for pediatric illnesses must fully account for age-specific factors. The varying levels of communication abilities in children of different ages add to the challenges faced by pediatric healthcare providers in observation and diagnosis. Pediatric diseases often have a rapid onset and progression, with a tendency to involve one or more organ systems. This necessitates treatments that are both timely and focused, as well as precise and comprehensive, while also requiring great compassion, patience, and responsibility. Any inappropriate approach or method of treatment may have long-term or even lifelong adverse effects on a child’s physical and psychological well-being. Pediatric practitioners are therefore expected to be well-versed in all aspects of treatment, including care, nutrition, medication, and psychological support, to ensure the holistic recovery of children.
Principles of Care
Care is a critical component of the treatment process in pediatric diseases, as many medical procedures are implemented through nursing activities. Effective care plays a key role in fostering recovery. Pediatricians are also expected to be familiar with nursing practices, and close collaboration between medical and nursing staff is essential for improving treatment outcomes.
Detailed Clinical Observation
Observation of atypical or subtle manifestations in children can provide clues to the pathological basis of their condition. For instance, an infant’s crying may be a normal physiological response but could also indicate illness. Distinguishing between these requires meticulous observation.
Rational Ward Arrangements
Patient rooms should be well-organized, clean, quiet, comfortable, well-ventilated, and maintained at an appropriate temperature. To improve the quality of care and treatment, ward arrangements should be based on factors such as age, disease type, disease severity, and care requirements.
- By Age: Separate wards for neonates and preterm infants, young infants, and older children.
- By Disease Type: Grouping of children with similar illnesses, with infectious diseases isolated according to their specific condition.
- By Disease Severity: Critical patients in intensive care units, while children in recovery stages can be grouped in the same room.
Routine Ward Life
Ample sleep and rest are crucial for sick children. Efforts should be made to minimize disturbances to their sleep during observation and aim to consolidate diagnostic and treatment procedures within designated time slots. Mealtimes should follow a regular schedule.
Prevention of Iatrogenic Diseases and Accidents
Avoidance of Cross-Infection
Healthcare workers must wash their hands before and after contact with patients, and routine cleaning and disinfection protocols must be followed in patient rooms.
Prevention of Iatrogenic Infections
Medical procedures such as catheterization and punctures should be performed correctly and according to standard practices. Disinfection equipment should be regularly inspected to prevent infections.
Prevention of Accidental Injuries
Side rails should be raised immediately after bedside procedures, and items like thermometers and medicine cups should be removed promptly to avoid potential harm during play. Infants should be held while being medicated or fed to prevent choking, vomiting, and subsequent asphyxia.
Principles of Dietary Therapy
The selection of appropriate diets based on the patient's condition can enhance treatment outcomes and recovery, while improper diets may worsen the illness and even endanger life. Breast milk is considered the best food for infants and should continue to be provided to breastfed infants even during illness. Non-breast milk options include the following categories:
Dairy Products
These include:
- Infant or Preterm Formulas: Formulated for use by newborns and preterm infants.
- Skim Milk: Partially or fully skimmed milk with low fat content, suitable for short-term use in cases of diarrhea or poor digestive function.
- Yogurt: Cow's milk treated with acid or fermented with lactic acid bacteria, forming small, easily digestible protein curds, suitable for those with diarrhea or weak digestion.
- Soy Milk: Appropriate for children with lactose intolerance or cow's milk allergy.
- Lactose-Free or Low-Lactose Milk Formulas: Contain sucrose, glucose polymers, maltodextrin, and corn syrup instead of lactose, for infants with long-term diarrhea or lactose intolerance.
- Low-Phenylalanine Formula: Designed for infants diagnosed with phenylketonuria (PKU).
- Amino Acid-Based or Hydrolyzed Milk Formulas: Designed for infants allergic to cow’s milk protein.
General Diet
This includes:
- Regular Diet: Nutrient-rich, energy-sufficient, and easily digestible foods.
- Soft Food: Soft, finely cooked foods such as thick porridge, overcooked rice, noodles, minced meat, steamed bun, and fish soup, suitable for children with partially restored digestive function or weak chewing ability.
- Semi-Liquid Diet: Semi-fluid foods such as milk, soybean milk, thin porridge, overcooked noodles, and steamed egg custard, often supplemented with small portions of biscuits or bread, suitable for children with weak digestion who cannot chew or swallow solid foods.
- Liquid Diet: Fully liquid foods such as milk, soybean milk, rice soup, egg drop soup, lotus root starch, fruit juice, and beef broth, which require no chewing and are easily digestible. These are suitable for children with high fever, digestive system disorders, acute infections, or those recovering from gastrointestinal surgery. Liquid diets are low in energy and nutrients and are generally recommended for short-term use only.
Specialized Diets
These include:
- Low-Residue Diet: Low in fiber, minimally irritating to the gastrointestinal tract, and easy to digest, suitable for children with gastrointestinal infections or enteritis.
- Salt-Free or Low-Salt Diet: Salt intake below 0.5g per day is considered salt-free, while less than 1.5g per day is low-salt. This is suitable for children with heart or kidney dysfunction who experience edema.
- Iron-Rich Diet: Includes foods high in iron, such as animal blood, liver, and various meats, suitable for children with anemia.
- High-Protein Diet: Additional protein-rich foods like eggs, lean meat, liver, or soy products are added to daily meals, appropriate for children with malnutrition or consumption-related diseases.
- Low-Protein Diet: Reduces protein content in the diet, with carbohydrates used to provide energy. Common foods include potatoes, sweet potatoes, and fruits. This is suitable for children with uremia, hepatic encephalopathy, or oliguria during acute nephritis.
- Low-Fat Diet: Eliminates or minimizes fats and oily foods, suitable for children with liver disease.
- Low-Calorie Diet: Reduces fats and carbohydrates in three daily meals while maintaining adequate protein and vitamins, using foods such as fish, eggs, beans, vegetables, and lean meat. This is recommended for children with simple obesity.
- Special Medical Infant Formulas: Formulated specifically for children with certain diseases, such as lactose-free or low-lactose formulas for lactose-intolerant children, amino acid-based or hydrolyzed protein formulas for those with cow's milk protein allergy, and phenylalanine-free formulas for infants with PKU. Special formulas also exist for preterm or low-birth-weight infants.
Diet Before Diagnostic Tests
Certain diagnostic procedures require specific dietary preparation:
- Diet to Avoid Occult Blood: A diet free of meat, liver, animal blood, and green leafy vegetables is recommended for three consecutive days before tests for gastrointestinal bleeding.
- Diet for Cholecystography: High-protein, high-fat diets (e.g., fried eggs) are used to stimulate gallbladder emptying as part of gallbladder and biliary tract evaluations.
- Dry Diet: Low-moisture foods such as rice, steamed buns, fish, and meat are used to facilitate urine concentration testing and 12-hour urine cell counts.
Fasting
In children unable to eat due to gastrointestinal bleeding or post-operative conditions, intravenous methods are used to provide energy while maintaining the balance of water and electrolytes.
Enteral Nutrition (EN) Support
Enteral nutrition involves delivering specialized formulas directly into the stomach, duodenum, or jejunum via oral intake or feeding tubes. This method is used when oral feeding cannot meet energy and nutritional needs but gastrointestinal function is preserved. Compared to parenteral nutrition, it has advantages such as preserving gastrointestinal function, lower costs, easier management, and higher safety. Enteral nutrition can be discontinued once oral feeding meets energy and nutrient requirements, enabling growth and development appropriate for the child’s age. The choice of enteral nutrition should ensure balanced energy and nutrient intake and align with the recommended intakes for healthy individuals in the same age group. Specialized formulations are available for patients with allergies or congenital metabolic disorders. Factors influencing formula selection include nutritional and energy needs, tolerance or allergies, gastrointestinal function, and delivery site and method. Monitoring for complications during use is also essential.
Parenteral Nutrition (PN) Support
Parenteral nutrition is used when oral feeding or enteral nutrition cannot provide adequate nutrition, aiming to prevent or correct malnutrition and support normal growth and development. Total parenteral nutrition (TPN) uses only parenteral nutrition for nutrient supply, while partial parenteral nutrition (PPN) combines parenteral nutrition with some enteral feeding. Even small amounts of enteral nutrition have been shown to be more effective than TPN alone. When clinically feasible, individualized plans incorporating a combination of enteral and parenteral nutrition are developed based on the patient’s condition to improve outcomes while minimizing risks such as catheter-related infections or cholestasis.
Principles of Drug Therapy
Medications play a critical role in the treatment of pediatric diseases. However, adverse reactions, allergic responses, and toxic effects of drugs can negatively impact the body. The outcome of drug action depends not only on the nature of the medication but is also closely related to the patient's physical condition. Since children are in a continuous state of growth and development, both in terms of physical stature and organ function, they have unique physiological characteristics and specific responses to drugs. A thorough understanding of the pharmacokinetics and pharmacodynamics of drugs in children of different age groups is crucial, along with careful selection of medications and appropriate dosages. The properties, mechanisms of action, side effects, indications, contraindications, precise dosage calculations, and suitable routes of administration must be understood as part of the pediatric medication process.
Unlike adults, the significant variability in anatomical, physiological, and organ function among children of different ages greatly affects drug absorption, distribution, metabolism, and excretion. As pediatric clinical pharmacology and developmental pharmacology continue to evolve, increasing attention is being paid to the effects of growth and development on drug actions, the principles of pediatric drug therapy, and the safety of drug use in children.
Characteristics of Pediatric Drug Therapy
Since the distribution of drugs within the body is influenced by factors such as body fluid pH, cell membrane permeability, the binding of drugs to plasma proteins, hepatic metabolism, and renal excretion, drug therapy in children has the following characteristics:
Age-Dependent Drug Distribution
The distribution of certain drugs in tissues varies by age. For example, barbiturates, morphine, and tetracycline exhibit significantly higher concentrations in the brains of young children compared to older children.
Age-Dependent Drug Response
The effects of drugs differ according to age. Morphine has a more pronounced inhibitory effect on the respiratory center in newborns compared to older children, while ephedrine has a weaker blood pressure-raising effect in premature infants.
Limited Hepatic Detoxification
Newborns and preterm infants, whose hepatic enzyme systems are underdeveloped, exhibit delayed drug metabolism, resulting in prolonged half-life and increased blood drug concentration, which raises the risk of toxicity.
Insufficient Renal Excretion
Renal function in newborns, particularly premature infants, is immature, resulting in prolonged retention of drugs and their metabolites in the body, which increases toxic and adverse effects.
Genetic Factors
Certain congenital conditions affect drug response. For example, children with genetic mutations linked to hearing loss are more susceptible to hearing damage from aminoglycoside antibiotics. A family history of drug allergies warrants caution in the use of specific drugs.
Drug Selection
The selection of medications is primarily based on the child’s age, type of disease, and severity of the condition, while also considering children’s specific drug responses and the long-term impacts of the medication.
Antibiotics
Since children are susceptible to infectious diseases, antibiotics and other antimicrobial agents are commonly used. Alongside an understanding of the pharmacological effects and indications for antibiotics, attention must also be paid to their toxic and side effects, including nephrotoxicity and suppression of hematopoietic function. Beyond these effects, excessive use of antibiotics can disrupt intestinal flora, causing imbalances in the body's micro-ecosystem and leading to fungal or drug-resistant bacterial infections. On a broader scale, overuse of broad-spectrum antibiotics can promote microbial drug resistance, with serious implications for public health.
Glucocorticoids
These are used in short courses for allergic conditions and severe infections and in longer courses for nephrotic syndrome, certain hematologic disorders, and autoimmune diseases. In asthma or certain skin diseases, topical applications are preferred. Their side effects require careful attention:
- Short-term, high-dose use may mask disease symptoms and should generally be avoided without a confirmed diagnosis.
- Prolonged use can inhibit bone growth and disrupt the metabolism of water, electrolytes, proteins, and lipids, potentially causing hypertension and Cushing's syndrome.
- Long-term use can also lead to adrenal cortical atrophy, reduced immunity, and the spread of infection foci.
Glucocorticoids are contraindicated in children with chickenpox to avoid exacerbating the condition.
Antipyretics
Acetaminophen and ibuprofen are the most commonly used antipyretics. Dosage should not be excessive, and repeated usage is typical. Aspirin is generally not recommended for infants due to the risk of Reye's syndrome.
Sedatives and Anticonvulsants
Sedatives, such as phenobarbital, chloral hydrate, and diazepam, may be considered in cases of high fever or irritability, particularly during seizures.
Antitussives and Bronchodilators
In infants and young children, antitussives are generally avoided in favor of expectorants, administered orally or via nebulization, to liquefy secretions for easier expulsion. For asthma, β2-adrenergic agonists may be used in inhalation therapy.
Antidiarrheal Agents and Laxatives
Caution is exercised when using antidiarrheal drugs. Oral rehydration therapy is prioritized for preventing dehydration and correcting electrolyte imbalances. Protective agents for the intestinal mucosa or probiotics may be used to restore intestinal microflora. Constipation in children is generally managed through dietary adjustments and stool-softening methods rather than laxatives.
Medications for Breastfeeding Mothers
Drugs such as atropine, phenobarbital, salicylates, antiarrhythmics, anticonvulsants, and anticoagulants may affect breastfeeding infants via breast milk and should be used with caution.
Medications for Newborns and Premature Infants
Due to immature metabolism in the liver and kidneys, these children are more prone to toxic and adverse effects. Examples include sulfonamides, which increase the risk of bilirubin encephalopathy by competing with albumin binding, vitamin K3, which may cause hemolysis and jaundice, and chloramphenicol, which is associated with "gray baby syndrome." Drug selection should be approached with caution.
Methods of Drug Administration
The choice of administration route, drug formulation, and dosing frequency should align with the child's age, medical condition, and overall health status to ensure drug efficacy while minimizing adverse effects. When deciding the method of administration, it is important to consider approaches that are acceptable for both the child and their caregivers.
Oral Administration
Oral administration is the most common method of delivering medications. For young children, syrup, solution, or powder formulations are generally more suitable. Tablets can be crushed and mixed with sugared water for ease of swallowing; older children can typically take tablets or pills directly. For infants, it is preferable to hold the child upright or slightly elevate their head while administering oral medications to reduce the risk of choking or spitting out the medication. Nasogastric administration may be used if the clinical condition warrants it.
Injection
Injection provides faster therapeutic effects compared to oral administration but can be more distressing for children. Intramuscular injections are typically administered in the upper outer quadrant of the gluteus maximus; however, frequent injections at this site can lead to gluteal muscle contractures, potentially affecting lower limb function. Thus, injection is avoided unless absolutely necessary. Intravenous bolus administration is employed in situations requiring a rapid drug effect, such as in emergencies or during diagnostic imaging. Intravenous infusion is a continuous method that introduces medication into the body at a controlled rate. When using this technique, factors such as age, drug half-life, and the severity of the illness influence the infusion rate and interval. For prolonged antibiotic use, sequential therapy is often preferred to improve efficacy and reduce the side effects of antibiotics.
Topical Application
Topical medications, commonly in the form of ointments, are also used, along with other formulations such as solutions, suspensions, or powders. Care must be taken to prevent children from touching the medication, as accidental contact with the eyes or ingestion could lead to unforeseen complications.
Other Methods
Surfactants are primarily administered to treat neonatal respiratory distress syndrome and are delivered through the airway. Nebulized inhalation is commonly used for conditions like bronchial asthma. Enemas are less frequently used in children but may involve time-release suppositories. Lozenges and mouthwashes are rarely used in young children but may be considered for older children.
Calculating Drug Dosage
Pediatric drug dosages require precise calculation and can be determined using the following approaches:
Calculation Based on Body Weight
This is the most common and fundamental method of dosage calculation. The daily or per-dose requirement is calculated as follows:
Daily or per-dose dosage = body weight (kg) × required dosage per kilogram per day or per dose.
The daily dosage is then divided into multiple doses according to the drug's package insert or based on the drug's half-life. For emergency medications such as antipyretics or sedatives, dosage is often calculated per dose. Children’s weight should be based on their actual measured weight. For older children, if the calculated dosage based on weight exceeds the adult dosage, the adult dosage is used as the upper limit.
Calculation Based on Body Surface Area (BSA)
This method is more accurate than weight-based calculations as it better correlates with physiological activities such as basal metabolic rate and glomerular filtration rate. The dosage is calculated as follows:
Dosage = BSA (m2) × required dosage per square meter of body surface area.
The formula for estimating BSA in children is as follows:
If body weight ≤ 30 kg: BSA (m2) = body weight (kg) × 0.035 + 0.1.
If body weight > 30 kg: BSA (m2) = [body weight (kg) − 30] × 0.02 + 1.05.
Calculation Based on Age
This approach is typically used for medications with a wide dosage range or those that do not require precise dosing, such as nutritional supplements. It is simple and practical.
Dosage Derived from Adult Dosages
When pediatric doses are not specified, the following formulas may be applied:
Pediatric dose = adult dose × child’s weight (kg) / 50.
Pediatric dose = adult dose × child’s BSA (m2) / 1.73.
This method often yields a smaller dosage, and as such, it is less commonly applied.
Clinical drug usage must also be adjusted according to the specific circumstances of the pediatric patient. For example, medications should be dosed conservatively for neonates or infants with impaired renal function. However, for drugs that neonates tolerate particularly well, such as phenobarbital, the dosage may be adjusted upward. In cases where crossing the blood-brain barrier is necessary, such as in the treatment of purulent meningitis with penicillins, an increased dosage is required. The purpose of the medication also influences dosage; for example, the dose of atropine administered to treat toxic shock is many times higher than the standard therapeutic dose.
Principles of Psychotherapy
Psychotherapy is a common method in the treatment of children with psychological and behavioral problems, emotional disturbances, psychiatric disorders, and psychosomatic illnesses. Psychotherapy can take various forms, such as individual therapy, group therapy, and family therapy. With the shift in medical paradigms, increasing attention is being paid to the role of psychological factors in the treatment and rehabilitation of pediatric illnesses. The implementation of psychotherapy or psychological interventions is no longer limited to child psychologists and psychiatrists but is increasingly being integrated into the overall diagnostic and therapeutic process. As a result, pediatric professionals are expected to understand the basic principles of child psychology and master foundational methods of clinical psychotherapy and psychological care.
Psychological and emotional disturbances such as anxiety, withdrawal, depression, and fear are often observed in subacute and chronic non-infectious diseases, particularly in conditions affecting the nervous, endocrine, digestive, circulatory, and urinary systems. These issues may arise during the course of disease diagnosis and treatment and can be both a consequence of the illness as well as a contributing factor to the worsening of the condition or reduced effectiveness of treatment. Prominent symptoms associated with psychosomatic disorders—such as chronic headaches, abdominal pain, or diarrhea—often intertwine with organic pathologies, making the existing medical condition more persistent and complex.
Common psychotherapy techniques include supportive therapy, behavioral therapy, suggestive therapy, and music therapy. For children undergoing treatment for the first time, a careful approach is important to assess and observe their needs without forcing them to modify their behavior to align with the expectations of the therapist. Respect for the child’s potential for self-improvement is fundamental. Techniques such as suggestion and gentle guidance can help children express and release inner emotional repression, thereby reducing the severity of their psychological and mental disturbances. This, in turn, aids in the recovery of the primary illness.
Illness itself may create psychological burdens for children, and being placed in the unfamiliar environment of a hospital can exacerbate feelings of anxiety, tension, or even fear. Common reactions include crying, withdrawal, sadness, refusal to communicate, resistance to treatment, or even sleepless nights. Key factors in mitigating such symptoms include a quiet, comfortable, and clean environment; kind words; gentle actions; friendly attitudes; and attentive care. Nurses should individualize psychological care based on careful observation, fostering trust and cooperation from children, which can enhance recovery from disease and support overall psychological and physical well-being.
Principles of Medical Ethics
The four basic principles of medical ethics—respect for autonomy, non-maleficence, beneficence, and justice—provide the foundation for ethical practice. These principles require that healthcare providers respect the dignity and individuality of pediatric patients, honor the right of the child or their guardians to informed consent and decision-making, strive to provide the best possible diagnostic and therapeutic care, and minimize harm or keep it to the lowest possible level.
Pediatric healthcare workers need to take into account the specific characteristics of pediatrics as well as the psychological and social needs of both the patients and their families. The ethical perspective should be continuously strengthened throughout medical practice. Placing oneself in the position of the patient, focusing on their wellbeing, and collaborating closely with nursing staff are essential for delivering ethical care. Clinical care should be provided with standardized medical practices complemented by compassionate care to ensure patients feel both reassured and satisfied. In doing so, pediatric professionals fulfill their responsibility for the long-term health of their young patients.
As advancements in biomedical science and technology continue, innovations such as new diagnostic techniques, novel therapeutic drugs, advanced reagents and devices, stem cell or gene therapy, and organ transplantation are becoming increasingly common in clinical settings. Effective clinical decision-making in these areas requires proper guidance from medical ethics to ensure that such innovations are applied responsibly and equitably.