Nursing and Pediatric Primary Care

Primary Care In Pediatric Nursing  

Pediatric Primary Care,Outcomes by Ethnic Groups,Obesity as Health Issue,Nutritional Issues In Pediatric Care,Prevention of Obesity.

Pediatric Primary Care

    Pediatric primary care has existed for a long time and has been provided by family practice physicians and pediatricians. In the last 25 years, primary care has changed to include pediatric nurse associates who are now called pediatric nurse practitioners (PNPs). 

    PNPs were the first nurse practitioners; they are advanced practice nurses who are educated to provide primary care services to children. Dr. Henry K. Silver and Dr. Loretta Ford started the PNP program in Colorado in 1964. Although the role has remained much the same from its inception, one major change is the level of education required. 

    Originally it was a 4 month continuing education program and now it is a 2-year educational program culminating with a master's degree. National certification is required, in some states to allow PNPs to practice. There are two certifying organizations for PNPs: the American Nurses Credentialing Center (ANCC) and the Pediatric Nursing Certification Board (PNCB).

Outcomes by Ethnic Groups

    Currently, there are differences in health care outcomes between minority and majority ethnic groups. Children in minority groups are at much greater risk for poor health care factors, and there is a lack of culturally competent health care providers. In 1998, President Clinton presented the Initiative to Eliminate Racial and Ethnic Disparities in Health. 

    This proposal seeks to eliminate disparities by the year 2010, and focuses on the same goals and outcomes as Health People 2010: infant mortality, child and adult immunizations, HIV/AIDS, diabetes, cardiovascular disease and stroke, and cancer screening and management. 

    Access to health care and quality of health care are also part of the focus (Stinson, 2003) Childhood immunizations, particularly in children less than 2 years of age, continue to be a major health concern in primary care. 

    Health People 2000 and the President's Childhood Immunization Initiative mandated a goal of 90% immunizations for children younger than 2 years of age by the year 2000. In 1992, only 55% of children under the age of 2 years had received an adequate number of immunizations . 

    By 1994, the rate had risen to 73%, and now it is close to the 90% goal. While these are excellent numbers, there still remain pockets primarily in large cities where immunization rates are much lower. 

    Data from the CDC National Immunization Survey suggest that minority children, primarily African-American and Hispanic, children living below the poverty level, children of teen mothers, children in large families, children of parents who lack education, families with transportation problems, and children of mothers who lack social support have lower rates of receiving immunizations by age 2 years than the national average.

Obesity as Health Issue

    Obesity is another health issue commonly seen in primary care. It is a complex issue and not fully understood. The number of obese children has increased substantially in the last 20 years, putting them at risk for serious health problems as adults including cardiovascular disease and stroke, diabetes, hypertension, arthritis, and psychological problems. 

    Obesity during infancy and childhood increases the risk of obesity in adolescence and adulthood. Children with a body mass index equal to or more than the 95th percentile are more likely to become obese adults, Obesity is considered to be multifactorial with both genetic and environmental components. 

    Family lifestyle, stress, socioeconomic status, and maternal characteristics are some of the environmental components. Sowan and Stember (2000) studied infants up to 15 months of age to identify parental characteristics and to see whether obesity was linked to any of these characteristics. 

    Age of the mother at the time of the infant's birth was predictive of obesity in the infant at 10 months of age. The chances of obesity increased in the infant with every 5 years of age increase in the mother. For every 25-pound increase in the mother's usual weight, the chances of the infant being obese at 7 months of age increased. 

    Maternal smoking increased the chances of infant obesity at 1 and 7 months of age. The usual stressors one might think could cause childhood obesity such as family stresses, socioeconomic status, and family life were found not to be significant predictors.

Nutritional Issues In Pediatric Care

    Faulkner (2002) studied 18 mothers of preschool children enrolled in a nutrition clinic for mothers and children in low-income households. Mothers were questioned in a 1-hour focus group as to how they defined overweight, how they thought their children became overweight, and what barriers existed in preventing and managing obesity. 

    Interestingly, the mothers described their children as strong or solid and did not think that standardized growth charts reflected a healthy weight. As long as children were active the mothers did not consider them overweight but if they were lazy or lay around then they were considered overweight. 

    The mothers thought that heredity and the environment determined the child's weight. In their attempts to manage their children's weight, the mothers had lots of difficulty. 

    Food was used as a reward by some, others did not want to deny their children food, and with others, family members did not want the mother restricting the child's diet. Mothers also thought that their own obesity affected their management of their child's weight.

Prevention of Obesity

    Prevention of obesity and development of effective programs for those who are overweight are critical to reversing the devastating long term effects. Unfortunately, there are not many effective programs available for children. Dietary management, increasing physical activity, and parental behavior management are critical ingredients in any program (Betz, 2000). 

    Primary care providers need to include appropriate eating patterns, types of foods and amounts when talking with parents during well-child visits. Parents have a crucial role in how children's eating habits develop and how that affects their overall health and psychological well-being. 

    K. James (2000) introduced a school-based intervention to reduce television and video viewing and then measured body mass index (BMI) at baseline and 7 months later. The children in the intervention group had a significant decrease in BMI when compared to those in the control group. 

    There are few studies which demonstrate significant reduction in children's weight. More innovative low or no cost programs aimed at families and children need to be developed and perhaps schools are the place for implementation.

    It is imperative that adequate and appropriate health services are available to children and families to help ensure positive outcomes. A variety of health care providers, including nurse practitioners with knowledge of the needs of children, is essential for changes to Occur.