Exam 1 — Pediatric client care and the four age groupsWeek 1
📚 Reading: Communication, med administration, pain, procedures
Match the intervention to what they fear and most questions answer themselves.In a child, blood pressure falls LAST —
a normal BP never rules out shock. Watch the heart rate and the behavior.
💡 The one idea
A child is not a small adult. They compensate brilliantly and then crash suddenly —
in children, blood pressure is the LAST thing to fall, so a normal BP
never rules out shock.
Age
Heart rate
Respirations
Systolic BP
Newborn
110–160
30–60
~65–85
Infant
100–150
25–40
~70–100
Toddler
90–140
20–30
~80–110
School age
70–120
18–25
~85–120
Adolescent
60–100
12–20
~95–140
🖼️ Pediatric medication administration.Swipe it sideways if it is cut off, or tap to open it full size.
The pattern is all you need: as age goes up, heart rate and
respirations come down, and blood pressure goes up. You can reason out any missing row.
🚨 Early signs of deterioration in a child
Tachycardia — the very first compensation
Tachypnoea, nasal flaring, grunting, retractions
Irritability, then lethargy — a change in behavior is a vital sign
Poor feeding in an infant; fewer wet diapers
A quiet, floppy child is far more worrying than a screaming one. Hypotension and bradycardia are pre-arrest signs.
🖼️ Acute respiratory failure, type I versus type II.Swipe it sideways if it is cut off, or tap to open it full size.
💉 Pediatric medication safety
Doses are always weight-based — mg/kg — and always double-checked.
Weigh in kilograms only, to avoid a 2.2× error.
IM sites:vastus lateralis for infants;
deltoid once walking well and muscle mass allows.
✅ Pain scales by age
FLACC — non-verbal, under 3 (Face, Legs, Activity, Cry, Consolability)
FACES — roughly 3 and older
Numeric 0–10 — about 8 and older
Children under-report pain to avoid injections. Behavior and physiology count as evidence.
🖼️ Pediatric asthma and cystic fibrosis.Swipe it sideways if it is cut off, or tap to open it full size.
⭐ High-yield — what the exam actually asks
Show 5 moreHide these 5
Ear drops split at age 3: pull the pinna down and back under 3, up and back over 3. Massage the tragus after. Warm refrigerated drops first.
Holliday-Segar maintenance fluids: 100 mL/kg for the first 10 kg, then 1000 mL + 50 mL/kg for kg 11–20, then 1500 mL + 20 mL/kg beyond 20 kg.
Pain scale by age: FLACC0–3 yr (behavioral, 5 items scored 0–2, max 10), Wong-Baker FACES 3+, numeric 5+ if cognitively able.
Injection volume ceilings: roughly 0.5–1 mL in infants, up to 2 mL in children. Vastus lateralis is the infant site.
Show 5 moreHide these 5
Only NS and LR are appropriate IV fluids in peds. Infuse slowly, strict I&O, watch for overload (crackles, rising HR and BP).
X-ray is the gold standard for confirming any feeding tube placement.
Specimen collection always moves least invasive to most invasive. A urine culture needs a sterile cath specimen; a 24-hour collection discards the first void.
The parent or guardian signs consent; the nurse witnesses and verifies understanding by teach-back.
Do procedures in a treatment room, never the child's bed — the bed has to stay a safe space.
Temperature route is decided by age. Rectal only up to about 5 years and only when an exact reading is needed; tympanic from 3 years; oral from 4 years if she will cooperate.
Pain tool follows the age too.FLACC covers 2 months to 7 years. Self-report is only reliable from 3 years up — under 3 a child cannot rate pain accurately, so you are reading behavior.
Expected temperature is essentially the adult range: about 36.4–37.5°C (97.5–99.5°F) from a month old onward.
Growth charts: WHO standards from 0–2 years, CDC charts after that.
Family-centered care treats the family as the expert on this child. When a caregiver says the child "isn't acting right," that is data — act on it.
📚 From your Maternal & Child textbook
Pillitteri, Maternal and Child Health Nursing — ch. 28 (growth and development) · ch. 34 (child health assessment) · ch. 35 (communication) · ch. 39 (pain).
Self-report of pain becomes usable at about age 3. Below that you are reading behavior, which is what FLACC scores.
Vital signs normalize in persistent pain and cannot be used to rule pain out. And a child who is playing can still be in pain — distraction is coping, not comfort.
⚠️ Exam traps
FLACC vs Wong-Baker: pick by whether the child can self-report, not by how much pain you think there is.
Consent is obtained by the provider and witnessed by the nurse. Those are different verbs on purpose.
The ear-drop direction reverses at 3 years, and the same up-and-back rule shows up again in the preschool assessment section.
🧠 Mind maps 6
One per disorder, built from the structure of your ATI chapter.
Pain Management
🎯 Who gets it
Factors shifting pain perception: age, developmental stage, acute vs chronic disease, previous pain experiences, personality, living situation and stressors, culture, socioeconomic status
👀 What you see
Young infant: rigid body or thrashing with a loud cry, reflexive local withdrawal from the stimulus, eyes squeezed shut with a squared-open mouth and brows lowered and drawn together, and no link made between stimulus and pain
Older infant: purposeful withdrawal from the stimulus plus facial expression of pain
Toddler: screaming, verbalizes pain, thrashes, pushes the stimulus away, uncooperative, clings to a caregiver, reacts in anticipation, asks for comfort
School-age: stalling, muscle rigidity, toddler-like behaviors but less anticipatory and more intense during the stimulus
🩺 What you do
Reassess pain frequently and after each intervention; check physical functioning afterward
Have the caregiver track the child's pain and ask whether they are satisfied with the control achieved
Monitor for adverse medication effects and review relevant labs
Mild pain over 3 months of age: start with a non-opioid; NSAIDs are commonly used from 6 months
Moderate pain: continue the non-opioid and add an opioid only as needed
Severe pain: combine non-opioid, opioid, and adjuvants — morphine is the opioid of choice
💬 What you teach
Distraction with play, music, computer games, movies, art or animal therapy
Relaxation: hold or rock infants, position older children comfortably, coach breathing
Guided imagery with the child supplying the details; positive self-talk during the procedure
⚠️ What goes wrong
Chronic pain syndromes develop when acute pain is poorly controlled
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
Death and Dying
🎯 Who gets it
Factors shaping grief and coping: relationships and social support, type and meaning of the loss, culture and ethnicity, spiritual and religious practices, prior losses, socioeconomic status
Parental grief is intense, prolonged, and complex, with secondary losses of hope and dreams, family disruption, and loss of the parent identity
Sibling grief differs from adult grief and may surface as psychosocial problems
🩺 What you do
Create room for anticipatory grieving — it shapes how the family copes afterward
Assign consistent staff and communicate with the child in developmentally appropriate language
Stay with the child as much as possible; help finish unfinished tasks
Give scheduled analgesics, treat breakthrough pain, escalate doses as needed, and add relaxation, imagery, and distraction
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
Oxygen and Inhalation Therapy
👀 What you see
Expected SaO2 is 95% to 100%, and may run lower in chronic respiratory illness or cyanotic heart disease
Early hypoxemia: tachypnea, tachycardia, restlessness, pallor of skin and mucous membranes, accessory muscle use, nasal flaring, dyspnea
Late hypoxemia: confusion and stupor, cyanosis, bradypnea, bradycardia, hypotension
Hypoxemia follows hypovolemia, hypoventilation, or interrupted arterial flow
🩺 What you do
Pulse oximetry probe goes on fingertip, toe, earlobe, or around the foot; site must be dry with good circulation; remove nail polish or earrings
Position the child comfortably and support the arm when using a finger
Compare the oximeter pulse with the radial pulse — a discrepancy needs further assessment
For continuous monitoring set high and low alarms, confirm they work and are audible, and move the probe per policy to prevent pressure necrosis in infants
💬 What you teach
MDI: shake well, remove cap, prime one to two doses if new, attach a spacer, hold with mouthpiece down and thumb near it with index and middle fingers on top
MDI closed-mouth method: seal lips around the inhaler, take a breath in and out, tilt head back slightly, press the canister while starting a slow deep breath over 3-5 seconds
DPI: do not shake, remove the cap, prepare the dose per manufacturer instructions, exhale completely, seal lips and inhale fast and deep, hold 5-10 seconds, remove and exhale slowly through pursed lips
⚠️ What goes wrong
Wrong dose delivered from poor technique — inhaling too fast, failing to coordinate breath with actuation, not holding the breath long enough; reinforce technique
Oral fungal infection from inhaled corticosteroids — inspect the mouth and have the child rinse after each dose
Combustion: post 'No Smoking' or 'Oxygen in Use' signs, know the nearest fire extinguisher, dress the child in cotton rather than synthetics or wool that generate static, avoid spark-producing toys, keep alcohol and acetone away, and teach the fire risk of smoking near oxygen
Oxygen toxicity, driven by high concentration, long duration of therapy, and the severity of lung disease — headache, confusion, nausea, substernal pain, dry nonproductive cough, altered vision, greater work of breathing, and CNS effects; hypoventilation with a climbing PaCO2 can bring rapid loss of consciousness
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
Pediatric Emergencies
🎯 Who gets it
Respiratory emergencies: infants and toddlers, obstructive lung disease from infection, anaphylaxis, bronchiectasis, or asthma, and restrictive disease from cystic fibrosis, pneumonia, or interstitial lung disease
Drowning: ages 1-4 years, swimming pool access, inadequate supervision near water, no life jacket, no swimming lessons, absent protective barriers
Brief resolved unexplained event: gastresophageal reflux, respiratory or other infection, seizure, feeding regimen, metabolic disorders, neurologic disorders, sleep position
Sudden unexpected infant death: maternal smoking in pregnancy, secondhand smoke, co-sleeping, non-crib sleep surface, prone or side-lying sleep, low birth weight, prematurity, twin or multiple birth, limited prenatal care, respiratory illness, family history, poverty, and age 1-6 months
👀 What you see
Early respiratory distress: restlessness, tachycardia, tachypnea, nasal flaring, grunting, retractions, diaphoresis, dyspnea, and wheezing
Advanced hypoxia: bradycardia, extreme restlessness, central or peripheral cyanosis, stupor, and coma
Choking: universal choking sign of clutching the neck, inability to speak, weak ineffective cough, high-pitched sound or no sound, cyanosis
Submersion: record where and when the child was submerged, whether CPR or rescue breathing was needed, respiratory status, core temperature for hypothermia, and any head or neck injury
🧪 What confirms it
Directed by history and assessment: CBC with differential, ABGs, urinalysis, blood cultures, liver function tests, and blood levels of lead, iron, and acetaminophen
Chest x-ray, viral studies, lumbar puncture, and CT for altered mental status
🩺 What you do
Follow American Heart Association CPR guidelines for respiratory and cardiac arrest and facility protocol for activating the rapid response team
Use current basic life support and pediatric advanced life support guidelines for neonates and children
Position to maintain a patent airway, monitor respiratory status and vital signs, give oxygen, suction as needed, and prepare for intubation
Give prescribed medications, IV fluids, and emergency drugs; update the family on the child's status; and keep a calm, comforting manner
💬 What you teach
Learn CPR and recognize the signs of choking
Teach prevention strategies including recognizing choking hazards for toddlers
Drowning can happen anywhere water is present — bathtub, toilet, bucket, pool, pond, or lake — and even a small amount of water is enough; submersion injury is more common than drowning and usually leads to hospitalization and sometimes rehabilitation
⚠️ What goes wrong
Outcome varies with the degree of anoxic insult or the blood lead level; cognitive impairment can follow lead exposure
Read left to right: who gets it → what you see → what confirms it → what you do → what goes wrong. Cover a column and rebuild it out loud.
Hospitalization — by age, then the procedures
Your Week 1 concept-map template, filled in. Each branch is one of the age nodes on the sheet; the key terms are the boxes down the side.
👶 Infants (0–1 y)
Fear: separation and strangers — peaks 6–18 months. Keep the caregiver in sight; consistent nurses.
Play: solitary, sensorimotor. Mobiles, rattles, peek-a-boo; play with the infant, not beside.
Pain tool: FLACC. Under 3 nobody can self-report — you read behavior.
Restrain the minimum for procedures; swaddle, sucrose and non-nutritive sucking for needle sticks.
🧒 Toddler (1–3 y)
Fear: separation (protest → despair → detachment) and loss of control. Give limited choices — two, both acceptable.
Play: parallel. Push-pull toys, blocks, imitation. Routines and rituals are security — keep home habits.
Pain tool: FLACC. Regression (bottle, bedwetting) is expected and reversible.
Explain right before, not days before — no concept of future time.
🎨 Preschool (3–6 y)
Fear:bodily harm and mutilation, punishment. Magical thinking — “I got sick because I was bad.”
Play: associative; therapeutic play shines here — let them handle equipment on a doll first.
Pain tool: Wong-Baker FACES from 3; simple words for the body, bandages matter (they think insides leak out).
Explain the day of, in play terms; never tell them it will not hurt if it will.
🎓 School age (6–12 y)
Fear: loss of control, disability, death; separation from peers and school. Wants to be competent.
Play: cooperative, rules and games. Give tasks and choices; explain why in concrete terms, days ahead.
Pain tool: FACES or the 0–10 numeric line; they can locate and describe pain.
Privacy starts to matter; schoolwork continues in hospital.
🧑 Adolescent (12–20 y)
Fear: altered body image, loss of independence, being different from peers. Confidentiality is the deal-breaker.
Play: peer contact, phones, games; a teen lounge if there is one. Include them in decisions.
Pain tool: numeric 0–10; ask directly — they under-report to look strong.
Interview part of the time without the parent present.
🔑 Key terms
Play therapy — play is how a child processes the hospital. Diversional (fun), therapeutic (works through fear with equipment), dramatic (acting it out).
Informed consent — the provider obtains it from the parent or legal guardian; the nurse witnesses the signature and checks understanding by teach-back. Emancipated minors and, in most states, minors seeking care for STIs, pregnancy or substance use can consent for themselves. Give the child age-appropriate assent.
Procedural considerations — do it in the treatment room, never the bed; the bed stays safe. Explain by age, restrain minimally, let a parent comfort (not restrain), reward afterwards.
🧺 Tubes, enemas, specimens
Enemas / suppositories — isotonic saline only, never tap water or soap suds in a child (water intoxication). Volumes: infant 120–240 mL, toddler 240–360, school-age 360–480, teen 480–720. Suppository past the sphincter with a gloved finger, hold the buttocks together 5–10 min.
Enteral tubes — measure nose–ear–xiphoid (to umbilicus for older). X-ray is the only gold standard for placement; pH ≤5 for ongoing checks; auscultating air is not acceptable. Head of bed up 30° while feeding.
Common tests / procedures — order is always least invasive to most invasive: vital signs, then anything that hurts last. Bring a parent, a comfort object, and finish with praise.
Urine specimens — clean-catch for a UA; a culture needs a sterile catheter specimen; bag collection for infants is UA only; 24-hour collection discards the first void, keeps every one after.
Stool specimens — collect from a clean diaper or hat; never from the toilet water; ova and parasites go to the lab warm.
💉 Pain management
Scheduled vs PRN: after surgery or with ongoing pain give it around the clock on a schedule; PRN alone lets pain climb and then it is harder to catch.
Severity decides the drug — WHO two-step: mild → non-opioid (acetaminophen; NSAIDs from 6 months); moderate–severe → add an opioid, morphine is the one of choice. Codeine is not used in children.
Reassess after every dose and every intervention. Vital signs normalize in persistent pain and cannot rule pain out; a child who is playing can still be in pain.
Non-pharmacologic: distraction (bubbles, video, music), guided imagery, relaxation and coached breathing, holding or rocking, sucrose and pacifier for infants, EMLA or vapocoolant before needles, a parent present.
Read across: what each age fears tells you how to explain, how to play, and which pain tool to reach for. Cover a column and rebuild it out loud.
Scale
Who
How it works
FLACC
2 months – 7 years, and anyone who cannot self-report
You score five behaviors 0–2 each — Face, Legs, Activity, Cry, Consolability — for a total out of 10. 0 = relaxed, no cry, consolable; 2 = clenched jaw or quivering chin, legs drawn up, arched or jerking, steady screaming, cannot be consoled.
Wong-Baker FACES
From about 3 years — the first age that can self-report
Six faces, 0 “no hurt” to 10 “hurts worst”, in steps of 2. The child points. It is their rating, not your read of their face.
Numeric 0–10
School age and up — once they understand a number line, roughly 8 years
0 = no pain, 5 = moderate, 10 = worst possible. Ask location, quality and what makes it better or worse as well.
The trap: pick the tool by whether the child can self-report, not by how much pain you think there is.
Routes of medication administration — children are not little adults
Page 2 of the template. The centre says safety first; every spoke is a route with the thing that is different in a child.
✅ The 6 rights, plus
Right client (two identifiers — name and birth date; the parent confirms; never a room number), drug, dose, route, time, documentation.
Dose is by weight (mg/kg) or body surface area — always recalculate, and know the safe range before you give it.
A caregiver who says “that is not what she usually gets” is data. Stop and check.
Children are not little adults: immature liver and kidneys change metabolism and clearance, so the same mg/kg is not the same effect.
💋 Oral
Preferred route when it works. Oral syringe aimed at the side of the cheek, small amounts, let them swallow — never into the back of the throat, never with the child flat.
Liquids for under 5–6 years; check whether a tablet may be crushed.
Do not hide it in an essential food (formula, milk) — if they refuse the food they refuse the drug, and they learn to distrust the food. A small amount of a non-essential food is fine.
No honey under 1 year (botulism). Praise afterwards; offer a choice of chaser.
👁️ Ophthalmic
Child supine, head slightly back. Pull the lower lid down, drop into the conjunctival sac, not onto the eye. Wipe inner to outer canthus.
For an infant, wait until the eyes open on their own; a toddler may need a second person to hold.
Ointment: thin ribbon inner to outer, then close the eye and gently massage.
👂 Otic
Under 3 years: pull the pinna down and back.3 years and up: up and back. The canal straightens in different directions — this is the exam question.
Warm the drops to body temperature; cold drops cause vertigo and pain. Lie on the opposite side, stay there 2–3 minutes.
That same up-and-back rule appears in the preschool assessment.
👃 Intranasal
Head back, drop into the nostril, keep the head back a minute; or an atomizer for midazolam and fentanyl in emergencies — fast and needle-free.
Infants are obligate nose breathers, so saline and suction before feeding and before sleep, not after.
💣 Rectal / transdermal / topical
Rectal: gloved pinky for infants, index finger for older, past the sphincter; hold the buttocks together 5–10 minutes. Cut a suppository lengthwise if you need half.
Topical: a child’s skin is thin and the surface area large for the weight — absorption is much higher. Thin layer, do not occlude unless told to, keep it off their hands.
Transdermal: fold used patches sticky sides together and dispose where a child cannot reach them — a used fentanyl patch is a lethal dose to a toddler.
💉 Injections
IM site by age:vastus lateralis for infants and toddlers (up to walking well); deltoid from about 18 months–3 years for small volumes; ventrogluteal from toddlerhood; never the dorsogluteal in a child.
Volume: infant 0.5–1 mL, toddler 1 mL, older child up to 2 mL. Needle 22–25 gauge, 5/8–1 inch.
Tell them right before, not earlier. Topical anaesthetic (EMLA 60 min before, or vapocoolant) for planned sticks. A second person to hold; a parent comforts but does not restrain.
Subcutaneous: abdomen, upper arm, anterior thigh; insulin and heparin do not aspirate.
🩸 IV and central lines
Peripheral IV: smallest gauge that will do (22–24); scalp veins in infants, hand and foot after that. Protect the site — board, cover, distraction — a child will pull it.
Infuse slowly on a pump with a volume-control set (no more than 1–2 hours of fluid hung). Strict I&O, weigh diapers. Overload shows as crackles, rising HR and BP, puffy eyes.
Central lines: sterile technique every time, flush per protocol, clamp before a cap change, and know the air-embolism position — left side, head down. Check the dressing and the length at the insertion site each shift.
Safety first, every route: weight-based dose double-checked, two identifiers, right equipment for the size, and a parent in the room.
🎭 Non-pharmacologic pain methods
Infant: swaddling, skin-to-skin, sucrose on a pacifier, rocking, facilitated tucking.
Toddler / preschool: distraction — bubbles, pinwheel, a video — a comfort object, and a parent’s voice. Therapeutic play afterwards.
School age / teen: guided imagery with the child supplying the details, positive self-talk, coached breathing, music, choice and control over what they can control.
Non-pharmacologic methods go with the medication, not instead of it.
Two questions come from this page more than any other: which way to pull the ear, and which muscle for the shot. Age decides both.
🎥 Lecture recordings 6
Tap a card to open that recording in Google Drive. The same list lives in the lecture library.
ATI Active Learning Template — System DisorderSafe Administration of Medication
Filled from ATI chapter 8, row by row from that chapter’s own sections — 12 of 12 rows have content.
10 rows came from outside your ATI chapter — 4 cite a source, 6 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Immature organ systems change pediatric drug metabolism and excretion, so doses are figured from age, weight, and body surface area. Safe administration also depends on medication and food allergies, dose appropriateness for age and weight, developmental age, physiologic and psychological status, skin and tissue integrity for IM/subcut/topical routes, and IV patency.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Teach parents to weigh in kilograms and to know the child’s current weight — doses change as they grow.
Never use a kitchen spoon. Supply and demonstrate an oral syringe.
Store everything locked and out of sight; the leading cause of pediatric poisoning is a medicine left within reach.
Teach that acetaminophen appears in many combination products, so it is easy to double-dose by accident.
Have the poison center number saved before it is needed.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not in your ATI chapter — filled from StatPearls, n.d..
Excess body fat changes how fat-soluble and water-soluble drugs distribute in the body, raising the risk of dosing errors.
In a child with obesity, weight-based dosing can lead to either therapeutic failure or unexpected drug toxicity.
From this module — built from the notes above on this page, not a section of the ATI chapter.
Expect the child to resist — that is normal, not non-compliance.
Expect a therapeutic response within the drug’s known onset; document whether it happened.
Paradoxical excitement can occur with antihistamines and some sedatives in young children.
Not expected: rash, wheeze, facial swelling, or a sudden change in level of consciousness.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
Therapeutic drug levels for the narrow-margin drugs — digoxin, phenytoin, vancomycin, gentamicin, theophylline.
Trough immediately before the next dose; peak at the time the drug specifies.
Renal and hepatic function before and during nephrotoxic or hepatotoxic therapy.
CBC with drugs that suppress marrow.
Weight and height at every visit — the dose depends on them.
Diagnostic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Independent double-check of the calculation for high-alert drugs — insulin, opioids, chemotherapy, heparin, digoxin.
Confirm the dose against mg/kg per dose and the maximum daily dose, and against the adult maximum.
If the calculated dose exceeds the adult dose, the calculation is wrong.
Two identifiers before every administration — a room number is not one.
Verify the route, especially where an oral syringe could reach an IV line.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Be honest — if it will taste bad, say so and offer a plan.
Give a choice of how, not whether: which drink after, which arm, sitting or on a lap.
Never call medicine candy, and never give it in a full bottle or cup — a refused feed then means a missed dose, and the child may learn to refuse the food.
Mix with a small amount of a non-essential food if allowed, so a partial refusal is not a partial dose.
Praise afterwards regardless of how it went; document what worked for next time.
Medications
Always calculate the safe dose range; call the provider if the ordered dose falls outside it or if preparation/route is unclear
Two-nurse verification for high-risk and facility-flagged medications
Two identifiers from the ID band (name, date of birth); use the caregiver to verify for infants and nonverbal children
Assess caregiver willingness to participate; offer the child real choices (which leg, who gives it) and prepare the child at their developmental level
Infant oral technique: hold semi-reclined, give with a dropper or bottle nipple, ask pharmacy to flavor it; never mix medication into a bottle of formula
Ophthalmic: supine or sitting, head extended and turned toward the affected eye, pull the lower lid down, instill into the conjunctival sac; run ointment inner to outer canthus, ideally before nap or bedtime
Vastus lateralis is the preferred IM site for infants and small children with little muscle mass — supine, side-lying, or sitting; 0.5-1 mL in infants, up to 2 mL in toddlers and children
Ventrogluteal: supine, side-lying, or prone; 0.5-1 mL in infants depending on muscle size, up to 2 mL in children
Therapeutic Procedures
Not in your ATI chapter — filled from StatPearls, n.d..
Pediatric doses are most commonly calculated using the child's actual body weight rather than age alone.
Clark's rule divides the child's weight in pounds by 150, then multiplies that fraction by the adult dose.
ATI Active Learning Template — System DisorderPain Management
Filled from ATI chapter 9, row by row from that chapter’s own sections — 12 of 12 rows have content.
7 rows came from outside your ATI chapter — 1 cite a source, 6 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Pain assessment is driven by the child's cognitive, emotional, and physical development. Atraumatic care means choosing interventions that minimize physical and psychological distress. Pain is treated with atraumatic, nonpharmacologic, and pharmacologic measures together.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Prevent pain rather than chase it — topical anesthetic, sucrose, and clustering of procedures.
Treat the first procedure well; a child who is hurt badly once is harder to treat every time afterwards.
Teach parents that children do feel pain, including newborns, and that treating it is not risky.
Give scheduled rather than as-needed analgesia for predictable pain.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Factors shifting pain perception: age, developmental stage, acute vs chronic disease, previous pain experiences, personality, living situation and stressors, culture, socioeconomic status
Assessment — Expected Findings
From this module — built from the notes above on this page, not a section of the ATI chapter.
Young infant: rigid body or thrashing with a loud cry, reflexive local withdrawal from the stimulus, eyes squeezed shut with a squared-open mouth and brows lowered and drawn together, and no link made between stimulus and pain
Older infant: purposeful withdrawal from the stimulus plus facial expression of pain
Toddler: screaming, verbalizes pain, thrashes, pushes the stimulus away, uncooperative, clings to a caregiver, reacts in anticipation, asks for comfort
School-age: stalling, muscle rigidity, toddler-like behaviors but less anticipatory and more intense during the stimulus
Adolescent: more verbal, less protest, muscle tension with controlled body
Self-report is valid from 3 years up; under 3 years children cannot reliably rate pain — use behavioral tools and include the caregiver's rating
FLACC for 2 months to 7 years, scored 0-10 across Face, Legs, Activity, Cry, Consolability
Atraumatic care: do painful procedures in a treatment room, never in the playroom or the child's bed
Explain in developmentally appropriate terms, offer choices, let caregivers stay through painful procedures
Use play therapy — let the child do the procedure on a doll or toy first
Medications
WHO two-step approach for children
Mild pain over 3 months of age: start with a non-opioid; NSAIDs are commonly used from 6 months
Moderate pain: continue the non-opioid and add an opioid only as needed
Severe pain: combine non-opioid, opioid, and adjuvants — morphine is the opioid of choice
Goal is the dose that controls pain without severe adverse effects; pick the least traumatic route
Oral preferred for convenience, cost, and steady levels, but peaks in 1-2 hr so it is unsuitable for rapidly changing or acute severe pain
Lidocaine-prilocaine cream 30-60 minbefore any skin puncture (IV start, biopsy) under an occlusive dressing; remove and clean before the procedure — reddened or blanched skin confirms effect
IV bolus gives control in about 5 min (morphine, hydromorphone); continuous infusion holds steady levels
Therapeutic Procedures
Not in your ATI chapter — filled from AAP, n.d..
For mild pain, AAP guidance favors ice, heat, elevation, and rest before considering any medication at all.
Distraction methods such as reading, games, movies, or music can lower a child's perceived pain level.
Even severe pain treated with opioids should be paired with these nondrug comfort measures, not used alone.
American Academy of Pediatrics · How to Manage Your Child's Pain & Prescription Opioid Use: 4 Safety Tips · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
From this module — built from the notes above on this page, not a section of the ATI chapter.
Distraction with play, music, computer games, movies, art or animal therapy
Relaxation: hold or rock infants, position older children comfortably, coach breathing
Guided imagery with the child supplying the details; positive self-talk during the procedure
Behavioral contracting with stickers or tokens, set time limits, reward cooperation
Containment by swaddling, rolled blankets, and proper positioning; nonnutritive sucking for infants
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Child life specialist for preparation and distraction — measurably reduces distress.
Pain service or anesthesia for regional blocks and patient-controlled analgesia.
Pharmacist for weight-based calculation and opioid conversion.
Physiotherapy, psychology and play therapy for chronic pain.
⚠️ What goes wrongComplications
Complications
Chronic pain syndromes develop when acute pain is poorly controlled
ATI Active Learning Template — System DisorderHospitalization, Illness, and Play
Filled from ATI chapter 10, row by row from that chapter’s own sections — 12 of 12 rows have content.
9 rows came from outside your ATI chapter — 3 cite a source, 6 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Hospitalization and illness stress both child and family, and the child's reaction tracks their developmental stage and cognitive ability. The family is treated as the client alongside the child. Separation anxiety in the hospital shows up as screaming, clinging, hostility toward strangers, panic when the caregiver leaves, refusing to sleep alone, and excessive safety worries.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Prepare the child for admission in a way that matches their developmental stage, not their size.
Keep the parent present wherever possible — rooming-in reduces distress measurably.
Keep school and peer contact going for longer stays.
Prepare siblings too; they interpret silence as something worse.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
From this module — built from the notes above on this page, not a section of the ATI chapter.
Separation anxiety peaks in the toddler and is the greatest stressor of hospitalization at that age.
Loss of control matters most to the school-age child; body image and peer separation to the adolescent.
Preschoolers may believe illness is punishment.
Repeated or prolonged admission, painful procedures, and unprepared transfers to intensive care.
Limited parental presence because of work, other children or travel.
Assessment — Expected Findings
Infant: cannot describe illness or follow directions, communicates by crying and single words; stranger anxiety; expresses discomfort physically; sleep deprivation from around-the-clock care; anxiety from an unfamiliar environment
Toddler: limited ability to describe illness, poorly formed body image and boundaries, no grasp of why procedures or routine changes are needed; separation anxiety, tantrums with procedures, behavioral regression
Preschooler: knows how illness feels but not its cause, magical-thinking fears, takes words literally, separation anxiety, fear of bodily harm, may see hospitalization as punishment
School-age: aware of body function, can describe pain, grasps cause and effect; fears loss of control and unknown pain; stressed by separation from peers and routine
Adolescent: judges illness severity by body image change, may become aggressive or regress, feels isolated from peers, worries about school and activities, may not adhere to treatment because of peer influence
Family responses: anxiety and depression, sleep loss, financial worry over missed work, concern for other children at home, fear from not understanding the illness, caregiver role strain; siblings feel loneliness, jealousy, guilt, fear, or anger
Assess the family's understanding of the illness, unique stressors, prior hospitalization experience, the child's current condition, and developmental needs
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
Cluster blood draws to reduce the number of needle events.
Use the smallest volume that will do — iatrogenic anemia is real in small children.
Topical anesthetic before planned venepuncture, given enough time to work.
Explain honestly what will happen and where; let them hold the equipment first.
Diagnostic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Observe play — it is the most reliable indicator of how a child is really coping.
Watch for protest, despair, then detachment in separation — the quiet, detached child is the most worrying, not the least.
Use a developmentally appropriate pain scale: FLACC, Wong-Baker faces, or numeric.
Assess regression — wetting, thumb-sucking, baby talk — which is expected and temporary.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Prepare child and family for what hospitalization will involve
Encourage family presence throughout the stay to lower stress
Preserve home routines as much as possible and build in independence and choice
Infants: consistent caregiver assignments; have absent parents record a voice memo
Toddlers: bring caregivers into the treatment plan, protect autonomy with real choices
Preschoolers: simple concrete language without jargon, allow self-care, invite expression of feelings, validate fears, provide toys for emotional release such as a pounding board, offer choices (cup or spoon), let them handle safe equipment
School-age: keep a normal routine including schoolwork on long stays, maintain peer contact
Adolescents: give factual information and include them in care planning to counter powerlessness
Play in the hospital lets children express fear, master developmental tasks, learn social behavior, receive teaching, and buffer stress
Medications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Treat procedural pain properly rather than expecting the child to tolerate it.
Topical anesthetic, sucrose for infants, and adequate premedication.
Give scheduled analgesia rather than waiting for the child to ask — children under-report.
Sedation for imaging or painful procedures, with proper monitoring.
Never use an injection as a threat or a punishment.
Therapeutic Procedures
Not in your ATI chapter — filled from AAP, n.d..
Before anesthesia, children typically stop solid food eight hours ahead and clear liquids two hours ahead.
Infants under one year may have breast milk until about four hours before an anesthesia procedure.
American Academy of Pediatrics · Preparing Your Child for Anesthesia: What to Expect on the Day of the Procedure · open the source →
💬 Around the patientClient Education · Interprofessional Care
Client Education
Not in your ATI chapter — filled from AAP, n.d..
Bringing a comfort item like a blanket or stuffed animal can ease a child's anxiety before a procedure.
A parent's calm, confident manner helps a hospitalized child feel safer, since children pick up on caregiver stress.
American Academy of Pediatrics · Preparing Your Child for Anesthesia: What to Expect on the Day of the Procedure · open the source →
Interprofessional Care
Not in your ATI chapter — filled from AAP, n.d..
The admitting physician should coordinate a hospitalized child's care and communicate directly with the primary care provider.
Clear team communication throughout a hospital stay helps minimize trauma to the child while maximizing treatment benefit.
American Academy of Pediatrics · AAP Clinical Report: Coordinating Care of a Hospitalized Child · open the source →
⚠️ What goes wrongComplications
Complications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Regression in feeding, toileting and speech — expected, and resolves after discharge.
Sleep disturbance and night terrors.
Post-hospital behavior: clinginess, tantrums, new fears.
Detachment, if separation is prolonged and unaddressed.
Delayed development where admission is long or repeated.
📋 Death and Dying6 parts
ATI Active Learning Template — System DisorderDeath and Dying
Filled from ATI chapter 11, row by row from that chapter’s own sections — 12 of 12 rows have content.
8 rows came from outside your ATI chapter — 1 cite a source, 7 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Care at end of life covers physical, psychological, spiritual, and emotional needs of both child and family. Palliative care is an interprofessional approach aimed at quality of life and symptom control rather than cure or prolonging life. Hospice care serves the dying client with family often acting as primary caregivers, focusing on pain control, comfort, and dignity.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Introduce palliative care early — it runs alongside treatment, it is not what happens when treatment stops.
Ask what the family and, where able, the child understand and want to know.
Advance care planning and goals-of-care conversations before a crisis forces them.
Support siblings deliberately; they are frequently the least informed people in the room.
Bereavement follow-up is part of the care, not an optional extra afterwards.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Factors shaping grief and coping: relationships and social support, type and meaning of the loss, culture and ethnicity, spiritual and religious practices, prior losses, socioeconomic status
Parental grief is intense, prolonged, and complex, with secondary losses of hope and dreams, family disruption, and loss of the parent identity
Sibling grief differs from adult grief and may surface as psychosocial problems
Infants and toddlers have little or no concept of death, seek routine, mirror parental emotion, react to hospital changes, may show separation anxiety and regress
Preschoolers stay egocentric with magical thinking, may read separation as punishment and blame themselves, and see death as temporary because the dead are imagined still sleeping, eating, and breathing — be straightforward
Signs of impending death: temperature changes, decreased sensation and movement in the legs, skin color and texture changes, dulled senses, confusion or loss of consciousness, lower appetite and thirst, difficulty swallowing, incontinence, bradycardia, hypotension, Cheyne-Stokes respirations, pooled secretions causing the death rattle
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
Stop tests that will not change what you do. Every draw has a cost to the child.
Continue only what guides comfort — glucose if hypoglycemia would be treatable and distressing.
Discuss withdrawal of routine monitoring openly rather than quietly stopping it.
Document the agreed limits of investigation so no one reflexively reorders.
Diagnostic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Assessment shifts from diagnosis to comfort: pain, breathlessness, secretions, agitation, nausea.
Use a validated pain tool the child can use, or FLACC if they cannot.
Recognize the signs of the last days: reduced intake, mottling, changed breathing, more sleep.
Assess the family’s understanding repeatedly — it changes, and shock erases what was said.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Create room for anticipatory grieving — it shapes how the family copes afterward
Assign consistent staff and communicate with the child in developmentally appropriate language
Stay with the child as much as possible; help finish unfinished tasks
Give scheduled analgesics, treat breakthrough pain, escalate doses as needed, and add relaxation, imagery, and distraction
Treat nausea, vomiting, and constipation; provide frequent mouth care and adequate nutrition and hydration
Soften lighting, offer soft music, arrange religious or cultural rituals the family wants
Plan care around the whole family, consulting child and family on desired measures and respecting cultural and religious preferences
During dying: explain disease, medications, procedures, and what to expect; invite loved ones to help with care and stay near; support decision-making and questions; keep communication open and honest; allow visitors as desired; involve play and behavioral therapists; stay neutral and calm
After death: let the family stay with and hold or rock the body as long as they wish, offer privacy, offer participation in preparing the body and in death rituals, use clear language, let everyone share stories and feelings, follow up later
Medications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Opioids for pain and breathlessness, titrated to effect. There is no ceiling dose when the goal is comfort.
Anticholinergics for terminal secretions; benzodiazepines for agitation and anxiety.
Antiemetics; laxatives alongside any opioid.
Convert to a route that works — buccal, subcutaneous, transdermal — when swallowing fails.
Fear of hastening death is not a reason to under-treat pain; properly titrated opioid does not shorten life.
Therapeutic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Comfort care: mouth care, positioning, skin care, a quiet and dimly lit room.
Allow the family to do care — washing, holding, dressing — if they want to.
Hospice referral, and honor a wish to be at home where it is possible.
Memory-making: handprints, a lock of hair, photographs. Offer it; do not require it.
Respect religious and cultural practices around the body, and ask rather than assume.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Not in your ATI chapter — filled from AAP, n.d..
Preschoolers need direct, concrete language about death rather than euphemisms like 'went to sleep,' which can frighten them.
Most children grasp that death is permanent and universal by about five to seven years of age.
Across all ages, children should be reassured that they did not cause the death and that the person no longer suffers.
American Academy of Pediatrics · How Children Understand Death: What to Say When a Loved One Dies · open the source →
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Palliative care team leads symptom control and goals of care.
Chaplain or spiritual care, matched to the family’s own tradition.
Child life specialist for the child and for siblings.
Social work for practical matters — finance, transport, funeral arrangements, leave from work.
Bereavement services, and organ or tissue donation discussion where appropriate.
⚠️ What goes wrongComplications
Complications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Uncontrolled symptoms, most often pain, breathlessness or agitation.
Complicated grief in parents and siblings.
Family conflict about goals of care, often between people who are equally frightened.
Moral distress and burnout in the staff caring for the child.
Sibling difficulties at school and behavior changes for months afterwards.
📋 Oxygen and Inhalation Therapy6 parts
ATI Active Learning Template — System DisorderOxygen and Inhalation Therapy
Filled from ATI chapter 16, row by row from that chapter’s own sections — 12 of 12 rows have content.
6 rows came from outside your ATI chapter — 4 cite a source, 2 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Oxygen supports cellular oxygenation in acute and chronic respiratory problems such as hypoxemia, cystic fibrosis, and asthma, and is delivered through several systems. Pulse oximetry monitors the effect of inhalation therapy. Common pediatric respiratory treatments are nebulized aerosol, metered-dose inhaler, dry powder inhaler, chest physiotherapy, oxygen therapy, suctioning, and artificial airways. Oxygen is a drug and requires a provider order.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from MedlinePlus, n.d..
Keep home oxygen equipment away from open flames, gas stoves, and other heat sources at all times.
No one should smoke near a child using supplemental oxygen, since oxygen makes fire spread much faster.
MedlinePlus (National Library of Medicine) · Using oxygen at home · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not in your ATI chapter — filled from StatPearls, n.d..
Premature infants given high concentrations of oxygen are at risk for retinopathy of prematurity.
An inspired oxygen level above 60 percent for even one day can cause lasting lung injury from oxygen toxicity.
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Pulse oximetry probe goes on fingertip, toe, earlobe, or around the foot; site must be dry with good circulation; remove nail polish or earrings
Position the child comfortably and support the arm when using a finger
Compare the oximeter pulse with the radial pulse — a discrepancy needs further assessment
For continuous monitoring set high and low alarms, confirm they work and are audible, and move the probe per policy to prevent pressure necrosis in infants
For a low SaO2: confirm probe placement with the LED over the top of the nail, verify the delivery system is working at the prescribed flow, and increase flow as ordered
Nebulizer: treatment runs 10-15 min using mouthpiece, mask, or blow-by; take vitals and saturation before and after; pour medication into the cup and connect to air or oxygen; coach slow deep mouth breathing; watch for tracheal or bronchial spasm or edema; help the family obtain a home unit
Schedule inhaled treatments before meals or at least 1 hr after, and at bedtime, to reduce vomiting and aspiration risk
Position semi-Fowler's or Fowler's to ease breathing and expand the chest; use a calm approach and explain everything to child and family
Give oxygen at the lowest flow that corrects hypoxemia and humidify it to loosen secretions and protect the mucosa
Medications
Not in your ATI chapter — filled from StatPearls, n.d..
A nasal cannula delivers 1 to 6 liters per minute, providing roughly 24 to 40 percent inspired oxygen.
A simple face mask runs at 5 to 10 liters per minute, delivering about 40 to 60 percent inspired oxygen.
Chest physiotherapy: manual or mechanical percussion, vibration, postural drainage, cough, huffing, and breathing exercises for thick secretions the child cannot clear; contraindicated with unstable hemodynamics, ARDS, or increased ICP
Tracheotomy is the sterile surgical incision into the trachea to create an airway; the resulting stoma is the tracheostomy, permanent or temporary
May be emergent for epiglottitis, croup, or foreign-body aspiration, or planned
Artificial airways placed orotracheally, nasotracheally, or through a tracheostomy; pediatric tubes are plastic and may be cuffed to prevent dislodgement
💬 Around the patientClient Education · Interprofessional Care
Client Education
MDI: shake well, remove cap, prime one to two doses if new, attach a spacer, hold with mouthpiece down and thumb near it with index and middle fingers on top
MDI closed-mouth method: seal lips around the inhaler, take a breath in and out, tilt head back slightly, press the canister while starting a slow deep breath over 3-5 seconds
DPI: do not shake, remove the cap, prepare the dose per manufacturer instructions, exhale completely, seal lips and inhale fast and deep, hold 5-10 seconds, remove and exhale slowly through pursed lips
Wait 1 minute (or the directed interval) between puffs; wipe the DPI mouthpiece weekly with a dry cloth and never wash it with water
Rinse the mouth and spit after inhaled corticosteroids, and clean the MDI and spacer after each use
Home tracheostomy care: keep a spare tube available in case of dislodgement, and suction to prevent occlusion
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Respiratory therapist for device selection, delivery and airway clearance.
Provider for escalation and for the target saturation range.
Home care company and case manager for equipment, oxygen supply and power backup.
Parents trained and assessed as competent before discharge, not told and sent home.
⚠️ What goes wrongComplications
Complications
Wrong dose delivered from poor technique — inhaling too fast, failing to coordinate breath with actuation, not holding the breath long enough; reinforce technique
Oral fungal infection from inhaled corticosteroids — inspect the mouth and have the child rinse after each dose
Combustion: post 'No Smoking' or 'Oxygen in Use' signs, know the nearest fire extinguisher, dress the child in cotton rather than synthetics or wool that generate static, avoid spark-producing toys, keep alcohol and acetone away, and teach the fire risk of smoking near oxygen
Oxygen toxicity, driven by high concentration, long duration of therapy, and the severity of lung disease — headache, confusion, nausea, substernal pain, dry nonproductive cough, altered vision, greater work of breathing, and CNS effects; hypoventilation with a climbing PaCO2 can bring rapid loss of consciousness
Prevent toxicity with the lowest effective oxygen level, monitor ABGs, report a rising PaCO2, and wean flow gradually
Accidental decannulation is an emergency before the tract matures because reinsertion is difficult — keep a spare tube and obturator at the bedside and have a second staff member present whenever the tube is moved
Occlusion by secretions blocks air exchange — maintain patency with suctioning
📋 Pediatric Emergencies6 parts
ATI Active Learning Template — System DisorderPediatric Emergencies
Filled from ATI chapter 43, row by row from that chapter’s own sections — 12 of 12 rows have content.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Emergencies requiring rapid assessment and intervention, and a chance to teach families and communities. In respiratory insufficiency the child works harder to breathe while gas exchange stays largely adequate, or becomes hypoxic and acidotic; in respiratory failure the blood can no longer be adequately oxygenated. Apnea means breathing stops longer than 20 seconds, central or obstructive in origin, sometimes with hypoxemia or bradycardia. Respiratory arrest is total cessation of breathing, and a foreign body can obstruct the airway. Sudden unexpected infant death is an infant death in the first year that is sudden and unexpected, whether or not a cause is later found.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Most pediatric emergencies are preventable injuries — car seats, helmets, water supervision, locked medicines, firearm storage.
Teach parents infant and child CPR and choking relief.
Emergency plans for known conditions: asthma, anaphylaxis, epilepsy, diabetes.
Poison center number known and stored before it is needed.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Respiratory emergencies: infants and toddlers, obstructive lung disease from infection, anaphylaxis, bronchiectasis, or asthma, and restrictive disease from cystic fibrosis, pneumonia, or interstitial lung disease
Drowning: ages 1-4 years, swimming pool access, inadequate supervision near water, no life jacket, no swimming lessons, absent protective barriers
Brief resolved unexplained event: gastresophageal reflux, respiratory or other infection, seizure, feeding regimen, metabolic disorders, neurologic disorders, sleep position
Sudden unexpected infant death: maternal smoking in pregnancy, secondhand smoke, co-sleeping, non-crib sleep surface, prone or side-lying sleep, low birth weight, prematurity, twin or multiple birth, limited prenatal care, respiratory illness, family history, poverty, and age 1-6 months
Poisoning: age under 6 years and toddlers especially; medications, household chemicals, and hazardous substances stored improperly; cosmetics, plants, and heavy metals as toxic sources; lead from lead-based paint or contaminated soil
Assessment — Expected Findings
Early respiratory distress: restlessness, tachycardia, tachypnea, nasal flaring, grunting, retractions, diaphoresis, dyspnea, and wheezing
Advanced hypoxia: bradycardia, extreme restlessness, central or peripheral cyanosis, stupor, and coma
Choking: universal choking sign of clutching the neck, inability to speak, weak ineffective cough, high-pitched sound or no sound, cyanosis
Submersion: record where and when the child was submerged, whether CPR or rescue breathing was needed, respiratory status, core temperature for hypothermia, and any head or neck injury
Brief resolved unexplained event: apnea during the event, color change to pallor or cyanosis, hypotonia, and being sleepier than usual
Poisoning history: name and location of the agent, amount ingested, and time of ingestion
Acetaminophen 0-24 hr: nausea, vomiting, sweating, pallor; 24-72 hr: apparent improvement with right upper quadrant pain; 72-96 hr hepatic stage: confusion, stupor, jaundice, coagulation disturbance with the greatest risk of death; then gradual recovery
Aspirin acute toxicity: vomiting, nausea, tinnitus, disorientation, dizziness, tachypnea, abdominal pain, and seizures; chronic toxicity is subtler but adds tachycardia, bleeding tendencies, and more severe seizures
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Directed by history and assessment: CBC with differential, ABGs, urinalysis, blood cultures, liver function tests, and blood levels of lead, iron, and acetaminophen
Diagnostic Procedures
Chest x-ray, viral studies, lumbar puncture, and CT for altered mental status
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Follow American Heart Association CPR guidelines for respiratory and cardiac arrest and facility protocol for activating the rapid response team
Use current basic life support and pediatric advanced life support guidelines for neonates and children
Position to maintain a patent airway, monitor respiratory status and vital signs, give oxygen, suction as needed, and prepare for intubation
Give prescribed medications, IV fluids, and emergency drugs; update the family on the child's status; and keep a calm, comforting manner
Choking: back blows combined with chest thrusts for infants, abdominal thrusts for children and adolescents
Remove visible obstructions or large debris from the mouth but never perform a blind finger sweep
Place a recovered child who resumes breathing in the recovery position — side-lying with knees bent for stability
Submersion injury care depends on the degree of cerebral insult: give oxygen and possibly mechanical ventilation, monitor vital signs, manage shivering, and watch for cerebral edema and respiratory distress
Brief resolved unexplained event: monitor for recurrent events and keep the family informed about testing
Medications
From this module — built from the notes above on this page, not a section of the ATI chapter.
Every dose is weight-based; use a length-based resuscitation tape when the weight is unknown.
Epinephrine for anaphylaxis — IM into the vastus lateralis, and it is the first drug, not the second.
Fluid resuscitation 20 mL/kg isotonic boluses, reassessed after each.
Glucose for hypoglycemia; naloxone for opioid toxicity.
Never delay epinephrine in anaphylaxis to give an antihistamine or a steroid.
Therapeutic Procedures
From this module — built from the notes above on this page, not a section of the ATI chapter.
Airway first — positioning, suction, adjuncts sized to the child.
Intraosseous access if IV access fails quickly; do not spend minutes on cannulation in an arrest.
High-quality compressions with correct depth and full recoil; minimize interruptions.
Defibrillation with pediatric attenuation where indicated.
Keep the parents present if they wish to be — the evidence supports it and they cope better afterwards.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Learn CPR and recognize the signs of choking
Teach prevention strategies including recognizing choking hazards for toddlers
Drowning can happen anywhere water is present — bathtub, toilet, bucket, pool, pond, or lake — and even a small amount of water is enough; submersion injury is more common than drowning and usually leads to hospitalization and sometimes rehabilitation
Latch toilet seats closed, never leave a child alone in the bathtub, and never leave a child unattended in a pool even if they can swim
Poison prevention: keep toxic agents out of reach, lock cabinets, use the dosing device supplied with liquid medicine, discard unused medications, never call medicine candy, use non-mercury thermometers, remove lead-based paint, wash hands before eating, and consider parental workplace lead exposure
Teach safe sleep and the risks of co-sleeping
Routine lead screening at 1, 2, and 3 years, with case management for elevated levels and referral to community nursing, teachers, and early intervention
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Pediatric resuscitation team, with clear role allocation.
Pharmacist at the bedside for weight-based dose calculation.
A nurse assigned to support the family, separate from the one running the resuscitation.
Child life and chaplaincy for siblings and family.
Debrief the team afterwards, every time.
⚠️ What goes wrongComplications
Complications
Outcome varies with the degree of anoxic insult or the blood lead level; cognitive impairment can follow lead exposure
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
Ear drops split at age 3: pull the pinna down and back under 3, up and back over 3. Massage the tragus after. Warm refrigerated drops first.
Holliday-Segar maintenance fluids: 100 mL/kg for the first 10 kg, then 1000 mL + 50 mL/kg for kg 11–20, then 1500 mL + 20 mL/kg beyond 20 kg.
Pain scale by age: FLACC0–3 yr (behavioral, 5 items scored 0–2, max 10), Wong-Baker FACES 3+, numeric 5+ if cognitively able.
Injection volume ceilings: roughly 0.5–1 mL in infants, up to 2 mL in children. Vastus lateralis is the infant site.
Specimen collection always moves least invasive to most invasive. A urine culture needs a sterile cath specimen; a 24-hour collection discards the first void.
Do procedures in a treatment room, never the child's bed — the bed has to stay a safe space.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
