pediatrics Archives - Page 3 of 5

Who’s Going to Smile at My Baby? When the Pandemic Comes to the NICU

From the doorway, I watched the mother gently stroke her newborn’s forehead. “I love you,” she whispered. “I’ll be back soon.”

As a resource parent in the neonatal intensive care unit (NICU) at a large children’s hospital, I am privileged with the task of offering support to families. This was a typical stop in one of many patient rooms. As I gingerly entered the room, the mother glanced up at me, tears welling in her eyes as she scrambled to adjust her mask.

“I’m sorry,” she stammered. “I didn’t want to cry.” A tear rolled down her cheek.

“Not at all,” I replied. “I understand. It’s hard being a mom in the NICU, now more than ever.”

I invited her to share her feelings, hoping to offer some help or comfort. Wiping her cheek with her sleeve, she explained that the pandemic visiting rules had made it difficult to be at her baby’s bedside.

“I have other children, and I need to go home to watch them. The hospital rules say I am the only person allowed to take off their mask in her room, but she needs to see faces for her development. Who is going to smile at my baby when I’m not here?”

Speaking from personal experience.

Guest Author2021-02-08T09:43:44-05:00February 8th, 2021|family experience, Nursing, Patients, pediatrics|0 Comments

Those Special Moments Nurses Sometimes Talk About

Before I became a nurse, I heard that nurses have special moments with their patients and families that they never forget, but I never truly understood what that meant.

My first neonatal code occurred about six months after I completed my orientation in the pediatric emergency department. I remember that shift being a particularly busy one. In the midst of the hustling and bustling of assessing and medicating patients and reevaluating and discharging them, I heard banging on the triage door and saw a mother and father wheeling in their baby carriage, frantically crying out that their baby Skye was blue in color.

By S.Hermann and F.Richter/Pixabay

I remember quickly removing her clothing and seeing how cyanotic she was, all while an electrocardiogram was being obtained and she was placed on the cardiac monitor. I recall hearing the doctors paging overhead for pediatric respiratory and anesthesiology to assist with resuscitation. Other team members included a CNA and a medical student who tried to relax the parents but were understandably not successful.

There were multiple unsuccessful attempts to obtain peripheral vascular access in Skye. I can still see the look of terror on Skye’s parents’ faces as the drill gun used to insert the intraosseous access whirled into baby Skye’s bone, then […]

Guest Author2020-10-23T10:48:41-04:00October 23rd, 2020|family experience, Nursing, Patients, pediatrics|0 Comments

The Pediatric Illness PANDAS: Easy to Misdiagnose, Often Overlooked

What would you do if your young, previously healthy and happy child suddenly developed obsessive-compulsive disorder or symptoms of Tourette’s syndrome?

In “PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection,” authors Christine Pabst and Kim Subasic discuss an unusual pediatric illness that, although identified more than 20 years ago, is not well recognized by clinicians: PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection.

PANDAS is characterized by the sudden and dramatic onset of “psychiatric” symptoms such as the ones above, appearing during or shortly after infection with group A streptococcus.

Two factors make PANDAS difficult to diagnose.

First, it seems so obviously a psychiatric disorder that psychotropic or other psychiatric medications may be prescribed without further investigation.
Second, carrying group A streptococcus without signs of actual infection can also precipitate PANDAS, making it difficult to connect PANDAS symptoms with a previous medical illness.

[…]

Betsy Todd, MPH, RN2020-08-24T06:27:32-04:00August 24th, 2020|Nursing, pediatrics|0 Comments

The Baby with Tetralogy of Flow

It is a good day so far—none of the 16 critically ill babies in the neonatal intensive care unit has coded or died. So far, the shrill electronic alarms for dying babies have been silent.

As the neonatologist on call, this gives me the opportunity to talk to Anna and Jake, Baby Milo’s parents. Milo peers up at them with big brown eyes as Anna leans over his crib and whispers to him. A small transparent plastic mask covers Milo’s tiny nose to help him breathe, and a cluster of saliva bubbles percolate between his lips. Despite a sleeve of tape securing his right hand, his tiny fingers tug the orange orogastric tube taped to his cheek.

Milo’s father, a brawny man wearing scuffed brown shoes, ripped blue jeans, a T-shirt, and a tattered Green Bay Packers cap, sits in a chair and nervously taps his knee while he stares with bloodshot eyes at the vital signs on Milo’s bedside monitor.

“Milo is adorable,” I say from the doorway. His parents look over to me as I step into the room.

“We think so,” Anna says with a smile.

“How are you both doing?” I ask. “Being in the NICU can be pretty stressful.”

Milo’s parents glance at each other and nod. Anna takes a seat next to Jake, who touches her shoulder.

I pull up a chair. “Can you tell me Milo’s story? How did you end up in the NICU?” I say.

“We were celebrating my birthday at a steakhouse,” Jake says. “Right after they brought […]

Guest Author2020-07-15T11:23:21-04:00July 15th, 2020|family, family experience, pediatrics|0 Comments

Is This Child in Pain?

When the child is nonverbal.

Nurses regularly assess patients’ pain. It’s a much more difficult task when the patient is unable to articulate what they’re feeling or even where they hurt. How much more difficult is it when the patient is a nonverbal child with a complex medical history?

In this month’s AJN, Brenna Quinn and colleagues share their research on pain in these children. They define “children with medical complexity” as “those having a cognitive-chronological age mismatch, profound developmental delays, limited or no verbal abilities, and multisystem diagnoses, and who are completely dependent on others for care.” These kids tend to experience pain more frequently (often, daily or weekly), and are more likely to be hospitalized than are neurotypical children.

A ‘wide range of pain-associated behaviors.’

While it is often harder to assess pain in children than in adults, most children have a narrow range of “pain behaviors” that are easily identifiable. This isn’t true of children with medical complexity; some may even seem, from their expressions, to be laughing when they are in pain.

“More than 40 pain assessment tools have been developed for use in infants and children who cannot provide self-report. Despite the availability of these tools, the evaluation of pain in children with medical complexity remains challenging, […]

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Betsy Todd, MPH, RN2018-08-13T08:09:58-04:00August 13th, 2018|family caregiving, Nursing, Patients, pediatrics|0 Comments