What Is The Rheumatic Fever And What Are The Symptoms

Rheumatic fever is a serious disease which affect the heart, joints, skin, and nerves. It is caused by a reaction of certain body tissues to the common strep bacteria. Often rheumatic fever occurs several weeks after a strep throat.

WHAT ARE THE SYMPTOMS

Usually there is a fever along with other symptoms  that can be mild or severe. There can be swelling, tenderness, and redness of the joints, called arthritis. There can be twitching of the muscles or writhing movements of the arms and legs, called chorea. Involvement of the heart is indicated by chest pain or shortness of breath. Involvement of the heart valves is indicated by a blood-flow noise, which your doctor can hear, called a murmur.

HOW COMMON IS IT?

Rheumatic fever occurs most commonly between ages 5 and 15 years.

HOW LONG DOES IT LAST?

Depending on the type of involvement, the episode of rheumatic fever may last from several weeks to several months and occasionally longer. Rheumatic fever can recur.

WHAT ARE THE COMPLICATIONS?

Though many of the problems  caused by rheumatic fever will disappear over the following weeks and months, half of the children may be left with rheumatic heart disease. Of those who have rheumatic heart disease about one third will experience improvement with age. Rheumatic fever is the leading cause of acquired heart disease in children. Remember, it can recur. Subsequent attacks can be life threatening, especially those that involve the heart. Therefore your child may need to take medicine for the rest of his/her life to prevent infections.

Take Your Child To The Hospital And Check Her Health Regularly

If you child must be hospitalized it is important that you are prepared. The main aspect of being prepared is to develop a calm attitude about the hospitalization. This is often difficult because many parents feel responsible for their child’s illness or feel unable to manage the problem. In order to do this you need to find out as much as possible about the hospitalization. You can do this by discussingyour concerns with your child’s doctor, talking with other parents who have previously been in similar situations (your doctor may suggest some families that you may contact), or by visitingthe hospital in advance. The latter may not be possible in an emergency situation. Hospitals and hospital personnel vary inntheir responsiveness to and accommodation of parental concerns. As a parent, you are your child’s advocate. As an advocate, your duty is to make the circumstancesthe least trying for your child.

Once you are prepared for your child’s hospitalization you can prepare your child. To some extent these preparations depend on your child’s age. A younger child, one less than 5 years of age, fears separation from the family. The older child has considerable fears surrounding what will happen to him/her during the hospitalization. This child may be afraid of personal harm or damage. Many children often feel that they are going to be hospitalization is not a form of punishment. Your child will be better prepared if he/she can find out as much as possible about the hospitalization just as you did for yourself. You can do this by having your child talk with other children who have previously been in similar situations (your doctor may suggest some families that you  may contact), by visiting the hospital in advance, or by using well illustrated books (see additional resources for children for children). Remember to always be honest with your child. Answer his/her question in a calm and logical manner. The child is, as a result of this procces of familiarization, reassured about the hospitalization as well as the protection of his/her parents in difficult.

AT THE HOSPITAL

As your child’s advocate you should try to stay with him/her during the hospitalization as much as possible. Your staying helps the younger child avoid fearing separation and abandonment. Most hospitals do have provisions for a parent to stay except in extremely unusual circumstances. If for whatever reason you cannot stay with your child, then you must explain to your child when you will be at the hospital. Your child will count on you to follow through with these promise. It may be helpful for you to have other family members or responsible friends stay with or visit your child. To make your child’s stay more comfortable let him/her bring a familiar toy and comfortable  clothing. Whoever stays with the child  should encourage hospital personnel to explain their role and what they are doing as well as answering your child’s concerns.

Children in the hospital often manifest different behaviors. It is quite healthy for the normal child to protest hospitalization and many of the procedures. A child who becomes too compliant or even withdrawn is having a bad psychological experience with the hospitalization. Though the hospital personnel may find this behaviour pleasing, it should serve as a warning sign for you and/or the child’s physician to explore the reasons for this behaviour.

AFTER THE HOSPITALIZATION

After a hospitalization it is very common for children to exhibit regressive behaviour such as sleep disturbances or regression in control of elimination habits. Your child may also have feelings such as anger that need to be ventilated. The child who has been well-prepared for the hospitalization often feels a sense of accomplishment after handling the situation.

All Things Which You Must Know About Newborn Baby

Each newborn is an individual. Your baby probably looks different from what you expected. At birth, its skin is covered with a thick, white, creamy substance called vernix, which, when removed, leaves a reddened, puffy, curried-up being-your new baby.

Your baby’s body may be covered with fine, downy hair (lanuago). The amount, color, and areas covered vary. The lanuago is shed naturally during the first weeks. The hands feet may be bluish and cold because of immature circulation.

SKIN

The skin may become dry and wrinkled because of the change from the moist womb environtment to room air. It is not necessary to rub the skin and scalp with oil.

Approximately 40 percent of all babies may have a rash during the first few weeks consisting of small, raised, white spots on the face (milia). This is the normal beginning of the function of oil and sweat glands. No treatment is needed as these spots disappear on their own (and should not be squeezed).

Fifty percent of all babies may have a rash consisting of red, raised patches (erythema toxicum). This rash begins during the first days of life and usually disappears within a week. The rash frequently occurs on the chest, abdomen, back, or bottom. No treatment is needed.

Babies are born with different amounts of hair. Some babies are even bald. The scalp hair may be rubbed away, in patches, as your baby shifts its head about. The hair color at birth is often different from that in childhood. Newborn fingermails are thin and long from growth in the womb.

The head appears large in relation to your baby’s body. Because of the head’s weight, it needs support when the baby is handled. The head may be misshapen because passage through the birth canal has molded the soft bones. This is normal and the skull will round out during the next year. The brain has not been damaged. If your baby favors lying in a particular position, that side of the skull may appear flat. This , too, returns to normal as the bones mature. There are two soft spots (fontanelles) in the head where the brain is overed by a tough membrane until bone grows over them during the nest year. The size of the soft spot is different for each child. There is no danger in washing or climbing the skin and hair over these areas.

The color of the eyes at birth may be different from that as an adult. Most newborns have eyes that are gray-blue or, if they are darker complected, brown in color. Occasionally, there will be a red blood spot (haemorrhage) in the white portion of one eye. This is due to the b reaking of a tiny blood vessel that often occurs during the birth process. Though the spot looks bad, it will resolve without treatment. Passage through the birth canal often causes considerable swelling of the eyelids which will take several days to resolve. Occasionally, swelling, mattering, or tearing from both eyes may be due to the eye drops used at birth. Coordination of your baby’s  eye movements develops gradually over the nest year.

The newborn’s face is usually rounded with the cheeks being pudgy. In the first few days, the lips will begin to form sucking callouses which look like tiny blisters. Occasionally, a baby’s tongue is short but will lengthen with age. This rarely causes speech difficulties. Your baby’s teeth will not break through the gums for many month.

In some babies, during the ensuing days, the breasts become enlarged and may secrete a milky substance. This is due to the transmission of the mother’s hormones prior to delivery. As their influences wears off, you baby’s breast size will return to normal and milk flow stop on its own during the next few weeks. Do not massage or squeezes the breasts.

The umbilical cord was the connection from the baby to the placenta inside the uterus. Though glistening white at birth, it turns brown during the first few days as it dries. If kept dry, it will fall off during the first few weeks. Some people dab it with alcohol, using a cotton ball, or swab several times daily to aid this drying process. At the time the cord falls off, it is normal to see some blood like drops on the raw naval, clothing, or diaper. Continue to keep the raw area dry and clea until it heals. If the area of attachment develops a bad odor, redness, or pus, contact your physician. Do not tub bathe your infant until the raw area has healed. Many babies particullary black infants, have an out-pouching of the belly button area (umbilical hernia). This hernia is due to a gap in the muscles of the abdominal wall around the naval. Most of these hernias disappear on their own during the first few years.

Often the genitals will seem large in comparasion to the rest of the body. Females may  a discharge from the vagina varying from white to red or brown in color. This is also due to the influence of the mother’s hormones and usually starts and stops in the first few weeks.

In a male infant whose  penis has been circumcised, the edge will take a number of days to heal. Care should be taken to prevent  irritation of the wound. Wash and dry this area gently. A dab of petroleum jelly on the wound will prevent it from sticking to the diaper. If not circumcised, after 6 month of age, you should begin trying to retract your child’s foreskin once daily. This may be most easily accomplished during his bath. It is normal, and of no significance, for erections to occur.

The arms and legs will often temporarily stay in a position similar to that in the womb. The legs may be bowed for the same reason. The feet, too, may be at an odd angle. As your child matres, particularly after walking has begun, the feet and legs return to more normal positions.

Though your infant looks helpless and is dependent on you for most of his/her needs, there are anumber of things babies can do. They posseses language, communicating with you by crying various ways. Each cry is different in characteristic. There is one to get attention, feeding, diapering, or for just being uncomfortable. Babies may normally have fussy periods during each day when they cry for variable amounts of time without apparent reason. Most commonly, this occurs in the late afternoon or early evening when the household is least relaxed.

Your baby can perform the basic life functions of breathing, sucking, swallowing, keeping warm, and expelling waste. These functions are performed with a pattern of regularity peculiar to your child. Your infant’s normal breathing pattern will vary, just like yours. Your child has the ability to see, hear, taste, smell, and feel. Newborns are quite capable of movements. A number of these are involuntary reflexes: rooting (turning the head toward that cheek which is touched as a prelude to feedig), sucking, starling to sudden contact or noise (known as the moro reflex), with drawing the limbs (a means of protection), grasping, blinking, yawning, gagging, coughing, and sneezing. The degree of active movement varies with each individual. Hiccups is another normal process which stops on its own.

With all this activity as well as considerable  growth, it is of no surprise that the average newborn sleeps 12 to 18 hours a day.

The frequently and intensity of each of these behaviors is different because each newborn is an individual.  

Preventive Health Care For Children which you need to know

Many parents wonder about the need for periodic well-baby or well-child exminations. This program of medical encounters provides your child with health screenings and preventive care. Additionally, it aids the parent in carrying ot the very important responsibility of maintaining their child’s health.

During the periodic well-baby or whell-child exams the doctor will review your child’s growth progress by comparing his/her height and weight with measurements from previous visits and with standart growth charts. The doctor usually performs a thorough physical exam. This exam includes observation to acces your child’s developmental progression in comparasion with previous visits against standars for his/her age. The doctor should explain the findings to you so that you may be reassured of your child’s health status. The older child should be specifically reassured of his/her physical normalcy.

Most significantly, these periodic examninations should review your child’s health history, deal with your particular concerns, and also introduce you to additional aspects of parenting. The doctor will be interested in many adpects of your child’s health history including eating, sleeping, elimination, crying, and other behaviour. One way of explaining these to the doctor is to try to give a simple organized explanation of the routine day. At these visits you as parents should try to develop a communicative relationship with your child’s doctor. The doctor too should be striving for this type of interaction. The resulting confidence in each other is extremely helpful in dealing with the many minor and few major health  crises that make up the average.

The frequency of these visits should be variable, based on your skills and your child’s health. First-time parents may require frequent encounters with the child’s doctor for guidance in rearing. Usually an infant is seen monthly during the first six months, then every other month during the second six months. The doctor may want to see your child two to four times yearly during the second and third year, with annual visits threreafter.

Child Doctor Tips : How To Find The Best Pediatrician For Your Kids

FAMILY PHYSICIAN OR PEDIATRICIAN?

If you prenatal care is being provided by a family physician who also takes care of children then you need read no further, as your new child will benefit from the care given by this doctor. If you don’t have a family physician then consider finding one just as you are probably considering finding a paediatrician for your child.

The family Physician is a specialist whose three years of postmedical school training included education in the broad areas of medicine: child care, adult medicine, psychiatry, surgery, obstetrics, gynecology, community medicine, and preventive health care. This gives the family physician the expertise to handle well over 90% of a family’s medical needs. Continuity of care is an important aspect of family practice training. This means that the family physician is always the family’s doctor.even when consultation with another doctor is recommended, the family physician never relinquishes full responsibility for supervision of care for the family member.

A pediatrician is a specialist in child care and has undergone training with a different emphasis than that of the family practitioner. In most pediatrict training programs, much of the emphasis relates to hospitalized children, special aspects of newborn care and management, and the management of complicated childhood illness and chronic problems. The paediatrician thus has a more comprehensive background than the family practitioner for dealing with complicated problems. On the other hand, most paediatricians are reluctant to treat adult illness, and they gave less training than family physicians in assessing overall health needs and in providing continuity of care

In other words, there are advantages and disanvantages to any specialistyou choose to care for you child,. The choice you make will depend on many individual factors for instance, convenient location, reccomendations of friend, recommendations of other physicians, helat needs of the rest of you family, etc.

However, whether you choose a family physician or a paediatrician, find a doctor and estabilish a relationship before your child is born

FINDING THE DOCTOR

Finding a doctor for your child is not always an easy task. If you are seeing an obstetrician then ask for his/her recommendations. Another way of getting some names of doctors is to ask reliable friends who takes care of their children whether or not they are pleased with the care being given. You can also ask physicians in training at your local hospital or ask some of the nursing staff who they might recommend or which physician takes care of their children. These people have an excellent opportunity to observe activities of physicians affiliated with the hospital.

Less discriminating ways of obtaining names of physicians include using the phone book or calling the local medical society. Societies do not recommend anyone in particular but rather provide a list of members who take  of children and are taking new patients. Some areas have consumer oriented directories of the local medical care providers and available services. Such a directory may be quite helpful.

CHECKING THE DOCTOR’S CREDENTIALS

Once some physicians name have been obtained you should check their credentials. You can check credentials with the local medical society, a national directory of medical specialist which most libraries have, or call the doctor’s secretary. First, make sure your doctor is licensed (this is usually required by state law). Second, find out what school he/she attended and when. Younger physicians often have more time to spend with their patients. A physician from an American medical school is likely to have received a good education. So too are physicians from the major industrialized nations medical school. Third, investigate the doctor’s training to determine if internship, residency, and in some cases, fellow-ship training were done in the specialty being practiced. Again, look for physicians who trained in American programs. Another important aspect of evaluating a physicians who are board-certified must have had a certain number of years training and have passed a special examination. A board-eligible physician is usually a younger physicians who has not yet taken the examination but otherwise has the specified training.

DOES THE DOCTOR FULFILL YOUR FAMILY NEEDS

You want a doctor in a convenient location with suitable office hours. Can appointments be obtained right away for urgent problems or within several weeks for routine preventive child care? Find Out whether or not the doctor has hospital privileges. This can be done by calling the administrator of the local hospital. Another important aspect of choosing a doctor for your child is to evaluate the partners or associates, since in an emergency they will have to be trusted just like your child’s own physician. Call the doctor’s office and ask about the more routine charges so that you may determine if the doctor is affordable by your family. 

ESTABLISH A RELATIONSHIP

Once you have selected a physicians for your child make a get acquainted appointment for the whole family. If you are expecting your first child, meet the doctor before delivery. If you have specific concerns, write them down. This will help keep your thoughts organized and you will be less likely to  forget the things you really wanted an answer to. 

Preterm Labor Tips : How To Care Of The Premature Baby Safely (For Nurses)

If the baby is born 3 or more weeks before the calculated date of birth (less than 37 weeks gestation), he is said to be premature. If his weight is less than 2500 grams (5 ½ pounds) he is said to be premature. If his weight is less than 2500 grams termine which babies would require special care. Currently, the individual’s behaviour and appearance are also considered in reaching the diagnosis of prematurity.

Although only 7 to 10 percent of all live births are premature, it, is a fact prematurity is the most frequent cause of death in infants. Premature birth may be due to abnormal conditions in the mother, multiple pregnancy, or induced labor. The survival of the premature infant depends on the skill, patience, devoition and judgement of those giving nursing care.

The basic principles to be observed in carin for the premature infant include :

a    1.  Maintenance of body temperature

      2. Protection from infection

c    3.  Maintenance o airways and adequate oxygen intake

d    4.  Conservation of infant’s energy

e    5.  Adequate fluid and calorie intake

Mechanical devices such as incubators and isolettes are of great value in maintaining the body heat of the infant and in providing him with isolation from sources of infection. They are designed to provide controlled heat and humidity and for the administration of oxygen, if prescribed. His temperature is taken every 2 or 3 hours until it has stabilized. Initially it is taken by rectum, but in the smaller infants it may be taken by axilla every 3 hours until the weight of 1500 grams is reached. As with the heavier infant, the temperature is then taken only twice a day when it has stabilized. In the isolette the baby wears only a diaper, the premature babies not in isolates are dressed in shirts, diapers and blankets. To further protect him from infection, all personnel working in the premature nursery must be free of respiratiory infections. Routine checkups are given and masks may be ordered. In addition, the personnel are required to wear special uniforms, scrub their hands carefully, and wear gowns when handling the infant.

The color, respiratory rhythm and ease of breathing of the premature infant must be carefully checked at frequent intervals. The infant is placed in the incubator with the head of the bed lowered four to six inches to allow the mucus and secretions to drain out. Suctioning equipment and oxygen should be available in case they are needed. All babies weighing less than 1500 grams, those with cyanosis, those babies having difficulty regulating body temperature, and infants who have respiratory difficulty require incubator or isolette care. The procedures followed in caring for the baby in the isolette are included in part 2.

The baby who has no sucking or swallowing reflexes may have to be fed by gavage or medicine dropper. The frequency and manner of feedings as well as the type and quantity of formula is prescribed by the paediatrician.

Babies weighing 1500 grams or more who can suck and swallow are fed in the usual manner with bottle and soft nipple. Usually five percent sugar solution is offered for four feedings on the second day of life. This is followed on the third day by an individually calculated formula. Since premature infants are more susceptible to deficiency diseases, vitamin preparations and iron are given after the seventh day.

To conserve his energy, handling of the infant is kept to a minimum. He is left in his bed for his bath, feedings and examinations until he weighs about 2000 grams. He is weighed onlyabout twice a week, unless he is in an isolette where trapeze-type scales can be used. There he can be weighed daily and his formula requirements calculated every twenty-four to forty-eight hours.

When the infant weighs about 2500 to 2700 grams he may be discharged. A public health nurse will visit the home prior to his discharge to help the mother plan for his care. After he goes home, she will visit at regular intervals to observe his growth and offer assistance as needed.

The American academy of pediatricians is studying the amount of nursing care required for infants of infants of various sizes and conditions and the types of personnel required to give this care. During your assignment to a pediatric service, therefore, you may not have an opportunity to work in the premature unit. Generally, about five hours of nursing care per infant would seem desirable. This would mean about one nurses to every babies. If student nurses re assigned to the premature nursery, they usually first give care to the larger “preemis”, 2500 to 2500 grams and then proceed to the smaller infants. The nurse in charge of the premature unit has received advanced training and has extensive experience in the care of the premature infant. She is responsible not only for the care of babies, but also for the training of personel and education of the parents as well. 

Pediatric Nurse Tips : Daily Nutritional Requirements For Child

Nutrition is concerned with determining the proper amounts of various components of food that will provide the best opportunity for the child’s growth and continued health. These components, called nutriens, include proteins, fats, carbohydrates, vitamins, minerals and water. As you will recall, water is found in all foods and comprises abaout 70% of our body weight. The “basic four” food groups are arranged  so that these nutrients could be obtained in the aveage daily diet. Figure 17—1 shows the four groups: dairy foods, meats, vegetables and fruits, and bread ad cereals.

NUTRIENTS

Each nutrients has a very special job to do for the growing child. Proteins build and repair our body tissue. Protein is the only nutrients which contains nitrogen, the element essential proteins to life and the growth of cell. Complete proteins are those which contain  all  the essential proteins to meet life needs. These are milk, meat, fish, eggs and cheese. Good proteins, although incomplete, are legumes, gelatin, nuts, and cereals. Since the child is constanly growing, he need daily protein. Most children like meats, although finances prohibit some families from purchasing as much as they should. The end product of the digestion of protein is amino acid.

Carbohydrates give us energy which is measured in calories. A calorie is the amount of heat necessary to raise the temperature of one gram ofe water one degree centigrade. One gram of carbohydrate yields four calories. At the completion of digestion, carbohydrates become glucose. The critically ill child who cannot eat may be given an intravenous injection of one to two percent glucose to restore his energy. This nutrient is the least expensive of the four basic foods groups. Our feeling of satisfaction is short-lived after a meal consisting entirely of carbohydrates. Fruits, vegetables, cereals and bread provide this nutrients. Fruits and vegetables also yiels minerals and vitamins.

Fat is used by the body to give us heat and energy. One gram of fat yields nine calories. Fat gives falvor and palatability to food. The sick child may need some fat in the form of meat fat or eggs. Fats take longer to digest than other nutrients, therefore, they give a feeling of satisfaction while being consumed.

The essential vitamins and minerals and their contributions to our health are shown in fig. 17.2. minerals are essential to the formation of bones and teeth. Vitamins are necessary for the functioning of our heart, nerves, muscles and the health of our eyes, skin and mucous membranes.

NAME	SOURCES	FUNCTIONS
Vitamin A	Green and yellow vegetables, fish liver oil, egg yolk, cream, cheese, tomatoes, yellow fruits	Essential to growth, vitality, vision, structure and function of cells of skin and mucous membrane and resistance to infection
Vitamin B1 Vitamin B2 Vitamin B6 Niacin	Organ meats, enriched cereal, bread, potatoes	Essential to general well being, good muscle tone, nerves and digestion
	Milk, organ meats, enriched cereal, eggs, leafy vegetables	Essential to growth, health of eyes, color and structure of flip tissue
	Organ meats, fish, oatmeal, potatoes, cabbage, carrots	Help to prevent muscle weakness and certain nervous disoders
	Meat, poultry, fish, peanut butter, whole grain cereal	Essential to growth, carbohydrate metabolism, function of nervous and digestive system
Vitamin C	Citrus fruits, cabbage, berries, potatoes, tomatoes	Essential to sound teeth, bones, blood vessels, gums, for repair of body tissues and resistance of infection
Vitamin D	Exposure to sunlight, irradiated milk, fish liver oils	Essential to absorption and metabolism of calcium and phosphorus to produce healthy bone, tooth structure
Vitamin K	Green leafy vegetables, soy and vegetables oils, pork liver	Essential in clothing of blood, for normal muscular contractions of the heart muscle
Calcium	Milk and milk products, green leafy vegetables	Essential in building bones and teeth for normal muscular contractions of the hearth muscle
Phosphorus	Poultry, fish, meat, cereals, nuts, legumes, milk and milk products	Essential to bone structure, maintaining acid-base balance, metabolism of proteins, fats and carbohydrates
Iron	Liver, Organ meats, egg yolks, green leafy vegetables, whole grain bread and cereal, risins and molasses	Essential part of every cell in the body, necessary for hemoglobin formation and oxygen bearing
Iodine	Ocean and sheel fish, iodized salt, vegetables grown in iodine rich soil	Normal thyroid gland function

17.2

DIET CHANGES AND GROWTH

In the case of the newborn, it is expected that the formula will provide not only the necessary nutrients, but also the callories and volume of liquid required for proper growth and development. During the last month of prenatal development, the fetus had been storing minerals such as iron, calcium and phosphorus to provide for immediate postnatal needs. To provide the necessary amounts of vitamin C, the paediatrician may start the baby on orange juice at about two weeks. To provide iron and thiamine the infant needs, the doctor may order cereals as early as the first week of life. Additional amounts of iron can be obtained from egg yolk and strained meats. The doctor will suggest the introduction of solid foods in keeping with the individual baby’s needs and development.

Finger foods, such as meat sticks, carrots, teething biscuits and fruit slices, can be introduced when the baby’s appetite is keenest. If the food is rejected the first time it is offered, no attempt should be made to force the child to accept it. Instead, the food may be offered again after several days. 

Because of this sensitivity to strong taste and temperature, the baby’s food should be warm (about 105 F) and lightly seasoned. The shild will usually be eating most o the table foods by his first birthday, the pieces will be smaller and the texture, softer. The year-old child will enjoy drinking from a cup , drinking his food in the milk and using his fingers is feeding himself. Sample menus for the 1 and 4 year old child are shown in fig 17-3.

MENU FOR 1 YEARS OLD

MENU FOR 4 YEAR OLD

6 a.m. Juice, preferably orange Breakfast Cereal with milk, dry toast or zwieback Mid Morning Snack Milk Noon Meal Soft cooked, poached or coddled eggs, chopped spinach, mashed potatoes with butter, gelatin dessert, milk Mid Afternoon Snack Milk and cheese sticks Evening Meal Junior foods, soups, applesauce, milk Evening Milk, water as desired

Breakfast Orange or orange juice, oatmeal with milk, toast with butter or margarine, glass of milk Mid Morning Snack Fruit or juice and cookies Dinner (Noon Meal) Baked potato with butter or margarine, meat ball or boneless fish, spinach or peas, carrots, fruit, jello or custard dessert, milk Mid Afternoon Snack Fruit or Milk and cookies Supper (Evening Meal) Vegetable soup or chicken soup, meat or cheese sandwich, tomato or carrot sticks, applesauce or baked apple, milk Water as desired

The needs of the toddles vary little from those of the infant. Because he does not grow as rapidly when a toddler, one might assume that child does not need as much food. However, the calories he does not consume in growth, he uses in muscular activity. The toddler requires 45 calories per pound of body weight, the 2 year old requires from 1000 to 1500 calories per day. The preschool child requires from 1400 to 1800 calories per day. The child should have 30 to 40 grams of protein per day, and it shoud be in the form of meat, fish, eggs or cheese. His daily food needs as he grows are shown in fig.17-5

Age	2-6 Mos.	7-12 Mos.	1-3 yrs.	4-6 yrs.
Weight: Kg.                Lb.	6 13	9 20	12 27	18 40
Height: Cm.               In.	60 24	70 28	87 34	109 43
Calories Protein gm. Calcium mg. Iron mg. Vitamin A I.U Thiamine mg. Riboflavin mg. Niacin mg. equiv. Ascorbic Acid mg. Vitamin D I.U.	Kg.X 120 * 600 5 1500 0.4 0.5 6 30 400	Kg.X 100 * 800 7 1500 0.5 0.8 7 30 400	1300 40 1000 7 2000 0.7 1.0 8 35 400	1700 50 1000 8 2500 0.9 1.3 11 50 400

*Allowances are not given for protein during infancy

** Includes preformed niacin and the precursor, tryptophan 

60mg. tryptophan equals 1 mg. niacin.

The hospital diet has been carefully planned for the growing child in order that he may get all the essential for this health and growth. Eating habits vary, however, from patient to patient. Children from underprivileged areas frequently eat a starchy diet because of the higher cost of protein. Other children will demand meats and fish.

The nurse may encourage the formation of good dietary habits by making an interesting game of eating all the nutrients served. The wise nurse will eliminate sweets from the diet and serve a balanced meal in small amounts. When the child becomes hungry and observes his little neighbors eating all their food, he will begin to ask for additional servings. Then sweets may complement the regular food. The nurses should record the child’s progress on his chart.

During growing child needs food from all of the four food groups. His experience under your supervision may be his firs opportunity to eat a balanced diet. He will show remarkable changes when he is obtaining adequate sources of balanced nutrients to help him grow and have energy to spare.

During the adolescent period and particulary following the menarche, the young girl should be encouraged to have a proper diet. Calories should total about 2200 to 2800 per day, and the diet should include the four basic foods groups. Calcium, iron, vitamins D and C and protein are important to the growth of body tissue and should be plentiful in the diet. Eight to ten hours of sleep are desirable, and time should be provided for relaxation or recreation. Overweight in this period is usually due to overeating and limited activity.

Because a great deal of emphasis is placed on physical characteristics at this time, the girl may attempt “crash diets” to control her weight. This may lead to nutritional deficiencies, fatigue, poor posture and dental problems. Frequently the plumpness about which she complains may be the plumpness of childhood which will disappear as the growth pattern progresses.