Caring for Military Children: Implications for Nurse Practitioners

Nearly two million American children belong to a military family. Armed Forces families are located in almost every state and around the globe. Military children are a unique and at times vulnerable population. Military children and adolescents may face significant stressors throughout their lives compared to their civilian counterparts. Military families encounter frequent moves and over half of these children have encountered at least one parental deployment since September 11th, 2001. Civilian health care providers often care for military children and adolescents. The purpose of this article is to provide pediatric providers with an understanding of the deployment cycle and how it relates to childhood development, to discuss common military stressors and their impact on the family, and to describe strategies and resources pediatric providers can utilize to care for this unique population.     

Caring for the newborn with an omphalocele

An omphalocele, a ventral defect of the umbilical ring resulting in herniation of the abdominal viscera, is one of the most common congenital abdominal wall defects seen in the newborn. Omphaloceles occur in 1 in 3000 to 10,000 live births. Associated malformations such as chromosomal, cardiac, or genitourinary abnormalities are common. Postnatal management includes protection of the herniated viscera, maintenance of fluids and electrolytes, prevention of hypothermia, gastric decompression, prevention of sepsis, and maintenance of cardiorespiratory stability. A primary or staged closure approach may be used to repair the defect. Some giant omphaloceles require a skin flap or nonoperative management approach, hoxvever. Immediate postoperative complications, usually related to significant changes in intra-abdominal pressures, include compromise of interior venous blood return and hemodynamic and respiratory instability due to diaphragmaric elevation. Complications occur more frequently with giant defects. Potential short-term complications include necrotizing enterocolitis, prolonged ileus, and respiratory distress. Long-term complications include parenteral nutrition dependence, gastroesophageal reflux, parenteral nutrition-related liver disease, feeding intolerance, and neurodevelopmental delay. Overall, advances in surgical therapies and nursing care have improved outcomes for infants with omphaloceles; survival rates for those with isolated omphaloceles are reported at 75 to 95 percent. Infants with associated anomalies and giant omphaloceles have the poorest outcomes.     

Caring for adolescents with mental health problems: challenges in the emergency department

AIM: To explore management issues in adolescents with mental health problems who presented to a children's hospital emergency department (ED). METHODS: Retrospective chart review of all mental health presentations of adolescents (12-18 years) to a tertiary children's hospital ED, over a 1-year period (2003-2004). Patients were identified based on a search of the electronic ED log. Medical and mental health records were manually abstracted. RESULTS: There were 203 presentations during the study period. Eighteen per cent of patients presented more than once. Mean age was 14.7 years, 73% were female and 67% presented after 6 pm. Fifty-seven per cent presented with non-accidental overdose, self-harm or suicide risk. There were 110 security incidents in 26% of presentations during the ED stay. A total of 47% were admitted, 27% to the medical inpatient service and 20% to a psychiatric inpatient facility. CONCLUSION: Adolescent mental health presentations to the ED require a high number of ED, mental health and inpatient service resources. Security incidents occur frequently. We propose changes to address identified problems. These include redesigning the physical structure of the ED, more mental health training and support for ED staff, better access to mental health records and crisis plans for adolescents at risk, and improved after-hours mental health services for children and adolescents.     

Caring for children with AIDS: new challenges for medicine and society

Caring for HIV-infected children under 13 years of age poses a serious and steadily increasing challenge to our society. Children with AIDS face devastating medical and psychosocial problems. Because of the unique implications for the entire family when a child is found to be HIV-infected, the health care profession is obliged to confront complex legal and psychosocial issues heretofore unparalleled in modern medicine. Decisions that concern schooling and daycare for the asymptomatic but HIV-seropositive individual are often influenced more by public frenzy than scientific information. Issues regarding reproductive choice and responsible parenthood are all confounded by debilitating and eventually fatal illness in infected parents. Problems of custody and foster care require innovative strategies to avoid further burden to an already stressed system. AIDS has become a disease for which research is standard of care. Access to experimental protocols is complicated by geographic location, public funding, and complexities of informed consent. The responsibility of the physician to an individual patient must be considered, and must be given its proper place within the broader responsibility to science and society.