Direct Care of the Child

1. Direct Care of the Child

2. Basic human needs... Psychologist Abraham Maslow developed a Pyramid of Human Needs, an hierarchy of needs critical to survival. • It is the parent’s job, as they care for their growing child, to help meet these needs: • The child has physical needs of food, water, shelter • The child must feel and be safe from harm • The child must feel love, a sense of belonging; acceptance • The child must feel a sense of self-worth • The child must strive to be “all that they can be” (fulfillment/ self-actualization) In the state of Nebraska, a parent is responsible and liable for their child until age 19, and needs to continue active parenting at least until then!

3. PHYSICAL AND SAFETY NEEDS

4. Sleeping habits... Sleep slows down your metabolism, heartbeat an respiration for needed relief from physical activity; makes you mentally sharper and better able to concentrate; is your mind’s outlet for dreaming which is essential to a healthy lifestyle; is a natural function, so lack of sleep causes irritability and affects mental and physical health; triggers a growth hormone needed to renew tissues, form new red blood cells, and promote bone formation. How much sleep do children need?

5. Nutritional needs... Caloric need for children will vary according to activity level, gender, age, and size. Generally, 2-3 year olds need 1,000 calories per day, about 1,500 for a 4-8 year old, and 1,800 for a 9-13 year old. Your child should eat 6 ounces from the grains group each day; 1 ½ cups from the vegetables group, 1 ½cups of fruits, 6 ounces from the meat group and 24 ounces from the dairy group. The amount may vary according to the child’s age, weight, and activity level. Limit added fats and sugars and stress 30 minutes of vigorous physical exercise each day.

6. Food precautions... Children are very susceptible to choking on objects and food. The majority of choking victims are less than 5 years old. Foods that children choke on most often are hot dogs, candy, peanuts, nuts, grapes, cookies, meat, carrots, apples, popcorn and peanut butter. Round foods (candy and nuts) cause trouble because they fit so well into a child's airway. Pliable or compressible foods (hot dogs, grapes) may form a tight plug in the throat. Hard or tough foods that are difficult to chew (carrots, candy) may result in large pieces being swallowed. Peanut butter can block the airway because it is so sticky. Here are a few extra pointers for parents of children under the age of five: Don't allow your child to walk, run, or play while he has food in his mouth. Never leave a little one alone while he/she eats. Make a rule against eating in the car. If your child chokes while you are at the wheel, you may not have time to take necessary action. Make sure your child is always sitting upright when he/she eats or drinks. Don't prop baby bottles. Instead, hold them for the infant during feeding. Keep in mind that anesthetics applied to the child's gum to numb the pain of teething make it difficult for him to eat foods that require chewing. Know the signs of choking: ineffective coughing, inability to speak or cry, high-pitched noises, and bluish lips, nails, and skin.

7. Children’s clothing has two purposes, to keep them warm and protect them from the weather (exposure). Clothing selection... When making clothing selections, children are influenced by what they think is “cute” or “neat”, by characters printed on the clothing, fashion trends and what their friends are wearing. They do not think ahead about weather conditions, only about how much fun it will be to make a snowman. The parent must assist in clothing decisions. There are two federal regulations governing children’s clothing, one limiting the length of hood cords/drawstrings and the other specifying flammability standards for pajamas. The U.S. Consumer Product Safety Commission can suspend unsafe products and can prosecute suppliers of unsafe products. Improper clothing can cause injuries. Hood cords or drawstrings that are too long can strangle a child if they get caught on playground equipment, fences, or in car/bus doors. Children choke on buttons that have come loose from their clothing. They can fall easily if shoelaces come untied, and they can be burned severely if clothing catches on fire.

8. LAW 79-201. Every person residing in a school district within the State of Nebraska who has legal or actual charge or control of any child not less than seven years of age and not more than eighteen years of age shall cause such child to attend regularly the public, private, denominational, or parochial day schools…each day that such schools are open and in session, except when excused by school authorities, unless such child has graduated from high school OR has reached the age of 16 years and such child's parent or guardian has signed a notarized release discontinuing the enrollment of the child on a form provided by the school. (2004) Education... Truancy is a child’s absence from school without permission from school authorities.Parents do not own children, and cannot waive children’s rights, so parents cannot excuse their child from school, but can only provide reasons for absences. Kindergarten attendance is not mandatory in Nebraska. In order to attend school, the child must have attained the age of 5 years on or before October 15. . It is the school’s job to provide the education, the parent’s job to get the child to school, and the child’s job to learn! Special needs students quality for services from birth to age 21.

9. There are two options for educating children in the state of Nebraska, public or private schools. Home schooling is one type of private school. Education options... Public schools are supported by tax dollars. Private schools, unlike public schools, are funded by individual tuition or by donations from special interest groups rather than by the government. Parochial schools are one type of private school funded at least in part by a religious affiliations. Because private schools are not funded by the government, they no not have to comply with many of the laws and mandates that regulate the public schools. Every child is entitled to an education provided by the public school system. Classrooms are diverse in nature, like society, in that students represent different races, economic groups, different values, widely varying ability levels, etc. Interdistrict and intradistrict school choice laws, known as option enrollment laws, allow families to choose any public school in the state for their child. Private schools offer children the opportunity to be educated in accordance with one’s own religious beliefs or value systems. To attend these schools is a privilege rather than a right, and enrollment can be limited to students within a specific economic, behavioral, ability level, or special interest profile. Although statistically home schooled children fare well academically, critics cite the lack of socialization, loosely regulated curriculum, and widespread range of the skills and training of the “teacher” as a problem.

10. Dental care... By age 3 children should be brushing their own teeth with adult supervision. By age 8 children are usually old enough to brush and floss by themselves with only occasional checks. Make sure children start with just a pea-sized dot of toothpaste. Start flossing your child's teeth daily when all the primary (baby) teeth are in or when teeth are touching each other. Make brushing and flossing a daily routine, but keep it enjoyable. The Tooth Fairy is a common childhood myth, that usually goes something like: When a tooth falls out, leave it under your pillow when you go to sleep. During the night, the Tooth Fairy will visit your room, take the tooth (probably to make pearl necklaces) and leave a small amount of money to pay you for it.There are pros and cons to promoting this myth. Unhealthy primary teeth are the best predictor of unhealthy permanent teeth!

12. Thumb sucking is a natural urge, an instinct found in babies and young children. Beyond the age of around 6 months, however, some children continue to suck their thumbs as a habit to sooth or comfort themselves when they are tired, hungry, afraid, bored, restless, or quiet. Thumb sucking... Other related oral habits are finger or lip sucking, tongue thrusting, nail biting, mouth breathing and grinding the teeth during sleep or stressful situations. Even this fetus will suck it’s thumb as an instinct. The American Dental Association identifies the ideal age for discontinuation of nonnutritive sucking habits on thumb or fingers may be around 24 months of age".  Sucking habits continued beyond the age of 24 months may result in increased risk of developing tooth misalignment and/or jaw malformations.

13. Toilet training... Toilet training is a developmental milestone. It cannot be rushed. In general, bowel training occurs before urine (bladder) training. This is because children can control the sphincter muscle at an earlier age than they are able to recognize and control muscles controlling urination. In addition, parents often can more easily recognize behavior that suggests a child needs to have a bowel movement. Daytime training occurs before night time training. Girls usually are toilet trained before boys. For girls, successful training starts around 18 months or later, for boys around 22 months or later. Toilet training problems often can be traced to other struggles between parent and child (discipline, authority acceptance, etc.). Before toilet training is started, the child needs to be old enough to have biological control of elimination.

15. Toilet training... To see if your child is ready to learn toilet training, answer the following questions: Can the child follow simple directions? Can the child sit in a chair for five minutes? Can the child wait at least 1-1/2 hours between elimination times? Does the child show an interest and is motivated by wearing "real" underwear? Can the child partially pull training pants down and up? Toilet training is a part of a life-long process of learning about the body and its functioning. Adults' attitudes toward genitals and the natural process of toilet training have an important influence on the child's developing feelings about her or his body and taking responsibility for bodily needs. Make certain the child has observed a parent or trusted adult using the toilet. Answer questions in a relaxed manner. Toilet training accomplished in a calm and positive way is an important support for life-long appreciation of human sexuality. Children may be frightened or curious about using a toilet “Where does it go?” “Will I fall in?” They may want to play with their urine or feces (it belongs to them). They also may want to examine their own or other children's genitals when using the toilet. This is normal experimental behavior. It is a good time to teach correct names for body parts and body functions. The goal is to teach children that all parts of the body are good, and body functions are natural.

16. Bed wetting... Enuresis (en-yoo-ree-sus) is the correct term for bedwetting. It is estimated that up to seven million children in the United States wet the bed on a regular basis; it runs in families and boys have more problems with this than girls. Nighttime bedwetting occurs in a fairly substantial number of children: at least 15 percent of 5- to 6-year-olds and even about 1 percent of adolescents. Once children are completely toilet trained, they are usually aware that wet beds cause smelly odors, that parents may be disappointed in them, and that it creates additional laundry chores. Children want acceptance, so may be embarrassed about bedwetting. Decrease fluids before bedtime – although not to excess – and increase trips to the toilet. Disposable absorbent underpants and sheet protectors can help cope with the situation. Some bedwetting is due to emotional stress or feelings of insecurity, but primarily it occurs due to a physically and/or neurologically immature bladder and/or a deep sleeping pattern. 

17. Toys, especially designed for a child’s pleasure, can be a danger to them. Toy selection... According to the U.S. Product Safety Commission statistics, there were 17 deaths and 191,000 toy-related injuries during the year 2000. Of the 17 deaths, 8 involved riding or power-operated riding toys; the remaining 9 were the result of suffocation or choking.  Look for warnings or other safety messages on toy packaging; carefully read all instructions for usage. Use recommended age labeling as a guide Throw away all toy packaging such as plastic, cellophane and styrofoam.

18. Toys for babies: Check all rattles, squeeze toys and teethers for small ends that could extend into the back of the baby's mouth. Avoid ball-shaped ends as well.  Remove toys and mobiles strung across cribs and playpens when baby begins to push up with hands and knees. Toy safety issues... Teach your child the proper use of toys. For example, darts and arrows should not be pointed at anyone. Throw away broken toys that cannot be fixed. Make sure that batteries in toys are properly installed, and do not allow a child to sleep with a battery-operated toy. Make sure that large toy boxes have good ventilation and that the lid is lightweight and well supported. It should be sturdy enough that it cannot be knocked over, and not have a latch. Teach children to put their toys away. Examine toys regularly for signs of wear and tear. Is the toy well made and sturdy? If not, it could break apart, potentially injuring a child. Does the toy have a safe finish? Paint should be nontoxic and durable so the finish doesn't peel. Are rideable toys stable, sturdy, and in good repair?

19. Are toys, including stuffed animals, washable? If not, they can become breeding grounds for germs. Toy safety issues... Does the toy have heating elements or electrical connections? Battery-powered toys are acceptable as long as the batteries and wires are safely enclosed and inaccessible or the toy is used only under close supervision. Are there any sharp points, edges, or brittle, breakable parts that could cause injury or entrap small hands, feet, or fingers? Does the toy make loud noises? Noise levels greater than 100 decibels can damage your child's hearing. "Caps" used in cap guns are dangerous if used indoors or closer than 12 inches from your child's ear. Does the toy involve throwing or shooting projectiles? Many such toys are best avoided because of potential injury, especially to the eyes. Make sure if your older child plays with bow and arrow sets, safety darts, etc. that they are used safely, away from younger children, and with constant adult supervision. Also make sure that any parts such as rubber suction cups do not fall off and become a choking hazard to younger children.

20. Toy safety issues... Avoid latex balloons. Be aware that one of the greatest choking hazards for children is un-inflated balloons and the pieces of burst balloons. Mylar balloons are safer. Is the toy -- or any part of the toy, external or internal -- small enough to swallow? If it can pass through a toilet paper tube, it can be swallowed. Can parts be bitten off? Check to make sure eye and noses on soft toys and small wheels are fastened securely. Balls and other toys made of foamlike materials may be hazardous if the child bites off pieces and attempts to swallow them. Does the toy have a string? Strings, ribbons, or cords longer than six inches place your child at risk for strangulation. Avoid such toys or remove or trim the strings. Are art supplies such as crayons, paints, and modeling dough nontoxic?

21. Vaccines work to safeguard children from illnesses and death caused by infectious or communicable diseases. Vaccines protect children by helping prepare their bodies to fight often serious, and potentially, deadly diseases. Childhood disease... Some vaccines are required by the State of Nebraska. Those include Diphtheria, Tetanus, Pertussis (DTaP), Measles, Mumps, Rubella (MMR), and Polio for all children attending licensed day cares, Head Start programs or grades K-12. Varicella and Hepatitis B vaccines are required for grades K, 1st, and 7th. Hib vaccines are required for day cares and Head Start programs. Additional vaccines available, but not required by law are Anthrax, Haemophilus Influenzae, Hepatitis A, Influenza, Lyme Disease, rotavirus, Meningococcal disease, Pneumococcal disease, disease, rabies, smallpox, tuberculosis, typhoid fever, yellow fever, and small pox. Vaccines to help prevent diseases generally contain weakened or killed viruses or bacteria specific to the disease. Vaccines, or actually having had the disease, helps the body recognize and fight these germs and protect you each time you come in contact with someone who is sick with any of these diseases. That is known as an immunity.

22. DIPHTHERIA Immunizations... Diphtheria is a serious disease that can cause death through airway obstruction, pneumonia, heart failure, and paralysis of the muscles used for swallowing. Diphtheria usually begins with a sore throat, slight fever, and swollen neck. Most commonly, bacteria multiply in the throat, where a grayish membrane forms. This membrane can choke the person. Sometimes, the membrane forms in the nose, on the skin, or other parts of the body. The bacteria can release a toxin that spreads through the bloodstream and may cause muscle paralysis, heart and kidney failure, and death. Approximately 5% of people who develop diphtheria (500 out of every 10,000) die from the disease and many more suffer permanent damage. In 1991, the Food and Drug Administration licensed the DTaP (diphtheria-tetanus-acellular pertussis) vaccine.  While DTP vaccine was made using whole cells of the pertussis germ, DTaP is made using only small, purified pieces of the germs.  Fewer side effects have been reported with the DTaP vaccine than with DTP. No diphtheria-only vaccine is available

23. PERTUSSIS WHOOPING COUGH Immunizations... Pertussis is a bacterial infection caused by Bordetella pertussis. The germ is spread when infected people cough or sneeze. Children with pertussis have decreased ability to cough up respiratory secretions and develop thick, glue-like mucus in the windpipe. This causes severe coughing spells that make it difficult for them to eat, drink, or breathe. The child may suffer from coughing spells for two to three weeks or longer. Sometimes the child coughs several times before breathing in; when the child finally does breathe in there is often a loud gasp or "whooping" sound. The disease is most severe when it occurs early in life; it often requires hospitalization. The majority of pertussis-related deaths are in young infants which may occur when other bacteria take the opportunity to invade the sick infant's lungs. Primary pertussis pneumonia also may be life-threatening in infancy. In 1997, adolescents and adults accounted for 46% of reported cases of pertussis, and they are often the ones who spread this disease to infants and children. Pertussis is one of the most contagious human diseases, so it is a great risk to those who are unvaccinated There is no pertussis-only vaccine available; it is given in combination with the diphtheria and tentanus

24. TETANUS/ LOCKJAW Immunizations... Tetanus is caused by toxin-producing spores that inhabit the soil and the bowels of animals and humans. Unlike other vaccine-preventable diseases, it is not spread from person to person. Tetanus infection is most often the result of wound contamination in an unimmunized person. Tetanus may occur following delivery in newborn babies of unimmunized women (resulting from contamination of the umbilical cord), and in injection drug users. It may also occur following puncture wounds, animal bites, burns, abrasions and surgery. Tetanus infection results in severe muscle contractions, or spasms. Fever, sweating, elevated blood pressure, and rapid heart rate may also occur. Spasms of the vocal cords or the muscles of respiration can interfere with breathing, and pneumonia is common. Contraction of muscles can be so severe that the spine or other bones are fractured. In the mid-1940s, the tetanus vaccine was combined with vaccines against pertussis and diphtheria. The combined DTP vaccine soon was routinely used in the United States, but is no longer recommended, but was replaced by the DTaP in 1991. The tetanus vaccine can be administered separately, and needs a booster every 10 years throughout the lifetime.

25. Immunizations... MEASLES Measles is a serious disease caused by a highly contagious virus, which spreads when people touch or breathe in infectious droplets passed by coughing and sneezing. Measles begins with fever followed by cough, runny nose, generalized rash, and conjunctivitis ("pink eye"). Infections of the middle ears, pneumonia, croup, and diarrhea are common complications. Measles encephalitis (an infection of the brain) occurs in 1 per 1,000 cases of natural measles, frequently resulting in permanent brain damage in the survivors. Approximately 5% of children will develop pneumonia, and 1 to 3 of every 1,000 to get measles in the United States dies from the disease. Prior to licensure of the first measles vaccine in 1963, virtually every person in the U.S. got the measles by age 20. Since the vaccine became available, there has been a 99% reduction in the incidence of measles. However, measles is still being “imported” from other countries. The first measles vaccine was licensed for use in the U.S. in 1963. Today, measles vaccine is generally given in combination with mumps and rubella vaccines (MMR).

26. MUMPS Immunizations... The current "Jeryl Lynn" strain of the mumps vaccine was developed by Dr. Maurice Hillman from the mumps virus that infected his 5-year-old daughter (whose name was Jeryl Lynn). This vaccine, combined with rubella or both rubella and measles vaccines (MMR), has been widely used worldwide (300 million doses given) since it was approved by the FDA in 1967. Mumps is a viral infection spread from person to person by secretions sneezed or coughed from the nose or throat. Mumps usually begins with swelling and tenderness of one or more of the salivary glands, so might affect one or both sides of the jaw/neck area. This lasts about a week. Complications can include inflamed testicles (20% to 50% of post-pubertal males infected, often resulting in sterility), brain involvement including aseptic meningitis (15% of cases), and inflammation of the pancreas (2% to 5% of cases) and ovaries (5% of post-pubertal females). Permanent deafness occurs in 1 out of 2,000 cases.

27. RUBELLA Immunizations... Rubella is caused by a virus that is transmitted from person to person in mucus droplets coughed or sneezed into the environment. Rubella usually is a mild illness. Symptoms include low-grade fever and swollen lymph nodes in the back of the neck followed by a generalized rash. Complications may include joint pain, a temporary decrease in platelets, and encephalitis (inflammation of the brain). Temporary arthritis may also occur, particularly in adolescents and adult women. Rubella in expectant women often leads to congenital rubella syndrome (CRS) in their fetuses. This is a devastating disease characterized by deafness, mental retardation, cataracts and other eye defects, heart defects, and diseases of the liver and spleen that may result in a low platelet count with bleeding under the skin. The incidence and severity of congenital defects are greater if infection occurs during the first month of gestation. Up to 85% of expectant mothers infected in the first trimester will have a miscarriage or a baby with CRS. The first vaccines for rubella were licensed in 1969. Today rubella vaccine is generally given in combination with measles and mumps vaccines (MMR). Rubella was often referred to as the 3 day measles.

28. POLIO Immunizations... Polio is caused by intestinal viruses that spread from person to person in stool and saliva. Most people infected with polio (approximately 95%) show no symptoms. Minor symptoms can include sore throat, low-grade fever, nausea, and vomiting. Some infected persons (1 to 2%) will have stiffness in the neck, back, or legs without paralysis. Less than 1% of polio infections (about 1 of every 1,000 cases) cause paralysis. In some cases, the poliovirus will paralyze the muscles used to breathe, leaving the victim unable to breathe on his or her own. Many paralyzed persons recover completely. Those who do recover from paralytic polio may be affected 30 to 40 years later, with muscle pain and progressive weakness. Before the polio vaccine, 13,000 to 20,000 people were paralyzed by polio, and about 1,000 people died from it each year in the United States. Most of those infected were elementary school children so it was often called 'infantile paralysis.' In the U.S., inactivated polio vaccine (IPV) is recommended. Children should receive doses of IPV—or IPV combined with the DTaP and hepatitis B vaccines

29. Immunizations... VARICELLA (CHICKEN POX) The varicella vaccine was recommended for routine use in the United States in 1995. The infection usually starts as a rash on the face that spreads to the rest of the body. The rash begins as red bumps that eventually become blisters. A child will often get 300 to 500 blisters during the infection, which crust over and fall off in one to two weeks. The virus can be spread in the fluid from the blisters or droplets from an infected person’s nose or throat.Varicella is generally a mild disease, but it is highly contagious and can be severe and even fatal in otherwise healthy children. Chickenpox can cause pneumonia (23 out of every 10,000 cases), and is an important risk factor for developing severe invasive “strep” (group A streptococcal disease), commonly referred to as “flesh-eating disease.” Treatment of this deep infection requires antibiotics and surgery to remove the infected tissue. The virus which causes chickenpox remains in the body for life and may reappear as shingles, particularly in the elderly.

30. Immunizations... HEPATITIS B Hepatitis B virus (HBV) is transmitted from one person to another through blood and body fluids, and primarily infects the liver. In the United States, it is most commonly spread through sexual contact or injection drug use. Health care workers and others exposed to infected blood or body fluids are also at high risk for infection. However, approximately 30% of those infected have no known risk factors. Worldwide, it is most commonly spread to infants by their infected mothers. More than half of those infected with the disease show no signs or symptoms, although they may become chronic carriers of the disease and may develop liver disease or liver cancer later in life (usually by age 40). Symptoms of HBV infection vary and may include loss of appetite, fatigue, nausea, and jaundice (yellow eyes and skin), joint pain, and skin rashes. The current form of the hepatitis B vaccine has been used in the United States since 1986. Worldwide, over 350 million people have chronic HBV infection, and approximately 1 million HBV patients die annually. An estimated 1.25 million people in the U.S. have chronic HBV infection. Each year, approximately 4,000 to 5,000 children are infected with hepatitis B in the United States. The younger the patient is when the disease is acquired, the more likely it is that he or she will develop chronic liver disease or liver cancer.

31. HIB Immunizations... Haemophilus influenzae type b (Hib) is a bacterium that can infect the outer lining of the brain causing an infection called meningitis. Hib is transmitted from person to person through mucus droplets that are spread by coughing or sneezing. Invasive Hib disease occurs most often at three months to three years of age, peaking at six to seven months of age. The disease is uncommon after age five years. Hib can cause a wide variety of serious infections, including pneumonia, severe throat swelling that makes breathing difficult (epiglottitis), and infections of blood, bones, joints, and the covering of the heart. Complications of Hib meningitis include blindness, deafness, mental retardation, learning disabilities, and death. About 5% of children (500 out of every 10,000) with Hib meningitis die despite antibiotic treatment. Prior to universal Hib immunization, Hib was the most common cause of bacterial meningitis in infants and preschool-age children, and caused approximately 20,000 cases of invasive disease annually.

32. Medical conditions... Head lice, or pediculosis is inflammation of the skin caused by tiny parasites (lice) which congregate in the hairy parts of the body, which in children is the scalp. The lice bite through the skin to obtain blood, causing red bite marks, and lay their eggs attached to the hairs (‘nits’). Head lice are spread by contact with an infested person or clothing. Head lice are common to pre-schools and schools, irrespective of the social standing of the infected individuals or establishment. Signs and symptoms are: itching and scratching, scalp inflammation, active lice and ‘nits’ in the scalp hair, (rarely) enlarged lymph glands in the neck. Treatment is generally by medicated shampoos and creams. (RID or NIX) Ensure that treatment is continued for at least five days after the lice disappear, as they can recur. Be sure to tell the child’s school or pre-school, and playmates’ families so that they can take precautions.

33. The common intestinal worms that infest children are: tapeworm, roundworm and threadworm. Worms are intestinal parasites that have different breeding cycles and depend on the human host in order to live and reproduce. Eggs of the worms are introduced into the child’s body by various means, e.g. pets, dirt, uncooked food, contact with an infected person. The systems of the body affected are the stomach, intestinal tract, bowel, and lungs. Although parents may deny it, most children at one time or another, become infested with the parasites. Medical conditions...

34. Medical conditions... Asthma is a persistent lung condition characterized by the inflammation of the airways leading to the lungs, progressing to sensitivity and/or allergy of the lining of the airways. And finally, with asthma there is an obstruction of airflow by the blockage of the airways. Asthma is one of the most common conditions for a child today, but is manageable if controlled properly. Bronchitis is basically a less severe case of pneumonia and it is from this infection that pneumonia usually develops from if left unchecked. It is an infection brought about by inflammation of the bronchial tubes, i.e. a respiratory infection. Bronchitis can be acute or chronic. Bronchitis has many causes. A virus, bacteria, heartburn, even smoking, can all lead to a bronchitis infection. It is a very common infection, much like the advanced version of the common cold. Symptoms may include, a dry cough that will entail mucus being brought up out of the lungs, headache, chills, fever, soreness or tightness in the chest, wheezing and problems breathing. Ringworm is a contagious fungal infection that can affect the nails, feet, scalp, body, and in particular, the groin area. The fungus that causes ringworm can be found in humans, animals, and soil, depending on the type of ringworm your child has. Characteristic of ringworm is a red ring on the patient's skin.

35. Medical conditions... Urinary Tract Infectionsor bladder infections occur because bacteria can start to move up the urethra (the tube that empties urine out of the bladder). If they reach the bladder, they can start to multiply. Normally, these bacteria are flushed out of the urethra by urination before this can happen, but they can take hold and cause an infection. This can be caused by an anatomic abnormality, holding urine in, frequent constipation, females wiping in a back-to-front direction after a bowel movement, or an irritant such as bubble bath, soap, powder, or tight clothing that rubs against the urethra. Girls are more prone to bladder infections than boys, and will complain of a burning sensation when they urinate. West Nile Virus is a mosquito-borne virus that causes an infection called West Nile Fever (WNF). Symptoms of WNF include fever, headache, muscle ache, swollen glands in the neck, rash, fatigue and weakness. Basically, it mimics the flu without the cough and stuffy nose. You can prevent mosquito exposure by wearing insect repellant, staying indoors at dawn and dusk during mosquito season, avoid stagnant water and empty out all outdoor toys and pots that fill with rainwater. Croup is a viral infection that affects younger children (under 5-6). It causes swelling in the child's vocal cords, which is what causes the barky cough. The vocal cords are already the narrowest part of the air passages, and any swelling from infection may narrow the airway enough to obstruct breathing. Croup is worse at night.

36. Lyme disease is carried by small, blood-sucking ticks. Although these ticks are native to Nebraska, outbreaks of Lyme disease are more common in the northeast coastal states, Wisconsin, Minnesota, California, Nevada, and Utah. Ticks are found in heavily wooded and uncut, grassy areas. Lyme disease... If you are bitten by a tick carrying the Lyme disease bacteria, a circular skin rash (called a bulls-eye rash) often develops at the site of the tick bite within a month. The rash slowly expands and may become very large. Flulike symptoms, such as fatigue, headache, sore muscles and joints, fever and chills, and swollen lymph nodes, also may occur. If not detected and treated with antibiotics early enough, the results could include permanent damage to skin, joints, nervous system, and heart.

37. Medical conditions... Pink Eye (Conjunctivitis) is caused by bacteria, a virus, an allergy, a foreign body, a scratched eye, or a plugged tear duct. Bacterial and viral conjunctivitis are the only two types that are contagious, and may need to be treated with antibiotic drops or ointment. One or both eyes may be affected, and will be symptomatically “pink” in color. The flu is a virus (called influenza). It is therefore not treatable with antibiotics. The flu will usually cause three or more (or all) of the following symptoms: High fever, chills, Sore throat, Headache, Nausea, Vomiting, Diarrhea, Abdominal pain, Body and muscle aches, Stuffy nose, Clear or green runny nose, Cough – dry or productive, Irritated, red eyes Treat the symptoms; push fluids; over-the-counter medications including ibuprofen Fifth Disease is a harmless viral illness caused by Parvovirus. It is so called because it was the fifth fever and rash illness identified (along with chickenpox, measles, etc.). It is also called "slapped cheek disease" because of its major distinguishing characteristic – bright red cheeks that look like the child has been slapped. It is most contagious the day before the rash starts, the day before any fever starts, and for as long as any fever is present. The virus is transmitted from a cough, runny nose, or saliva

38. Medical conditions... Hives are caused by an allergic reaction within the body. Histamine is released under the skin and causes areas of swelling. They appear as red or white, raised welts on the skin. They can appear suddenly out of nowhere, spread rapidly, and disappear just as suddenly. They are most common on the chest, tummy, and back, but can also be on the extremities, face, and neck. The hives reaction can be caused by food, medications, stress, illnesses, and all sorts of external irritants. Treat with antihistamine. Roseola is a virus that generally causes 3 days of high fever (often over 103). The fever then subsides, and afterwards the child breaks out in a flat or bumpy red rash, usually starting around the neck, back and chest, then spreading out. The rash lasts a few days to a couple weeks. Some children will have swelling of the glands in the front and back of the neck, runny nose, cough, ear pain, vomiting or diarrhea with this illness. Children can have one or all of these symptoms. RSV (Respiratory Syncytial Virus) is a virus that causes a respiratory tract infection. It can cause respiratory tract illness in patients of all ages, but children under the age of one are especially vulnerable, especially those who were born prematurely. The initial symptoms of RSV infection are similar to a cold and include: fever, runny nose, and coughing. More serious symptoms include wheezing, difficulty breathing, inability to eat, and apnea or pauses in breathing.

39. Health issues... If you’re looking for information about vaccines and state-required immunizations, try the following website: http://www.immunizationinfo.org/vaccineInfo/vaccine_detail.cfv?id=24 There are so many medical issues affecting children, we cannot possibly cover more than the most major afflictions or those that are most probable to affect a child. For specific information regarding those issues we have included in this lesson, or for issues we have not covered, try the following website. It provides an organized collection of links to websites on each issue: http://www-hsl.mcmaster.ca/tomflem/ill.html

40. Handling emergencies... For cuts or scrapes, stop bleeding by applying pressure. Head and face cuts bleed more than others. Clean the area as needed. Apply an antibiotic ointment and a bandage. Any cut that is gaping open with visible dark red muscle or yellowish fat and/or is larger than 3/16 of an inch should probably be closed, even if it is small. A doctor may choose staples, steri-strips, stitches or skin superglue. If the normal redness around the area begins to spread , your child develops a fever, or you see a foul- smelling greenish discharge from the wound, it may indicate an infection. • The very first step for burns is to stop the heat. Do this by submerging the burned area in cool water as fast as you can. Increase coldness and continue for 20 minutes. Do not use ice. Do not put any butter, grease, or powder on the burn. Give the child acetaminaphen or ibuprofen for pain relief and to help decrease the inflammation. • Calm the child, and assess the burn: • First degree burns. This is simply redness, with no blistering. • Second degree burns. This is redness with blistering of the skin and is usually the most painful type on burn. NEVER pop the blisters. • Third degree burns. This occurs when many layers of skin are actually burned away. Usually there is no blister because all the top layers of skin are gone. This burn usually leaves a scar, even with proper treatment. See a doctor. • You can apply a burn ointment or aloe vera to 1st or 2nd degree burns. Leave uncovered if possible, or unless blisters have broken.

42. These are just a few of the plants that commonly decorate our homes but can prove poisonous to children: 1. Sago palm 2. Asiatic hybrid lily 3. Dieffenbachia 4. Dieffenbachia 5. Peace Lily 6. Caladium species 7. English Ivy 8. Poinsettia 9. Philodendrum 10. Azalea Accidental poisoning... Poisonous plants can cause illness or death. The severity of the poisoning will depend on the amount eaten, as well as the part of the plant that was ingested. 8 9 10

43. Accidental poisoning... It is possible for a child to die from liver damage after swallowing as few as five adult-strength vitamin pills with iron. Children can also start vomiting blood or have bloody diarrhea less than an hour after ingesting even a few iron supplements. Don't take medicine in front of small children; they often imitate adults. And never refer to medicine as candy. Adult medications that are especially dangerous for children include: Diet pills and other stimulants, Decongestants, Antidepressants, Blood pressure pills, Iron supplements. When children swallow alcohol, they can potentially have seizures, go into a coma or even die. There are many types of alcohol — each used in different household products. For example, wood alcohol (methanol) is used in antifreeze, windshield washer fluid, shellac, varnish and paint remover. Other types of alcohol are used in mouthwash, facial cleaners, after-shaves, cologne and antibacterial hand cleaners.

44. Store all poisonous household substances out of sight and out of reach. Locked cabinets are best. Make sure your prescription medications come with child-resistant caps. Close containers right after you use them. Keep dangerous substances in the containers they came in. This keeps the safety information on the label right with the pertinent product. If you suspect poisoning, check your child for sleepiness even though it's not nap time, inability to follow you with his or her eyes, burns or stains around the mouth, and/or strange-smelling breath Accidental poisoning... Drain openers, toilet bowl cleaners, rust removers and oven cleaners can cause chemical burns. Dishwasher soap, bleach and ammonia are all toxic if swallowed. If bleach and ammonia are mixed, they produce a poisonous gas. Ammonia also comes in the form of smelling salts capsules, which could be mistaken for candy. Furniture polish is part of a broad category (hydrocarbons) that includes gasoline, kerosene, lamp oil, motor oil, lighter fluid and paint thinners. Hydrocarbons are among the leading causes of poisoning death in children. DO NOT INDUCE VOMITING. CALL 911 OR 1-800-222-1222 FOR A POISON CONTROL CENTER! While most child poisonings involve eating or drinking toxic substances, poisons also can enter the body through the skin or eyes, or by being inhaled. For example, many of the chemicals used to kill bugs and other pests can be absorbed through the skin, or the fumes can be inhaled. Some of these chemicals affect the nervous system and can make it difficult to breathe.

45. Child-proof home... Cribs need narrow side slats and adjustable-height mattresses 120 degree upper limit setting on hot water heater Child-proof latches on cabinets Avoid sharp corners and edges on furniture selections Electrical outlets need sliding covers (or at least individual plugs) Electrical cords should be away from easy access Stairways need safety gates at the top and bottom Smoke detectors and carbon monoxide detectors should be properly placed and batteries functioning Properly installed latches on refrigerators/freezers and dishwashers, and well-placed controls on stove Cords on draperies and blinds fastened to cleat A toddler can drown in just 2 inches of water, so secure toilet lids, etc. Beware of non-tempered glass Use hearth guard on fireplace

46. LOVE NEEDS

47. Love and belonging... It’s important to continue the nurturing relationship you had with your infant throughout the child-rearing process. Communicate love for the child verbally and non-verbally through actions, physical contact, and facial expressions. Do not associate “love” with liking or disliking the child’s behavior. • The family is the primary nurturing unit of society. Within the family, your child should experience love and caring. There are 6 characteristics of strong families: • They support and appreciate one another • They spend time together • They communicate with one another • They manage resources and share responsibilities • They share moral standards • They share family rituals and traditions

48. Family traditions... Children sense security in the practice of family traditions. It includes the “special way” an individual family has of doing things, whether that is celebrating a holiday or serving the same meal on the same night of the week. Traditions give a family “identity” and builds strength. Recognize your family’s history. Save photos, videos, momentos, and share stories of past generations or culture. Take cues from the children, and respond accordingly when you hear things like “That’s not the way we do it, we always do it this way!” Give your traditions a name if they don’t already have one, like “Tuesday is taco night”. Remain committed to family rituals to promote “connection”.

49. ESTEEM AND SELF-ACTUALIZATION NEEDS VIDEO: SELF IDENTIFY AND SEX ROLE DEVELOPMENT

50. Direct Care of the Child