Current Trends

Pagcaliwagan, Beverly D. BSN-II

Current Trends on Maternal and Child Nursing

Goal Improve the health and well-being of women, infants, children, and families.

Overview Improving the well-being of mothers, infants, and children is an important public health goal for the United States. Their well-being determines the health of the next generation and can help predict future public health challenges for families, communities, and the health care system. The objectives of the Maternal, Infant, and Child Health topic area address a wide range of conditions, health behaviors, and health systems indicators that affect the health, wellness, and quality of life of women, children, and families.

Why Are Maternal, Infant, and Child Health Important? Pregnancy can provide an opportunity to identify existing health risks in women and to prevent future health problems for women and their children. These health risks may include: 

Hypertension and heart disease

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Diabetes

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Depression

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Intimate partner violence

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Genetic conditions

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Sexually transmitted diseases (STDs)

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Tobacco, alcohol, and substance use

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Inadequate nutrition

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Unhealthy weight

The risk of maternal and infant mortality and pregnancy-related complications can be reduced by increasing access to quality preconception (before pregnancy), prenatal (during pregnancy), and inter-conception (between pregnancies) care. Moreover, healthy birth outcomes and early identification and treatment of developmental delays and disabilities and other health conditions among infants can prevent death or disability and enable children to reach their full potential

Understanding Maternal, Infant, and Child Health Many factors can affect pregnancy and childbirth, including: 

Preconception health status

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Age

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Access to appropriate preconception, prenatal, and inter-conception health care

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Poverty

Infant and child health are similarly influenced by sociodemographic and behavioral factors, such as education, family income, and breastfeeding, but are also linked to the physical and mental health of parents and caregivers. There are racial and ethnic disparities in mortality and morbidity for mothers and children; in particular, maternal and infant mortality and morbidity are highest for African Americans. These differences are likely the result of many factors.

Determinants of Maternal, Infant, and Child Health Conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes. Environmental and social factors such as access to health care and early intervention services, educational, employment, and economic opportunities, social support, and availability of resources to meet daily needs influence maternal health behaviors and health status. The determinants that influence maternal health also affect pregnancy outcomes and infant and child health. Racial and ethnic disparities exist in infant mortality and can be partly attributed to disparities in social determinants of health. Child health status varies by both race and ethnicity, as well as by family income and related factors, including educational attainment among household members and health insurance coverage.  Child health status and well-being can also be influenced by access to high-quality health care, such as that received through a medical home and maternity care practices that promote breastfeeding and safe sleep environments. The cognitive and physical development of infants and children may be influenced by the health, nutrition, and behaviors of their mothers during pregnancy and early childhood. Consumption of recommended amounts of folic acid before and during pregnancy can reduce the risk for neural tube defects. Breast milk is widely acknowledged to be the most complete form of nutrition for most infants, with a range of benefits for their health, growth, immunity, and development. Furthermore, children reared in safe and nurturing families and neighborhoods, free from maltreatment and other adverse childhood experiences, are more likely to have better outcomes as adults.

Emerging Issues in Maternal, Infant, and Child Health

Recent efforts to address persistent disparities in maternal, infant, and child health have employed a “life course” perspective to health promotion and disease prevention. At the start of the decade, about half of all pregnancies were unplanned. Unintended pregnancy is associated with a host of public health concerns such as delayed initiation of prenatal care, poor maternal health, and preterm birth. In response, perinatal health initiatives have been aimed at improving the health of women and infants before and during pregnancy through a variety of evidence-based interventions and attention to emerging public health concerns, such as Zika. The life course perspective also supports the examination of quality of life, including the challenges of male and female fertility. An estimated 6.9 million American women ages 15 to 44 have received infertility services (including counseling and diagnosis) in their lifetime. Disparities in infertility diagnosis and treatment exist among racial and ethnic groups, and may increase as childbearing practices continue to change. In particular, African American women experience higher rates of infertility.

https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health

CURRENT PRINCIPLES, PRACTICES & TRENDS IN PEDIATRIC NURSING TRENDS IN PEDIATRICS AND PEDIATRIC NURSING

 Child Health Care has changed dramatically in recent years due to advances in medical knowledge and understanding of emotional response of children.  Health exists when an individual meets minimum physical, physiological, intellectual, psychological and social aspects to function appropriately for their age and sex level.  Illness is the situations when individual experiences a disturbance in any of these areas that prevents functioning at appropriate level.  Modern concept of child health emphasizes on continuous care of “whole child”  According to UNICEF, assistance for meeting the needs of children should no longer be restricted to one aspect like nutrition, but it should be broad based and geared to their long-term personal development ensuring holistic health care of children.  At present, in child health care more emphasis is given on preventive approach rather than on curative care only.  Primary Health Care concept with team approach and multidisciplinary collaboration are adopted for child care.  The challenge of this time is to study child health in relation to community, to social values and social policy.  Increased public awareness, consumerism and family participation in child care are newer trends.  Family health, a new concept is accepted for the care of children in their families and families in society.  Need based, problem oriented, risk approach is practiced for better child health.  In developed countries, child health care extended up to adolescence, whereas in developing countries and in India, child care is extended up to 10-12 years of age. Recently, special emphasis is given on adolescent health through RCH package services in our country.  Special attention is given on the children at risk like orphans, destitute, pavement dwellers, slum dwellers, child labors and handicapped children.  Movements against gender bias, female feticide, child abuse and neglect and maltreatment are in highlight at present.  Interest of political leaders and understanding the importance of child health, constitution of national health policy for children and implementation of various health programs for improvement of child health are great achievements for children.  Population control and family welfare approach, improvement of educational status especially women education and women empowerment, involvement of government and non-government organizations, and special budgetary allocation for child health activities, international guidance by WHO, UNICEF and other child welfare organizations for improvement of child health are promising aspects towards survival, health and wellbeing of children.  Growth of sub specialties for the super-specialized care of children is the recent trend. The sub areas are neonatology, perinatology, pediatric surgery, pediatric cardiology etc.  Medical science is advancing in every moment. So, child health will also progress by various movements towards the aim to improve the survival and wellbeing of all children.

Changing Role of Pediatric

SHIFT FROM 1. Disease centered care 2. That of discouraging the families on neglect

FOCUS ON Child center care Taking special care of the female child as she is

of the female child. 3. Starting care for the woman after she becomes pregnant. 4. Special care during last trimester and the post-natal period to the child born with congenital anomalies and hereditary disorders. 5. Only caring for child after birth of child. 6. Only care to the sick children in hospital. 7. Caring of the physical condition of child in isolation. 8. Not allowing the parents to be with the child in the hospital and rigid visiting hours. 9. One of illness oriented. 10. Only cleanliness and treatment oriented. 11. Only curative and rehabilitative to the children in hospitals.

12. The concept of pediatrics as infant feeding and care of a few diseases of children 13. Adapting indifferent attitude to child neglect and abuse by family and society.

the future mother. Immunization of all girls for tetanus and rubella before marriage. Health education on planned parenthood and guarding the maternal health before conception. Early identification and family counseling based on biochemical screening and chromosomal studies to prevent congenital anomalies and hereditary disorders in children. Guarding the health of child from day of conception. The participation in prevention of illness, health promotion activities. Comprehensive care of child in relation to his home and the community in which he lives and providing emotional support to the family Ensuring the children must have one parent stay with them in the hospital and participate in care. Flexible visiting hours in children wards. One that is health oriented. Warmth and love oriented. Providing tactile stimulation to the infants. Health promotion activities by ensuring environmental stimulation and intelligent manipulation of the environment. Adequate play activities. Services related to fertility, sex education and counseling. The comprehensive care of child in its totality from conception to maturity within the framework of his family and community. Safeguarding and protection of children’s rights by health providing cultural practices

GOBI FFF Currently UNICEF is promoting following ways of child health revolution by a campaign known as GOBI FFF. • G - for growth charts to monitor child development. • O – for oral rehydration to treat mild and moderate dehydration. • B – for breast feeding, and • I – for immunization against 6 killer diseases e.g., measles, diphtheria, polio, pertussis, tetanus and tuberculosis. • FFF – Family Welfare, Female Child, Food and Nutrition.

https://aiimsrishikesh.edu.in/newwebsite/wpcontent/uploads/2019/01/988_Current_principles_practies_and_trends_in_pediatric_nursing.pdf

Maternal health refers to the health of women during pregnancy, childbirth and the postnatal period.  Each stage should be a positive experience, ensuring women and their babies reach their full potential for health and well-being.  Although important progress has been made in the last two decades, about 295 000 women died during and following pregnancy and childbirth in 2017. This number is unacceptably high. The most common direct causes of maternal injury and death are excessive blood loss, infection, high blood pressure, unsafe abortion, and obstructed labor, as well as indirect causes such as anemia, malaria, and heart disease.  Most maternal deaths are preventable with timely management by a skilled health professional working in a supportive environment.  Ending preventable maternal death must remain at the top of the global agenda. At the same time, simply surviving pregnancy and childbirth can never be the marker of successful maternal health care. It is critical to expand efforts reducing maternal injury and disability to promote health and well-being. Every pregnancy and birth are unique. Addressing inequalities that affect health outcomes, especially sexual and reproductive health and rights and gender, is fundamental to ensuring all women have access to respectful and high-quality maternity care. About 140 million births take place every year and the proportion attended by skilled health personnel has increased: from 58% in 1990 to 81% in 2019. This is mostly due to larger numbers of births taking place at a health facility.  Deaths from complications during pregnancy, childbirth, and the postnatal period have declined by 38% in the last two decades, but at an average reduction of just under 3% per year, this pace of progress is far too slow.  It also hides vast inequalities within and across countries. 

More than half of maternal deaths occur in fragile and humanitarian settings. Sub-Saharan Africa and Southern Asia share the greatest burden of maternal deaths, 86% of the global total in 2017.  The Sustainable Development Goals (SDGs) offers an opportunity for the international community to work together and accelerate progress to improve maternal health for all women, in all countries, under all circumstances.  SDG targets for maternal health include 3.1, aiming for an average global ratio of less than 70 deaths per 100 000 births by 2030, and 3.8, calling for the achievement of universal health coverage. These cannot be achieved without reproductive, maternal, newborn and child health coverage for all.  Improving maternal health is one of WHO’s key priorities, grounded in a human rights approach and linked to efforts on universal health coverage.   WHO advocates for health planning where women’s values and preferences are at the center of their own care? Meaningful engagement and empowerment of women, families, communities, and providers is essential for quality improvement initiatives. Promoting health along the whole continuum of pregnancy, childbirth and postnatal care is also crucial. This includes good nutrition, detecting and preventing diseases, ensuring access to sexual and reproductive health and supporting women who may be experiencing intimate partner violence. It is WHO’s responsibility to monitor progress towards the global goal for reducing maternal death (SDG target 3.1). WHO generates data, research, clinical guidelines and programmatic tools to support achievement of global targets and evidence-based strategies for ending preventable maternal mortality (EPMM) and improving maternal health and well-being?  WHO supports Member States as they implement plans to promote access to quality health services for all? Strong partnerships are crucial, such as The Network for Improving Quality of Care for Maternal, Newborn and Child Health, launched by WHO and UNICEF.     https://www.who.int/health-topics/maternal-health#tab=tab_3