Running Head: PEDIATRIC HEALTH PROMOTION PROJECT 1

Pediatric Health Promotion Project

Delaware Technical Community College

NUR 330 Population & Community Health

Reneé Smallwood

April 21, 2018

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Health Promotion Project

“It takes a village to raise a child,” is a true statement in the pediatric population

consisting of neonates, infants, developing children, and adolescents (Lu & Rosenbaum, 2014).

This young and vulnerable population rely on their community and the world around them to

guide and protect them, yet many of their needs are not met today. In addition to typical children,

special needs and complex medical children also have needs. The resources these children need

to build a healthy and safe environment is a goal of public health. Public health protects and “…

improve the health of population from the local level all the way to the global level” (Savage,

Kub, Groves, 2016, p. 23). Public health nurses play an essential role in maintaining a healthy

lifestyle through education, screening, and prevention programs. Goals of the public health nurse

are to eliminate health disparities, improve health, promote a quality life free of preventable

diseases, injury, death, and disability, create healthy physical and social environments, and

promote healthy behaviors and development in all stages of life (Savage et al.,2016). Promotion

and prevention are required to achieve health for all people.

Beginning as a vision to improve care for medically fragile children and connecting the

gap between traditional in-patient hospital treatment and pediatric home care, Exceptional Care

for Children (ECC) opened its doors in 2006 as Delaware’s first and only pediatric skilled

nursing home (Exceptional Care for Children, n.d.). “Exceptional Care for Children improves the

lives of technology-dependent children and their families through skilled nursing, transitional

and palliative care.” “We are a haven for healing fragile bodies when improvement is possible,

and a refuge for nurturing vulnerable spirits when a cure is unattainable” (Exceptional Care for

Children, n.d.).
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Exceptional Care is a long-term care facility serving the technology-dependent child with

feeding tubes, a tracheostomy, port-a-cath, and/or central venous line (CVL) from newborn to the

age of twenty-one. The facility currently has thirty-five special needs children with complex life-

long health issues such as cerebral palsy, complications due to prematurity, and respiratory issues

like asthma. A variety of languages are spoken by the families, staff, and children including

English, Spanish, Creole, and French. All ethnicities and cultures are placed and referred to the

facility, but the child must have Delaware Medicaid to qualify which is the predominant health

insurance for the children at ECC. Delaware Medicaid “furnishes medical assistance to eligible

low-income families and to eligible aged, blind and/or disabled people whose income is

insufficient to meet the cost of necessary medical services. Medicaid pays for: doctor visits,

hospital care, labs, prescription drugs, transportation, routine shots for children, mental health

and substance abuse services” (Division of Health and Social Services, n.d.).

As these children continue to grow and thrive, their disease is managed by a

multidisciplinary team of doctors from Nemours who continuously communicate with specialty

pediatric doctors making sure the children at ECC are safe and sufficiently cared for. Physical,

occupational, and speech therapist are in-house to assist with gaining strength, increase range of

motion, muscle function, mobility, feeding, cognitive and sensory processing, and integrating

motor skills for basic independent task. The disease management and preventative measure in the

pediatric population are beneficial for overall health and well being.

Many children are placed or referred to ECC because they are too strong to be in the

hospital but still not healthy enough to be home. Some children are referred by Delaware Divison

of Family Services (DFS), other children have no family or safe place to go due to family

dynamics or the shortage of nurses in the community to allow for safe discharge home. Children
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are faced with many barriers as they depend on nurses, family, or even strangers to make sure

their needs are met daily. These barriers include minimal health insurance, poverty including

unsafe living arrangements, money, access to resources, lack or no education, and limited time

(Beck et al., 2016). Lack of family support, occupation, race/ethnicity, language, or where they

live have also been identified as a barrier. More than 20% of children are living in poverty

nationally, and an additional 22% live in low-income families (Beck et al., 2016). According to

Kuo, Etzel, Chilton, Watson & Gorski (2012), “poverty can imped children’s ability to learn and

contributes to social, emotional and behavioral problems” (p. e18). Children living in poverty,

especially children of a younger age, have the potential to have their overall wellbeing affected

which can lead to potential long-term effects such as a higher risk of developing a social,

emotional or behavioral problem that can also affect physical and mental health (Kuo et al.,

2012). Pediatric primary care physicians (PCP) should continue to treat children who are sick but

should also incorporate education on preventive measures to keep the child from getting injured

or sick in the first place. Including the family to recognize and screen for possible problems or

issues offers support and this time could be used to encourage healthy behaviors while promoting

wellness. Including the family will assist in public health as many children face challenges in the

community, home, or school setting.

Facility policies and procedures are in place at ECC for identifying how to adequately

provide care using best evidenced-based practices, such as, drug administration, changing a

tracheostomy tube, hanging TPN, changing a wound or CVL dressing, or flushing a CVL to

name a few. The state of Delaware has also implemented policies to assist in support of the

pediatric population. The policies include Health in All policy (HiAP), a plan put in place to

educate and increase awareness to decision makers of health implications in all state policies
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(Delaware Health and Social Services, n.d.). As a vulnerable population, the state has also

implemented policies that address car seat laws, to provide safety to all children riding in a

vehicle, clean air act prohibiting smoking in indoor areas around the general population, and free

vaccination for the underinsured and uninsured. There is also a mandatory law to report neglect

and abuse of children by required professionals including physicians, dentists, residents, nurses,

social workers, and psychologists, school employees, healthcare institutions, and law

enforcement agencies to name a few (Delaware Division of Professional Regulations, n.d.). In

addition to the above policies, the Individuals with Disability Education Act (IDEA) is a four-

part law signed in 1997 to ensure services are provided for kids with disabilities throughout the

nation. “IDEA governs how states and public agencies provide early intervention, special

education, and related services to more than 6.5 million eligible infants, toddlers, children and

youth with disabilities” (U.S. Department of Education, n.d.). Children from birth to two years

old and their family qualify for early intervention services and children between the ages of three

and twenty-one receive special education services (U.S. Department of Education, n.d.). These

services are beneficial as the number of children with disabilities continue to rise.

According to Kids Count Data Center, there were 204,274 children under the age of 18 in

the state of Delaware in 2016 (2017). In 2016 the population in the state of Delaware was 926,

864 people (Center for American Progress, n.d.). Statistical data in 2016 showed 108,211 people

lived in poverty and 17% were children under the age of 18 in the state of Delaware (Center for

American Progress, n.d.). More than 20, 000 students with disabilities were enrolled in school in

2017 (Rodel Foundation of Delaware, n.d.). As children with special needs continue to rise, more

public health nurses are also needed.

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Public health nurses work mostly in the community but can also work in nontraditional

environments like hospitals and long-term care facilities. The community nurse helps to care for

the sick population in promoting health and taking preventative measures to ensure patients are

provided with all health care needs. Thorough assessments of patients are done to provide

adequate care. They provide education to patients and families and attend to any emergencies

that may occur (G. Liter, personal communication, 2018). In the community, the nurse is the

primary healthcare provider which means they are the eyes and ears for what is going on with

their patients. Not having a physician around can be challenging at times if a higher level of

medical expertise is needed. Limited resources can also be a challenge in a home or nursing

home setting when there is only so much medical equipment for diagnosing or trying to figure

out further complex medical issues whereas a hospital has all of the equipment and resources

needed in some instances (G.Liter, personal communication, 2018). Public health nurses help

children succeed and grow while protecting them in their community; the place they call home.

The priorities of care for the pediatric population are safety, prevention of nosocomial

diseases like pneumonia including ventilator-associated pneumonia (VAP) and respiratory

syncytial virus (RSV), decrease the incidence of poverty, and family support. With the

opportunity to have clinical experience at a pediatric nursing home and in the community

allowed understanding of a different side of nursing not previously used to and awareness of the

unmet needs of the pediatric population regardless of being in a long-term facility or at home.

These problems include scarcity of pediatric subspecialist, shortage of home health care nurses

making hospital and nursing home stays more prolonged and expensive, and family dynamics.

“Before we can effectively address the health need of children in our community, we

have to step back and listen…Their feedback is incredibly important in directing our efforts and
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advocacy into the future” (Children’s Hospital and Medical Center Omaha, n.d., p. 1). Goals

should be centered around the problem and the people in need like the pediatric population.

Goals to address the needs and challenges of the pediatric community are:

 By the end of 2023, access to pediatric specialty will be expanded to area

hospitals and specialty centers who serve a diverse population.

 Within three years, home care agencies will track the need of special needs

children they are serving and those still needing to be served in the community

and provide the information to state officials to develop a plan.

 Within two years families with special needs children will have support from PCP

and social/case workers to screen for family problems and needs.

The goals can be attained through social or caseworkers and through state agencies who

have a mission to support the child and family such as:

 Delaware Health and Social Services assist with child care, food supplement,

temporary assistance, medical assistance, and general assistance. Contact

information: Lewis Building, DHSS Campus Herman Holloway Sr. Campus

(Main Office) 1901 N. DuPont Highway New Castle, Delaware 19720 Phone #:

1-800-372-2022 Fax #: (302) 255-4454

 Children and Family First help children who are facing hardships. The

organization strengthens Delaware families through evidence-based programs and

services. Contact Information: (Statewide Administrative Office) 809 Washington

Street Wilmington, DE 19801 Phone #: 302-658-5177

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 Delaware Guidance Services for Children and Youth, INC. “exist to provide

quality therapeutic services to children, youth, and their families to increase their

social, emotional, and behavioral wellness” (Delaware Guidance, n.d.). There are

five offices in the state and crisis hotline available 24 hours a day, seven days a

week. Contact Information for Newark Office: 261 Chapman Road Suite 102

Newark, Delaware 19702 Phone: (302) 455-9333 Fax: (302) 455-9544

To tackle these goals and maintain public health the principles of community pediatric

health should be incorporated into residency training (Kuo et al., 2012). Incorporating these

principles will allow for physicians to understand children’s health issues and advocate while

addressing the barriers that affect children’s health. Evidence-based research is another

intervention required in meeting these goals. According to Beck et al. (2016), “pediatric primary

care practices need methods for stratifying risk among both medical and social vectors… child

health educators should evaluate milestones for trainees as they manage social, poverty-related,

pathology…child health advocates should ensure a “child health in all policies” approach, one

that defines and evaluates how certain policies will affect the health and well-being of children”

(para. 32). In addition to research and physicians’ education, money is needed to obtain the

appropriate resources and educate residents during training. In the end, children will possibly

have positive outcomes in the future and awareness will be raised about pediatric public health.

Once goals and interventions are in place, the plan will need to be evaluated. To evaluate

the responses, quarterly or yearly check-ins should be performed on a regular. Residents should

be tested and observed post training to witness the treatment of the sick while incorporating

principles of community health. Research requires more time, but as data becomes available, this

should be compared against current data.

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The pediatric population remains a vulnerable population and are affected by their

environment. Children’s health is vital in their development, yet many of their needs are not met

today. Lack of resources, pediatric specialist, and poverty will need to be addressed to prevent

adverse effects in the lives of children. Public health is put in place to prevent illness and protect

people in their homes, stores, and parks they enjoy.

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References

Beck, A.F., Tschudy, M.M., Coker, T.R., Mistry, K.B., Cox, J.E., Gitterman, B.A, ......

Fierman, A.H. (February 2016). Determinants of Health and Pediatric Care Practices.

American Academy of Pediatrics News & Journals Gateway. Retrieved from:

http://pediatrics.aappublications.org/content/early/2016/02/21/peds.2015-3673

Centers for American Progress. (n.d.). Talk Poverty. Retrieved from Talkpoverty.org:

https://talkpoverty.org/state-year-report/delaware-2017-report/

Children's Hospital and Medical Center. (n.d.). Youth Health Assessment Reveals Top Concerns

of Parents, Opportunities for Community Leaders. Retrieved from childrensomaha.org:

https://www.childrensomaha.org/community-health-needs-assessment

Delaware Divison of Professional Regulation. (n.d.). Mandatory reports related to child abuse

and neglect. Retrieved from Delaware.gov:

https://dpr.delaware.gov/boards/investigativeunit/mandatorychild/

Division of Health and Social Services. (n.d.). Health equity - Health in all policy. Retrieved

from Delaware.gov: http://dhss.delaware.gov/dph/mh/healthequityhiap.html

Exceptional Care for Children. (n.d.). Exceptional Care for Children. Retrieved from

Exceptional Care for Children: http://www.exceptionalcare.org/

Kids Count Data Center. (n.d.). Child population by age group. Retrieved from Kids Count Data

Center: https://datacenter.kidscount.org/data/tables/101-child-population-by-age-

group#detailed/1/any/false/871,870,573,869,36,868,867,133,38,35/62,63,64,6,4693/419,4

20
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Kuo, A. A., Etzel, R. A., Chilton, L. A., Watson, C., & Gorski, P. A. (2012). Primary care

pediatrics and public health: Meeting the needs of today's children. American Journal of

Public Health, 102(12), e17-e23. doi:10.2105/AJPH.2012.301013

Liter, G. (2018 February 19). Personal Interview.

Lu, Hong, Rosenbaum, S. Oct-Dec 2014. Developmental Pharmacokinetics in Pediatric

Populations. Journal of Pediatric Pharmacology and Therapeutics. Vol. 19, No. 4,

pp 262-276. Retrieved from: http://www.jppt.org/doi/full/10.5863/1551-6776-19.4.262

Rodel Foundation of Delaware. (n.d.). Delaware Public School Students. Retrieved from Rodel

Foundation of Delaware: http://www.rodelfoundationde.org/ataglance/

Savage, C. L., Kub, J. E., & Groves, S. L. (2016). Public health science and nursing practice.

Philadelphia, PA: F.A. Davis Company.

U.S. Department of Education. (n.d.). Individuals with Disabilities Education Act (IDEA).

Retrieved from ed.gov: https://sites.ed.gov/idea/

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