Midwife Licensure Exam Infant & Child Health (Growth, Development & IMCI) — Paediatric Assessment, Hospitalization & PainConcept Map

Concept

Principles of Paediatric Physical Assessment

Sub Concepts

• Least-to-most invasive sequencing
• Building trust before touching
• Position of comfort (parent's lap)
• Equipment familiarisation
• Developmental modifications

Relationship To Central

Foundation for all paediatric nursing practice; guides how nurses safely and effectively examine children across developmental stages

Concept

Age-Specific Vital Signs & Techniques

Sub Concepts

• Apical pulse counting (full minute in infants)
• Abdominal respirations in infants
• Blood pressure cuff sizing
• Temperature measurement routes
• Vital sign trend interpretation

Relationship To Central

Critical for accurate assessment and early detection of complications; normal ranges differ significantly by age

Concept

Developmental Communication Strategies

Sub Concepts

• Infant: soft voice, holding, primary caregiver presence
• Toddler: concrete language, preparation timing, choices, rituals
• Preschooler: simple words, non-threatening language, reassurance
• School-age: explanations, honesty, privacy, involvement
• Adolescent: respect, honesty, privacy, control, confidentiality

Relationship To Central

Enables effective therapeutic interaction and reduces fear/anxiety; improves child cooperation and coping

Concept

Child's Response to Hospitalization

Sub Concepts

• Separation anxiety (toddlers): Protest → Despair → Detachment
• Loss of control (all ages)
• Fear of bodily injury/mutilation (preschoolers)
• Regression behaviours (normal response)
• Nursing management strategies

Relationship To Central

Major source of psychological distress; requires nursing interventions aligned with developmental stage and stressors

Concept

Paediatric Pain Assessment

Sub Concepts

• FLACC scale (infants/non-verbal)
• FACES/Wong-Baker scale (≥3 years)
• Numeric rating scale (≥7–8 years)
• Neonatal scales (NIPS, CRIES)
• Behavioural and physiologic cues
• Misconceptions about paediatric pain

Relationship To Central

Pain is the fifth vital sign; accurate assessment is foundational to safe and effective pain management

Concept

Paediatric Pain Management

Sub Concepts

• Non-pharmacologic measures: distraction, positioning, cuddling, sucrose
• Topical anaesthetics (EMLA)
• Paracetamol: 10–15 mg/kg/dose q4–6h (safest first-line)
• Ibuprofen: 5–10 mg/kg/dose q6–8h with food
• Opioid management and monitoring
• Aspirin contraindication in viral illness
• Pain reassessment protocols

Relationship To Central

Comprehensive approach balancing non-pharmacologic and pharmacologic strategies; weight-based dosing is critical

Concept

Atraumatic Care Principles

Sub Concepts

• Prevention/reduction of separation
• Promotion of control and autonomy
• Minimisation of pain and fear
• Use of treatment rooms (not bedside)
• Therapeutic holding vs. forced restraint
• Preservation of safe spaces (bed, playroom)

Relationship To Central

Overarching framework minimising physical and psychological distress; guides all paediatric nursing interventions

Concept

Safe Medication Administration in Children

Sub Concepts

• IM injection sites: vastus lateralis preferred (infants)
• Ventrogluteal and deltoid sites (older children)
• Contraindication of dorsogluteal site (young children)
• Oral medication administration technique
• Weight-based dose verification
• Avoiding medication hiding in formula

Relationship To Central

Critical skill requiring age-specific techniques and weight-based dosing to prevent medication errors

To

Age-Specific Vital Signs & Techniques

From

Principles of Paediatric Physical Assessment

Strength

strong

Relationship

Assessment principles guide HOW to obtain vital signs; technique must match developmental stage for accuracy

To

Principles of Paediatric Physical Assessment

From

Developmental Communication Strategies

Strength

strong

Relationship

Communication prepares the child for assessment; reduces anxiety and improves cooperation during physical exam

To

Developmental Communication Strategies

From

Child's Response to Hospitalization

Strength

strong

Relationship

Understanding developmental responses guides communication approach; prevents separation anxiety through appropriate interaction

To

Paediatric Pain Management

From

Paediatric Pain Assessment

Strength

strong

Relationship

Accurate pain assessment using age-appropriate tools is the foundation for effective pain management planning

To

Paediatric Pain Management

From

Atraumatic Care Principles

Strength

strong

Relationship

Atraumatic care framework guides pain management to minimise physical and psychological distress

To

Child's Response to Hospitalization

From

Atraumatic Care Principles

Strength

strong

Relationship

Atraumatic care strategies directly address hospitalization stressors (separation, loss of control, fear) and promote coping

To

Principles of Paediatric Physical Assessment

From

Safe Medication Administration in Children

Strength

moderate

Relationship

IM administration technique must follow assessment principles; use correct site based on developmental stage

To

Safe Medication Administration in Children

From

Paediatric Pain Management

Strength

moderate

Relationship

Many pain medications (analgesics) are administered via IM or other routes; dosing must be weight-based and age-appropriate

To

Child's Response to Hospitalization

From

Age-Specific Vital Signs & Techniques

Strength

moderate

Relationship

Abnormal vital signs (tachycardia, tachypnoea) may reflect anxiety/fear related to hospitalization; interpret in context

To

Developmental Communication Strategies

From

Paediatric Pain Assessment

Strength

strong

Relationship

Pain assessment tool selection depends on child's developmental stage and communication abilities

To

Principles of Paediatric Physical Assessment

From

Atraumatic Care Principles

Strength

strong

Relationship

Least-to-most invasive sequencing and position of comfort are core atraumatic care strategies implemented during assessment

To

Atraumatic Care Principles

From

Child's Response to Hospitalization

Strength

strong

Relationship

Understanding separation anxiety, loss of control, and regression guides implementation of atraumatic care interventions

To

Paediatric Pain Assessment

From

Developmental Communication Strategies

Strength

moderate

Relationship

Age-appropriate communication explains pain assessment process; helps child cooperate with tool administration

To

Paediatric Pain Assessment

From

Age-Specific Vital Signs & Techniques

Strength

moderate

Relationship

Physiologic vital sign changes (↑HR, ↑BP, ↑RR) are indicators used in pain assessment, especially in non-verbal children

To

Atraumatic Care Principles

From

Safe Medication Administration in Children

Strength

moderate

Relationship

Correct technique (site selection, position of comfort, minimal distress) is essential atraumatic care during medication administration