#pediatrics

Toddler to Preschooler (1 year - 5 years)

We all know this age group when our young ones begin to learn to talk and feed themselves. They learn to use the potty and start making new friends. This is when they love the word, “No!” 

A lot of development occurs during this period of time and the growth in children, both mentally and physically are key. Here are some brief notes for you to look at for reference to what is to come with this age group:

• Increase in illness, due to being around new children and playing with them.
  
• Immune system will begin to grow in new environments
• Neuromuscular growth occurs as they begin to develop finer motor skills
  
• Brain will weigh 90% of an adult’s
  
• Renal development is important as they begin to learn toilet training.
  
• 12 to 15 months feeling of fullness is known
• 18 months ability to control bladder muscles for excretions
• Separation anxiety peeks 10 – 18 months
  
• Basic language is mastered at 36 months
  
• Age 3 – 4 most can understand full sentences.
• Children begin learning sexual differences by observing their role models and siblings
  
• Tip: do no try reason with children this age as to why a procedure needs to be done.
  

Written by: MedDaily

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by Meghan Meehan

My mother would tell you that my decision to go into nursing came as a surprise. The adjectives one typically associates with nurses, such as caring and compassionate were apparently not ones my teenage self was known for. Using a morning run during my senior year of high school as a time to pray and seek divine guidance on choosing a college major, I returned home and announced that nursing was the answer I had received. While my mother was glad for my having a plan, I am sure she also sent up a silent prayer of concern for my future patients. Thankfully, much to my mother’s relief, God has gradually transformed me to the point where using quintessential “nursing” adjectives to describe me is less of a stretch. And for this, I am so grateful. I consider it a blessing to have been guided in this direction and have truthfully never once questioned if I took the right path.

Perhaps because I did not have any family or acquaintances in the medical field, God used a different avenue to expose me to the nursing profession. At the time, my favorite movie was The English Patient, in which a military nurse named Hana leaves her post in the war to devote herself to the care of a dying man. Her character’s actions resonated with me on a deep level - what greater gift and purpose is there than to devote oneself to minimizing the suffering of a fellow human being? And what could possibly be more fulfilling? Perhaps it is not surprising that I gravitated towards oncology, where suffering and grief are often present. After my pediatric rotation in school, I knew I was a “peds person”. Being an instrument of healing for these little ones so full of wonder, joy and innocence was hands down the most incredible first job I could have hoped for. For 8 years, I had the amazing opportunity to care for pediatric oncology patients and their families as a bedside nurse, which brought the tremendous privilege of journeying with them through one of the arguably most trying time of their lives.

Putting the words “child” and “cancer” together in your job description often creates a knee jerk response. “How do you do that, isn’t that depressing?” “How can you stand to see kids suffer?” Ironically, to me adult oncology is much more heart wrenching. As adults we fully comprehend what the “C” word entails - how it has the potential to disrupt our lives, fill us with fear and turn our worlds upside down. Mercifully, many pediatric oncology patients are not mature enough to grasp the gravity nor complexity of their diagnoses. And though it is not always possible to prevent treatment side effects such as nausea, pain and infections, as a team we create a safe and comfortable environment with many happy distractions such as playrooms and doggy visits. Notably, children have a level of strength and resiliency that can humble any adult. They bravely get their shots, become accustomed to sleep disrupted by vital signs and medical assessments, take their medicines like champs, and undergo routine procedures such as spinal taps and central line dressing changes often without complaints or tears. They truly are pint-sized little warriors.

While every patient along the way leaves their mark, certain situations do stand out. As peds hem/onc nurses, we never forget the patients who earn their “angel wings” while under our care, or when a child we are particularly close with relapses. Our hearts grieve when saying goodbye to a child who leaves the hospital to spend their remaining days surrounded by the people and things they love. While there are many heartbreaking moments such as these, there are also countless moments of joy, tenderness and triumph. Particularly sweet are the bonds we create with special patients and also parents who whole-heartedly trust us to care for their precious son or daughter. We are touched when patients and families who would otherwise be virtual strangers, support and encourage each other through the dark days. We laugh and cheer while singing the “happy last chemo” song to an exuberant patient after their very last treatment, while his mother captures the moment on camera as she sheds happy tears. Strangely, as glad as they are to leave us, and us them, both parties feel the loss of the well established relationships. When you weather such a storm together and the time comes to separate, one feels as though she is saying goodbye to a beloved family member.

Despite the burdens they face, many of our families use their circumstances to create meaningful change in the lives of others. We have had parents and siblings come to work at the hospital after their loved one has passed, parents who have lost their child become mentors for other parents in the early stages of the grieving process. Families have started organizations to honor their children, spread awareness and raise funds for childhood cancer research. One family honors their daughter’s memory every Thanksgiving by serving all the hospitalized children and their families a traditional holiday meal. Gestures such as these remind me of God’s ability to create beauty from ashes.

People often say that those who go into pediatric oncology are answering a calling, and perhaps they are right. Yet to those of us in the field, we feel incredibly lucky to walk alongside and care for these inspiring children and their families. We know how blessed we are to make a difference in the lives of sick children each day. To summarize an article by Sara Judd (a peds hem/onc nurse in Utah) although we see suffering, heartache, frustration, fear and sometimes despondency, we see the greater theme of hope. Hope for cures, brighter futures, normal childhoods, and the day where pokes and medicines become distant memories. And thankfully, those hopes are often realized. One of the best parts of our job is bumping into a previous patient who bears a full head of baby-soft hair, smiles and stories of their post-chemo adventures.

Above all dressed up at the Gala in support of the hospital 

So when asked how I can do my job, my knee-jerk response is “How could I not?” Writing this has caused me to take pause and truly reflect on how lucky I am to work where I do, alongside amazing healthcare professionals, and with the cutest bald tykes you could ever imagine. May God give everyone the opportunity to find such purpose and joy in their occupation. I am so grateful I asked, listened and responded to the direction I received once upon a time on a morning run.

Note- All photos used of the patients were used with patients/parents approval