ANATOMIC AND PHYSIOLOGICAL

DIFFERENCES BETWEEN A CHILD

AND AN ADULT

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Sl.No CONTENT

1. INTRODUCTION

2. TERMINOLOGIES

3. ANATOMIC AND PHYSIOLOGICAL DIFFERENCE

4. INTEGUMENTARY SYSTEM

5. RESPIRATORY SYSTEM

6. HEART AND CIRCULATORY SYSTEM

HEMATOLOGIC SYSTEM
7.
8. GI SYSTEM

9. FLUID AND ELECTROLYTES

10. URINARY SYSTEM

11. ENDOCRINE SYSTEM

12. REPRODUCTIVE SYSTEM

13. LYMPHOID AND IMMUNOLOGIC SYSTEM

14. MUSCULOSKELETAL SYSTEM

15. NEUROLOGIC SYSTEM

16. CONCLUSION

17. BIBLIOGRAPHY
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THE DIFFERENCE IN ILLNESS IN CHILDREN AND ADULTS:

The child’s body is building up to maximum level of development rather than

being a plateau of physical fitness or in a stage of decline. The exact age of the peak of the
process of bodily repair is not known, but repair does seem to decrease after 18 to 21 years of
age. The difference in illness in children and adults are based on anatomic, physiologic and
psychologic difference between the immature child and the mature adult.

ANATOMIC AND PHYSIOLOGIC DIFFERENCE:

Anatomic differences between the newborn and adult are obvious. Size is the outstanding
difference; it influences the method and equipment used in caring for the child. A more specific
anatomic difference between them is the greater size and weight of the newborn baby’s head,
when compared with body length and weight. This characteristic, coupled with immature motor
development, makes handling the infant quite different from handling the older child or adult.

The sutures of the skull in the newborn baby are not united: the brain is not protected by
the skull in the areas of the open fontanel. The infant’s bones are neither as firm nor as brittle as
those of the older child. Thus, when ICP develops in the infant, the head simply enlarges as the
sutures separate. This is not possible in older child or adult, who exhibits other indications of
increased ICP.

The normal shape of the head and the chest of the infant can be altered by constant pressure
from lying in one position. The parent or the nurse must move the infant frequently so that the
child bones will not become deformed. The difference in the physiologic processes of the
newborn infant and the older child or adult is less obvious than the anatomic differences. But the
physiologic characteristics of an age group are more important in the adaptation of nursing
intervention to needs that are anatomic ones, since they are subject to greater control by medical
and nursing procedures.

Physiologic development, in addition to changes in anatomic structure of the various parts of

the body, influences the child’s susceptibility to certain diseases, the symptoms of the disease,
and the probability of lasting harm. Certain changes in the body caused by anatomic and
physiologic development from the newborn period through adolescent are discussed below.

INTEGUMENTARY SYSTEM:

The functions of the skin include thermoregulation and protection of the body
from the all environment. The skin is composed of collagen; elastic fibers; hair follicles; eccrine,
apocrine, and sebaceous glands; and blood and lymphatic vessels and nerves.

• At birth the structures within the skin are present, but many of the functions of the
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integument are immature. The two layers of skin, the epidermis and the dermis, are
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 loosely bound to each other and are very thin. Rete pegs, which later in life anchor the
epidermis to the dermis, are not developed.
• Slight friction across the epidermis, such as from rapid removal of tape, can cause
separation of these layers and blister formation and or loss of epidermis.
• In term infants the transitional zone between the cornified and the living layers of
the epidermis is effective in preventing fluid from reaching the skin surface.
• The eccrine sweat glands are found over the entire body surface, being most dense
on the palms and soles. They function irregularly during infancy and toddler period..
Eccrine sweating of the palms and soles is produced by high emotion. It is less marked in
prepubescent children than in adolescents and adults.
• The apocrine sweat gland is found in axillae, areola, peri-umblical area, and
perianal and genital areas. The activities of these glands result from adrenergic stimuli,
generally due to emotional stress. These glands are small and nonfunctional from birth
through the preschool years and begin to function at between 8 and 10 years of age, and
their functioning increases during pubescence, adolescence, and adulthood.
• The lipid surface film of the skin aids in its protection. This film is produced by
sebaceous glands and the keratinizing epidermis. An accumulation of this sebaceous
material in the skin of the fetus and newborn is the vernix caseosa, a thick, cheesy, oily
substance.
• The sebaceous glands are large in neonates; however they diminish in size after
birth and remain small during childhood. They again become active at puberty.
• The hair of the neonate is fine and silky; however, it becomes coarser with
physiological development. The newborn baby’s nail are soft and thin but become harder
and thicker as child grows older.
• Adipose tissue beneath the skin and other parts of body accumulates during
infancy and then declines and ceases to accumulate during the early childhood years.
This is the reason the toddler and the preschooler child seem “thinner” than they were as
infants.
• Because the amount of melanin is low at birth, newborns are lighter skinned than
they will be as children. Consequently, infants are more susceptible to the harmful
effects of the sun.

RESPIRATORY SYSTEM:

• During the newborn period and infancy, the tissues of respiratory tract are delicate and do
not produce mucus as they do during childhood. The dermal layers of the mucous
membranes and epithelium do not provide protection from invasion of infectious
organisms.
• In case of throat infection, the anatomic closeness of the throat, eustachian tube and
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middle ear increases the susceptibility of infants and young children to fluid being
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trapped in ear, as a result, the potential for otitis media.

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 • The tonsils and adenoids are relatively large during childhood and are involved in the
production of immune bodies.
• The sneeze and cough reflex is essential for maintenance of life. It clears nasal passage
and foreign matter respectively.

❖ Babies have a relatively larger head with a prominent occiput. The head needs to be
stabilised for intubation. The neck is short and the tongue large. The airway is prone to
obstruction. The relatively large head with little hair leads to greater heat loss. The head
should be covered.

❖ Infants and neonates breathe mainly though their noses. Their nostrils are small and
easily obstructed.

❖ The larynx is more anterior and is situated at a higher level relative to the cervical
vertebrae (C3 to C4 at birth) compared to an adult (C6). The epiglottis is relatively
longer, leaflike and U shaped. The inexperienced anaesthetist may find the baby more
difficult to intubate.

❖ The trachea is short and the right main bronchus is angled less than the left. Right main
bronchus intubations are more likely. With most infants, if the 10 cm mark on the
endotracheal tube is at the gums, the tip of the tube will be just above the carina. In older
children the length of the endotracheal tube may be estimated by (age/2) + 12 cm.
Always listen to both lungs to check that the endotracheal tube is not in one lung.
Because the length of the trachea is short, a small movement of the tube may move it to
the wrong position. The tube should be secured to the maxilla rather than the mandible,
which is mobile.

❖ The narrowest part of the upper airway is the cricoid ring in the pre-pubertal child. After
puberty, the narrowest part of the airway is at the level of the vocal cords. One of the
most serious complications of endotracheal intubation is mucosal oedema and post
extubation stridor due to pressure from the external surface of the endotracheal tube. The
diameter of the trachea in the newborn is 4 to 5 mm. Just 1 mm of oedema can cause
serious harm. Children before puberty should have an uncuffed tube and there should be
a slight air leak with positive pressure ventilation. It is important to select the correct size
endotracheal tube.

Paediatric endotracheal size and age:

• Premature: 2.5 - 3.0 mm

• Neonate – 6 months: 3.0 - 3.5 mm
• 6 months – 1 year: 3.5 mm – 4.0 mm
• Greater than 1 year : (Age/4) + 4

o Their ribs are more horizontal and any increase in the volume of the thorax is due to
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downward movement of the diaphagm. A distended abdomen or surgical retraction can

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easily reduce ventilation.

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 o Oxygen consumption in neonates may be greater than 6 ml/kg/min, i.e twice the oxygen
consumption of adults. In infancy a gradual change towards the adult rate (3.5 ml/kg)
occurs. A higher oxygen consumption means that neonates and infants will rapidly
consume their oxygen reserves and become cyanotic if they are apnoeic. The anaesthetist
must be skilled at maintaining a clear airway and intubation. Attempts at intubation must
not exceed 30 seconds. Higher oxygen consumption leads to a higher carbon dioxide
production, which requires increased ventilation to remove it. The increased ventilation is
mainly achieved by a higher respiratory rate (newborn 35 to 40 breaths/minute). The tidal
volume/kg is similar for adults and children.

o Peripheral airways are narrower and airway resistance is relatively higher in babies. In the
newborn or the pre-term baby the brain control of respiration is immature. Pre- mature and
ex-premature babies up to 52 weeks post conceptual age are at risk of apnoea after general
anaesthesia. They must be very closely observed for at least 24 hours.

Respiratory support:
Initial stabilization maneuvers include mild tactile stimulation, head positioning, and suctioning
of the mouth and nose followed as needed by
Supplemental O2
Continuous positive airway pressure (CPAP)
Bag and mask ventilation or mechanical ventilation
Neonates who cannot be oxygenated by any of these means may require a full cardiac evaluation
to exclude congenital heart disease and treatment with high-frequency oscillatory ventilation,
nitric oxide, extracorporeal membrane oxygenation, or a combination.
• Oxygen: O2 may be given using a nasal cannula, face mask, or O2 hood, with O2
concentration set to achieve a Pao2 of 50 to 70 mm Hg in preterm infants and 50 to 80
mm Hg in term infants or an O2 saturation of 84 to 90% in preterm infants and 92 to 96%
in term infants. Lower Pao2 in preterm infants provides almost full saturation of Hb,
because fetal Hb has a higher affinity for O2; maintaining higher Pao2 increases the risk
of retinopathy of prematurity. No matter how O2 is delivered, it should be warmed (36 to
37° C) and humidified to prevent secretions from cooling and drying and to prevent
bronchospasm. An umbilical artery catheter (UAC) is usually placed for sampling ABGs
in neonates who require fraction of inspired O2 (Fio2) ≥ 40%. If a UAC cannot be placed,
a percutaneous radial artery catheter can be used for continuous BP monitoring and blood
sampling.
• Neonates who are unresponsive to these maneuvers may require fluids to improve cardiac
output and are candidates for CPAP ventilation or bag and mask ventilation (40 to 60
breaths/min). If the infant does not oxygenate with or requires prolonged bag and mask
ventilation, endotracheal intubation with mechanical ventilation is indicated, although
very immature neonates (eg, < 28 wk gestation or < 1000 g) are typically begun on
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ventilatory support immediately after delivery so that they can receive preventive
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surfactant therapy. Because bacterial sepsis is a common cause of respiratory distress in

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 neonates, it is common practice to draw blood cultures and give antibiotics to neonates
with high O2 requirements pending culture results.
• Continuous positive airway pressure: CPAP delivers O2 at a positive pressure, usually
5 to 7 cm H2O, which keeps alveoli open and improves oxygenation by reducing the
amount of blood shunted through atelectatic areas while the infant breathes
spontaneously. CPAP can be provided using nasal prongs and various apparatuses to
provide the positive pressure; it also can be given using an endotracheal tube connected
to a conventional ventilator with the rate set to zero. CPAP is indicated when Fio2 ≥ 40%
is required to maintain acceptable Pao2 (50 to 70 mm Hg) in infants with respiratory
disorders that are of limited duration (eg, diffuse atelectasis, mild respiratory distress
syndrome, lung edema). In these infants, CPAP may preempt the need for positive
pressure ventilation.
• Mechanical ventilation: Endotracheal tubes are required for mechanical ventilation
✓ Endotracheal tubes 2.5 mm in diameter (the smallest) typically used for infants <
1250 g
✓ 3 mm for infants 1250 to 2500 g
✓ 3.5 mm for infants > 2500 g
• Intubation is safer if O2 is insufflated into the infant's airway during the procedure.
Orotracheal intubation is preferred. The tube should be inserted such that the
✓ 7-cm mark at the lip for infants who weigh 1 kg
✓ 8-cm mark for 2 kg
✓ 9-cm mark for 3 kg
• The endotracheal tube is properly placed when its tip can be palpated through the anterior
tracheal wall at the suprasternal notch. It should be positioned about halfway between the
clavicles and the carina on chest x-ray, coinciding roughly with vertebral level T2. If
position or patency is in doubt, the tube should be removed and the infant should be
supported by bag and mask ventilation until a new tube is inserted. Acute deterioration of
the infant's condition (sudden changes in oxygenation, ABGs, BP, or perfusion) should
trigger suspicion of changes in the position of the tube, patency of the tube, or both.
Adjunctive treatments: used with mechanical ventilation in some patients include
Paralytics
Sedation
Nitric oxide
➢ Paralytics: (eg, vecuronium or pancuronium Some Trade Names PAVULON
bromide 0.03 to 0.1 mg/kg IV q 1 to 2 h prn [with pancuronium Some Trade Names )

PAVULON
A test dose of 0.02 mg/kg is recommended in neonates])
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Sedatives (eg, fentanyl)

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 Trade Names
o ACTIQ
o DURAGESIC
o SUBLIMAZE1 to 4 μg/kg IV push q 2 to 4 h or midazolam Some Trade Names.
0.05 to 0.15 mg/kg IV over 5 min q 2 to 4 h) may facilitate endotracheal intubation and
can help stabilize infants whose movements and spontaneous breathing prevent optimal
ventilation.
Weaning from the ventilator can occur as respiratory status improves. The infant can be weaned
by lowering
Fio2
Inspiratory pressure
Rate
❖ Continuous-flow positive pressure ventilators permit the infant to breathe spontaneously
against PEEP while the ventilator rate is progressively slowed. After the rate has been reduced
to 10 breaths/min, the infant usually tolerates extubation. The final steps in ventilator weaning
involve extubation, possibly support with nasal (or nasopharyngeal) CPAP, and, finally, use of
a hood or nasal cannula to provide humidified O2 or air.
❖ Very low-birth-weight infants may benefit from the addition of a methylxanthine (eg,
aminophylline.
❖ Some Trade Names: theophylline Some Trade Names
• ELIXOPHYLLIN
• THEO-DU (caffeine) during the weaning process.
• Methylxanthines are CNS-mediated respiratory stimulants that increase
ventilatory effort and may reduce apneic and bradycardic episodes that may
interfere with successful weaning.
• Caffeine is the preferred agent because it is better tolerated, easier to give, safer,
and requires less monitoring.
• Corticosteroids, once used routinely for weaning and treatment of chronic lung
disease, are no longer recommended in premature infants because risks (eg,
impaired growth and neurodevelopmental delay) outweigh benefits.
Complications:
Mechanical ventilation complications more common among neonates include
Pneumothorax
Asphyxia from endotracheal tube obstruction
Ulceration, erosion, or narrowing of airway structures due to adjacent pressure
Bronchopulmonary dysplasia.
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Surgical management:
Extracorporeal membrane oxygenation (ECMO): ECMO is a form of
cardiopulmonary bypass used for infants who cannot be oxygenated adequately or
ventilated with conventional ventilators.

HEART AND CIRCULATORY SYSTEM:

• The weight of the heart increases rapidly after 4th month of gestation. During newborn
period, there is a little gain in the weight of the heart, but from 4 weeks to puberty, it
increases steadily in size.
• Heart sounds are of higher pitch and not distinctive during growth years. With increasing
vagal control, the heart rate slows down and functional murmurs may not be heard.
• The normal pulse rate of 140 beats per minute in the newborn slows over the years of
growth to about half rate in the late adolescent period.
• Normal systolic and diastolic blood pressure readings of children increase with advancing
age from newborn period to the end of adolescent period.
• Electrocardiograms done on normal children at the age group of 6 years are similar to
those of older adolescents or young adults.

Cardiac output in the neonate might be 200 to 400 ml/kg/min compared to 70 to 80

ml/kg/min in the adult because of the higher metabolic rate and oxygen requirement in the
neonate. Stroke volume is relatively fixed in the newborn due to the poorly compliant
ventricular muscle. Stroke volume in the newborn is 5 to 7 ml/kg compared to 1 to 2 ml/kg in
adults. Therefore, an increase in cardiac output is achieved by an increase in heart rate. The
newborn’s resting heart rate is much higher than that of the adult (130 to 140/min in the
neonate, 70/min in the adult) and it is not until about the age of ten that it reaches adult rates.

Blood pressure is lower in children than adults because of low peripheral resistance.

Blood volume in the neonate is about 80 ml/kg compared to 70 ml/kg in the adult.

The sympathetic nervous system is not well developed. Infants can easily become
bradycardic. Atropine premedication will reduce the incidence of bradycardia and reduce
secretions. (Intravenous or intramuscular dose is 0.01 to 0.02 mg/kg). Maximum dose should
be less than 0.06 mg/kg.

Haemoglobin at birth is high (18 g/dl) and falls to a low at 3 to 6 months of about 11 g/dl.
The change is due to a decrease in foetalhaemoglobin. Foetalhaemoglobin is not able to deliver
oxygen to the tissues as efficiently as adult haemoglobin. A haemoglobin of less than 13 g/dl in
the newborn and less than 10 g/dl in the first 6 months of life may be significant.

Paediatric Cardiovascular Parameters:

o Age: Newborn
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Weight (kg): 3.5

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 Heart Rate: 120
Blood Pressure: 80/40

o Age: 3 months
Weight (kg): 6.0
Heart Rate: 140
Blood pressure: 95/55

o Age: 6 months
Weight: 7.5
Heart Rate: 140
Blood pressure: 95/55

o Age: 1 year
Weight: 10
Heart rate: 125
Blood pressure: 95/65

o Age: 3 year
Weight: 14
Heart Rate: 100
Blood pressure: 100/60

o Age: 7 year
Weight: 22
Heart Rate: 90
Blood pressure: 100/70

o Age: 10 year
Weight: 30
Heart Rate: 80
Blood pressure: 105/70

o Age: 14 year
Weight: 50
Heart Rate: 80
Blood pressure: 120/70

HEMATOLOGIC SYSTEM:

• At about 2 months of age, erythropoiesis gradually increases. This results in a greater

proportion of reticulocytes in the blood and a rise in the concentration of hemoglobin.
•
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There is a decline in concentration of hemoglobin during the first few weeks of neonatal
life.
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 FLUIDS AND ELECTROLYTES:

• The total body water in infants is about 750 ml/ kg body weight; in adults it is 550 ml/kg
body weight.
• In the newborn baby, approximately 75-80% of body weight is composed of body water
whereas approximately 60 % of body weight is body water in the adult man.
• During infancy, the normal rapid weight gain in weight is due to an increase in adipose
tissue.
• The percentage of body fluid, contained in the extracellular compartment is greater for
children up to 2 years of age than it is for adults.

Estimating Maintenance Fluid Requirements:

Newborn first 24 hours: 3 ml/kg/h

Newborn day 1 to 7: 5 ml/kg/h
Infant: 4 ml/kg/h for the first 10kg adding 2 ml/kg for the second 10 kg and 1 ml/kg/h for
each kg over 20 kg.
[for example a 16 kg child needs (10 kg x 4
ml) + (6 kg x 2 ml) = 52 ml/h or 1248 ml/day]

Note:
o Remember that the maintenance fluid volume will need to be reduced (70% maintenance) in
many unwell children: ie children with suspected neurological [meningitis and encephalitis]
and respiratory [bronchiolitis and pneumonia] disease.

Well children 0.45% NaCl with 5% glucose (+/- 20 mmolKCl/l)

Unwell children 0.9% NaCl

o Remember that most children in hospital should receive oral fluids and nutrition.

o Children who are dehydrated preoperatively need fluid replacement before surgery.

o The degree of dehydration must be assessed.

o Children have a relatively small blood volume. A 5kg infant will have a blood volume of
only 400 ml. Blood loss of only 40 ml is a 10% decrease in blood volume and 80 ml a
20% loss of blood volume. A soaked swab will contain at least 5 ml and a small pack at
least 20 ml of blood.

o Urine output should be at least 0.5 ml/kg/h.

o The neonate has decreased glomerular filtration and tubular function. The ability to
excrete a fluid load is initially poor but this function rapidly increases in the first month
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of life. The ability to produce concentrated urine is also initially poor and improves
rapidly in the first two months reaching adult levels by two years of age.
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GASTROINTESTINAL SYSTEM:

• Dentition: humans have 20 primary and 32 primary teeth. Teeth calcify at 4-7 months
gestation. Calcification ends when the roots of the permanent third molars are complete.
The first permanent teeth to erupt are the 6 year molars.
• Organs of digestion: the structures of mouth and esophagus functions in an immature
manner allowing only movements related to sucking and swallowing in newborns. In
neonates, the emptying time of the stomach is about 21/2-3 hrs; in older infant it is 3-6
hours. The tissues of the GI tract are delicate, they lack the ability to secrete adequate
amounts of enzymes and fluids, and the mucous linings do not have the immunologic
characteristics during early infancy that they will have in childhood. The liver is
approximately 4% of body weight in newborn infants and occupies a major portion of the
abdominal cavity.
• Digestion of carbohydrates, proteins and fats: At birth, a small amount of ptyalin or
salivary amylase converts starch into maltose and dextrose, which helps in digestion of
starch in the absence of pancreatic amylase as it does not reach the adult level for several
months after birth. Protein breakdown is incomplete during early life, whereas the
neonates absorb 85-90% of human milk fat, it gets absorbed like that of adults with
increasing age.

URINARY SYSTEM:

• Under stress the functional reserves of kidneys in infants are reduced as compared with
the adults.
• The GFR increases with the advancing age.
• Young infants cannot concentrate their urine as well as older children and adults.
• Premature infants smaller than 34 weeks gestation have decreased re-absorption of
glucose, sodium, bicarbonate and phosphate.

ENDOCRINE SYSTEM:

• The endocrine system develops during infancy and childhood.

• Levels of serum growth hormone produced by anterior pituitary increases during fetal
life, decreases near term, then increases during childhood and decreases again as full
growth is achieved.
• The production of hormone ADH or vasopressin by the posterior pituitary gland is
limited during the first 12 months of life and thus the infant cannot regulate fluid balance.
• Thyroid stimulating hormone is secreted in small amounts during fetal life. Increasing
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amounts are produced during infancy.

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 • The adrenal glands are small during infancy and have limited functions, but increase their
functions during puberty. Since ACTH has minimal function during infancy, therefore it
cannot respond to the stress of fluid and electrolyte imbalance.
• When the mother is diabetic, the pancreas of the fetus produces a large amount of insulin
than normal. The islets of langerhans produces insulin that regulates carbohydrate
metabolism.

REPRODUCTIVE SYSTEM:

• Ovaries: in a normal full term baby girl, the ovary is approximately 10 mm in length and
2-4 m in width. Throughout the years, the follicles mature and undergo atresia, the
cellular residue contributes to the increase in the size of the ovaries. Increase in the
ovarian mass and follicular size implies an increased production of estrogen.
Gonadotropic stimulation from the pituitary gland is responsible for ovarian growth
during childhood.
• Testes: after birth, the testes are 1.5-2 cm in length and 0.7-1 c in width. They weigh 0.5
gm each. The size increases slowly until school age, greater increase occur between 6-12
years. The progressive maturation of the testes occurs with the increase in the pituitary
gonadotropins during puberty. Development is complete between 13-17 years. The fully
developed testes is approximately 3.5-5.5 c in length and 2.1-3.2 cm width, and weighs
around15-20 gms.

LYMPHOID AND IMMUNE SYSTEM:

• The function of lymphoid system is same in children and in adults; however, the relative
maturation varies with the child’s age.
• The antigenically stimulated fetus can synthesize IgM by 10.5 weeks, IgG by 12 weeks and
IgA by 30 week of gestation. Newborn infants can respond to variety of antigens, but the
predominant antibody is initially is of the IgM class. Adult levels of IgM are reached at about
1 years of age, and of IgA at about 10 years of age.
• Lymphoid tissue is proportionately small but is well developed at birth. But increases rapidly
in relative size until 10 to 12 years. By the child is 6 years of age, the lymphoid tissue in adult
size, after which slow atrophy occurs. The rapid growth of lymphoid tissue early in life is due
to antigenic stimulation.
• Swelling of the spleen may also occur with some infections. As in lymph nodes, this swelling
is due to the filtration of microorganisms, infected cells and their debris, and the active
hyperplasia of the immune-active cells. When the spleen is enlarged, there is a risk of
traumatic rupture with accompanying danger of hemorrhage.
• During the first trimester of fetal life, immunologic competence is probably lacking. After
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this period the fetal lymphoid system is gradually populated with immunologically competent
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cells. During the last 6 months of gestation, the fetus can develop delayed hypersensitivity and

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 can form plasma cells that are capable of synthesizing specific immunoglobulins, usually of
IgM and IgA classes.
• If the infant’s immunologic system is normal, there will be a progressive hyperplasia of the
follicles and a gradual appearance of plasma cells in lymphoid tissue in the body. This results
in enlargement of the tonsils and lymph nodes from their miniature size at birth.
• The passive immunity obtained from the maternally derived IgG antibodies is gradually lost.
The duration of young infant’s immunity to a particular infection depends on the level of that
particular antibody in the mother plasma during pregnancy and upon the amount of antibody
required to protect the infant from that particular kind of infection.
• If there is a congenital absence of the thymus gland or stem cells, the precursor of B and T
lymphocytes, the affected infant will be unable to live a long, normal life. Since the immune
system cannot develop without B and T lymphocytes, the infant will acquire severe bacterial,
viral, or fungal.

MUSCULOSKELETAL SYSTEM:

• Since muscular tissue is almost completely developed at birth, growth occurs due to
increase in size of muscle fibers, due to genetic inheritance, stimulation primarily use and
exercise.
• The growth hormone, insulin and thyroxin stimulate the growth of muscle tissue from
birth till puberty, at puberty the male hormone androgen causes increased muscle size in
boys.
• During fetal life, bony tissues begin to develop as closely packed connective tissue. New
bony tissues are constantly produced during the period of growth.
• Postural changes are the result of development of neurologic control, growth and
development of bones and muscles, and deposition of adipose tissue.

NEUROLOGIC SYSTEM:

• The brain weight of a neonate is about 300-350 gms. At 1 year of age, the weight two-
thirds of that of adults.
• The sulci of the lobes of the cortex deepen, increase in number and become more
prominent with rapid growth with age.
• Reflex activity, normal during infancy begins to disappear as voluntary control is
developed. The knee jerk and blinking reflex never fade altogether.
• Myelination, the formation of insulation and protection of nerves is mostly completed by
2 years of age, when the child can perform motor movements like an adult but with less
speed and co-ordination.
• In neonates, the eyes are not anatomically mature, thus are not able to function like those
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of an adult. The newborn infant has adequate central vision for fixation and can co-
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 ordinate eye movements. Depth perception begins to develop at 9 months of age.
Lacrimal glands start to function during 2nd to 3rd months.
• The neonate can hear louder noises at birth but by second month after birth, the infant can
hear softer, soothing sounds. With further myelination, it can localize sounds by turning
the head in their direction.

Paediatric Pharmacology:
The differences in physiology of the infant will alter the effect of some drugs.
o All opioids and central nervous system depressants must be given with caution in neonates
unless the patient is being ventilated and closely monitored. Morphine clearance in
neonates is one quarter that of adults so that the elimination half time will be four times that
of adults. The immature respiratory centre makes the neonate more sensitive to the
respiratory depressive effects of morphine.
o The proportion of cardiac output going to the brain is greater in the neonate than in older
children.
o The dose of intravenous induction agents should be reduced in neonates.
o Decreased renal and liver function results in certain drugs being excreted more slowly. The
dosing interval should be increased to avoid toxicity.
o Neonates and infants require a greater dose suxamethonium (2 mg/kg) than adults (1
mg/kg).
o The MAC of inhalational agents is greater in the young and decreases with increasing age,
however neonates require lower concentrations than infants do. There may be nearly a 30%
greater anaesthetic requirement for inhalation agents but there is a smaller margin of safety
between adequate anaesthesia and cardiovascular and respiratory depression in infants
compared with adults. Both induction and recovery from inhalation agents is more rapid in
children than adults.

CONCLUSION:

In summary, the symptoms of disease in an infant are different from those in older child
or adult, owing to the pathogenic state caused by the injurious agents on the tissues in different
stages of anatomic and physiologic development. It is important for the pediatric nurse to learn
the cause and effect relationship of any pathologic agent to the development stage of child’s
body, to provide preventive and curative nursing intervention.

BIBLIOGRAPHY:

• Dorothy R Marlow, Barbara A Redding, TEXTBOOK OF PAEDIATRIC

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NURSING, Saunders Elsevier, 6 edition.
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