Prior to the mid-nineteenth century, ill children were cared for by their families, using the aid of “folk medicine.” Only the wealthy had access to formal physicians, who had limited resources themselves. The medical care of children changed with the founding of The Children’s Hospital of Philadelphia (CHOP) in 1855. According to the hospital’s website (http://www.chop.edu/), CHOP is the “birthplace of many dramatic firsts in pediatric medicine;” and is generally regarded as launching pediatric nursing as a specialty.
Nursing continues to evolve. Today, an interesting sub-specialty cares for disorders of the endocrine system in the pediatric population. Registered nurses (RNs) interested in specializing in their career may want to consider pediatric endocrinology.
The Career at a Glance
In general, pediatric nurses are very knowledgeable about normal growth and development. The nursing care must be individualized, depending on the child’s developmental level. In addition, they acknowledge the family dynamics, treating the family as a care-partner. As any pediatric nurse knows, many disease presentations for pediatric patients can be very different from the adult population, and treatment approaches need to be tailored to the educational and emotional needs of the child. Further details on the scope of pediatric nursing practice can be found at the Society of Pediatric Nurses (http://www.pedsnurses.org/).
Pediatric nurses who specialize in the area of endocrinology must blend knowledge of normal growth and development with advanced knowledge of this complex organ system. The endocrine system encompasses:
- Thyroid –a butterfly-shaped gland in the neck; produces hormones involved in metabolism.
- Pituitary–a gland at the base of the brain; regulates growth, reproduction and other metabolic functions.
- Parathyroid –four tiny glands in the neck; produce hormones to regulate calcium and phosphorus levels in the blood.
- Adrenals –two glands that sit atop the kidneys; produces hormones that control blood pressure and other functions.
- Pancreas –the oblong flattened gland located deep in the abdomen; produces and secretes hormones (insulin and glucagon) that work together to regulate blood sugar levels.
According to the MD Anderson Cancer Center (http://www.mdanderson.org/), tumors can arise in all glands of the endocrine system. Tumors arising from the endocrine system can be benign or malignant, and can greatly affect a child’s growth, metabolism and sexual development. Cancerous endocrine tumors are very rare in children, with thyroid cancers being the most common.
Scope of Practice for Pediatric Endocrinology
Pediatric nurses can potentially care for many endocrine disorders. Here are a few:
Childhood obesity is a serious medical condition that affects children and adolescents. It occurs when a child is well above the normal weight for his or her age and height. This condition can lead to diabetes, high blood pressure and high cholesterol, as well as the emotional issues of poor self-esteem and depression. In this situation, there are significant nursing opportunities for education with regard to healthy diet and exercise habits of the entire family.
Congenital adrenal hyperplasiais a collection of genetic conditions that limit the adrenal glands’ ability to make certain vital hormones. This can cause problems with normal growth and development in children; and affects both males and females.
Precocious puberty is when someone’s body begins changing from a child into an adult too soon. Puberty includes rapid growth of bones and muscles, changes in body shape and size, and development of the body’s ability to reproduce. Puberty that begins before age 8 for girls and before age 9 for boys is considered ‘precocious puberty.’ The cause is unknown; treatment typically includes medication to delay further development. Many nursing implications for teaching and psychosocial support are present with this clinical condition.
Type 1 diabetes, also known as juvenile diabetes is a condition in which the child’s pancreas no longer produces the needed insulin to survive. Families need nursing support as they learn and navigate a new lifestyle: giving insulin injections, counting carbohydrates and monitoring blood sugar.
For nurses interested in this career path, several resources exist:
- The Magic Foundation, a non-profit organization, provides support for families with children who have disorders, syndromes and disease that affect growth.
- The Pediatric Endocrine Nursing Society is a non-profit nursing organization committed to the art and science of pediatric endocrine nursing.
Earning a BSN degree does not instantly qualify a nurse for this career path, however it is a vital step in the process. Advancing your education as a registered nurse can improve job opportunities and options, such as working in pediatric endocrinology. Individuals are encouraged to do their own research as job growth and salary will differ depending upon location, education and experience.