module 3 infants_student copy

8/3/2019 Module 3 Infants_Student Copy

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INFANTSHealth Promotion and Disease Prevention


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Health Promotion of the Infant

and Family


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PROMOTING OPTIMUMGROWTH AND DEVELOPMENT

Growth - an increase in the physical sizeof a whole or any of its parts

Cephalocaudal- head to toe

Proximodistal- central to peripheral

Same general pattern and sequence

Individual rate and timing for range of normal


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Proportional changes

5 to 7 ounces of weight gain every week

Double birth weight by age 5-6 months

Triple birth weight by age 1 year Height increases by 1 inch per month for 6

months

Growth in spurts rather than gradually


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Assessment of Growth

Height

Weight

Head Circumference Anterior Fontanel 12-18 months

Posterior Fontanel 2-3 months

Developmental Milestones Motor Skills


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Maturation of Systems

Respiratory R 40-60 Abdominal Breathers Respiratory Rate Progressively Slows Risk for Respiratory Complications

Immunologic Decrease ability to produce Immunoglobulin (Ig) A in the lungs

Cardiovascular HR 120-150 HR Progressively Slows

Hematopoietic changes Fetal Hemoglobin

Fetal Iron Stores

Digestive processes - Meconium 24-48 hours later Variation of Stools Immature Liver


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Maturation of Systems Thermoregulation

Adipose Fat

Renal

Loss of body water

Risk for dehydration

5%-10% of water loss the first 5 days of life

Secrete 15-60 ml/kg/24 hours of urine output

Less than 0.5ml/kg/hr after 48 hrs consideredoliguria


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Maturation of Systems

Sensory

Vision - focus on 2-3 months

Hearing

Refer to Pages 466 in Wong Text

Box 12-2 and 12-3


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Focus on Visual Objects


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Fine Motor Development

Grasps object, age 2 to 3 months

Transfers object between hands, age

7 months Pincer grasp, age 10 months

Removes objects from container, age

11 months Builds tower of two blocks, age 12 months


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Crude Pincer Grasp


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Neat Pincer Grasp


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Gross Motor Development

Head control

Rolls overage 5 to 6 months

Sits aloneage 7 months Moves from prone to sitting positionage

8-10 months (attempts at 6 months)


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Head Control


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Development of Sitting


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Locomotion

Cephalocaudal direction of development

Crawlingage 6 to 7 months

Creepingage 9 months Walk with assistage 11 months

Walk aloneage 12 months


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Development of Locomotion


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Psychosocial Development

Eriksons phase Ideveloping a sense oftrust

Trust vs. mistrust

Importance of caregiver-childrelationship

Delayed gratification Importance of consistency of care


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Cognitive Development

Piaget

Sensorimotor phase

Birth to 1 monthreflex stage

1 to 4 monthsprimary circular reactions

4 to 8 monthssecondary circularreactions

Imitation

Play

Affect


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Finding Hidden Object


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Language Development

Crying is first verbal communication

Vocalizations

Three to five words with meaning by age1 year


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Development of Body Image

Concept of object permanence

By end of first year, recognize that theyare distinct from parents


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Viewing Own Image


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Development of Gender Identity

Hormonal influences

Infant

Parental influences on development ofsexuality


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Common Parental Concerns -

Infant Separation Anxiety Fear of Strangers 6 months of age

Spoiled Child Limit-Setting/Discipline

Child Care Arrangements

Thumb Sucking/Pacifier Teething


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Coping with Common ParentalConcerns

Separation and stranger fear

Stranger fear and separation anxiety are not signs ofundesirable, antisocial behavior, but are part of astrong, healthy, parent-child attachment

Accustom the infant to new people

Provide opportunities to safely experience strangers

Clinging, dependent behavior by the child is healthy,desirable, and necessary for the childs optimal

emotional development


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Stranger Fear


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Parents can reassure the child in their presence,talking to the infant when leaving the room, talking onthe telephone, and use of a transitional objectreassures the child of the parents continued

presence Strangers should talk softly, meet the child at eye

level, maintain a safe distance from the infant, andavoid sudden, intrusive gestures


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Temperament

Revised Infant TemperamentQuestionnaire

Childrearing practices related totemperament


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Limit Setting and Discipline

Need for setting safe limits to preventinjury

Need for age-appropriate discipline

Time-out


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Spoiled Child

Infants cannot be spoiled by picking them up

Research shows that infants who are not

responded to promptly cry more

Spoiled child syndrome

excessive self-centered and immature behavior,

resulting from the failure of parents to enforceconsistent, age-appropriate limits


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Alternative Child Care Arrangements

Types of child care

Guiding parents in selecting child care


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Thumb Sucking and Use of Pacifier

Importance of sucking in infancy

Relationships between pacifier use andfrequency and adequacy of feedings

Safety considerations with pacifier use


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Teething

During the first 2 years of lifeAge of child in months 6 = Number of teeth

Exampleat 8 months of age8 6 = 2

(An 8-month-old should have two teeth.)


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PROMOTING OPTIMUM HEALTH DURINGINFANCY

Nutritionbreast milk is best for first 6months of life

Introduction of solid foods

Introduce foods at intervals of 4 to 7 days toallow for identification of food allergies

Weaning from breast or bottle


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Neonates/Infants0-1 Year

Preterm Infants (Less than 37 weeksgestation, Wt. < 2500 g)

Require 50-60 kcal/kg/day (Parenteral), 75

kcal/kg/day orally

Breast milk is recommended/formula fine

Formula available in many calories/oz

Caloric needs with illness


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Neonates/Infants0-1 Year

Birth to 1 year

Breast milk or formula

4-6 months, Iron-fortified cereal (rice Cereal)

6-8 months-yellow vegtables, fruits

8-10 months- meats

Foods delayed until after 1 year:

Eggs, whole milk, strawberries, wheat, corn, fishand nut products

Before 1 year may cause allergies


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Breast Milk

Excellent nutritionalbalance

Promotes GI Function Immune defenses

Promotes bonding Free Can feed on demand May need Iron

Supplements until foodintroduced

Lowers incidencesOtitis Media; otherinfections

Type 2 DM

CV Disease/Obesity


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MEMORIZE THIS TABLE


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Facts about Formula

Do not use Soy formula in infants with congenitalhypothyroidism

May use tap water to mix with powder Must be refrigerated Discard what baby does not drink. Dont re-

refrigerate Do not use well-water unless tested & safe Older homes /Lead pipes-be aware/cold water

only

Do not use microwave to warm bottle Never prop bottle in bed


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So Why Not Cows Milk the First

Year? Can cause GI

Bleeding

Anemia (Low ironcontent)

Interferes withabsorption of somenutrients

High soluteconcentration-Hardon the kidneys


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Figure 8-6 Early childhood caries. This child has had major tooth decay related to sleeping as an infant and toddlerwhile sucking bottles of juice and milk. Source: Courtesy of Dr. Lezley Mcllveen, Department of Dentistry, ChildrensNational Medical Center, Washington, DC.


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Sleep and Activity

Back to Sleep campaign

Sleep problems

Sleeping arrangements

Concept of graduated extinction


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Dental Health

Initial dental care includes wiping teethand gums with damp cloth; progress totoothbrushing

First dental visit1 year of age

Fluoride supplementation


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Immunizations

Recommendations provided by

Advisory Committee on ImmunizationPractices (ACIP) of the Centers for Disease

Control and Prevention (CDC) Committee on Infectious Diseases of the

American Academy of Pediatrics (AAP)


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Current Recommendations

http://www.cdc.gov/nip (NationalImmunization Program from the CDC)

http://www.aap.org

AAP Report of the Committee onInfectious Diseases (The Red Book)

CDC Morbidity and Mortality WeeklyReport (MMWR)


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Injury Prevention

Aspiration of foreign objects

Suffocation

Motor vehicle injuries

Falls

Poisoning

Burns Drowning


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Infant Car Restraint


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Health Problems During Infancy


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NUTRITIONALDISTURBANCES

Vitamin disturbances

Mineral disturbances

Vegetarian diets

RDAs

MyPyramid


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Mineral Disturbances

Macrominerals

More than 100 mg daily requirement

Include calcium, phosphorus, magnesium,

sodium, potassium, chloride, and sulfur

Microminerals (trace elements)

Less than 100 mg daily requirement


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Deficiencies in VegetarianDiets?

Well-planned vegetarian diets are adequate for allstages of the life cycle and promote normal growth

Requires knowledge of specific nutritional elements

Major deficiencies may occur Inadequate protein for growth

Inadequate calories for energy and growth

Poor digestibility of many of the bulky natural, unprocessedfoods, especially for infants

Vitamin B6, B, niacin, riboflavin, vitamin D, iron, calcium, andzinc

May require supplements

P t i d E M l t iti


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Protein and Energy Malnutrition(PEM)

AKA Severe childhood undernutrition (SCU)

Worldwide health problem for childrenyounger than age 5

Adequate food Lack of sanitation (death from diarrhea)

Occasionally seen in United States Chronic illness (CF, Renal dialysis, cancer, and

GI malabsorption) Elderly with chronic malnutrition

Untreated anorexia nervosa


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Most ExtremeProtein and Energy Malnutrition(PEM)

Kwashiorkor Deficient protein but adequate calorie intake

Edema and muscle wasting

Large abdomen due to ascites Marasmus

General malnutrition of both calories and protein

Often seen with drought conditions in

underdeveloped countries No edema, but loose wrinkled skin + small head

size

F d S iti it


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Food Sensitivity

Includes all adverse reactions to foodor food additives

AKA food sensitivity, hypersensitivity,

allergy, and intolerance

Cows milk allergy

Lactose intolerance

Cli i l M if t ti f F d


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Clinical Manifestations of FoodHypersensitivity

SystemicAnaphylactic, growth failure

GIAbdominal pain, vomiting, cramping,diarrhea

RespiratoryCough, wheezing, rhinitis,infiltrates

CutaneousUrticaria, rash, atopicdermatitis

American Academy of Pediatrics, 2009

M t C All


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Most Common Allergens

ChildrenEggs, cows milk, andpeanuts

AdultsSoy, wheat, corn, tree nuts,

shellfish, and fish allergies

AtopyAllergy with a hereditarytendency

S i F d All M t


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Serious Food Allergy Management

For children who have risk of anaphylaxisfrom food allergies

Rapid onset of airway difficulties

EpiPen

Liquid diphenhydramine

MedicAlert bracelet

Emergency plan

Caution for biphasic response

CONDITIONS RELATED TO


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CONDITIONS RELATED TOFEEDING

F di Diffi lti


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Feeding Difficulties

Regurgitationand spitting up

Reflux/GERD

Colic (paroxysmal abdominal pain)

Th C li C


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The Colic Carry


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Failure to Thrive (FTT)

Weight


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Calculating Required Calories

kcal/kg required =RDA for weight age (kcal/kg) Ideal weight for height

Actual weight

Ideal weight for height is the medianweight for the childs height based on

the current National Center for Health

Statistics weight-for-height growthcharts.

A Consistent Nurse in Nonorganic FTT


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A Consistent Nurse in Nonorganic FTT


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SKIN DISORDERS

Diaper Dermatitis


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Diaper Dermatitis

Principal factors in development

Therapeutic management

Nursing considerations

Seborrheic Dermatitis


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Seborrheic Dermatitis

Chronic, recurrent, inflammatory reactionof the skin

Scalpcradle cap

Eyelidsblepharitis

External earotitis externa

Cause unknown


Atopic Dermatitis


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Atopic Dermatitis

Also called eczema

Is a category of dermatologic diseasesand not a specific etiology

Pruritic

Usually associated with allergy

Hereditary tendency (atopy)

Therapeutic Management


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Therapeutic Management

Hydrate the skin

Relieve pruritus

Reduce inflammation

Prevent and control secondary infection


DISORDERS OF UNKNOWN


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DISORDERS OF UNKNOWNETIOLOGY

Sudden infant death syndrome (SIDS)

Apparent life-threatening events (ALTEs)

Back to Sleep campaign

Increased incidence of plagiocephaly

Infants at Risk for SIDS


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Infants at Risk for SIDS

Infants with one or more severe ALTEsrequiring CPR or vigorous stimulation

Preterm infants experiencing apnea at

time of discharge from hospital

Sibling of two or more SIDS victims

History of central hypoventilation

Risk Factors for SIDS


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Risk Factors for SIDS

Low birth weight Low Apgar scores

Recent viral illness

Siblings of two or more SIDS victims Male sex

Infants of Native American or African-

American ethnicity

Research Findings SIDS


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Research FindingsSIDS Practices that may reduce the risk of SIDS

Avoid smoking during pregnancy and near the infant

Breast-feeding

Supine sleeping position

Avoid soft, moldable mattresses, blankets, andpillows

Avoid bed sharing

Avoid overheating during sleep

Vary infant head position to prevent plagiocephaly

Apnea of Infancy


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Apnea of Infancy

DefinitionUnexplained respiratory pauselasting 20 seconds or more OR

Less than 20 seconds accompanied by

pallor, cyanosis, bradycardia, orhypotension (term infant)

Many possible causes to be explored

Apnea of Prematurity


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Apnea of Prematurity

Cessation of breathing longer than 20seconds, or any period with bradycardiaand cyanosis not associated with any

predisposing conditions Therapeutic management Theophylline, caffeine

Home apnea monitors

Family support

CPR training

ALTE


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ALTE

Apparent life-threatening event

May be with ORwithout accompanyingapnea

Apnea Monitoring


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Apnea Monitoring

Complementary and


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Complementary andAlternative Medicine (CAM)

Misuse or overuse of vitamins/megavitamintherapy

Herbs known to have adverse effects in children Ephedra

Comfrey

Pennyroyal

Herbal therapy with questionable safety forchildren

St. Johns wort

Dong quai

Kava

Complementary and


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Complementary andAlternative Medicine (CAM)contd

Other concerns

May counteract or potentiate Rx meds

Little research about safety of herbal

medicines

Various herbal therapies have been a partof medicine since early days and some are

beneficial

Breast-Feeding Mothers:


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Breast Feeding Mothers:Galactogogues

To increase milk supply Fenugreek

Blessed thistle

Fennel Chaste tree

Few studies support the efficacy or safetyof these herbs in breast-feeding infants

Adverse effects may include colic anddiarrhea in breast-feeding infants

module 3 infants_student copy

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