INFANTS

Health Promotion and Disease Prevention

Health Promotion of the Infant and Family

PROMOTING OPTIMUM GROWTH AND DEVELOPMENT Growth - an increase in the physical size of 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

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

Assessment of Growth
Height Weight Head Circumference Anterior Fontanel 12-18 months Posterior Fontanel 2-3 months Developmental Milestones Motor Skills

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

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 considered oliguria

Maturation of Systems
Sensory
Vision - focus on 2-3 months Hearing

Refer to Pages 466 in Wong Text Box 12-2 and 12-3

Focus on Visual Objects

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

Crude Pincer Grasp

Neat Pincer Grasp

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)

Head Control

Development of Sitting

Locomotion
Cephalocaudal direction of development Crawlingage 6 to 7 months Creepingage 9 months Walk with assistage 11 months Walk aloneage 12 months

Development of Locomotion

Psychosocial Development
Eriksons phase Ideveloping a sense of trust Trust vs. mistrust Importance of caregiver-child relationship Delayed gratification Importance of consistency of care

Cognitive Development
Piaget Sensorimotor phase
Birth to 1 monthreflex stage 1 to 4 monthsprimary circular reactions 4 to 8 monthssecondary circular reactions Imitation Play Affect

Finding Hidden Object

Language Development
Crying is first verbal communication Vocalizations Three to five words with meaning by age 1 year

Development of Body Image

Concept of object permanence By end of first year, recognize that they are distinct from parents

Viewing Own Image

Development of Gender Identity

Hormonal influences Infant Parental influences on development of sexuality

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

Coping with Common Parental Concerns

Separation and stranger fear Stranger fear and separation anxiety are not signs of undesirable, antisocial behavior, but are part of a strong, 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

Stranger Fear

Coping with Common Parental Concerns

Parents can reassure the child in their presence, talking to the infant when leaving the room, talking on the telephone, and use of a transitional object reassures the child of the parents continued presence Strangers should talk softly, meet the child at eye level, maintain a safe distance from the infant, and avoid sudden, intrusive gestures

Temperament
Revised Infant Temperament Questionnaire Childrearing practices related to temperament

Limit Setting and Discipline

Need for setting safe limits to prevent injury Need for age-appropriate discipline Time-out

Coping with Common Parental Concerns

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 enforce consistent, age-appropriate limits

Alternative Child Care Arrangements

Types of child care Guiding parents in selecting child care

Thumb Sucking and Use of Pacifier

Importance of sucking in infancy Relationships between pacifier use and frequency and adequacy of feedings Safety considerations with pacifier use

Teething
During the first 2 years of life
Age of child in months 6 = Number of teeth

Exampleat 8 months of age

86=2

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

PROMOTING OPTIMUM HEALTH DURING INFANCY

Nutritionbreast milk is best for first 6 months of life Introduction of solid foods
Introduce foods at intervals of 4 to 7 days to allow for identification of food allergies

Weaning from breast or bottle

Neonates/Infants 0-1 Year

Preterm Infants (Less than 37 weeks gestation, 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

Neonates/Infants 0-1 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, fish and nut products Before 1 year may cause allergies

Breast Milk
Excellent nutritional balance Promotes GI Function Immune defenses Promotes bonding Free Can feed on demand May need Iron Supplements until food introduced Lowers incidences Otitis Media; other infections Type 2 DM CV Disease/Obesity

MEMORIZE THIS TABLE

Facts about Formula

Do not use Soy formula in infants with congenital hypothyroidism May use tap water to mix with powder Must be refrigerated Discard what baby does not drink. Dont rerefrigerate 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

So Why Not Cows Milk the First Year?

Can cause GI Bleeding Anemia (Low iron content) Interferes with absorption of some nutrients High solute concentration-Hard on the kidneys

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

Sleep and Activity

Back to Sleep campaign Sleep problems Sleeping arrangements Concept of graduated extinction

Dental Health
Initial dental care includes wiping teeth and gums with damp cloth; progress to toothbrushing First dental visit1 year of age Fluoride supplementation

Immunizations
Recommendations provided by
Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) Committee on Infectious Diseases of the American Academy of Pediatrics (AAP)

Current Recommendations
http://www.cdc.gov/nip (National Immunization Program from the CDC) http://www.aap.org AAP Report of the Committee on Infectious Diseases (The Red Book) CDC Morbidity and Mortality Weekly Report (MMWR)

Injury Prevention
Aspiration of foreign objects Suffocation Motor vehicle injuries Falls Poisoning Burns Drowning

Infant Car Restraint

Health Problems During Infancy

NUTRITIONAL DISTURBANCES
Vitamin disturbances Mineral disturbances Vegetarian diets RDAs MyPyramid

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

Deficiencies in Vegetarian Diets?

Well-planned vegetarian diets are adequate for all stages 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, unprocessed foods, especially for infants Vitamin B6, B, niacin, riboflavin, vitamin D, iron, calcium, and zinc May require supplements

Protein and Energy Malnutrition (PEM)

AKA Severe childhood undernutrition (SCU) Worldwide health problem for children younger 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

Most Extreme Protein 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

Food Sensitivity
Includes all adverse reactions to food or food additives AKA food sensitivity, hypersensitivity, allergy, and intolerance Cows milk allergy Lactose intolerance

Clinical Manifestations of Food Hypersensitivity

SystemicAnaphylactic, growth failure GIAbdominal pain, vomiting, cramping, diarrhea RespiratoryCough, wheezing, rhinitis, infiltrates CutaneousUrticaria, rash, atopic dermatitis
American Academy of Pediatrics, 2009

Most Common Allergens

ChildrenEggs, cows milk, and peanuts AdultsSoy, wheat, corn, tree nuts, shellfish, and fish allergies AtopyAllergy with a hereditary tendency

Serious Food Allergy Management

For children who have risk of anaphylaxis from food allergies
Rapid onset of airway difficulties

EpiPen Liquid diphenhydramine MedicAlert bracelet Emergency plan Caution for biphasic response

CONDITIONS RELATED TO FEEDING

Feeding Difficulties
Regurgitation and spitting up Reflux/GERD Colic (paroxysmal abdominal pain)

The Colic Carry

Failure to Thrive (FTT)

Weight <5th percentile; height WNL Organic FTT
Inadequate caloric intake Inadequate absorptionCF/ Celiac disease, other Increased metabolism Defective utilizationgenetic/ metabolic

Nonorganic FTT

Calculating Required Calories

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

Ideal weight for height is the median weight for the childs height based on the current National Center for Health Statistics weight-for-height growth charts.

A Consistent Nurse in Nonorganic FTT

SKIN DISORDERS

Diaper Dermatitis
Principal factors in development Therapeutic management Nursing considerations

Seborrheic Dermatitis
Chronic, recurrent, inflammatory reaction of the skin
Scalpcradle cap Eyelidsblepharitis External earotitis externa

Cause unknown Nursing considerations

Atopic Dermatitis
Also called eczema Is a category of dermatologic diseases and not a specific etiology Pruritic Usually associated with allergy Hereditary tendency (atopy)

Therapeutic Management
Hydrate the skin Relieve pruritus Reduce inflammation Prevent and control secondary infection Nursing considerations

DISORDERS OF UNKNOWN ETIOLOGY

Sudden infant death syndrome (SIDS) Apparent life-threatening events (ALTEs) Back to Sleep campaign Increased incidence of plagiocephaly

Infants at Risk for SIDS

Infants with one or more severe ALTEs requiring 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

Low birth weight Low Apgar scores Recent viral illness Siblings of two or more SIDS victims Male sex Infants of Native American or AfricanAmerican ethnicity

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, and pillows Avoid bed sharing Avoid overheating during sleep Vary infant head position to prevent plagiocephaly

Apnea of Infancy
DefinitionUnexplained respiratory pause lasting 20 seconds or more OR Less than 20 seconds accompanied by pallor, cyanosis, bradycardia, or hypotension (term infant) Many possible causes to be explored

Apnea of Prematurity
Cessation of breathing longer than 20 seconds, or any period with bradycardia and cyanosis not associated with any predisposing conditions Therapeutic management
Theophylline, caffeine Home apnea monitors Family support CPR training

ALTE
Apparent life-threatening event May be with OR without accompanying apnea

Apnea Monitoring

Complementary and Alternative Medicine (CAM)

Misuse or overuse of vitamins/megavitamin therapy Herbs known to have adverse effects in children
Ephedra Comfrey Pennyroyal

Herbal therapy with questionable safety for children

St. Johns wort Dong quai Kava

Complementary and Alternative Medicine (CAM)contd

Other concerns
May counteract or potentiate Rx meds Little research about safety of herbal medicines

Various herbal therapies have been a part of medicine since early days and some are beneficial

Breast-Feeding Mothers: Galactogogues

To increase milk supply
Fenugreek Blessed thistle Fennel Chaste tree

Few studies support the efficacy or safety of these herbs in breast-feeding infants Adverse effects may include colic and diarrhea in breast-feeding infants